Speech Language Pathology for Dysfunctional Breathing Disorders

Speech language pathologists are often consulted and provide therapy for a number of dysfunctional breathing disorders. A speech language pathologist invited to give a talk at the ACAAI annual meeting discussed the discipline’s role in treating such conditions such as exercise-induced laryngeal obstruction (EILO) and exercise induced asthma.

“Fundamentally, the goal of treatment is to take inefficient breathing and make it efficient,” said Karen Drake, MA, CCC-SP, of Oregon Health & Science University in Portland. “[However], exercised-induced asthma and laryngeal obstruction are not usually covered in training,” proceeding to offer tips via a case study and a robust question-and answer period.

Treatment is based on retraining on the normal physiology by building awareness, interrupting the current pattern, and replacing it with a new pattern. Drake, who teaches preventive strategies as well as rescue strategies, then implements those strategies while patients are walking stairs and hills with exposure to scents (a common trigger). One frequent goal, Drake said, is to decrease laryngeal tension with voicing.

“I tell them to focus on taking the effort out the throat and pulling it forward,” she said. “Then the muscles downstream relax.”

A typical session also includes breathing techniques, negative practice (“do it tight, do it loose, do it tight, do it loose”), visual biofeedback, and cough suppression breathing. Drake noted that while new techniques to test and treat breathing disorders while patients are exercising were useful, she also said that it is essential to teach efficient breathing at rest, as it builds patient awareness and improves technique. Buy-in from the patient, Drake said, is critical, as it is the patient is the one who will ultimately implement it.

Finally, Drake stressed that “treatment does work.” Real-world efficacy studies have shown that more than 70% of adolescent and adult patients experience significant improvement in symptoms. However, treatment success is dependent on clinician experience; the clinician’s ability to explain the goals and techniques as well as motivate the patient; and patient engagement and adherence. Importantly, the clinician must be able to problem-solve and adapt optimal breathing to fit individual sports and situations.

Reflux was an emerging theme of the audience discussion. Drake said that although reflux can be present and that treatment for reflux is acceptable,  the condition has been over-diagnosed. Patients may stop seeking treatment for other underlying issues such as dysfunctional breathing issues if they are simply told they have reflux. The newer tendency is to de-emphasize reflux, she said, because it is not as common as once believed, and diagnosis is likely to include voice problems and dysfunctional breathing.