The impact of a specialist physiotherapist in the Leeds difficult asthma service

Introduction: Physiotherapy is a key role for difficult asthma services. However, non-attendance and long waits from referral to treatment can be barriers to therapy. Methods: To address this, the Leeds team redesigned the service to include access to a specialist physiotherapist who was present in the clinic alongside the specialist nursing and medical team. The physiotherapist provided assessment and treatment of breathing pattern disorders, sputum clearance and exercise advice. Data were collected over a period of 9 months and compared to an equivalent period when the previous model was in place. The previous model was a separate respiratory physiotherapy out- patient service. ACQ, BPAT and Nijmegen scores were recorded pre- and post-treatment for patients with dysfunctional breathing. Results: Prior to the change in service there was an 8-10 week waiting time for specialist physiotherapy, 19 referrals and a 42% non-attendance rate in a 9 month period. Post introduction of the specialist physiotherapist into the asthma clinic, the wait was 0-4 weeks, with 78 referrals and a non-attendance rate of 14% in the equivalent time period. Of the 19 patients who completed a course of treatment for breathing dysfunction, 6 were discharged from the asthma service. Within this group there were changes in ACQ (3.3 vs 2.8 p=ns), BPAT (7.2 vs. 2.4 p Conclusion: Improved access to physiotherapy has increased the number of referrals, decreased wait time and made the service more efficient, with improved patient outcomes and improved patient engagement. This study supports the essential role of physiotherapy in difficult asthma services.