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- Ahmadi, Zainab
(author)
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Prevalence and Pharmacologic Treatment of Breathlessness in Severe Chronic Obstructive Pulmonary Disease
- 2019
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Doctoral thesis (other academic/artistic)abstract
- BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.Aims•To evaluate the prevalence of symptoms and their management at the end of life in patients with oxygen-dependent COPD in Sweden, compared to those with cancer (Study I).•To quantify the reported indications for opioid prescriptions in oxygen-dependent COPD in Sweden (Study II).•To investigate the efficacy of supplemental oxygen therapy for breathlessness in COPD patients with no or mild hypoxemia (Study III).•To assess potential recognition and treatment of chronic breathlessness as compared to chronic pain by physicians in Sweden, using a case-based survey (Study IV).Study DesignNationwide register-based cohort study of patients with oxygen-dependent COPD recorded in the Swedevox register linked with the Swedish Register of Palliative Care (Study I) and with the Swedish Prescribed Drug Register (Study II). Cochrane systematic review and meta-analysis of the efficacy of supplemental oxygen therapy for breathlessness (Study III). Randomized, controlled, double-blind, parallel-group, web-based trial of Swedish physicians treating a hypothetical patient with COPD and severe breathlessness versus a patient with severe pain (Study IV).Results and conclusionsAt the end of life, breathlessness was three times more common in patients with COPD than in those with cancer (Study I). Opioids were commonly prescribed for pain in oxygen-dependent COPD patients but rarely to treat breathlessness, which represented 2% of the stated indications (Study II). Supplemental oxygen therapy modestly reduced breathlessness during exercise in COPD with no or mild hypoxemia, but there was no evidence of an effect in daily life or on quality of life (Study III). In a case presentation of a COPD patient, severe chronic breathlessness was less likely to be identified by physicians as requiring symptomatic treatment and also less likely to be treated with opioids as compared to a patient with chronic pain (Study IV).
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| 2. |
- Sandberg, Jacob, et al.
(author)
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Relating Experienced To Recalled breathlessness Observational (RETRO) study : A prospective study using a mobile phone application
- 2019
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In: BMJ Open Respiratory Research. - : BMJ Publishing Group. - 2052-4439. ; 6:1
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Journal article (peer-reviewed)abstract
- Background: Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient's history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness. Methods: A mobile phone application will be used to collect data during daily life. Medically stable participants, ≥18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0-10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses. Results: Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. Discussion: This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection. © 2019 Author(s).
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| 3. |
- Sundh, Josefin, 1972-, et al.
(author)
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REgistry-based randomized controlled trial of treatment and Duration and mortality in long-term OXygen therapy (REDOX) study protocol
- 2019
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In: BMC Pulmonary Medicine. - : BioMed Central. - 1471-2466. ; 19:1
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Long-term oxygen therapy (LTOT) during 15 h/day or more prolongs survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia. No randomized controlled trial has evaluated the net effects (benefits or harms) from LTOT 24 h/day compared with 15 h/day or the effect in conditions other than COPD. We describe a multicenter, national, phase IV, non-superiority, registry-based, randomized controlled trial (R-RCT) of LTOT prescribed 24 h/day compared with 15 h/day. The primary endpoint is all-cause-mortality at 1 year. Secondary endpoints include cause-specific mortality, hospitalizations, health-related quality of life, symptoms, and outcomes in interstitial lung disease.METHODS/DESIGN: Patients qualifying for LTOT are randomized to LTOT 24 h/day versus 15 h/day during 12 months using the Swedish Register for Respiratory Failure (Swedevox). Planned sample size in this pragmatic study is 2126 randomized patients. Clinical follow-up and concurrent treatments are according to routine clinical practice. Mortality, hospitalizations, and incident diseases are assessed using national Swedish registries with expected complete follow-up. Patient-reported outcomes are assessed using postal questionnaire at 3 and 12 months.DISCUSSION: The R-RCT approach combines the advantages of a prospective randomized trial and large clinical national registries for enrollment, allocation, and data collection, with the aim of improving the evidence-based use of LTOT.TRIAL REGISTRATION: Clinical Trial registered with www.clinicaltrials.gov , Title: REgistry-based Treatment Duration and Mortality in Long-term OXygen Therapy (REDOX); ID: NCT03441204.
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| 4. |
- Sundh, Josefin, et al.
(author)
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REgistry-based randomized controlled trial of treatment and Duration and mortality in long-term OXygen therapy (REDOX) study protocol 11 Medical and Health Sciences 1102 Cardiorespiratory Medicine and Haematology
- 2019
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In: BMC Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 19:1
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Journal article (peer-reviewed)abstract
- Objective: Long-term oxygen therapy (LTOT) during 15 h/day or more prolongs survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia. No randomized controlled trial has evaluated the net effects (benefits or harms) from LTOT 24 h/day compared with 15 h/day or the effect in conditions other than COPD. We describe a multicenter, national, phase IV, non-superiority, registry-based, randomized controlled trial (R-RCT) of LTOT prescribed 24 h/day compared with 15 h/day. The primary endpoint is all-cause-mortality at 1 year. Secondary endpoints include cause-specific mortality, hospitalizations, health-related quality of life, symptoms, and outcomes in interstitial lung disease. Methods/design: Patients qualifying for LTOT are randomized to LTOT 24 h/day versus 15 h/day during 12 months using the Swedish Register for Respiratory Failure (Swedevox). Planned sample size in this pragmatic study is 2126 randomized patients. Clinical follow-up and concurrent treatments are according to routine clinical practice. Mortality, hospitalizations, and incident diseases are assessed using national Swedish registries with expected complete follow-up. Patient-reported outcomes are assessed using postal questionnaire at 3 and 12 months. Discussion: The R-RCT approach combines the advantages of a prospective randomized trial and large clinical national registries for enrollment, allocation, and data collection, with the aim of improving the evidence-based use of LTOT.
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