{
  "abstract": "Introduction Unexplained exertional dyspnoea in patients with normal pulmonary function tests presents a diagnostic challenge and may lead to inappropriate reassurance or delayed management. Exercise-induced laryngeal obstruction (EILO) is an under-recognised cause of exertional breathlessness and may not be identified using cardiopulmonary exercise testing (CPET) alone. We introduced a dedicated suspected EILO clinic combining CPET with continuous laryngoscopy during exercise (CLE), delivered by a multidisciplinary team, to improve diagnostic accuracy in this patient group.Methods A retrospective service evaluation was conducted of all patients referred to the suspected EILO clinic during the first 20 months of service delivery. Referral criteria included normal pulmonary function tests and symptoms of exertional dyspnoea. Patients underwent baseline flexible laryngoscopy to assess for inducible laryngeal obstruction (ILO). Where appropriate, CPET was performed, followed by CLE at 90% of maximal workload. Outcomes from CPET and laryngeal assessment were compared to determine diagnostic yield and impact on clinical interpretation. Demographic data are presented as mean ± SD.Results Thirty-four patients were referred during the evaluation period (42% female; age 40.1 ± 12.9 years; BMI 26.7 ± 4.2 kg/m 2). CPET was not conducted in six cases due to severe ILO or vocal cord palsy identified at baseline (n=3), inability to maintain cycling cadence (n=2), or exceeding ergometer weight limits (n=1). A further six patients declined assessment.Twenty-two patients completed CPET and CLE. Breathing pattern disorder and deconditioning were the most common contributors to dyspnoea. In 18/22 cases (82%), the combined assessment identified a cause of symptoms and informed management, including four cases (18%) that would have been classified as normal or supranormal if CPET had been interpreted in isolation. Deconditioning was unexpectedly common within a presumed physically active referral cohort (military referrals). Inducible laryngeal obstruction was identified in 40% of patients presenting with a breathing pattern disorder.Conclusions Integration of CPET with laryngeal assessment improves diagnostic yield in patients with unexplained exertional dyspnoea and reduces the risk of false reassurance from CPET alone. This multidisciplinary clinic model represents an effective service redesign that supports accurate diagnosis and targeted management, aligning with quality improvement priorities in complex diagnostic pathways.Abstract P53 Figure 1",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Sussex, Brighton & Hove, United Kingdom"
      ],
      "name": "Max Thomas"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Samuel Wallbanks"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Nicola Pargeter"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Andy Johnston"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Adel Mansure"
    }
  ],
  "title": "P53 The outcomes from introducing continuous laryngoscopy during exertion to an exertional dyspnoea cardiopulmonary exercise testing service",
  "uid": "5bf13374-be2b-592e-812f-f943708de951"
}