ABSTRACT
Introduction: Breathlessness is a common symptom in clinical practice and in many prevalent diseases including chronic obstructive lung disease (COPD), asthma, heart failure, lung cancers and post COVID-19 syndrome. Understanding patients' experience of living with breathlessness, their expectations of care and self-management needs is essential to support development of health services and resources that meet their needs. Aim(s): To explore the perspectives of patients and their careers, on living with chronic breathlessness, provision and quality of medical care, and accessing information and resources to assist self-management. The study also explored their views on three evidence-based breathlessness patient education materials (PEMs). Method(s): Qualitative study involving in-depth semi-structured interviews with 16 patients living with chronic breathlessness (>=2 weeks) and their careers. Topics explored included: (1) experience living with breathlessness;(2) current medical care experience and their expectations;and (3) self-management resources, needs and views on some current publicly available PEMs. Result(s): Fourteen patients (cardiac, respiratory, and non-cardiorespiratory) and two carers (50% female) were interviewed (mean age 57 years). Twelve main themes were identified - (1) Breathlessness controls their lives, (2) Breathlessness avoidance and the vicious cycle, (3) Coping vs Fatalism, (4) Feeling misunderstood by their surroundings and health providers, (5) Diagnostic delays, misdiagnosis, and knowledge gaps, (6) Discontinuity of care, (7) Focus on pharmacologic management of breathlessness, (8) Demand for choice, non-pharmacologic options and support, (9) Beyond curing disease: symptom relief and improving quality of life as a goal, (10) Being more aware and in control of their disease, (11) Self-management and limited support for it, and (12) Resources they would value. Conclusion(s): Breathlessness remains a neglected condition in Australia. Patients suffer from lack of clinician and community awareness, discontinuity of care, and too few clinical and self-management options.
ABSTRACT
Background and Aim: This study aimed to understand the impact of breathlessness on quality of life, productivity loss and healthcare use of Australian adults. Method(s): The National Breathlessness Survey was a nationwide cross-sectional web-based survey in Oct 2019, recruiting Australians aged >=18 years stratified by age-group, gender and state of residence. Severity of breathlessness using the modified Medical Research Council (mMRC) dyspnoea scale (0-5), quality of life (QoL) using EQ-VAS and EQ-5D-5L, and healthcare use (HCU) and productivity loss associated with having a "breathing problem" in the past 12 months were analysed. Quintile regression was conducted to analyse QoL and binary logistic regression for HCU and productivity loss outcomes. Effect sizes were adjusted for age, gender, Indigenous background, self-reported heart and lung disease, high PHQ-4 score, multimorbidity and smoking. Result(s): 10,072 adults completed the survey. The prevalence of clinically important breathlessness (mMRC>=2) was 9.54%. mMRC>=2 was associated with worse QoL, and greater healthcare use and productivity loss compared with mMRC=1 (Table). Despite COVID-19 impacts, similar prevalence (8.15%) and associations were seen in a repeat cross-sectional survey in December 2020 (n=10,024). Conclusion(s): Breathlessness carries a significant burden for patients, the healthcare system, and the economy.
ABSTRACT
Rationale Difficult to treat asthma (DTTA) is asthma that is uncontrolled despite medium/high ICSLABA treatment and/or maintenance oral corticosteroids (OCS);severe asthma is a subset. Previous research suggests that anxiety and depression are common among patients with severe asthma;these may impact asthma control and quality of life. Screening for anxiety and depression has been recommended, followed by appropriate psychiatrist/psychologist referral. However, little is known about whether the mental health support needs of people with DTTA are being met, and any attributable health service utilisation. The aims of this study were to explore mental health issues, and healthcare utilization, in people with DTTA within a nationally-representative population of people with a diagnosis of asthma.Methods The DTTA Survey was a cross-sectional survey in February-March 2021 of 5457 participants aged ≥18 years with current asthma, randomly selected from a large web-based survey panel of adult Australians. All survey participants answered demographic questions and questions regarding asthma symptoms, medications and health service use, with additional questions for those with DTTA. DTTA was identified based on ERS/ATS criteria.Mental status was assessed via reported comorbidities, mental health referrals and treatment, and the Hospital Anxiety and Depression Scale (HADS) which assesses feelings in the previous week. The Consultation and Relational Empathy (CARE) measure was also used to gauge participants' perceptions about the consultation process with their general practitioner.Results 1170 (21.4%) of participants had DTTA. Of these 56.8% (664/1170) were female (Table). The proportions of DTTA participants who reported being told by a doctor/nurse that they had anxiety or depression, and selected “have at present” for these diagnoses, were 35.9% and 28.9% respectively;21.8% indicated both. However, by HADS, 63.4% self-reported current anxiety symptoms and 39.9% current depression symptoms. 50% reported feeling more anxious about their asthma due to COVID19. Overall, 47.9% of those with DTTA (561/1170) reported treatment for anxiety or depression in the previous year. Treatments included medication (72.7%);Cognitive Behavioural Therapy (42.8%);and mindfulness training (23.9%). Concerning mental health support, 611 participants (52.2%) had consulted with a psychologist or counsellor in last 5 years;38.8% of those visits were within the previous 3 months. Over half these consultations (52.5%) were initiated by the participant, and 33.6% by the GP. Conclusion The findings from this representative population survey provide insights regarding prevalence and management of anxiety and depression among people with DTTA, and may assist clinicians in supporting their mental health needs. (Table Presented).
ABSTRACT
Respirable aerosols (< 5 µm in diameter) present a high risk of SARS-CoV-2 transmission. Guidelines recommend using aerosol precautions during aerosol-generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min-1 to count and size-fractionate close to all exhaled particles (0.5-25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high-flow nasal oxygen and single or dual circuit non-invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6-fold during talking and 370.8-fold during coughing (p < 0.001). High-flow nasal oxygen 60 at l.min-1 increased particle counts 2.3-fold (p = 0.031) during quiet breathing. Single and dual circuit non-invasive respiratory therapy at 25/10 cm.H2 O with quiet breathing increased counts by 2.6-fold and 7.8-fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non-invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions.