Improving the diagnosis of breathlessness: Results from the co-design pilot Breathlessness diagnostics in a Box (BiaB)

Introduction: Breathlessness is a common reason for consulting a General Practitioner (GP). There is a lack of easy-to-perform, efficient, and readily available tests to diagnose potential underlying respiratory and cardiac conditions in primary care. Methods: Pulmonary, cardiology, and primary care specialists co-developed and tested a diagnostic tool to improve breathlessness diagnosis by putting together the following tests in a box: an oscillometer, 12+ lead ECG with 4 electrodes (CardioSecur®), NT-proBNP test (positive at ≥450 pg/ml) and SpO2 meter. All tests were integrated within an app for use in primary care. At the end, we interviewed participants (n=9) and healthcare providers (n=5) about their experiences with the BiaB diagnostic tool. Results: A total of 122 patients presenting with breathlessness or consulting their GP for monitoring of asthma, COPD or cardiovascular risk management were tested at 5 Dutch general practices (Table 1). Interviews revealed that BiaB was generally well perceived by healthcare workers and patients. In particular, the potential of oscillometry to detect obstructive lung patterns in a simple and effortless way, as compared to spirometry, was appreciated. However, it was identified that the NT-proBNP required a lower cut-off point (e.g. 300 pg/mL) to rule out heart failure. Discussion: This co-design pilot indicated feasibility of the pathway and a need for further optimisation of the BiaB approach. This includes the addition of the Patient Health Questionnaire (PHQ)-4 to assess potential psychological causes of breathlessness. After optimisation, an international scale-up study will be performed in the Netherlands, United Kingdom, and Spain to study the effectiveness of BiaB in reducing the time to a new diagnosis of COPD or heart failure.