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Research ArticleOriginal Research

Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in Subjects With Advanced COPD

Amany F Elbehairy, Hannah McIsaac, Elizabeth Hill, Patrick A Norman, Andrew G Day, J Alberto Neder, Denis E O'Donnell and Ingrid A Harle
Respiratory Care April 2020, 65 (4) 444-454; DOI: https://doi.org/10.4187/respcare.06950
Amany F Elbehairy
Palliative Care and Respirology Divisions, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Hannah McIsaac
Palliative Care and Respirology Divisions, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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Elizabeth Hill
Palliative Care and Respirology Divisions, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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Patrick A Norman
Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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Andrew G Day
Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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J Alberto Neder
Palliative Care and Respirology Divisions, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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Denis E O'Donnell
Palliative Care and Respirology Divisions, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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  • For correspondence: [email protected]
Ingrid A Harle
Palliative Care and Respirology Divisions, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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Abstract

BACKGROUND: Severe exertional dyspnea is a commonly reported symptom in patients with COPD, especially in the advanced stages. Our objective was to assess the preliminary impact of comprehensive, individualized management provided by a specialized tertiary center clinic on exertional dyspnea and patient-centered outcomes in patients with advanced COPD.

METHODS: This retrospective analysis included 45 subjects with COPD who were evaluated in a newly established dyspnea clinic over 3 years. Those with severe exertional dyspnea (Medical Research Council dyspnea score of ≥4/5), despite optimal disease-targeted therapy were eligible for referral. We used the revised Edmonton Symptom Assessment System (ESAS-r) to assess symptoms. Responders were defined as those whose change from baseline to 2-months met the minimum clinically important difference of ≤−1 in ESAS-r score for shortness of breath.

RESULTS: Subjects (mean ± SD age 70 ± 7 years) had an average FEV1 of 36 ± 18% predicted and a Medical Research Council dyspnea score of 4.7 ± 0.4. Responses to the intervention were variable and mean change in the ESAS-r score for shortness of breath in the total group was −0.32 ± 3.39, P = .53. Forty-seven percent of the subjects were identified as responders, and 42, 40, 40, and 33% met the minimum clinically important difference for improvement in ESAS-r scores for tiredness, anxiety, well-being, and depression, respectively. Responders had fewer emergency department annual visits in the 2 years after their first clinic visit compared with nonresponders (mean ± SD, 1.38 ± 1.63 vs 4.45 ± 5.52, P = .034).

CONCLUSIONS: Although the impact of our specialized advanced dyspnea clinic was variable, as evaluated by the ESAS-r, it provided measurable additional clinically important benefit to almost half of the subjects with advanced COPD and severe refractory dyspnea.

  • dyspnea
  • COPD
  • comprehensive management
  • palliative care

Footnotes

  • Correspondence: Denis O'Donnell PhD FRCPI FRCPC, Respirology Division, Department of Medicine, Queen's University and Kingston Health Sciences Centre, 102 Stuart Street, Kingston, Ontario, Canada K7L 2V6. E-mail: odonnell{at}queensu.ca.
  • The authors have disclosed no conflicts of interest. This study was sponsored by a research grant from Boehringer Ingelheim (Investigator Initiated Trial # 1237-0079).

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (4)
Respiratory Care
Vol. 65, Issue 4
1 Apr 2020
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Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in Subjects With Advanced COPD
Amany F Elbehairy, Hannah McIsaac, Elizabeth Hill, Patrick A Norman, Andrew G Day, J Alberto Neder, Denis E O'Donnell, Ingrid A Harle
Respiratory Care Apr 2020, 65 (4) 444-454; DOI: 10.4187/respcare.06950

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Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in Subjects With Advanced COPD
Amany F Elbehairy, Hannah McIsaac, Elizabeth Hill, Patrick A Norman, Andrew G Day, J Alberto Neder, Denis E O'Donnell, Ingrid A Harle
Respiratory Care Apr 2020, 65 (4) 444-454; DOI: 10.4187/respcare.06950
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Keywords

  • dyspnea
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