Background Dyspnea is a prevalent and debilitating symptom, especially in patients with advanced pulmonary diseases. Dyspnea support services have been shown to improve functional outcomes and quality of life. This report presents a retrospective audit of a novel inpatient dyspnea support service for advanced respiratory diseases in Singapore.
Methods ICARE employs multidisciplinary dyspnea management, pulmonary rehabilitation, structured comorbidity screening using CO-morbidity Assessment Template (COAT), and dyspnea self-management interventions for patients discharged from Respiratory Medicine. The primary outcomes assessed were 6 min Walk Distance (6MWD) and Modified Barthel Index (MBI). Secondary outcomes include clinical issues identified by COAT that were treated, as well as 30 day readmissions.
Results ICARE had 39 unique admissions with 4 recurrent patients. The patients were mostly elderly Chinese males who were exceptionally frail with considerable co-morbidity. Their mean age was 73.2 (±9.5) years, 87.1% had COPD of which 81.8% was GOLD stage 3/4. Admission 6MWD was 130.4 m (±90.6). 3.3 (±1.3) of 5 basic ADLs were affected by dyspnea. They had mean 5.1 respiratory hospitalisations 1 year prior to ICARE admission with median hospital LOS 30.0 (IQR 20.0–60.0) days, 12.8% had 10 hospitalisations.
The median program duration was 24.0 (IQR 12–35) days. 6MWD improved by median 30 m (IQR 20–60) (p=0.05). Patients with admission 6MWD=100 m had mean improvement 62.2 m (±73.1). MBI improved from 69.1 (±13.9) to 82.1 (±12.7) (p=0.001). Patients with MBI 75 on admission had mean improvement of 16.2 (±11.7) (p=0.05). 30 day readmissions for non-infective exacerbations was 15.6% (vs 29.2% from historical data). Median duration to exacerbation, death, or censure was 116.5 (IQR 53–206) days. Mean number of issues identified by COAT was 5.6 (±2.5), 80.3% were improved or resolved before discharge.
Conclusion ICARE is a novel inpatient dyspnea support service that improves functional capacity and exercise tolerance, identifies and treats co-morbid medical conditions, and potentially reduces 30 day re-admission to tertiary institutions.
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