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Vilarinho R, Ribeiro C, Abreu V, Souto-Miranda S, Silva F, Jácome C. The Brompton breathing pattern assessment tool (BPAT): Portuguese translation and cultural adaptation. Pulmonology 2024:S2531-0437(24)00011-4. [PMID: 38402127 DOI: 10.1016/j.pulmoe.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- R Vilarinho
- FP-I3ID, Escola Superior de Saúde-Fernando Pessoa, Porto, Portugal; CIR, ESS, Polytechnic of Porto, Porto, Portugal.
| | - C Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - V Abreu
- FP-I3ID, Escola Superior de Saúde-Fernando Pessoa, Porto, Portugal; KinesioLab Research Unit in Human Movement, Department of Physiotherapy, School of Health, Piaget Institute, Vila Nova de Gaia, Portugal
| | - S Souto-Miranda
- KinesioLab Research Unit in Human Movement, Department of Physiotherapy, School of Health, Piaget Institute, Vila Nova de Gaia, Portugal; Northern Health School of Portuguese Red Cross, Oliveira de Azeméis, Portugal
| | - F Silva
- FP-I3ID, Escola Superior de Saúde-Fernando Pessoa, Porto, Portugal
| | - C Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
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Pfeffer PE, Rupani H, De Simoni A. Bringing the treatable traits approach to primary care asthma management. FRONTIERS IN ALLERGY 2023; 4:1240375. [PMID: 37799134 PMCID: PMC10548136 DOI: 10.3389/falgy.2023.1240375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
Asthma continues to be a major cause of illness with a significant mortality, despite its increasing range of treatments. Adoption of a treatable traits approach in specialist centres has led to improvements in control of asthma and reduced exacerbations in patients with severe asthma. However, most patients with this illness, particularly those with mild-to-moderate asthma, are cared for in primary care according to guidelines that emphasise the use of pharmacotherapeutic ladders uniformly implemented across all patients. These pharmacotherapeutic ladders are more consistent with a "one-size-fits-all" approach than the treatable traits approach. This can be harmful, especially in patients whose symptoms and airway inflammation are discordant, and extra-pulmonary treatable traits are often overlooked. Primary care has extensive experience in patient-centred holistic care, and many aspects of the treatable traits approach could be rapidly implemented in primary care. Blood eosinophil counts, as a biomarker of the treatable trait of eosinophilia, are already included in routine haematology tests and could be used in primary care to guide titration of inhaled corticosteroids. Similarly, poor inhaler adherence could be further assessed and managed in primary care. However, further research is needed to guide how some treatable traits could feasibly be assessed and/or managed in primary care, for example, how to best manage patients in primary care, who are likely suffering from breathing pattern disorders and extra-pulmonary treatable traits, with frequent use of their reliever inhaler in the absence of raised T2 biomarkers. Implementation of the treatable traits approach across the disease severity spectrum will improve the quality of life of patients with asthma but will take time and research to embed across care settings.
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Affiliation(s)
- Paul E. Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Hitasha Rupani
- Department of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Anna De Simoni
- Wolfson Institute of Population Health and Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
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Reilly CC, Floyd SV, Raniwalla S, Gall N, Rafferty GF. The clinical utility of the Breathing Pattern Assessment Tool (BPAT) to identify dysfunctional breathing (DB) in individuals living with postural orthostatic tachycardia syndrome (POTS). Auton Neurosci 2023; 248:103104. [PMID: 37393657 DOI: 10.1016/j.autneu.2023.103104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Dysfunctional breathing (DB) resulting in inappropriate breathlessness is common in individuals living with postural orthostatic tachycardia syndrome (POTS). DB in POTS is complex, multifactorial, and not routinely assessed clinically outside of specialist centres. To date DB in POTS has been identified and diagnosed predominately via cardiopulmonary exercise testing (CPEX), hyperventilation provocation testing and/or specialist respiratory physiotherapy assessment. The Breathing Pattern Assessment Tool (BPAT) is a clinically validated diagnostic tool for DB in Asthma. There are, however, no published data regarding the use of the BPAT in POTS. The aim of this study was therefore to assess the potential clinic utility of the BPAT in the diagnosis of DB in individuals with POTS. METHODS A retrospective observational cohort study of individuals with POTS referred to respiratory physiotherapy for formal assessment of DB. DB was determined by specialist respiratory physiotherapist assessment which included physical assessment of chest wall movement/breathing pattern. The BPAT and Nijgmegen questionnaire were also completed. Receiver operating characteristics (ROC) analysis was used to compare the physiotherapy assessment based diagnosis of DB to the BPAT score. RESULTS Seventy-seven individuals with POTS [mean (sd) age 32 (11) years, 71 (92 %) female] were assessed by a specialist respiratory physiotherapist, with 65 (84 %) being diagnosed with DB. Using the established BPAT cut off of four or more, receiver operating characteristics (ROC) analysis indicated a sensitivity of 87 % and specificity of 75 % for diagnosing DB in individuals with POTS with an area under the curve (AUC) of 0.901 (95 % CI 0.803-0.999), demonstrating excellent discriminatory ability. CONCLUSION BPAT has high sensitivity and moderate specificity for identifying DB in individuals living with POTS.
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Affiliation(s)
- Charles C Reilly
- Department of Physiotherapy, King's College Hospital, Denmark Hill, London, UK; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, UK.
| | - Sarah V Floyd
- Department of Physiotherapy, King's College Hospital, Denmark Hill, London, UK
| | - Shehnaz Raniwalla
- Department of Physiotherapy, King's College Hospital, Denmark Hill, London, UK
| | - Nicholas Gall
- Department of Cardiology, King's College Hospital, Denmark Hill, London, UK
| | - Gerrard F Rafferty
- Centre for Human & Applied Physiological Sciences, King's College London, UK
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Grillo L, Russell AM, Shannon H, Lewis A. Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation. BMJ Open Respir Res 2023; 10:e001395. [PMID: 36627142 PMCID: PMC9835958 DOI: 10.1136/bmjresp-2022-001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To explore physiotherapists' opinions of physiotherapy assessment of Breathing Pattern Disorder (BPD). METHODS Qualitative study using focus groups (FGs) with reflexive thematic analysis and survey methods. The survey was distributed via social media and email to UK specialist physiotherapy interest groups. Two FGs, conducted in different settings, included physiotherapists based in hospital outpatients/community, private practice and higher education. RESULTS One-hundred-and-three physiotherapists completed the survey. Respondents identified a lack of consensus in how to define BPD, but some agreement in the components to include in assessment. Fifteen physiotherapists participated in the FGs. Three themes emerged from FG discussions: (1) nomenclature and language of breathing, (2) BPD and breathlessness and (3) The value of assessment of breathlessness. CONCLUSION The inconsistent nomenclature of dysfunctional breathing pattern impacts assessment, management and understanding of the diagnosis. Clarity in diagnosis, informing consistency in assessment, is fundamental to improving recognition and treatment of BPD. The findings are useful in the planning of education, training, future research and guideline development in BPD assessment.
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Affiliation(s)
- Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Physiotherapy, Royal Brompton and Harefield Hospitals, London, UK
| | | | - Harriet Shannon
- Physiotherapy, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
| | - Adam Lewis
- Department of Health Sciences, Brunel University London, London, UK
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Bondarenko J, Holland AE. Clinimetrics: The Breathing Pattern Assessment Tool. J Physiother 2022; 69:127. [PMID: 36526557 DOI: 10.1016/j.jphys.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Janet Bondarenko
- Physiotherapy Department, Alfred Health, Melbourne, Australia; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
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Hylton H, Long A, Francis C, Taylor RR, Ricketts WM, Singh R, Pfeffer PE. Real-world use of the Breathing Pattern Assessment Tool in assessment of breathlessness post-COVID-19. Clin Med (Lond) 2022; 22:376-379. [PMID: 38589144 PMCID: PMC9345218 DOI: 10.7861/clinmed.2021-0759] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Breathing pattern disorders (BPDs) are a common cause of chronic breathlessness, including after acute respiratory illnesses such as COVID pneumonia. BPD is however underdiagnosed, partly as a result of difficulty in clinically assessing breathing pattern. The Breathing Pattern Assessment Tool (BPAT) has been validated for use in diagnosing BPD in patients with asthma but to date has not been validated in other diseases. METHODS Patients undergoing face-to-face review in a post-COVID clinic were assessed by a respiratory physician and specialist respiratory physiotherapist. Assessment included a Dyspnoea-12 (D12) questionnaire to assess breathlessness, physiotherapist assessment of breathing pattern including manual assessment of respiratory motion, and BPAT assessment. The sensitivity and specificity of BPAT for diagnosis of BPD in post-COVID patients was assessed. RESULTS BPAT had a sensitivity of 89.5% and specificity of 78.3% for diagnosing BPD in post-COVID breathlessness. Patients with a BPAT score above the diagnostic cut-off had higher levels of breathlessness than those with lower BPAT scores (D12 score mean average 19.4 vs 13.2). CONCLUSION BPAT has high sensitivity and moderate specificity for BPD in patients with long COVID. This would support its use as a screening test in clinic, and as a diagnostic tool for large cohort studies.
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Affiliation(s)
| | | | | | | | - William M Ricketts
- Barts Health NHS Trust, London, UK and Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Paul E Pfeffer
- Barts Health NHS Trust, London, UK and honorary senior lecturer, Barts and The London School of Medicine and Dentistry, London, UK.
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