Breathless patients often present a clinical challenge for doctors. Is it the heart or the lungs behind the complaint, or perhaps it’s the muscles, or even the brain?
To tackle this common and complex clinical problem, the Woolcock Institute of Medical Research in Sydney has launched a Breathlessness Clinic. Its mission is to make a doctor’s job easier by fast tracking a diagnosis for this worrying, anxiety-inducing complaint.
Woolcock respiratory physician Dr Tracy Smith said breathlessness, or dyspnoea, is one of the most common reasons Australians call an ambulance. Despite this, too few patients are able to get their breathlessness problem resolved quickly.
“Breathless patients are often referred to a respiratory physician or a cardiologist first, only to be sent to the other specialist later,” Dr Smith said. “This process can be time-consuming and frustrating for all involved.
“On top of that, treatment recommendations for conditions which can lead to breathlessness are constantly changing, and there are few clinical guidelines to help specialists manage problems which affect more than one organ system, for instance patients with both heart and lung disease,” she explained.
The Woolcock Breathlessness Clinic seeks to solve this problem with a new and innovative model of care. Under this multispecialty approach, patients see a cardiologist and a respiratory physician at the same time to allow rapid, comprehensive assessment.
“This is NSW’s first one-stop-shop for breathlessness, promising to investigate, diagnose and treat all patients under one roof and in a timely fashion,” Dr Smith said. “We’ll collaborate closely with GPs to ensure they are kept informed of the patient’s assessment and treatment recommendations.”
Dyspnoea has many potential causes. It can be triggered by long-standing lung disease like asthma, or it could be linked to heart conditions like coronary disease or arrhythmia, said the clinic’s chief cardiologist Professor Len Kritharides. “And for those with daily, long-term breathlessness, it may be caused by a range of lung, heart or muscle conditions, obesity, poor fitness or a combination of things,” Professor Kritharides said. “The fact there can be multiple inputs can make this a difficult clinical problem to solve in primary care.”
The Woolcock Breathlessness Clinic is for patients who present to their GP with breathlessness persisting for 4-8 weeks or longer. The GP is recommended to conduct baseline tests and treatments for any underlying asthma, COPD or heart disease. If no improvements are seen, they can be referred to the Clinic where patients will complete a screening questionnaire, full lung function testing and chest x-ray prior to seeing specialist doctors. “All our patients see a cardiologist and respiratory physician simultaneously,” Dr Smith said. “GPs will receive detailed correspondence regarding recommendations after each clinical assessment.”
“Our ultimate goal is to help patients identify their treatment options as quickly as possible so they can get back to living a healthy, fulfilled life,” she said.
GPs can download referral forms online at www.woolcock.org.au/referral or email the Woolcock on firstname.lastname@example.org to request a referral pad.