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Key points

  • Speech and language therapy services for people with respiratory care needs is provided within an integrated, multidisciplinary context
  • All people with idiopathic or refractory chronic cough and inducible laryngeal obstruction (vocal cord dysfunction) should have access to an appropriate respiratory speech and language therapy service
  • SLT services can engage in evolving the respiratory SLT role through continuous appraisal of service provision and skill mix
  • The speech and language therapy profession has a responsibility to work towards improved clinical audit and research in the field of respiratory speech and language therapy.
  • Standardised training and competencies for the respiratory SLT role need to be agreed to ensure professional integrity

Introduction

Here you will find tips and resources to:

  • Influence your local decision-makers and budget holders.
  • Raise awareness of the role of speech and language therapy in adult respiratory care.

There are also resources to support you to:

  • Demonstrate the value of your service.
  • Develop your leadership skills.

Please contact us if you have any suggestions or feedback on these pages. 

Workforce Context

Speech and language therapy is a constantly evolving profession, within which new roles are developing to fit changing needs and emerging evidence

In 2011, the RCSLT ran a feature section in their professional publication, Bulletin, on the emerging field of respiratory speech and language therapy (Haines, 2011; Illsley, 2011). As a result, numerous clinicians came forward registering their current, planned or intended diverse input in the respiratory field.

It is our vision that the respiratory speech and language therapy role will become established practice, supported by regulatory standards, policy statements, position papers, robust evidence, training opportunities and competency frameworks.

In 2015 a position paper and web pages were written to:

  • Define and promote the role of speech and language therapy as part of a dedicated multidisciplinary team (MDT) in the respiratory field.
  • Provide a comprehensive overview of the evolving role of speech and language therapy in adult respiratory care.
  • To formalise discussion of key areas to achieve that goal and ensure implementation is well guided and appropriate.
  • Formalise the workforce development to date and act as a resource for clinicians who are keen to embrace this evolving role.
  • Generate discussion between commissioners and service providers regarding the provision of speech and language therapy services which meet the requirements of people with respiratory speech and language therapy needs.
  • Aid stronger collaborations with multi-disciplinary team (MDT) members and professionals, and be used as a platform to foster and formalise emerging links.

In 2018, the web guidance for members was updated to coincide with the move to the new RCSLT website. A full review and update of a second edition position paper is scheduled for 2018. Foundation work has occurred for this and, of significant note, the dysphagia section will be removed and linked with other dysphagia work streams.

Future recommendations

The future for the speech and language therapy profession is exciting. In the current economic climes, accountability and delivery of cost-effective services is key to further development and investment.

Several key issues need to be addressed in the future to enable the role to be developed succinctly, within professional boundaries, and facilitate effective delivery of care. These include:

  • The improved and standardised audit data from existing respiratory speech and language therapy services.
  • Some cost analysis data on the provision of respiratory speech and language therapy.
  • Some robust prospective evidence for treatment.
  • An increased speech and language therapy representation at national and international respiratory conferences.
  • The improved information dissemination across the profession and multi-disciplinary professions.
  • An increase in RCSLT’s national and regional respiratory speech and language therapy advisers.
  • The formalised training and competency requirements for the respiratory speech and language therapy role.

Addressing the above points would facilitate a better understanding of the respiratory speech and language therapy role, and highlight the cost-effectiveness of its development.

The data gathered would influence clinical guidelines, both within speech and language therapy and other professions, give support for further resources to increase the number of respiratory SLTs and, most importantly, have a positive impact on patient care.

It is important to note, as with any emerging role, barriers to evolution and implementation of change will occur. This may be within the profession, externally with service commissioners, or with members of the MDT. Educating the workforce and generating high-quality evidence base will be key to overcoming these barriers, in addition to those points above.

See Evolving Roles guidance 

Influencing stakeholders

General resources

Our local influencing pages provide resources that will help you demonstrate to your local stakeholders how you:

Specific resources on adult respiratory care

Campaigning to Raise Awareness

The RCSLT’s Giving Voice pages provide tips for demonstrating how speech and language therapy makes a difference to individuals and the broader society across the UK.

Statistics

There are no large epidemiology studies investigating the prevalence and incidence in these populations, and therefore the true data is unknown.

However, chronic cough is:

  • Thought to affect approximately 12% of the UK population (Ford et al., 2006).
  • Responsible for up to 40% of specialist respiratory outpatient referrals (Morice, Garvey and Pavord, 2006).

A systematic approach to diagnosis and treatment can be successful, but chronic cough can remain resistant to standard therapies in approximately 20% of cases (Pratter and Abouzgheib, 2006). In specialist clinics, this figure increases to 40% (Haque, Usmani and Barnes, 2005).

The true prevalence of Inducible Laryngeal Obstruction (vocal cord dysfunction) is unknown (Mansur, 2010), though it can:

  • Be present more commonly in females than males - ratio 4:1.
  • Be present in certain professions, e.g. athletes.
  • Frequently co-exist with asthma and chronic cough (Pargeter et al. 2011).

Newman et al. (1995) found that 56% of 95 patients with VCD had co-existent asthma, based on objective testing, but had previously shown that 10% of their refractory asthma population in fact had VCD alone (Newman & Dubester 1994, Newman et al. 1995).

The prevalence of VCD in the non-severe asthma population is unknown, although clinical consensus suggests it may be just as common. 5.4 million people are currently receiving treatment for asthma (Asthma UK 2015), this suggests a significant proportion with VCD.

Worsening asthma lead to over 50,000 hospital admissions with an annual pharmaceutical spend of £800 million. If a significant proportion of these costs and impacts are based on inaccurate or incomplete diagnoses, there is potentially an enormous amount to be gained by improved recognition and treatment of VCD.

References

Asthma UK (2015). What is asthma?

Ford, A.C., Forman, D., Moayyedi, P. & Morice, A.,(2006). Cough in the community: a cross sectional survey and the relationship to gastrointestinal symptoms. Thorax, 61(11), 975-979.

Haque, R.A., Usmani, O. S. & Barnes, P. J. (2005). Chronic idiopathic cough: a discrete clinical entity? Chest, 127(5), 1710 – 1713.

Mansur, A. H. (2013) Vocal cord dysfunction. In P. Palange & A.K. Simonds (Eds), European Respiratory Society Handbook of Respiratory Medicine. (2nd ed). London.European Respiratory Society

Morice, A.H., McGarvey, L. & Pavord, I. (2006). Recommendations for the management of cough in adults. Thorax, 61(1), 1–24.

Newman, K.B. & Dubester, S.N. (1994). Vocal Cord Dysfunction: masquerader of asthma. Seminars in Respiratory and Critical Care Medicine, 15(2),161-167.

Newman, K.B., Mason 3rd, U. G. & Schmaling, K. B. (1995). Clinical features of vocal cord dysfunction. American Journal of Respiratory and Critical Care Medicine, 152(4), 1382-1386.

Pargeter, N.J., Stonehewer, L. & Mansur, A. H. (2011). Patient management: hyperventilation syndrome and psychological aspects of breathlessness. Foundation Years Journal, 5(9), 34- 39.

Pratter, M.R. & Abouzgheib, W. (2006). Make the cough go away. Chest, 129(5), 1121-1122.