Breathlessness
Breathing new life into a vital area of healthcare

Shortness of breath, or breathing difficulty, is the a common reason for visiting a hospital A & E department. The common causes of breathlessness include Chronic Obstructive Pulmonary Disease (COPD) or heart failure and under this theme we are working to improve the assessment and care of patients experiencing breathlessness.

The problem in NW London is significant as these statistics from 2010-11 demonstrate:
  • Of 2,874 patients admitted with COPD, 56% were readmitted within 90 days
  • Of 1,984 patients admitted for heart failure, 60% were readmitted within 90 days.

Both of these conditions have high mortality rates.
Around 20% of patients with COPD also have Heart Failure and vice versa.*

Currently under the Breathlessness theme, CLAHRC NWL is supporting the following projects:

  • Non- Invasive Ventilation - Improving outcomes and patient experience with understanding. The aim is to improve the quality of care for patients requiring acute NIV by improving patient/carer experience of NIV through understanding and engagement; and by improving staff awareness of patient perspective through a holistic approach to NIV education. A primary driver of the project is the development and implementation of an NIV bundle to ensure excellent NIV delivery and improve outcomes. 
  • SHINE2 improving physical health care for people with severe mental health problems. The aim of this project is to improve the collection, communication and recording of physical health information about patients across the mental health pathway. In additon, the aim is to provide patients with personalised information about what their health risk factors are and how they can reduce them and ensure they have the help necessary to achieve that.
  • Developing guided self-help to improve mental and physical wellbeing in people with asthma. People with asthma have an elevated incidence of anxiety/depression. Effective treatment of these conditions reduces the use of health care resources by asthma sufferers as well as improving quality of life. Most people who could benefit from psychological treatment do not access it. Therefore the aim is to develop an integrated care pathway which includes a guided self-help programme to increase the number of people with asthma getting effective psychological care.
  • Hounslow Community Atrial Fibrillation Screening Project. Numerous studies and audits show that care for patients with AF is suboptimal and that many people with AF who suffer a stroke are not on appropriate anticoagulants. The project aim is to improve the detection of AF, improve the risk assessment for stroke and allow patients to make an informed choice regarding treatment with anticoagulation within the London Borough of Hounslow.



*Eur J Heartfail 2009; 11:130-139

Previous projects which CLAHRC NWL has supported since 2014 include :
  • Acute care Heart Failure (HF) bundle. Following the bundle model we used in hospital for patients with COPD, we are developing a package of interventions for heart failure, including assessment and referral for rehabilitation. 
  • Common rehabilitation service for COPD and HF. Working closely with stakeholders and service users we will be examining the current provision and distribution of pulmonary and cardiac rehabilitation services to explore ways of developing an holistic, all cause breathlessness service. 
  • Primary care COPD bundle – adapting the North West London acute hospital COPD bundle for use in a GP setting. Working closely with clinicians and patients we aim to develop the initial model and customise it to the GP setting and then roll it out across the GP community of North West London.