The frequency and outcome of acute dyspnoea in primary care: An observational study

Winckelmann, Karin von; Renier, Walter; Thompson, Matthew; Buntinx, Frank

doi:10.1080/13814788.2016.1213809

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…11,21,35 At the health system level, systematic screening and assessment may help to reduce the unplanned use of primary and secondary health care, including acute-on-chronic breathlessness presentations to emergency departments and hospital admissions. 10,[36][37][38][39] Future therapeutic interventions should aim to improve people's ability to perform activities both for basic self-care, and to enrich life, reduce/prevent social isolation, and its impact on mental well-being; and to stop and/or reverse deconditioning. 40,41 Allied health such as occupational therapists and physiotherapists play a key role in optimizing function in this setting.…”

Section: Discussionmentioning

confidence: 99%

Activities Forgone because of Chronic Breathlessness: A Cross-Sectional Population Prevalence Study

Kochovska

Chang

Morgan

et al. 2020

Palliative Medicine Reports

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Background: Chronic breathlessness is a prevalent disabling syndrome affecting many people for years. Identifying the impact of chronic breathlessness on people's activities in the general population is pivotal for designing symptom management strategies. Objective: This study aimed to evaluate the association between chronic breathlessness and activities respondents identify can no longer be undertaken (''activities forgone''). Design: This population-based cross-sectional online survey used a market research company's database of 30,000 registrants for each sex, generating the planned sample size-3000 adults reflecting Australia's 2016 Census by sex, age group, state of residence, and rurality. Setting/Subjects: The population of focus (n = 583) reported a modified Medical Research Council (mMRC) breathlessness scale ‡1 and experienced this breathlessness for ‡3 months. Measurements: Activities forgone were categorized by mMRC using coding derived from the Dyspnea Management Questionnaire domains. Activities were classified as ' 'higher/lower intensity' ' using Human Energy Expenditure scale. Results: Respondents were male 50.3%; median age 50.0 (IQR 29.0); with 66% living in metropolitan areas; reporting 1749 activities forgone. For people with mMRC 1 (n = 533), 35% had not given up any activity, decreasing to 9% for mMRC 2 (n = 38) and 3% for mMRC 3-4 (n = 12). Intense sport (e.g., jogging and bike riding) was the top activity forgone: 42% (mMRC 1), 32% (mMRC 2), and 36% (mMRC 3-4). For respondents with mMRC 3-4, the next most prevalent activities forgone were ''sexual activities'' (14%), ''lower intensity sports'' (11%), and ''other activities'' (11%). Conclusions: People progressively reduce a wide range of activities because of their chronic breathlessness.

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Section: Discussionmentioning

confidence: 99%

Activities Forgone because of Chronic Breathlessness: A Cross-Sectional Population Prevalence Study

Kochovska

Chang

Morgan

et al. 2020

Palliative Medicine Reports

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“…GPs consider all these diagnoses when confronted with the often non-specific symptoms of dyspnoea and chest pain 1. Dyspnoea represents a reason for consultation in 0.9%–2.6% of cases in primary care,2–6 and is even the fourth reason for consultation by older patients 7. Chest pain represents from 0.7% to 2.7% of patient consultations in general practice 3 6 8 9.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

et al. 2020

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ObjectivesDyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner’s (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs’ sense of alarm when confronted with dyspnoea and chest pain.Design and settingsProspective observational study in general practice.ParticipantsPatients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation.Primary outcome measuresLife-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the International Classification of Primary Care (ICPC)-2 classification. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks.Results25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 (95% CI 1.49 to 2.82), the negative likelihood ratio was 0.55 (95% CI 0.37 to 0.77).ConclusionsWhere the physician experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient had, in fact, a life-threatening disease was about twice as high as the pretest odds.Trial registration numberNCT02932982.

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“…Chronic breathlessness syndrome, defined as disabling breathlessness which persists despite optimal treatment of the underlying pathophysiology [ 3 ], is associated with impaired physical and mental components of quality of life [ 4 ]. Primary care is the most common setting for both its initial presentation and ongoing clinical management [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…General practice provides care for the largest number of people with chronic breathlessness [ 5 – 7 ]. These consultations result in an average of three medications being prescribed for each two consultations where breathlessness is the reported reason for encounter [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Breathlessness and opioid prescribing in COPD in general practice: a cross-sectional, observational study

et al. 2020

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Chronic breathlessness is a disabling syndrome, prevalent in people with advanced chronic obstructive pulmonary disease (COPD). Regular, low-dose, oral sustained-release morphine is approved in Australia to reduce symptomatic chronic breathlessness. We aimed to determine the current prescribing patterns of opioids for chronic breathlessness in COPD in Australian general practice and to define any associated patient and practitioner characteristics.Five years (2011 to 2016) of the Bettering the Evaluation and Care of Health database, an Australian national, continual, cross-sectional study of clinical care in general practice were used. The database included 100 consecutive clinical encounters from almost 1000 general practitioners annually (n=488 100 encounters). Descriptive analyses with subsequent regression models were generated.Breathlessness as a patient-defined reason for encounter was identified in 621 of 4522 encounters where COPD was managed. Opioids were prescribed in 309 of 4522 encounters where COPD was managed (6.8%; (95% CI) 6.1–7.6), of which only 17 were prescribed for breathlessness, and the rest for other conditions almost entirely related to pain. Patient age (45–64 years versus age 80+ years, OR 1.68; 1.19–2.36), Commonwealth Concession Card holders (OR 1.70; 1.23–2.34) and socioeconomic disadvantage (OR 1.30; 1.01–1.68) were associated with increased likelihood of opioid prescription at COPD encounters. The rate of opioid prescriptions rose over the 5 years of study.In primary care encounters for COPD, opioids were prescribed in 6.8% of cases, but almost never for breathlessness. These data create a baseline against which to compare changes in prescribing as the treatment of chronic breathlessness evolves.

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The frequency and outcome of acute dyspnoea in primary care: An observational study

Cited by 12 publications

References 10 publications

Activities Forgone because of Chronic Breathlessness: A Cross-Sectional Population Prevalence Study

Activities Forgone because of Chronic Breathlessness: A Cross-Sectional Population Prevalence Study

Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

Breathlessness and opioid prescribing in COPD in general practice: a cross-sectional, observational study

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