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A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease.

ABSTRACT: Dyspnoea is a cardinal symptom of fibrotic interstitial lung disease (ILD), with a lack of proven effective therapies. With emerging evidence of the role of facial and nasal airflow for relieving breathlessness, this pilot study was conducted to examine the feasibility of conducting a clinical trial of a handheld fan (HHF) for dyspnoea management in patients with fibrotic ILD. In this mixed-methods, randomised, assessor-blinded, controlled trial, 30 participants with fibrotic ILD who were dyspnoeic with a modified Medical Research Council Dyspnoea grade ≥ 2 were randomised to a HHF for symptom control or no intervention for 2 weeks. Primary outcomes were trial feasibility, change in Dyspnoea-12 scores at Week 2, and participants' perspectives on using a HHF for dyspnoea management. Study recruitment was completed within nine months at a single site. Successful assessor blinding was achieved in the fan group [Bang's Blinding Index - 0.08 (95% CI - 0.45, 0.30)] but not the control group [0.47 (0.12, 0.81)]. There were no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes. During qualitative interviews, participants reported that using the HHF relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit. Oxygen-experienced participants described the HHF being easier to use, but not as effective for symptomatic relief, compared to oxygen therapy. Our results confirmed the feasibility of a clinical trial of a HHF in fibrotic ILD. There was a high level of patient acceptance of a HHF for managing dyspnoea, with patients reporting both symptomatic benefits and ease of use.

SUBMITTER: Khor YH

PROVIDER: S-EPMC7994303 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease.

Khor Yet H YH Saravanan Kirushallini K Holland Anne E AE Lee Joanna Y T JYT Ryerson Christopher J CJ McDonald Christine F CF Goh Nicole S L NSL

Scientific reports 20210325 1

Dyspnoea is a cardinal symptom of fibrotic interstitial lung disease (ILD), with a lack of proven effective therapies. With emerging evidence of the role of facial and nasal airflow for relieving breathlessness, this pilot study was conducted to examine the feasibility of conducting a clinical trial of a handheld fan (HHF) for dyspnoea management in patients with fibrotic ILD. In this mixed-methods, randomised, assessor-blinded, controlled trial, 30 participants with fibrotic ILD who were dyspno ...[more]

PMID: 33767311

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Project description:BackgroundThe SARS-CoV-2 pandemic necessitated novel health care delivery for patients with interstitial lung disease (ILD), including reduced in-person appointments and physiologic testing to minimize transmission. Clinicians often have been required to rely on patients' subjective assessments of their clinical status during phone follow-up appointments. It is unknown how accurate a patient's self-assessment is compared with that of their physician during an in-person evaluation.Research questionAre patients' self-assessments of their clinical status in agreement with their physicians' assessments, and are telemedicine vs in-person visits acceptable?Study design and methodsPatients were enrolled prospectively from the University of Calgary ILD clinic. Participants were asked by phone before the in-person appointment and after the appointment to rate their clinical status on a five-point Likert scale. Physicians then rated the patient's clinical status after the appointment on a similar five-point Likert scale, masked to patient responses. Patients and physicians were asked if an in-person appointment was necessary or if telemedicine would have sufficed. Clinical variables associated with physician assessments were assessed.ResultsFifty patients with mean age of 67 ± 11.8 years participated. Mean time since last follow-up was 5.0 ± 3.0 months. No correlation was found between the preclinical patient self-assessment and postclinical physician assessment (P = .18; κ = 0.28). Correlation of postclinical assessment was statistically significant (P < .001), with moderate agreement (κ = 0.49). Physicians thought telephone visits were acceptable for 58% of appointments, whereas only 12% of patients preferred telephone visits. Physician's assessment of clinical status seemed to be driven by change in diffusion capacity of the lungs for carbon monoxide (P = .039).InterpretationTelemedicine may improve access to care for patients during pandemic management, in rural communities, and for those with impaired mobility. Despite these benefits, our data support that patients and physicians may not agree on determination of clinical status and that patients generally prefer in-person patient-physician interactions.

Project description:BackgroundHigh-flow nasal oxygen (HFNO) therapy delivers humidified, heated air with flow rates of up to 60 L/min with oxygen entrained. HFNO has advantages over conventional oxygen therapy, including precise and reliable fraction of inspired oxygen delivery, therefore is recommended as first-line treatment for people with acute hypoxaemic respiratory failure.ObjectivesThis pilot study aimed to determine the feasibility and acceptability of domiciliary nasal high flow (NHF) without entrained oxygen for people with chronic obstructive pulmonary disease (COPD) and severe breathlessness.DesignSingle-arm, mixed-methods, pilot study of an 8-day, air-only NHF intervention in adults with COPD and severe breathlessness not requiring domiciliary oxygen therapy.MethodsParticipants were educated and advised to use NHF for ⩾7 h per night for 7 nights with day use as desired. Patient-reported outcome measures were assessed on Days 3, 5 and 8.Primary outcomefeasibility.Secondary outcomesbreathlessness (dyspnoea), fatigue, quality of life, physical function, sleep, tolerability and safety. Acceptability was also assessed through semi-structured interviews.ResultsFifteen participants were enrolled (mean age 73.6; 40% women; mean FEV1 41% predicted, mean DLCO 43.0% predicted; mean modified Medical Research Council score 3.7). Thirteen (87%) completed the trial, with 8 (54%) keeping the device at the end of the trial and 3 (20%) continuing use long-term. Adherence varied, with average daily usage higher amongst participants who kept the device compared to those who returned it (6.8 h ± 2.3 h vs 3.4 h ± 3.7 h). No changes in worst breathlessness (mean = 0.7, SD = 1.2, p = 0.109), dyspnoea mastery (mean = 0.3, SD = 0.6, p = 0.176) or fatigue (mean = 0.0, SD = 2.4, p = 1.00) were observed at Day 8 compared to baseline. No significant adverse events were reported. Qualitative interviews demonstrated subjective improvements in breathlessness, dry mouth and sputum production for some participants, whilst others found NHF uncomfortable. Fear of NHF dependence and concerns regarding long-term running costs were reported.ConclusionDomiciliary NHF was a feasible intervention, albeit with varied adoption and acceptability. These trial implementation outcomes may have affected preliminary effectiveness outcomes. Further research is required to determine what role domiciliary NHF may have for people with COPD and severe breathlessness.Trial registrationACTRN12621000044820.

Project description:Objectives: To initially clarify the efficacy and tolerability of nintedanib in patients with idiopathic-inflammatory-myopathy-related interstitial lung disease (IIM-ILD). Methods: A retrospective, real-world analysis was conducted in IIM-ILD patients who regularly received outpatient visit or hospitalization from January 2018 to March 2020 in three centers. And the patients were divided into two groups depending on presence or absence of nintedanib therapy. Comparisons, Kaplan-Meier survival analysis and propensity score matching were made to identify difference in time to death from any cause, incidence of rapidly progressive interstitial lung disease (RP-ILD) and comorbidity of pulmonary infection between the two groups. The following logistic regression analyses and Cox proportional-hazard regression analyses were used to verify the therapeutic value of nintedanib as well as clinical significance of other factors. Adverse events were descriptively recorded. Results: Thirty-six patients receiving nintedanib therapy and 115 patients without use of nintedanib were included. Before and after propensity score matching, the primary comparisons revealed better survival (P = 0.015, P = 0016, respectively) and lower incidence of RP-ILD (P = 0.017, P = 0.014, respectively) in patients with nintedanib therapy. Logistic regression analysis identified that disease activity (P < 0.001), percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.036), nintedanib therapy (P = 0.004, OR value = 0.072) and amyopathic dermatomyositis (ADM, P = 0.012) were significantly correlated with RP-ILD. Cox proportional hazards regression analysis suggested that disease activity (P < 0.001), anti-MDA5 antibody (P < 0.001) and nintedanib therapy (P = 0.013, HR value=0.268) were significantly associated with survival of IIM-ILD patients. Similar results can also be seen in analyses after propensity score matching. In the 36 patients with nintedanib therapy, diarrhea was the most common adverse event (44.4%) and hepatic insufficiency contributed to most dosage reduction (44.4% of nine patients) or therapy discontinuation (60.0% of five patients). Conclusions: Nintedanib was found to reduce incidence of RP-ILD and improve survival in IIM-ILD patients in a real-world setting. Anti-MDA5 antibody could be taken as a risk factor for unfavorable outcome. ADM was significantly correlated with occurrence of RP-ILD. In addition to the most frequent diarrhea, hepatic insufficiency was closely related to dosage reduction or therapy discontinuation.

Dataset Information

A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease.

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A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease.

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