Tuesday, February 10, 2015
Time To Start Comparing Apples With Apples
The study by Williams and colleagues advances the field by demonstrating that specific descriptors of breathlessness can be used to suggest a diagnosis of COPD. Prospective testing is necessary to examine whether fluency in this language can differentiate other common respiratory diseases. In a preliminary study of 142 patients presenting with a chief complaint of breathlessness, Harver and associates found that the descriptor “chest tightness or constriction” had a specificity of 95% and positive predictive value of 86% for the diagnosis of asthma. Two phrases “effort or work of breathing” and “can’t get a deep breath” had a sensitivity of 74% for the diagnosis of COPD.
Based on this information, we encourage physicians and other health-care providers to ask patients about descriptors of dyspnea as part of the medical history. In the office setting, the nurse could take vital signs and then ask each patient to describe “what it feels like” when he/she has breathing discomfort. The nurse could write down (or enter into a computer) the key words along with the vital signs. The nurse could then give each patient a list of descriptors and ask him/her to select the “best two or three” that describe breathlessness. It is time for physicians to become fluent in the language of dyspnea! This will help us to better understand the experience of our patients, to diagnose the cause of breathlessness in a patient, and to and enhance our therapeutic efforts to provide relief.
She introduction of health-care technologies into medical practice is happening at a breathtaking pace. Some of these technologies are real advances and provide great benefits to patients, but many others offer only slight improvements despite substantially increasing health-care costs. Unfortunately, when faced with a decision to implement new technologies in their practices, many practitioners are often at a loss in determining the relative strengths and weaknesses of their options. When perusing the literature on reports about new technologies, it is frequently only case series or studies aimed at obtaining Food and Drug Administration approval that one can find, but no proper comparisons with conventional and established approaches.