Questions and Answers From the Clinical Perspectives™ Webinar “Evaluation of Patients Presenting With Chronic Dyspnea”
By: Chris Troksa
November 30, 2018
The following is a portion of the question and answer section from “Evaluation of Patients Presenting With Chronic Dyspnea,” the Clinical Perspectives™ webinar on the topic of shortness of breath. During the Q and A session, Victor Test, MD, FCCP, answers questions from the audience during the live portion of the webinar. The webinar is a part of a series presented by CHEST Analytics. The next will be at 11 am CT on December 5 on understanding barriers to timely diagnosis of pulmonary diseases and is titled CHEST Clinical Perspectives™ “Delays in Diagnosis.” Register now.
1. Time pressures might be a barrier to the evaluation of dyspnea. How can we change behaviors of the 25-40% of clinicians who are not evaluating dyspnea on a regular basis?
Dr. Test: That is a fantastic question and one that we continue to struggle with. For example, at the center, in terms of just quantification of dyspnea, the number of hurdles that I had to overcome was pretty substantial. Part of it is generating a continued awareness of the importance of shortness of breath for our physicians, nurses, nurse practitioners, and physician assistants so that we understand the importance of it, much like we did with pain scales in years’ past. Once we have established with everyone the importance of that like the government did with pain, then we can start to move forward on a more regular basis.
Also, with the development of electronic medical records, placing information as a part of that record in the vital signs or in the subjective history as a click tab would make the information more useful and user-friendly while also less time intensive.
2. Is there a need for new tools to evaluate dyspnea in the practice setting? How would these tools need to evolve?
Dr. Test: There is an ongoing need for the development of new tools, even though we do have excellent tools to quantify dyspnea that span across disease states. Most of the respiratory questionnaires and dyspnea scales were originally designed by folks on one particular disease type and that is one of the hurdles particularly when you deal with super specialties and ranking quality of life and symptoms. Are those scales applicable to different disease state? For example, are some applicable in COPD and IPF if they are applicable in pulmonary vascular disease?
Some of the simpler scales, the Borg scale, for example, or the mMRC Scale, should be applicable across multiple disease states. One of the hurdles to overcome is proving that or developing new scales that are simple or take little time. I think that is one of the things that is crucial for getting these scales widely used because physicians are expected to see patients in high volumes so if it takes a lot of time, the scale will not be used.
3. Do we need a tool that can be used in multiple settings such as primary care, pulmonology, and cardiology so that there is consistency?
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