Coping better, breathing better: exploring the impact of a multidisciplinary, home-based program targeting chronic breathlessness in patients with COPD

<bold>Background:</bold> Breathlessness is a distressing symptom leading to high healthcare costs and reduced quality of life (QoL). Published evidence suggests that multidisciplinary clinics for breathlessness are effective in mixed, predominantly palliative populations, but evidence specific to COPD is needed. <bold>Aims:</bold> To evaluate whether a home-based "Breathless Clinic" (BC) can reduce the impact of chronic breathlessness for COPD patients. <bold>Methods:</bold> In this prospective, single site, open-label trial of BC, a home-based health service intervention, we recruited 92 subjects with COPD and mMRC score≥2. Following detailed case review, an individualised program was developed and implemented by the MDT. Questionnaire data about breathlessness impact, mental health and QoL compiled at baseline were repeated on completion of the 9-week program. <bold>Results:</bold> Subjects were mean age 71 years, mean FEV1 37% and 35% male, with 18% of them reporting breathlessness at rest. On program completion, numeric rating scales (NRS) for breathlessness intensity, unpleasantness and confidence improved statistically but only the last achieved MCID. The primary outcome, CRQ mastery was positive (p=0.0002) and exceeded MCID. CRQ dyspnoea and fatigue scores also improved without reaching MCID. After BC, reduced depression, anxiety and stress levels were reflected by lower DASS 21 scores (p=0.02, p=0.008 and p=0.06, respectively), with significantly fewer patients classified as moderate or worse for depression (p<0.0001). <bold>Conclusion:</bold> Modest short-term gains seen after BC related more to psychological factors, coping skills and confidence than reduced breathlessness per se.