Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in Subjects With Advanced COPD.
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 pat...
| Publicado en: | Respiratory Care Vol. 65; no. 4; pp. 444 - 455 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Apr2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142481242&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 142481242 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Apr2020 vid: 65 iid: 4 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 142481242 142481242 142481242 10.4187/respcare.06950 142481242 ppf: 444 ppct: 11 formats: fmt: @attributes: type: P tig: atl: Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in Subjects With Advanced COPD. aug: au: Elbehairy, Amany F. McIsaac, Hannah Hill, Elizabeth Norman, Patrick A. Day, Andrew G. Neder, J. Alberto O'Donnell, Denis E. Harle, Ingrid A. affil: Palliative Care and Respirology Divisions, Department of Medicine, Queen's University sug: subj: Pulmonary Disease, Chronic Obstructive Dyspnea Therapy Ambulatory Care Facilities Individualized Medicine Treatment Outcomes Ontario Human Female Male Middle Age Aged Retrospective Design Tertiary Health Care Hospitalization Emergency Service Descriptive Statistics Data Analysis Software Paired T-Tests Wilcoxon Signed Rank Test Fisher's Exact Test Wilcoxon Rank Sum Test Scales Middle Aged: 45-64 years Aged: 65+ years Female Male ab: 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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