P23 Patient-reported onset factors in inducible laryngeal obstruction

Introduction and Objectives Inducible Laryngeal Obstruction (Ilo) is poorly understood, in terms of aetiology and onset by patients and clinicians. Patients presenting to our Tertiary Airways service commonly seek an understanding of the causes and triggers of their Ilo episodes. This study aims to develop a taxonomy of categories of patient-reported onset factors for Ilo from a sample of patients with confirmed Ilo on laryngoscopy, referred to our service. Method Within a nine month period, 103 patients referred to the Airways service (76% female, 24% male; age range 15–86 years (median=52)) with endoscopically-confirmed Ilo were asked to report historical factors contemporaneous with the initial onset of Ilo symptoms. A retrospective analysis of patient notes was also conducted to identify co-morbidities and additional onset factors. Single or multiple onset factors for each patient were collected, which were coded into initial themes. From these themes, second-order onset categories were developed which incorporated factors reported by all participants. Results Thirteen initial onset themes were developed. These included psychological factors (25% of patients), upper respiratory tract infections (23%), reflux (17%), chest infections (14%), medical conditions (12%) and surgery (10%). These were then refined into a taxonomy of five categories of onset factors: Respiratory Tract Infections and Viruses (40% of patients) Underlying Medical Conditions, e.g., rhinitis with post nasal drip, reflux (34%) Psychological difficulties (25%) Irritants, e.g., medication (23%) Exercise (7%) Only one patient had onset factors in multiple categories, indicating that these categories are largely independent of each other. The prevalence of certain onset factors was mediated to some degree by age, e.g., medical conditions were more frequent factors for older participants, whereas exercise was a more common factor in younger participants. Conclusions This study demonstrates patient-reported onset factors for Ilo can be usefully translated into a detailed taxonomy based on specific conditions/triggers. This understanding may be useful in furthering our understanding, both of common trigger and onset factors that can be communicated to patients, and may help to inform therapeutic interventions aimed at the active self-management of Ilo.