Oral Presentation Palliative Care Nurses Australia Conference 2020

Multi-disciplinary Breathlessness Clinic to improve breathlessness mastery in COPD: Pilot study. (70395)

Mary M Roberts 1 2 3 , Tracy A Smith 1 2 , Jin G Cho 1 2 3 , John R Wheatley 1 2 3
  1. Westmead Hospital, Wentworthville, NSW, Australia
  2. University of Sydney, School of Medicine, Westmead Clinical School, Westmead, New South Wales, Australia
  3. Ludwig Engel Centre for Respiratory Research - Westmead Institute for Medical Research, , Westmead, New South Wales, Australia

Introduction/Background/Significance: Breathlessness is key symptom for patients with COPD, often persisting despite optimal pharmacological management.

Aims/Objectives/Hypothesis/Goals or Problem: To pilot a complex, multidisciplinary, non-pharmacological intervention in Australian patients with COPD.

Approach/Methods/Procedure: We recruited patients with moderate to very severe COPD (FEV1:FVC<70%; FEV1<60% predicted) and significant breathlessness (modified Medical Research Council (mMRC)≥2) to an 8-week non-pharmacological, complex intervention. Participants received individualised advice including hand-held fans, breathing techniques, exercise, energy conservation, relaxation and dietary advice from a multidisciplinary team (doctors, nurses, physiotherapist, occupational therapist and dietitian). We excluded patients with documented cognitive decline or those unwilling to participate in self-management. We assessed patients at baseline, Week-8 and 12-months using: Chronic Respiratory Questionnaire (CRQ; Range0-7au; higher scores=better) with our primary outcome being CRQ mastery subscale; EQ-5D-5L; breathlessness intensity, unpleasantness and confidence managing breathlessness (0-10 numerical rating scale). All-cause hospitalisations for 12 months before and after clinic completion were collected from local hospital records. We used paired t-tests to compare data for baseline to 8 weeks and unpaired t-tests for baseline to 12 months.

Results/Findings/Outcomes: Eleven patients (7 women) aged 67.9±5.4 years (mean±SD) with FEV1 28±6% predicted were recruited. CRQ mastery tended to increase (4.1 to 5.1 over 8 weeks; p=0.07). At 8 weeks, improvements were seen in: mMRC (-0.6;p=0.01), CRQ dyspnoea and fatigue (+1.02,p=0.02; +0.95;p=0.01, respectively), EQ-5D-5L overall health (+12;p=0.03), and confidence managing breathlessness (+4;p=0.01). Eight patients contributed 12 month data (1 lost to follow up, 2 died) and no statistically significant changes were detected. Hospitalisations, predominantly due to reductions in respiratory admissions, were significantly reduced over 12 months (admissions/year: 4.4±2.2 12-months pre vs 2.5±1.8 at 12-months post; p=0.045).

Conclusion: An 8-week multidisciplinary intervention reduced breathlessness and fatigue, improved overall health, increased confidence managing breathlessness and reduced hospitalisations over 12 months. These pilot data support undertaking a randomised controlled trial to evaluate the intervention