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During the COVID-19 pandemic, semi-structured interviews were undertaken with 20 adults awaiting a diagnosis for their chronic breathlessness. Three key themes were identified using thematic analysis: (1) de-prioritisation of diagnosis, (2) following UK ‘lockdown’ guidance for the general population but patients fearful they were more at risk, and (3) the impact of lockdown on coping strategies for managing breathlessness. The existing unpredictable pathway to diagnosis for those with chronic breathlessness has been further interrupted during the COVID-19 pandemic.

Background Currently, the acceptability and efficacy of pulmonary rehabilitation for adults with severe asthma is unknown. Objective To investigate the feasibility of performing a randomized controlled trial of asthma-tailored pulmonary rehabilitation (AT-PR) versus usual care (UC). Methods Adults with severe asthma were recruited and randomized 2:1 to AT-PR and UC. The primary outcomes were recruitment, retention, and serious adverse event rates. Secondary outcome measures included those for a future trial assessing the feasibility of collecting data. Assessments were performed at baseline, 12 weeks, and 9 months including measures of physical performance, health-related quality of life, and asthma control. A recruitment rate of 30% was estimated with 95% CI of ±7%, a retention rate of 75% ± 14% if we recruited 40 patients to AT-PR, and a serious adverse event rate of 2.5%. Results Sixty-one (26%) of 238 eligible patients were recruited (38 women; mean age, 54 ± 13 years; body mass index, 32 ± 7 kg/m2; FEV1, 1.9 ± 0.7 L; FEV1/forced vital capacity, 69% ± 11%). Fifty-one patients were randomized to AT-PR (n = 34) and UC (n = 17). The retention rate was 62% for the AT-PR group and 53% for the UC group, with a serious adverse event rate of 3.3% related to the study visits. Overall collection of the outcome measures was feasible. The results of the AT-PR group were suggestive of improvements in exercise performance, health-related quality of life, and asthma control, but the UC group results were either unchanged or worsened. Conclusions Both recruitment and retention rates were within the a priori estimated 95% CI. Our results indicate that AT-PR may be efficacious for adults with severe asthma but any future intervention and trial design would need further modifications to improve acceptability and retention rate.

IntroductionChronic breathlessness is a common and debilitating symptom, associated with high healthcare use and reduced quality of life. Challenges and delays in diagnosis for people with chronic breathlessness frequently occur, leading to delayed access to therapies. The overarching hypothesis is a symptom-based approach to diagnosis in primary care would lead to earlier diagnosis, and therefore earlier treatment and improved longer-term outcomes including health-related quality of life. This study aims to establish the feasibility of a multicentre cluster randomised controlled trial to assess the clinical and cost-effectiveness of a structured diagnostic pathway for breathlessness in primary care.Methods and analysisTen general practitioner (GP) practices across Leicester and Leicestershire will be cluster randomised to either a structured diagnostic pathway (intervention) or usual care. The structured diagnostic pathway includes a panel of investigations within 1 month. Usual care will proceed with patient care as per normal practice. Eligibility criteria include patients presenting with chronic breathlessness for the first time, who are over 40 years old and without a pre-existing diagnosis for their symptoms. An electronic template triggered at the point of consultation with the GP will aid opportunistic recruitment in primary care. The primary outcome for this feasibility study is recruitment rate. Secondary outcome measures, including time to diagnosis, will be collected to help inform outcomes for the future trial and to assess the impact of an earlier diagnosis. These will include symptoms, health-related quality of life, exercise capacity, measures of frailty, physical activity and healthcare utilisation. The study will include nested qualitative interviews with patients and healthcare staff to understand the feasibility outcomes, explore what is ‘usual care’ and the study experience.Ethics and disseminationThe Research Ethics Committee Nottingham 1 has provided ethical approval for this research study (REC Reference: 19/EM/0201). Results from the study will be disseminated by presentations at relevant meetings and conferences including British Thoracic Society and Primary Care Respiratory Society, as well as by peer-reviewed publications and through patient presentations and newsletters to patients, where available.Trial registration numberISRCTN14483247.

Background: Rehabilitation is a successful intervention for patients with pulmonary and cardiac disease. The interventions are usually provided as disease-specific programmes; yet their components are the same and both treat breathlessness symptoms. The aim of this study was to evaluate the effectiveness of a breathlessness rehabilitation programme. Methods: Patients attended rehabilitation twice/week for 6 weeks to complete education, aerobic and resistance exercises. Typical rehabilitation outcomes were collected pre and post the programme. Results: 99 patients (54.5% COPD, 17.1% Heart Failure, 28.4% other) went through the breathlessness programme in 8 months. 56 had complete pre-post data. 58% male, mean age 69.3 (SD11.5) years, BMI 29.9 (SD7.4). See table 1 for outcomes. Conclusions: The results show that patients had statistically and clinically significant improvements in typical rehabilitation outcomes: comparable with previous research and UK national audit data. The success of the breathlessness programme allows space to be released in the disease-specific classes which are better suited for patients with more complex needs.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Background: The management of severe asthma poses many challenges related to treatment, adherence and psychosocial morbidity. There is little direct data from the patient perspective to understand and negotiate the complexities of managing severe asthma Objective: To explore the patient perceptions of living with severe asthma and the experience of managing severe asthma, in order to better understand the support that might promote more effective self-management for severe asthma. Methods: Participants were recruited from a specialist Difficult Asthma Service. Semi-structured interviews were conducted by researchers independent of the patient’s care. Interviews were transcribed verbatim and inductive Thematic Analysis was performed. Results: Twenty-nine participants [13 male, mean (SD) age 49.5 (13.6) years, mean Asthma Control Questionnaire 2.2 (1.2)] participated in an interview. Analysis resulted in four major themes describing the experience and challenges to managing severe asthma: Understanding of severe asthma, emotional impact of living with severe asthma (sub-theme: fear of hospitalisation), public perceptions of asthma, and concerns about medications. Conclusion: Healthcare professionals need to consider and discuss with patients their perceptions of severe asthma and the relevant treatments; particular attention should focus around education of disease control and actively exploring thoughts around hospitalisation. Our data highlights the potential for psychological and social support to enhance self-management by directly addressing the wide-ranging individual challenges patients face. There is also a need for greater public awareness and education about severe asthma to minimise patient distress particularly in the work environment.