Abstract

Background
Breathlessness is a distressing and complex symptom. It's often multifactorial involving complex interactions between respiratory, cardiovascular, and nervous systems.  System-wide services for breathlessness are fragmented preventing accurate diagnosis and support for patients.

Objective:
Integrated primary and secondary care weekly multidisciplinary team (MDT) to establish a symptom-based Assessment of Breathing Clinic (ABC).

Methods
The clinic was established in June 2023 and includes Respiratory and Cardiology Consultants, General Practitioners, Physiotherapy, Speech Therapy, Specialist Nurses, Psychologists, and Social Prescribers.

Breathless patients were referred into ABC following 3 or more admissions to A&E with breathlessness in the past 6 months, or by secondary care.

Patients had a holistic assessment and diagnostic appointment with a GP or clinical practitioner. Weekly MDT discussion recorded all diagnoses and treatable traits affecting breathing with patients receiving a tailored, holistic treatment plan for breathlessness.   

Results
To date, 156 patients attended ABC.  Mean age 61 years (17-92). 61.5% (n=96) female, 38.5 %(n=60) male. 18.6 % (n=29) current smokers, 44.9 % (n=70) ex-smokers and 36.5% (n=57) never smokers. Mean BMI 30.9 kg/m2 (15.5-62.3 kg/m2)

90% (n=141) patients had a respiratory diagnosis. 13% (n=20) had a cardiac cause. 10% (n=15%) had no cardiac or respiratory cause for their symptoms.

Regarding treatable traits: 86% (n=135) presented with breathing pattern disorder. 64% (n=100) with anxiety, 55% (n=86) had high BMI contributing to breathlessness and 51% (n=80) had upper airways symptoms.

68% (n=98) patients were referred for lifestyle support. 82% (n=121) were referred to physiotherapy for breathing pattern disorder and 50% (n=71) referred to SALT for upper airway support.



Discussion


Establishing the ABC MDT demonstrates an integrated care model is novel and feasible. Patients receive accurate diagnosis for multifactorial breathlessness. They can access appropriate assessment and treatment pathways across primary and secondary care to manage their breathlessness and address their treatable traits more cohesively.