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A common model for the breathlessness experience across cardiorespiratory disease

Sarah L. Finnegan, Kyle T.S. Pattinson, Josefin Sundh, Magnus Sköld, Christer Janson, Anders Blomberg, Jacob Sandberg, Magnus Ekström
ERJ Open Research 2021 7: 00818-2020; DOI: 10.1183/23120541.00818-2020
Sarah L. Finnegan
1Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK
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  • ORCID record for Sarah L. Finnegan
  • For correspondence: sarah.finnegan@ndcn.ox.ac.uk
Kyle T.S. Pattinson
1Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK
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Josefin Sundh
2Dept of Respiratory Medicine, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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  • ORCID record for Josefin Sundh
Magnus Sköld
3Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
4Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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Christer Janson
5Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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  • ORCID record for Christer Janson
Anders Blomberg
6Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
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Jacob Sandberg
7Respiratory Medicine and Allergology, Dept of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Magnus Ekström
7Respiratory Medicine and Allergology, Dept of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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  • ORCID record for Magnus Ekström
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Figures

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  • FIGURE 1
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    FIGURE 1

    a) Connectogram. Measures are plotted as a wheel with connections between each measure input to the model shown as a thread. The thickness of the thread provides a visual representation of the strength of the relationship between any two measures (R≥0.35). Coloured dots highlight the common factors underlying groups of measures. Pink dots correspond to Factor 2 (affect/mood), red to Factor 1 (body burden), blue to Factor 3 (breathing burden) and orange to Factor 4 (anger/frustration). b) Factor diagram. The retained measures are shown on the left hand side of the diagram while the contribution of each measure to the resulting factor is shown as a loading weight (rectangular boxes) Factors are shown as ovals with descriptive labels underneath. The covariance across factors is illustrated by the curved lines.

  • FIGURE 2
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    FIGURE 2

    Clustergram. A matrix of each participants score across the four factors. Factor score is measured in arbitrary units (au). Each of the four factors is displayed along the bottom, with participants forming the y-axis. Factors 1 and 3 correspond to body and breathing burden, while Factors 2 and 4 correspond to affect/mood and anger/frustration. A dendrogram is displayed along the left side and highlights the division of participants into the two groups, higher symptom burden and lower symptom burden.

  • FIGURE 3
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    FIGURE 3

    The relative proportion of each disease category belonging to the higher and lower symptom burden groups shown. Each participant is represented by a single square. Colours encode disease category as follows. Red: idiopathic pulmonary fibrosis; orange: other interstitial lung disease; yellow: COPD; blue: asthma; purple: heart failure; and pink: “other” (including depression, cancer, diabetes and renal failure).

  • FIGURE 4
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    FIGURE 4

    Factor diagram. A compact factor model in which low loading measures were sequentially removed. The retained measures are shown on the left-hand side of the diagram with the contribution of each measure to the resulting factor shown as a loading weight (rectangular boxes). Removed measures are shown in shaded boxes next to the factor to which they previously belonged. Factors are shown as ovals with descriptive labels underneath. The covariance across factors is illustrated by the curved lines.

Tables

  • Figures
  • TABLE 1

    Demographic information per main cause of breathlessness (total subjects=182)

    Main cause of breathlessnessAttended at baselineAge yearsFemaleBMI kg·m−2
     COPD45 (24.7%)71.6±9.22926.6±7.8
     Asthma39 (21.4%)53.2±15.22927.9±5.3
     Heart failure35 (19.2%)76.4±7.9830.5±5.7
     IPF34 (18.7%)75.1±6.81625.9±3.9
     Other ILD5 (2.7%)69.3±11.7228.4±4.5
     Other diagnoses#24 (13.2%)66.4±14.61325.9±6.7
    Number of patients with 1/2/3/4 comorbidities50/16/4/1
    Comorbidity frequency by diagnosis
     COPDDiabetes n=30; heart failure n=10; other breathlessness n=7; asthma n=5; cancer n=4; renal failure n=2
     AsthmaDiabetes n=8; other breathlessness n=2; ILD n=2
     Heart failureDiabetes n=13; renal failure n=8; COPD n=4; other breathlessness n=2; asthma n=2; cancer n=2
     IPFDiabetes n=5; renal failure n=2; other breathlessness n=2; heart failure n=1; asthma n=1
     Other ILDDiabetes n=2; COPD n=1; heart failure n=1
     Other diagnoses#Heart failure n=5; diabetes n=5; asthma n=3; renal failure n=2; cancer n=1; COPD n=1

    Data are presented as mean±sd, n (%) or n. IPF: idiopathic pulmonary fibrosis; ILD: interstitial lung disease; BMI: body mass index. #: other diagnoses include depression, cancer, diabetes and renal failure.

    • TABLE 2

      A list of measures included in the exploratory factor analysis model

      1. Sex14. mMRC
      2. Age15. EQ-5D-5L – Index
      3. BMI16. FACIT – Fatigue Scale
      4. Dyspnea-12 – Affect17. Average severity of pain
      5. Dyspnea-12 – Physical18. CAT
      6. MDP_A2_Anxiety19. MDP_A2_Depression
      7. MDP_A2_Afraid20. MDP_A1_Breathing Discomfort
      8. MDP_A2_Angry21. MDP_SQ1_Physical Effort
      9. MDP_A2_Frustrated22. MDP_SQ2_Hunger
      10. Breathlessness at rest23. MDP_SQ3_Tightness
      11. Breathlessness mean24. MDP_SQ4_Mental Effort
      12. HADS – Depression25. MDP_SQ5_Hypernoea
      13. HADS – Anxiety

      BMI: body mass index; MDP: multidimensional dyspnea profile; SQ: sensory dimension; A2: emotional response domain; HADS: hospital anxiety and depression scale; FACIT: functional assessment of chronic illness therapy – fatigue scale; mMRC: modified Medical Research Council breathlessness scale; CAT: COPD assessment test; EQ-5D–5L: EuroQol five dimensions – five levels.

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      A common model for the breathlessness experience across cardiorespiratory disease
      Sarah L. Finnegan, Kyle T.S. Pattinson, Josefin Sundh, Magnus Sköld, Christer Janson, Anders Blomberg, Jacob Sandberg, Magnus Ekström
      ERJ Open Research Apr 2021, 7 (2) 00818-2020; DOI: 10.1183/23120541.00818-2020

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      A common model for the breathlessness experience across cardiorespiratory disease
      Sarah L. Finnegan, Kyle T.S. Pattinson, Josefin Sundh, Magnus Sköld, Christer Janson, Anders Blomberg, Jacob Sandberg, Magnus Ekström
      ERJ Open Research Apr 2021, 7 (2) 00818-2020; DOI: 10.1183/23120541.00818-2020
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