Breathing Better for Longer: Outcomes at 12 months for a multidisciplinary, home-based breathlessness intervention service targeting patients with chronic obstructive pulmonary disease (COPD)

Background: Chronic breathlessness reduces quality of life (QoL), imparting high healthcare costs. 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. Aim: To evaluate whether Macarthur Breathless Clinic (MBC), a bespoke health service intervention, can reduce breathlessness impact for a cohort of Australians with COPD. Methods: A prospective, single-arm cohort trial was conducted. Eligible patients had at least moderately severe COPD, defined by spirometry, and chronic breathlessness impacting QoL. Following detailed case review and therapy optimisation, an individualised program was implemented over 8 weeks. Questionnaire data assessing breathlessness burden, mental health and QoL compiled at baseline were repeated at weeks 9 and 52. Results: Subjects (n=89) were mean age 71 years, 35% male and 10% Aboriginal Australian with 18% reporting breathlessness at rest. Mean FEV1 was 37% predicted. Primary outcome, Chronic Respiratory Questionnaire - Mastery Subscale improved by 0.5 at 9 weeks (p=0.0001) and by 0.9 at 52 weeks (p<0.0001). Measures of confidence, breathlessness severity and COPD symptom burden yielded positive results too; all parameters demonstrating effect durability to 12 months. Conclusion: Clinically-relevant gains after MBC reflected improved symptom burden, coping skills and confidence that were retained or further enhanced at 12 months.