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IntroductionCOVID-19 leads to persistent symptoms and in some instances oxygen desaturation (>3%) (Greenhalgh et al, 2020). Field walking tests are used in respiratory diseases to assess oxygen desaturation and exercise capacity due to their high reliability (Hernandes et al, 2014). However, under COVID-19 restrictions these tests became problematic to perform due to limitations of space, time, and equipment. This project aims to investigate sit to stand test’s (1STS & 5STS) in comparison to the Incremental shuttle walk test (ISWT) to assess function and oxygen desaturation (SpO2) in patients following COVID19 infection. In addition, to investigate if there is a difference in results to patients who received hospital care during the acute stage of COVID-19, to those who were managed in the community.MethodsPatients attending out-patient COVID-19 rehabilitation comprised of those hospitalised for acute COVID-19 and community managed referrals. Oxygen saturation was recorded directly before and after the tests. An independent T- test was used to measure group means for statistical difference and Pearson’s correlation was used to compare 5STS, 1STS and ISWT performance outcomes.ResultsTwenty-nine patients were eligible for analysis, mean (SD) age 54 (7.8) years (65.5% female and 69% White British) 7 (24%) participants had hospital admissions with a mean time from discharge to assessment of 347 days. There were desaturations of >3% in 3 (10%) participants during the 1STS and 9 (38%) in the ISWT and no desaturations of >3% during the 5STS. The difference between patient groups and SPO2 desaturations are non-significant at 0.559 for ISWT, 0.447 for 1STS and 0.447 5STS. There was no significant difference between SpO2, RPE and BORG for patient groups in each test condition. There was a strong correlation (R=-0.88) between the 1STS repetitions and 5STS time. There was a moderate correlation between ISWT and both STS tests (5STS R=-0.53 and 1STSR=-0.66).ConclusionsThe 5STS does not detect desaturation, whilst the ISWT detected meaningful desaturation in 38% of the population. There was a strong correlation with respect to performance on both STS tests, but not with the ISWT.

IntroductionBreathing pattern dysfunction (BPD) describes when an individuals breathing is disconnected from their respiratory or metabolic requirements. BPD is a recognised reason for sustained breathlessness and is acknowledged as important in post-COVID syndrome1 (PCS). The Breathing Pattern Assessment Tool (BPAT) is used to assess and screen for BPD. A score of ≥4 being a trigger for potential onward referral to a specialist physiotherapist for assessment2.ObjectivesEvaluate the utility of the BPAT in a PCS assessment clinicCompare BPAT scores with other outcome measures of breathlessness, BPD and QoL.MethodsA convenience sample of consecutive patients attending PCS assessment clinic between October 2021 and May 2022 was used. Patients had sustained symptoms 12-weeks following initial COVID-19 infection, not explained by an alternative diagnosis. Patients completed BPAT, Nijmegen Questionnaire (NQ), EQ5D, PHQ, GAD7 and symptom-based numerical rating scales (NRS). The BPAT was carried out by the specialist physiotherapists and occupational therapists. Results are described as mean (standard deviation) and frequencies. Correlations between measures were completed using Pearson’s correlation coefficient.ResultsSeventy-three patients were included (table 1). Twenty-eight (38%) had a BPAT>4, 15(54%) of which were referred on to a specialist respiratory physiotherapy service for specific BPD treatment. The BPAT showed moderate correlation with the NQ (r=0.303, p>0.001) and weak correlations with NRS for breathlessness (r=0.305, p>0.014), cough (r=0.265, p>0.034) and fatigue (r=0.254, p>0.043). The NQ correlated moderately with both the PHQ (r= 0.578, p>0.001) and GAD7 (r=0.485, p>0.001).Abstract P219 Table 1Patient demographicsDemographics Age 43.14 (13.21) Gender Male n=22, Female n=51 Ethnicity White n=47 Black n=12 Asian n=7 Mixed n=7 Outcome measures from post covid clinic BPAT 3.44 (3.02) Nijmegen 27.82 (13.79) EQ5D 12.48 (11.71) Breathlessness NRS 4.17(2.39) Cough NRS 2.31 (2.93) Fatigue NRS 5.92 (2.41) Pain NRS 3.57 (3.41) Sleep NRS 4.74 (2.84) 1 minutes Sit to Stand 22.97 (11.47) GAD7 5.72 (6.96) PHQ9 5.97 (7.60) BPAT >4 n=28 (38%) Mean (standard deviation) unless otherwise stated; NRS: Numerical Rating ScaleConclusionThe BPAT Tool is a useful component of breathlessness assessment in the context of a PCS assessment clinic. It can provide a useful screening tool to identify patients with BPD who may benefit from specialist intervention with respiratory physiotherapists. Further understanding is required of how BPD responds to therapy and which type of treatments are important for this cohort.ReferencesHylton H, Long A, Francis C, et al. Real-world use of the Breathing Pattern Assessment Tool in assessment of breathlessness post-COVID-19. Clin Med (Lond). 2022 Jun 27.Todd S, Walsted ES, Grillo L et al. Novel assessment tool to detect BPD in patients with refractory asthma. Respirology. 2018;23(3).

British Thoracic Society (BTS) guidelines recommend assessment of breathing pattern disorder (BPD) for ongoing breathlessness post COVID-19 infection. 23.7% of patients attending post covid clinic were referred for breathing pattern retraining (BPR) (Heightman et al, 2021)2 and evidence suggests that BPR can improve breathlessness arising from BPD (British Thoracic Guidance, 2020)1. Due to large referral numbers, limited specialist work force and increased waiting times following redeployment during the Covid pandemic, virtual group BPR treatment (VGT) was trialled as an alternative to one-to-one intervention.Data were collected from patients referred for BPR following completion of post Covid-19 multidisciplinary clinic assessment. Breathlessness (Dyspnoea 12- D12), breathing pattern (Brompton Breathing Pattern Assessment Tool – BPAT) and fatigue (Fatigue Assessment Scale – FAS) were assessed by a specialist Physiotherapist on referral and completion of VGT. VGT consisted of 6, 1 hour, physiotherapist led sessions run fortnightly using a virtual platform. The programme included BPR at rest and on exertion, activity management, pacing advice, psychological health advice and relaxation. The interactive nature of the sessions also enabled facilitated peer support. Group size was 6–10 participants. A Wilcoxon Sign Rank test was used to compare pre and post treatment data.32 patients enrolled, 26 completed the groups in full across 4 cohorts. 6 dropped out due to work or medical reasons.Complete data sets (n=18) were analysed (16 female, 2 male, median age= 46, mean 15 months post infection).VGT for 26 patients saved 52 hours of clinician time compared with usual, one-to-one interventionImprovement in BPAT, D12 and FAS were statistically significant (table 1)Abstract P221 Table 1Virtual group BPR treatment improved breathing pattern and breathlessness for patients within the post covid BPD. With social distancing regulations, VGT offers an effective alternative to face to face group treatment. This saved clinician time which could enable reduced wait times for treatment.ReferencesBritish Thoracic Society. British thoracic society guidance on respiratory follow up of patients with a clinico-radiological diagnosis of COVID-19 pneumonia, 2020.Heightman M, Prashar J, Hillman TE, et al. Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals. BMJ Open Resp Res, 2021;8.

IntroductionLaryngeal dysfunction can present as a spectrum of clinical presentations, including Inducible laryngeal obstruction (ILO) and/or Chronic Cough (CC). ILO and CC can occur following an initial viral insult (Hull et al). In our Tertiary Airways service, we noted an increase in the numbers of referrals for patients with upper airway and laryngeal symptoms following infection with Covid-19.AimsTo describe the clinical presentations of patients referred to our service with laryngeal and upper airway symptoms following Covid-19 infection.MethodsReferrals received between April 2020 and May 2022 with suspected laryngeal dysfunction (ILO, CC or heightened laryngeal sensitivity) following Covid infection were reviewed. Electronic records were searched for referral information, demographic details, and assessment results.Results66 (18%) referrals out of 362 received within the time period were for symptoms following infection with Covid-19. 57 patients (86%) had no premorbid laryngeal difficulties before Covid-19 infection. Mean age was 53 (range 27–75), and 71% were female. 98% were of White British ethnicity.Reason for referral was categorised into four types, with 34 patients having more than one reason cited.To date, 38 of the 66 patients have had laryngoscopic assessment, which confirmed ILO for 26 patients. 21 of the 26 (80%) did not have ILO before Covid-19 infection. 13 of the 26 patients with ILO had suspected ILO on referral, whilst 13 did not. A binary logistic regression using referral reason as the predictor for ILO was non-significant, indicating that no specific referral reason predicted subsequent ILO diagnosis with laryngoscopy.Abstract P223 Table 1ConclusionsIn line with the literature, viral insult can lead to laryngeal hypersensitivity and hyperresponsiveness, which can manifest as a clinical spectrum, including ILO. New presentation with ILO was common in patients assessed for upper airway symptoms post-Covid-19. Correlation between referral reason and assessment outcome was poor, therefore assessment via laryngoscopy is essential to confirm diagnosis before intervention. Patients from minority ethnic groups were not referred to the service, despite being at higher risk of medical complications following Covid-19.