The Manchester Airways Service

The Manchester Airways Service manages people who feel breathlessness. This can be due to different causes including problems with the throat or changes in their pattern of breathing. These conditions include:

• Inducible Laryngeal Obstruction (ILO)
• Breathing Pattern Disorder (BPD)

The service is led by Professor Stephen Fowler (Consultant Respiratory Physician) and Siobhan Ludlow (Consultant Speech and Language Therapist).

Inducible Laryngeal Obstruction (ILO)

Inducible laryngeal obstruction (ILO) is a condition that affects breathing at the level of the throat (larynx). It is sometimes also called vocal cord dysfunction.

In ILO, the throat can tighten when it should be open during breathing. This narrows the airway and can cause:

• Noisy breathing
• Breathlessness
• A tight feeling in the throat

Sometimes the breathing difficulties can also be associated with other throat problems, such as voice changes, coughing or difficulty swallowing.

ILO can be triggered by things such as strong smells, aerosols, exercise, temperature change, shouting, laughing, coughing, and emotions. Symptoms often come on quickly and usually settle within a few minutes. Speech and language therapy is the main treatment for helping people manage ILO symptoms and associated throat problems.

Breathing Pattern Disorder (BPD)

Breathing Pattern Disorder (BPD) happens when the way someone breathes changes and becomes less efficient. This can lead to more breathlessness than is expected for the activity. This could mean becoming short of breath with light movement or even at rest.

Breathing may become too fast, too shallow, or rely on muscles in the chest, neck, or shoulders rather than relaxed, lower (diaphragmatic) breathing.

Symptoms may include:

• Tightness in the chest or throat
• Feeling unable to take a deep breath
• Air hunger, frequent sighing, or yawning
• Dizziness or feeling light-headed
• Tingling in the fingers, lips, or face
• A racing heart or palpitations
• Tightness in the shoulders, neck, or jaw

BPD can be triggered or worsened by stress, illness, pain, poor posture, or long periods of breathlessness. Respiratory physiotherapists can assess breathing patterns and help retrain a more comfortable and efficient way of breathing.

Working with Other Services

These conditions can occur alongside other breathing problems, such as asthma. This can make diagnosis more complicated and sometimes lead to delays.

To ensure coordinated care, the specialist multidisciplinary team at the Manchester Airways Service works closely with other respiratory services, such as the Severe Asthma service and the Chronic Cough service at Manchester University NHS Foundation Trust.

Referrals

We accept referrals from healthcare professionals for individuals across the UK who have complex breathlessness and/or upper airway symptoms.

Guide for referrers

To help the team triage referrals, please provide the following information where available in your referral letter.

Assessment

Most new patients are offered a “one-stop” appointment. This is a longer visit than a typical clinic, so that you can be seen and assessed by several members of the team specialised in respiratory and upper airway conditions. This may include:

• A respiratory (lung) doctor
• A nurse
• A speech and language therapist
• A physiotherapist

You will have time to talk about your symptoms in detail. If needed, tests may be carried out on the same day. These can include:

• Breathing tests (such as spirometry and lung function tests)
• Chest X-ray
• Blood tests
• Allergy blood tests
• Sputum tests
• Provocation laryngoscopy (a camera test to look at the throat while symptoms are happening)

Sometimes you may need to come back for further testing if needed, such as a bronchoscopy (a camera test to look inside the airways) or a Chest CT scan.

We will also review any previous test results, so tests are not repeated unless needed. This helps us understand your symptoms fully and work with you to create a personalised treatment or management plan.

As this is a University Hospital, medical students and other healthcare professionals in training may be present during your appointment.

Treatment

Once we understand what is causing your breathlessness, we will work with you to agree personalised treatment and management options that suit your needs. These may include:

• Medical review
• Clinical nurse review
• Respiratory physiotherapy
• Speech and language therapy
• Psychology

The service takes a holistic approach, recognising the emotional and psychological impact that chronic breathlessness and delayed diagnosis can have on patients. Care focuses on treating the person, not just the condition.

Appointments can be offered in different ways and may take place:

• Face-to-face at Wythenshawe, Altrincham, or Withington Hospital
• Online using Microsoft Teams
• By telephone

Research Activity

We are involved in research to help improve care for people with breathing problems. You may be invited to take part in a research study. Taking part is your choice, and your decision will not affect your care.