Abstract
Introduction: Refractory dyspnoea is a common symptom of chronic respiratory disease, often poorly recognized by healthcare professionals. Pharmacological treatments are of limited effectiveness. A multidisciplinary intervention carried out by a specialized palliative care team has demonstrated its effectiveness in helping patients improve their quality of life. The aim of this pilot study was to verify the effects of a multidisciplinary intervention carried out by a team not specialized in palliative care (physician, psychologist, physiotherapist, social worker, dietician). Methods: A longitudinal, single-arm interventional study was conducted between February 2019 and May 2022. All consecutive patients with refractory dyspnoea – referred by a pulmonologist – had a non-pharmacological paramedical intervention (ventilatory education, mindfulness meditation, respiratory rehabilitation, psychological and dietary support, etc.) tailored to their situation after an initial interview. The primary endpoint was the evolution of the Chronic Respiratory Questionnaire (CRQ) before and after the intervention. Results: Fifty-eight patients were referred; 56 patients underwent the intervention. Patients were comparable to previous studies on the basis of LCADL and ESAS scores. The CRQ increased from 4.7 ± 1.5 to 6.2 ± 1.5 pre- and post-intervention overall (p < 0.001), with a significant change in all sub-items (fatigue, dyspnoea, emotional function, control). Conclusion: A non-specialized multidisciplinary palliative care team can help patients with refractory dyspnoea improve their quality of life.
Journal Section:
Clinical Investigations
References
1.
Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society
. Am J Respir Crit Care Med
. 1999
;159
(1
):321
–40
. 2.
Johnson
MJ
, Yorke
J
, Hansen-Flaschen
J
, Lansing
R
, Ekström
M
, Similowski
T
, et al. Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness
. Eur Respir J
. 2017
;49
(5
):1602277
. 3.
Booth
S
, Burkin
J
, Moffat
C
, Spathis
A
. Managing breathlessness in clinical practice
. London
: Springer London
; 2014
.4.
Booth
S
, Johnson
MJ
. Improving the quality of life of people with advanced respiratory disease and severe breathlessness
. Breathe
. 2019
;15
(3
):198
–215
. 5.
Currow
DC
, Plummer
JL
, Crockett
A
, Abernethy
AP
. A community population survey of prevalence and severity of dyspnea in adults
. J Pain Symptom Manage
. 2009
;38
(4
):533
–45
. 6.
Clark
G
, Marechal
M
, Monnin
D
. Late Breaking Abstract - COPD knowledge in a swiss frail selected population
[cited 2023 Dec 16]. Available from: https://www.ers-education.org/lr/show-details/?idP=2125927.
Lynn
J
, Ely
EW
, Zhong
Z
, McNiff
KL
, Dawson
NV
, Connors
A
, et al. Living and dying with chronic obstructive pulmonary disease
. J Am Geriatr Soc
. 2000
;48
(S1
):S91
–100
. 8.
Higginson
IJ
, Bausewein
C
, Reilly
CC
, Gao
W
, Gysels
M
, Dzingina
M
, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial
. Lancet Respir Med
. 2014
;2
(12
):979
–87
. 9.
Farquhar
M
, Higginson
IJ
, Fagan
P
, Booth
S
. Results of a pilot investigation into a complex intervention for breathlessness in advanced chronic obstructive pulmonary disease (COPD): brief report
. Palliat Support Care
. 2010
;8
(2
):143
–9
. 10.
Farquhar
MC
, Prevost
AT
, McCrone
P
, Brafman-Price
B
, Bentley
A
, Higginson
IJ
, et al. The clinical and cost effectiveness of a Breathlessness Intervention Service for patients with advanced non-malignant disease and their informal carers: mixed findings of a mixed method randomised controlled trial
. Trials
. 2016
;17
:185
. 11.
Sánchez-Cárdenas
MA
, Garralda
E
, Benítez
E
, Arias-Casais
N
, van Steijn
D
, Centeno
C
. Palliative care coverage across European national health systems: proposal of a synthetic indicator
. Int J Environ Res Public Health
. 2021
;18
(20
):10753
. 12.
Prof. JM Martin-Moreno MMH, Spain DCCD of PM& PHABI 15 E-46010 V. Palliative care in the European union; 2008 [cited 2023 Dec 16]. Available from: https://policycommons.net/artifacts/1341562/palliative-care-in-the-european-union/1953677/
13.
Bocéréan
C
, Dupret
E
. A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees
. BMC Psychiatry
. 2014
;14
(1
):354
. 14.
Zigmond
AS
, Snaith
RP
. The hospital anxiety and depression scale
. Acta Psychiatr Scand
. 1983
;67
(6
):361
–70
. 15.
Bourbeau
J
, Maltais
F
, Rouleau
M
, Guímont
C
. French-Canadian version of the Chronic Respiratory and St George’s Respiratory questionnaires: an assessment of their psychometric properties in patients with chronic obstructive pulmonary disease
. Can Respir J
. 2004
;11
(7
):480
–6
. 16.
Schünemann
HJ
, Puhan
M
, Goldstein
R
, Jaeschke
R
, Guyatt
GH
. Measurement properties and interpretability of the chronic respiratory disease questionnaire (CRQ)
. COPD
. 2005
;2
(1
):81
–9
. 17.
Pautex
S
, Vayne-Bossert
P
, Bernard
M
, Beauverd
M
, Cantin
B
, Mazzocato
C
, et al. Validation of the French version of the Edmonton symptom assessment system
. J Pain Symptom Manage
. 2017
;54
(5
):721
–6.e1
. 18.
Beaumont
M
, Couturaud
F
, Jego
F
, Pichon
R
, Le Ber
C
, Péran
L
, et al. Validation of the French version of the London chest activity of daily living scale and the dyspnea-12 questionnaire
. Int J Chron Obstruct Pulmon Dis
. 2018
;13
:1399
–405
. 19.
Spruit
MA
, Singh
SJ
, Garvey
C
, ZuWallack
R
, Nici
L
, Rochester
C
, et al. An official American thoracic society/European respiratory society statement: key concepts and advances in pulmonary rehabilitation
. Am J Respir Crit Care Med
. 2013
;188
(8
):e13
–64
. 20.
Reilly
CC
, Bausewein
C
, Garrod
R
, Jolley
CJ
, Moxham
J
, Higginson
IJ
. Breathlessness during daily activity: the psychometric properties of the London Chest Activity of Daily Living Scale in patients with advanced disease and refractory breathlessness
. Palliat Med
. 2017
;31
(9
):868
–75
. 21.
Chauvin
A
, Rupley
L
, Meyers
K
, Johnson
K
, Eason
J
. Research corner outcomes in cardiopulmonary physical therapy: chronic respiratory disease questionnaire (CRQ)
. Cardiopulm Phys Ther J
. 2008
;19
(2
):61
–7
. 22.
Verberkt
CA
, van den Beuken-van Everdingen
MHJ
, Schols
JMGA
, Hameleers
N
, Wouters
EFM
, Janssen
DJA
. Effect of sustained-release morphine for refractory breathlessness in chronic obstructive pulmonary disease on health status: a randomized clinical trial
. JAMA Intern Med
. 2020
;180
(10
):1306
–14
. 23.
Ekström
M
, Ferreira
D
, Chang
S
, Louw
S
, Johnson
MJ
, Eckert
DJ
, et al. Effect of regular, low-dose, extended-release morphine on chronic breathlessness in chronic obstructive pulmonary disease: the BEAMS randomized clinical trial
. JAMA
. 2022
;328
(20
):2022
–32
. 24.
Ambrosino
N
, Fracchia
C
. Strategies to relieve dyspnoea in patients with advanced chronic respiratory diseases. A narrative review
. Pulmonology
. 2019
;25
(5
):289
–98
. 25.
Gruenberger
J-B
, Vietri
J
, Keininger
DL
, Mahler
DA
. Greater dyspnea is associated with lower health-related quality of life among European patients with COPD
. Int J Chron Obstruct Pulmon Dis
. 2017
;12
:937
–44
. 26.
Hanania
NA
, O’Donnell
DE
. Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions
. Int J Chron Obstruct Pulmon Dis
. 2019
;14
:1127
–38
. 27.
Schunk
M
, Le
L
, Syunyaeva
Z
, Haberland
B
, Tänzler
S
, Mansmann
U
, et al. Effectiveness of a specialised breathlessness service for patients with advanced disease in Germany: a pragmatic fast-track randomised controlled trial (BreathEase)
. Eur Respir J
. 2021
;58
(2
):2002139
. 28.
Puhan
MA
, Frey
M
, Büchi
S
, Schünemann
HJ
. The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease
. Health Qual Life Outcomes
. 2008
;6
:46
. 29.
McCarthy
B
, Casey
D
, Devane
D
, Murphy
K
, Murphy
E
, Lacasse
Y
. Pulmonary rehabilitation for chronic obstructive pulmonary disease
. Cochrane Database Syst Rev
. 2015
;2015
(2
):CD003793
. 30.
Balk
EM
, Bonis
PAL
, Moskowitz
H
, Schmid
CH
, Ioannidis
JPA
, Wang
C
, et al. Correlation of quality measures with estimates of treatment effect in meta-analyses of randomized controlled trials
. JAMA
. 2002
;287
(22
):2973
–82
. 31.
Lahham
A
, Holland
AE
. The need for expanding pulmonary rehabilitation services
. Life
. 2021
;11
(11
):1236
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