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

01 Apr 2024
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.

Resource information

Respiratory conditions
  • Chronic Breathlessness
Respiratory topics
  • Diagnosis
Type of resource
Abstract
Conference
Athens 2024
Author(s)
Ms Chantal Arling 1, Thomas A. le Rütte 1, Lars Dijk 1, Marjan Kerkhof 1, Merijn M.G. Driessen-Roelfszema 1, Yoran H. Gerritsma 1, Chris P. Gale 2,3, Ana M. Cebrián-Cuenca 4,5, Fiona Mosgrove 6, Rudolf A. de Boer 7, Richard E. Russell 8, Bernardino Alcázar-Navarrete 9, Huib A.M. Kerstjens 10,11, Janwillem W.H. Kocks 1,11,12 1 General Practitioners Research Institute (GPRI), Groningen, The Netherlands, 2 Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 3 Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom, 4 Primary Health Care Center Cartagena Casco, Cartagena, Spain, 5 Biomedical Research Institute of Murcia (IMIB), Murcia, Spain, 6 Newburn Health Centre, Aberdeen, United Kingdom, 7 Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands, 8 Peter Gorer Department of Immunobiology, Kings College, London, United Kingdom, 9 Pulmonology Department, Hospital Virgen de las Nieves, Granada, Spain, 10 Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, 11 Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, 12 Observational and Pragmatic Research Institute (OPRI), Singapore, Singapore