Breathlessness and presentation to the emergency department: a survey and clinical record review

Abstract

BackgroundBreathlessness is a frequently occurring symptom of cardiorespiratory conditions and is a common cause of emergency department presentation. The aim of this study was to estimate the prevalence of acute-on-chronic breathlessness as a cause for presentation to the major emergencies area of the emergency department.MethodsA prospective patient self-report survey and clinical record review of consecutive attendees to the major emergencies area of the emergency department in a single tertiary hospital between 12/5/14 and 29/5/14 was conducted. Eligible patients were clinically stable and had mental capacity to provide data.ResultsThere were 2,041 presentations during the study period, of whom 1,345 (66%) were eligible. There was a 90% survey response rate (1,212/1,345); 424/1,212 (35%) self-reported breathlessness most days over the past month of whom 245 gave breathlessness as a reason for this presentation. Therefore, the prevalence of acute-on-chronic breathlessness as a reason to present to the major emergencies area was 20.2% (245/1,212, 95% CI 17.9% to 22.5%). During this period there were 4,692 major and minor presentations; breathlessness was therefore a cause of at least 5.2% (245/4,692, 95% CI 4.6 to 5.9%) of all emergency department presentations.ConclusionsThis study found that one in five ambulance presentations to the ED were due to acute-on-chronic breathlessness. Most patients had non-malignant underlying conditions, had experienced considerable breathlessness for an extended period, had discussed breathlessness with their GP and presented out of daytime hours. Others were often involved in their decision to present. This represents clinically significant burden for patients, their family carers and the emergency health services.

Individualized breathlessness interventions may improve outcomes in patients with advanced COPD

“…In the advanced stages, patients may develop refractory breathlessness, defined as breathlessness persisting at rest or on minimal exertion despite optimal medical management . Importantly, approximately 20% of patients presenting by ambulance to hospital emergency departments report acute‐on‐chronic breathlessness …”

“…2 Importantly, approximately 20% of patients presenting by ambulance to hospital emergency departments report acute-on-chronic breathlessness. 3 Refractory breathlessness is difficult to manage, requiring a holistic approach including both nonpharmacological and pharmacological strategies, in addition to optimal disease-directed management. Pulmonary rehabilitation, physical activity, breathing exercises, the use of a hand-held fan to move air on the face and walking aids are non-pharmacological strategies that have demonstrated efficacy in managing Correspondence: Natasha Smallwood…”

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department

“…Further, acute medical illnesses including severe pain and shortness of breath may worsen symptoms of distress. [3][4][5][6] Nonpharmacologic treatment of anxiety and distress are well described in the pediatric literature and could represent an avenue for managing distress in adult patients during periods of waiting. [7][8][9] Given that the ED is a stress inducing environment, nonpharmacologic therapy for anxiety in the form of art therapy may be useful.…”

How to use humidified high‐flow nasal cannula in breathless adults in the emergency department

“…Undifferentiated breathlessness is a common presenting symptom in the ED . Until recently, supplemental oxygen via a facemask has been the ‘one‐size fits all’ initial treatment; however, research shows us that hyperoxaemia may be detrimental in some clinical contexts .…”

“…Undifferentiated breathlessness is a common presenting symptom in the ED. 1 Until recently, supplemental oxygen via a facemask has been the 'onesize fits all' initial treatment; however, research shows us that hyperoxaemia may be detrimental in some clinical contexts. 2 Attention has turned to oxygen-sparing alternatives, and heated humidified high-flow nasal cannula (HHFNC) with its attractive theoretical basis, has achieved acceptance and widespread use somewhat ahead of the supporting evidence.…”