The impact of a multidisciplinary clinic on children with complex breathlessness

Introduction: It is difficult to accurately identify aetiological factors causing breathlessness (symptoms disproportionate to those expected from a given diagnosis that impacts on the ability to exercise). Effective management relies on an accurate diagnosis. Aims: To review routinely collected diagnostic and clinical data of children referred to the complex breathlessness clinic. Methods: Routinely collected data was analysed from May 2017-Jan 2019 from one of the only paediatric complex breathlessness clinics in Europe. Children (including high level athletes) were referred across North West England. The structured diagnostic process included clinical assessment (respiratory, physiotherapy, ENT), physiological measurement, and laryngoscopy pre and post exercise. Tailored follow-up therapy was directed by a specialist physiotherapist. Results: 32 children attended clinic (age 7-18 [mean 14] years; 25/32 [78%] female). 12/32 (38%) were high level athletes; 4/32 (12.5%) were ex-athletes. Aetiological diagnoses identified were: Dysfunctional breathing 17/32 (53%), Deconditioning 12/32 (39%), Anxiety or other psychosocial factors 12/32 (38%), Laryngeal obstruction 9/32 (29%), Asthma 7/32 (22%), Exercise-induced bronchoconstriction 2/32 (6%) and Reaching maximal exercise capacity 2/32 (6%). Following specialist therapies, 23/32(72%) children were discharged due to resolution of symptoms, 6/32 (19%) are currently receiving treatment and 3/32 (9%) did not attend follow-up therapy. Conclusion: Complex breathlessness is caused by multiple factors, and requires a multispecialty diagnostic approach. Tailored therapies had a positive impact on children with complex breathlessness.