Breathlessness Matters - Australian Cohort Study Evaluating the Impact of a Multidisciplinary, Home-Based...

Chronic breathlessness causes reduced quality of life (QoL) and high healthcare costs. Accumulating evidence shows that multidisciplinary breathlessness services can ameliorate breathlessness which persists despite guideline-directed treatments. Current literature largely reflects trials of interventions in European settings applied to cancer-predominant populations, raising doubt about broad applicability. The research objective was to evaluate whether Macarthur Breathless Clinic (MBC), a bespoke health service intervention, could reduce the impact of chronic breathlessness for a cohort of Australians with COPD.

The MBC intervention was tested in a prospective, single-arm cohort study, targeting recruitment of 92 patients. Eligible patients had chronic breathlessness impacting QoL and at least moderately severe COPD, defined by spirometry. Following detailed case review to ensure optimal medical therapy, an individualized program was developed and implemented by MBC's multidisciplinary team during a nine-week program. Questionnaires assessing breathlessness burden, mental health and QoL were administered at baseline, repeated on program completion and again at 12 months.

Eighty-nine eligible subjects were mean age 71 years, 65% female and 10% Aboriginal Australian with 18% reporting breathlessness at rest. Mean FEV1 was 37% predicted. Compared with baseline, the primary outcome, Chronic Respiratory Questionnaire - Mastery Subscale improved after program completion (0.5 at nine and 0.8 at 52 weeks, p<0.0001). Measures of confidence, COPD symptom burden and breathlessness also yielded durable positive results at 12 months.

Clinically relevant gains seen after MBC were retained or even increased at 12 months and more reflected enhanced coping skills and confidence than reduced breathlessness intensity.