The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis

Predictors of hospital admission when presenting with acute-on-chronic breathlessness: Binary logistic regression

BACKGROUND

Breathlessness due to medical conditions commonly causes emergency department presentations and unplanned admissions. Acute-on-chronic breathlessness is a reason for 20% of emergency presentations by ambulance with 69% of these being admitted. The emergency department may be inappropriate for many presenting with acute-on-chronic breathlessness.

AIM

To examine predictors of emergency department departure status in people with acute-on-chronic breathlessness.

DESIGN, SETTING AND METHOD

Secondary analysis of patient-report survey and clinical record data from consecutive eligible attendees by ambulance. Variables associated with emergency department departure status (unifactorial analyses; p<0.05) were included in a binary logistic regression model. The study was conducted in a single tertiary hospital. Consecutive survey participants presenting in May 2015 with capacity were eligible. 1,212/1,345 surveys were completed. 245/1,212 presented with acute-on-chronic breathlessness, 171 of whom consented to clinical record review and were included in this analysis.

RESULTS

In the final model, the odds of admission were increased with every extra year of age [OR 1.041 (95% CI: 1.016 to 1.066)], having talked to a specialist doctor about breathlessness [9.262 (1.066 to 80.491)] and having a known history of a heart condition [4.177 (1.680 to 10.386)]. Odds of admission were decreased with every percentage increase in oxygen saturation [0.826 (0.701 to 0.974)].

CONCLUSION

Older age, lower oxygen saturation, having talked to a specialist, and having history of a cardiac condition predict hospital admission in people presenting to the emergency department with acute-on-chronic breathlessness. These clinical factors could be assessed in the community and may inform the decision regarding conveyance.

Social Support Mediates the Relationship Between Coping Styles and the Mental Health of Medical Students

Purpose

This study aimed to explore the impact that coping styles and social support have on the mental health of medical students by constructing a corresponding structural situation model that reveals the complex relationship between these three factors. In doing so, it seeks to help medication students better manage mental health problems.

Patients and Methods

The online study was conducted between March 6, 2021 and May 6, 2021. A total of 318 participants from multiple medical schools were involved. The general information questionnaire, simple coping style questionnaire (SCSQ), perceived social support scale (PSSS) and symptom checklist 90 (SCL-90) were used to collect relevant information from the subjects by snowball sampling. An independent t-test, ANOVA, Pearson correlation coefficient analysis, and intermediary effect analysis were all used to analyze the relevant data and construct the structural equation model.

Results

There was a significant difference in SCL-90 between medical students and national college students (1.78±0.70, P < 0.001), and the positive rate of mental health status was as high as 40.3%. Sleep quality, regular diet, and positive coping style were positively correlated with mental health (P < 0.01), while negative coping styles and total scores of coping style as well as family, friends, and other sources of social support and total scores of social support were negatively correlated with mental health problems (P < 0.01). Positive and negative coping styles have an impact on mental health through the mediating effect of between social support and coping styles, as well as in the direct pathway.

Conclusion

The mental health status of medical students was significantly poor. Medical schools should thus pay close attention to the mental health status of students and encourage them to develop healthy living habits, optimize coping styles, and establish stable sources of social support to improve their psychological wellbeing.

Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study

OBJECTIVES

This study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support.

DESIGN

A qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach.

SETTING

The Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits.

PARTICIPANTS

Patients with moderate to very severe COPD who had completed the WBS programme 6 months earlier.

RESULTS

Thirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A 'chaos narrative' appeared to be prevalent, and many participants had poor recall of the programme.

CONCLUSIONS

Self-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management.

TRIAL REGISTRATION NUMBER

ACTRN12617000499381.

Idiopathic pulmonary fibrosis: a more common condition than you may think

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive incurable lung disease that affects a significant amount of people in the UK. Many health professionals have a limited understanding of IPF, which can result in a delayed diagnosis and inadequate care for individuals and their families. This article aims to provide an overview of IPF and help to enhance health professionals' understanding of the disease, thus contributing towards improving the care that IPF sufferers receive. This article provides a definition of IPF and explores its pathophysiology. It discusses the causes and risk factors for developing the condition, examines how IPF is diagnosed and details the treatment options available for IPF patients.

Openness Personality Trait Associated With Benefit From a Nonpharmacological Breathlessness Intervention in People With Intrathoracic Cancer: An Exploratory Analysis

CONTEXT

Breathlessness is common in people with lung cancer. Nonpharmacological breathlessness interventions reduce distress because of and increase mastery over breathlessness.

OBJECTIVES

Identify patient characteristics associated with response to breathlessness interventions.

METHODS

Exploratory secondary trial data analysis. Response defined as a one-point improvement in 0-10 Numerical Rating Scale of worst breathlessness/last 24 hours (response-worst) or a 0.5-point improvement in the Chronic Respiratory Questionnaire (CRQ) mastery (response-mastery) at four weeks. Univariable regression explored relationships with plausible demographic, clinical, and psychological variables followed by multivariable regression for associated (P < 0.05) variables.

RESULTS

About 158 participants with intrathoracic cancer (mean age 69.4 [SD 9.35] years; 40% women) were randomized to one or three breathlessness training sessions. About 91 participants had evaluable data for response-worst and 107 for response-mastery. In the univariable analyses, the personality trait openness was associated with response-worst (odds ratio [OR] 1.99 [95% CI 1.08-3.67]; P = 0.028) and response-mastery (OR 1.84 [95% CI 1.04-3.23]; P = 0.035). Higher CRQ-fatigue (OR 0.61 [95% CI 0.41-0.91]; P = 0.015), CRQ-emotion (OR 0.68 [95% CI 0.47-0.96]; P = 0.030), and worse CRQ-mastery (OR 0.61 [95% CI 0.42-0.88]; P = 0.008), and the presence of metastases and fatigue were associated with reduced odds of response-mastery. In the adjusted response-mastery model, only openness remained (OR 1.73 [95% CI 0.95-3.15]; P = 0.072).

CONCLUSION

Worse baseline health, worse breathlessness mastery, but not severity, and openness were associated with a better odds of response. Breathlessness services must be easy to access, and patients should be encouraged and supported to attend.