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Althobiani MA, Shuttleworth R, Conway J, Dainton J, Duckworth A, Da Ponte AJ, Mandizha J, Lanario JW, Gibbons MA, Lines S, Scotton CJ, Hurst JR, Porter JC, Russell AM. Supporting self-management for patients with Interstitial Lung Diseases: Utility and acceptability of digital devices. PLOS DIGITAL HEALTH 2024; 3:e0000318. [PMID: 38190384 PMCID: PMC10773949 DOI: 10.1371/journal.pdig.0000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Patients diagnosed with Interstitial Lung Diseases (ILD) use devices to self-monitor their health and well-being. Little is known about the range of devices, selection, frequency and terms of use and overall utility. We sought to quantify patients' usage and experiences with home digital devices, and further evaluate their perceived utility and barriers to adaptation. METHODS A team of expert clinicians and patient partners interested in self-management approaches designed a 48-question cross-sectional electronic survey; specifically targeted at individuals diagnosed with ILD. The survey was critically appraised by the interdisciplinary self-management group at Royal Devon University Hospitals NHS Foundation Trust during a 6-month validation process. The survey was open for participation between September 2021 and December 2022, and responses were collected anonymously. Data were analysed descriptively for quantitative aspects and through thematic analysis for qualitative input. RESULTS 104 patients accessed the survey and 89/104 (86%) reported a diagnosis of lung fibrosis, including 46/89 (52%) idiopathic pulmonary fibrosis (IPF) with 57/89 (64%) of participants diagnosed >3 years and 59/89 (66%) female. 52/65(80%) were in the UK; 33/65 (51%) reported severe breathlessness medical research council MRC grade 3-4 and 32/65 (49%) disclosed co-morbid arthritis or joint problems. Of these, 18/83 (22%) used a hand- held spirometer, with only 6/17 (35%) advised on how to interpret the readings. Pulse oximetry devices were the most frequently used device by 35/71 (49%) and 20/64 (31%) measured their saturations more than once daily. 29/63 (46%) of respondents reported home-monitoring brought reassurance; of these, for 25/63 (40%) a feeling of control. 10/57 (18%) felt it had a negative effect, citing fluctuating readings as causing stress and 'paranoia'. The most likely help-seeking triggers were worsening breathlessness 53/65 (82%) and low oxygen saturation 43/65 (66%). Nurse specialists were the most frequent source of help 24/63 (38%). Conclusion: Patients can learn appropriate technical skills, yet perceptions of home-monitoring are variable; targeted assessment and tailored support is likely to be beneficial.
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Affiliation(s)
| | - Rebecca Shuttleworth
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - John Conway
- Exeter Patients in Collaboration for Pulmonary Fibrosis Research (EPIC-PF), Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Jonathan Dainton
- Exeter Patients in Collaboration for Pulmonary Fibrosis Research (EPIC-PF), Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Anna Duckworth
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Ana Jorge Da Ponte
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Joseph W. Lanario
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Michael A. Gibbons
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Sarah Lines
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Chris J. Scotton
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - John R. Hurst
- Department of Medicine, University College London, London, United Kingdom
| | - Joanna C. Porter
- Department of Medicine, University College London, London, United Kingdom
| | - Anne-Marie Russell
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
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Verduri A, Carter B, Rice C, Laraman J, Barton E, Clini E, Maskell NA, Hewitt J. Frailty Prevalence and Association with Clinical Outcomes in Interstitial Lung Disease, Asthma, and Pleural Disease. Geriatrics (Basel) 2023; 8:82. [PMID: 37623275 PMCID: PMC10454934 DOI: 10.3390/geriatrics8040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Frailty is a syndrome characterised by increased vulnerability to negative outcomes. Interstitial lung disease (ILD), asthma, and pleural disease are leading causes of morbidity and mortality. We aimed to investigate the prevalence and impact of frailty in adult patients with these diseases. METHODS We conducted a systematic review and meta-analysis, searching PubMed, Web of Science, The Cochrane Library, and EMBASE for studies reporting on frailty in ILD, asthma, and pleural disease. MeSH terms including interstitial lung disease, Idiopathic Pulmonary Fibrosis, Non-specific Interstitial Pneumonia, Chronic Hypersensitivity Pneumonitis, systemic sclerosis-associated ILD, connective tissue disease-associated ILD, and frailty were used as key words. The primary outcome was prevalence of frailty. Where enough contextually homogeneous studies were included, a pooled random-effects meta-analysis was performed with mortality and hospitalisation as the outcomes. RESULTS The review found three studies relating to frailty in asthma. No studies relating to pleural disease and frailty were identified. The median prevalence in asthma was 9.5% (IQR, 7.8-11.3). Six relevant studies incorporating 1471 ILD patients (age 68.3 ± SD2.38; 50% male) were identified, which were either cohort or cross-sectional design rated either good or fair. The median prevalence of frailty was 48% (IQR, 25-50). There was a positive association between frail ILD patients and increased risk of long-term mortality (pooled OR, 2.33 95%CI 1.31-4.15, I2 9%). One study reported a hospitalization rate of HR = 1.97(1.32-3.06) within 6 months in frail ILD patients. CONCLUSIONS Frailty is very common and associated with increased mortality in patients with ILD. There are still minimal data regarding the prevalence of frailty and its influence on the risk in this population.
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Affiliation(s)
- Alessia Verduri
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Ceara Rice
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
| | - James Laraman
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
| | - Eleanor Barton
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK; (E.B.); (N.A.M.)
| | - Enrico Clini
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Nick A. Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK; (E.B.); (N.A.M.)
| | - Jonathan Hewitt
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
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Saketkoo LA, Russell AM, Patterson KC, Obi ON, Drent M. Sarcoidosis and frailty: recognizing factors that foster holistic resilience. Curr Opin Pulm Med 2023:00063198-990000000-00099. [PMID: 37522560 DOI: 10.1097/mcp.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW Sarcoidosis is a multiorgan system disease exerting significant impact on biophysical, social, psychological and emotional well-being. Mortality and disability correlate to accessible, timely, expert care for sarcoidosis and its related complications. Across health conditions, positive healthcare interactions and interventions can rehabilitate unfavourable factors tied to concepts of 'frailty'. Here, we set out to introduce concepts related to frailty and their impact in the context of sarcoidosis. RECENT FINDINGS Studies examining frailty across other multiorgan and single organ-based diseases that mirror organ involvement in sarcoidosis demonstrate findings that bear relevance in sarcoidosis. Namely, factors predisposing a person to frailty are a multifactorial phenomenon which are also reflected in the lived experience of sarcoidosis; and that early diagnosis, intervention and prevention may alter a course towards more favourable health outcomes. SUMMARY Factors predisposing to frailty in other health conditions may also signal a risk in sarcoidosis. In turn, proactive health preservation - regardless of age - may lead to improved biopsychosocial reserve and health-related quality of life. Fortifying holistic resilience in sarcoidosis is anticipated to reduce risk of the occurrence and prolongation of health-related complications, and facilitate swifter recovery from biophysical complications as well as from psychosocial and emotional stressors.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center
- University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs
- Louisiana State University School of Medicine, Section of Pulmonary Medicine
- Tulane University School of Medicine, Undergraduate Honors Department, New Orleans, Louisiana, USA
| | - Anne-Marie Russell
- Exeter Respiratory Innovations Center, University of Exeter, Exeter
- Royal Devon and Exeter NHS Foundation Trust, Devon
- Imperial College Healthcare NHS Trust, London
| | - Karen C Patterson
- Brighton & Sussex Medical School, Department of Clinical & Experimental Medicine, Falmer, UK
| | - Ogugua Ndili Obi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Marjolein Drent
- Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht
- ILD CARE Foundation Research Team, Ede, The Netherlands
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Varjú C, Pauling JD, Saketkoo LA. Multi-Organ System Screening, Care, and Patient Support in Systemic Sclerosis. Rheum Dis Clin North Am 2023; 49:211-248. [PMID: 37028832 DOI: 10.1016/j.rdc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a heterogenous systemic autoimmune disease of complex multi-organ manifestations with a disease-specific mortality of >50%. The patient journey is fraught with severe, diverse, and diffuse physical impairment, psychological burden, and diminishing health-related quality of life. SSc remains unfamiliar to many clinicians. Delayed/misdiagnosis, inadequate screening, and attention for common complications with potentially preventable disability/death contribute to patients feeling isolated and unsupported. We present actionable standards including screening, anticipatory guidance, and counseling in patient-centered SSc-care emphasizing psycho-social health as the central goal, whereas robust vigilance and efforts to improve biophysical health and survival are imperatives that support this goal.
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Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - John D Pauling
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, LA, USA; Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA; Tulane University School of Medicine, New Orleans, LA, USA.
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