Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T13:20:12.892Z Has data issue: false hasContentIssue false
  • English
  • Français

Results of a pilot investigation into a complex intervention for breathlessness in advanced chronic obstructive pulmonary disease (COPD): Brief report

Published online by Cambridge University Press:  23 March 2010

Morag Farquhar ,
Irene J. Higginson ,
Petrea Fagan  and
Sara Booth
Morag Farquhar*
Affiliation:
Macmillan Post Doctoral Research Fellow, University of Cambridge, General Practice and Primary Care Research Unit, Department of Public Health & Primary Care, Institute of Public Health, Cambridge, England
Irene J. Higginson
Affiliation:
Department of Palliative Care, Policy & Rehabilitation, King's College London, London, England
Petrea Fagan
Affiliation:
Cambridge University Hospitals' NHS Foundation Trust, Breathlessness Intervention Service, Addenbrooke's Hospital, Cambridge, England
Sara Booth
Affiliation:
Cambridge University Hospitals' NHS Foundation Trust, Breathlessness Intervention Service, Addenbrooke's Hospital, Cambridge, England
*
Address correspondence and reprint requests to: Morag Farquhar, Department of Public Health & Primary Care, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR, England. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Breathlessness is the most common devastating symptom of advanced chronic obstructive pulmonary disease (COPD). The Breathlessness Intervention Service (BIS) is a multidisciplinary service that uses both pharmacological and non-pharmacological evidence-based interventions to reduce the impact of the symptom. The results of a Phase II evaluation of the service are reported.

Method:

Pretest - posttest analysis of non-randomized data was performed for 13 patients with severe advanced COPD referred to BIS.

Results:

Mean VAS-Distress scores (primary outcome measure) decreased (improved) for the group between baseline and follow up suggesting a clinically significant improvement: 6.88 (SD = 2.50) to 5.25 (SD = 2.99). At an individual level, 11 of the 13 patients showed a decrease in their distress due to breathlessness, and for eight of these this was clinically significant (range of all decreases 0.3–7.1 cm). Changes in secondary outcome measures are also reported.

Significance of results:

The Breathlessness Intervention Service appears to reduce distress due to breathlessness among patients with advanced COPD. A Phase III fully-powered randomized controlled trial is warranted.

Keywords

BreathlessnessChronic obstructive pulmonary diseaseComplex interventionFeasibility study
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 2 , June 2010 , pp. 143 - 149
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Booth, S. & Adams, L. (2001). The shuttle walking test: A reproducible method for evaluating functional capacity in people with advanced cancer. Thorax, 56, 146–150.CrossRefGoogle Scholar
Booth, S., Farquhar, M., Gysels, M., et al. (2006). The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnoea: A qualitative Phase I study. Palliative & Supportive Care, 4, 287–293.CrossRefGoogle Scholar
Booth, S., Kelly, M., Cox, N.P.G., et al. (1996). Does oxygen help dyspnoea in cancer patients? American Journal of Respiratory Critical Care Medicine, 153, 1515–1518.CrossRefGoogle Scholar
Booth, S., Silvester, S. & Todd, C. (2003). Breathlessness in cancer and chronic obstructive pulmonary disease: Using a qualitative approach to describe the experience of patients and carers. Palliative & Supportive Care, 1, 337–344.CrossRefGoogle ScholarPubMed
Bredin, M., Corner, J., Krishnasamy, M., et al. (1999). Multicentre randomised control trial of nursing intervention for breathlessness in patients with lung cancer. British Medical Journal, 318, 901–904.CrossRefGoogle ScholarPubMed
Brenes, G.A. (2003). Anxiety and chronic obstructive pulmonary disease: Prevalence, impact, and treatment. Psychosomatic Medicine, 65, 963–970.CrossRefGoogle ScholarPubMed
Charles, M., Reymond, L. & Israel, F. (2008). Relief of incident dyspnea in palliative cancer patients: a pilot randomized, controlled trial comparing nebulized hydromorphone, systemic hydromorphone, and nebulized saline. Journal of Pain and Symptom Management, 36, 29–38.CrossRefGoogle ScholarPubMed
Corner, J., Plant, H., A'Hern, R., et al. (1996). Non-pharmacological intervention for breathlessness in lung cancer. Palliative Medicine, 10, 299–305.CrossRefGoogle ScholarPubMed
Farquhar, M., Higginson, I.J., Fagan, P., et al. (2009a). The feasibility of a single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease. BMC Palliative Care, 8, 9.CrossRefGoogle ScholarPubMed
Farquhar, M., Higginson, I.J. & Booth, S. (2009b). Fast-track trials in palliative care: An alternative randomized controlled trial design. Journal of Palliative Medicine, 12, 213.Google ScholarPubMed
Guyatt, G.H., Berman, L.B., Townsend, M., et al. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax, 42, 773–778.CrossRefGoogle ScholarPubMed
Higginson, I.J., Vivat, B., Silber, E., et al. (2006). Study protocol: Delayed intervention randomised controlled trial within the Medical Research Council (MRC) Framework to assess the effectiveness of a new palliative care service. BMC Palliative Care, 2, 7.CrossRefGoogle Scholar
Matthews, J.N.S., Altman, D.G., Campbell, M.J., et al. (1990). Analysis of serial measurements in medical research. British Medical Journal, 800, 280–281.Google Scholar
Medical Research Council. (2000). A Framework for Development and Evaluation of RCTs for Complex Interventions to Improve Health. London: Medical Research Council.Google Scholar
Murray, C.J.L. & Lopez, D. (1997). Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet, 349, 1498–1504.CrossRefGoogle ScholarPubMed
Puhan, M.A., Frey, M., Buechi, S., et al. (2008). The minimal important difference of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease. Health and Quality of Life Outcomes, 6, 46.CrossRefGoogle ScholarPubMed
Roberts, D.K., Thorne, S.E. & Pearson, C. (1993). The experiences of dyspnea in late-stage cancer. Patients' and nurses' perspectives. Cancer Nursing, 16, 310–320.CrossRefGoogle ScholarPubMed
Rocker, G.M., Sinuff, T., Horton, R., et al. (2007). Advanced chronic obstructive pulmonary disease: innovative approaches to palliation. Journal of Palliative Medicine, 10, 783–797.CrossRefGoogle ScholarPubMed
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed