Differences in uni-dimensional breathlessness measures and thresholds for clinical response in a randomised controlled trial in people with chronic breathlessness: an exploratory study.

Ferreira, D; Ekström, M; Louw, S; McCloud, P; Johnson, M; Clark, K; Currow, D

Differences in uni-dimensional breathlessness measures and thresholds for clinical response in a randomised controlled trial in people with chronic breathlessness: an exploratory study.

Ferreira, D Ekström, M Louw, S McCloud, P Johnson, M Clark, K Currow, D

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ Open Respir Res, 2024, 11, (1), pp. e002370
Issue Date:: 2024-12-04

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Field	Value	Language
dc.contributor.author	Ferreira, D
dc.contributor.author	Ekström, M
dc.contributor.author	Louw, S
dc.contributor.author	McCloud, P
dc.contributor.author	Johnson, M
dc.contributor.author	Clark, K
dc.contributor.author	Currow, D https://orcid.org/0000-0003-1988-1250
dc.date.accessioned	2025-01-02T04:03:06Z
dc.date.available	2024-07-29
dc.date.available	2025-01-02T04:03:06Z
dc.date.issued	2024-12-04
dc.identifier.citation	BMJ Open Respir Res, 2024, 11, (1), pp. e002370
dc.identifier.issn	2052-4439
dc.identifier.issn	2052-4439
dc.identifier.uri	http://hdl.handle.net/10453/182805
dc.description.abstract	INTRODUCTION: Optimally measuring improvements in chronic breathlessness in clinical practice and research continues to evolve. The aim of this study was to consider the performance of uni-dimensional measures in chronic breathlessness limiting exertion. METHODS: We report five measures of breathlessness (intensity: worst, best and average in the previous 24 hours; breathlessness now; and an affective component unpleasantness now) and two clinical thresholds over baseline on their 0-100 mm visual analogue scale (8.9 mm absolute improvement; and 15% relative improvement) collected in a multi-site, randomised, double-blind, parallel-arm, placebo-controlled trial of regular, low-dose, sustained-release morphine for people with chronic breathlessness with optimally treated underlying causes. RESULTS: Participants (n=284) were mostly elderly men with severe, chronic breathlessness. Worst breathlessness in the previous 24 hours showed improvement in people with more severe breathlessness and chronic obstructive pulmonary disease. By contrast, breathlessness now and average breathlessness in the previous 24 hours generated similar patterns of response, as did unpleasantness now and breathlessness now. Best breathlessness added little value. The two clinical thresholds showed differing patterns of significance. DISCUSSION: Consistent with other recent work, worst breathlessness may be an important uni-dimensional outcome in evaluating chronic breathlessness clinically and in research. This study does not support a differential between unpleasantness now and breathlessness now, previously observed in laboratory-generated, acute-on-chronic breathlessness. Timeframe for recall (now or the last 24 hours) and the threshold for a clinical meaningful improvement (absolute (8.9 mm) or relative (15%)) affect assessment performance.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation.ispartof	BMJ Open Respir Res
dc.relation.isbasedon	10.1136/bmjresp-2024-002370
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	3201 Cardiovascular medicine and haematology
dc.subject.classification	3202 Clinical sciences
dc.subject.mesh	Humans
dc.subject.mesh	Dyspnea
dc.subject.mesh	Male
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Double-Blind Method
dc.subject.mesh	Middle Aged
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Morphine
dc.subject.mesh	Treatment Outcome
dc.subject.mesh	Severity of Illness Index
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Humans
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Dyspnea
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Morphine
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Treatment Outcome
dc.subject.mesh	Severity of Illness Index
dc.subject.mesh	Double-Blind Method
dc.subject.mesh	Aged
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Middle Aged
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Humans
dc.subject.mesh	Dyspnea
dc.subject.mesh	Male
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Double-Blind Method
dc.subject.mesh	Middle Aged
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Morphine
dc.subject.mesh	Treatment Outcome
dc.subject.mesh	Severity of Illness Index
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Analgesics, Opioid
dc.title	Differences in uni-dimensional breathlessness measures and thresholds for clinical response in a randomised controlled trial in people with chronic breathlessness: an exploratory study.
dc.type	Journal Article
utslib.citation.volume	11
utslib.location.activity	England
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2025-01-02T04:03:02Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	11
utslib.citation.issue	1

Abstract:

INTRODUCTION: Optimally measuring improvements in chronic breathlessness in clinical practice and research continues to evolve. The aim of this study was to consider the performance of uni-dimensional measures in chronic breathlessness limiting exertion. METHODS: We report five measures of breathlessness (intensity: worst, best and average in the previous 24 hours; breathlessness now; and an affective component unpleasantness now) and two clinical thresholds over baseline on their 0-100 mm visual analogue scale (8.9 mm absolute improvement; and 15% relative improvement) collected in a multi-site, randomised, double-blind, parallel-arm, placebo-controlled trial of regular, low-dose, sustained-release morphine for people with chronic breathlessness with optimally treated underlying causes. RESULTS: Participants (n=284) were mostly elderly men with severe, chronic breathlessness. Worst breathlessness in the previous 24 hours showed improvement in people with more severe breathlessness and chronic obstructive pulmonary disease. By contrast, breathlessness now and average breathlessness in the previous 24 hours generated similar patterns of response, as did unpleasantness now and breathlessness now. Best breathlessness added little value. The two clinical thresholds showed differing patterns of significance. DISCUSSION: Consistent with other recent work, worst breathlessness may be an important uni-dimensional outcome in evaluating chronic breathlessness clinically and in research. This study does not support a differential between unpleasantness now and breathlessness now, previously observed in laboratory-generated, acute-on-chronic breathlessness. Timeframe for recall (now or the last 24 hours) and the threshold for a clinical meaningful improvement (absolute (8.9 mm) or relative (15%)) affect assessment performance.

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http://hdl.handle.net/10453/182805