P203 Correlation of Nijmegen score and hospital anxiety/depression (HAD) score in dysfunctional breathlessness

Abstract

Introduction Dysfunctional Breathlessness has an incidence of about 10% among the general population and can often coexist with other chronic cardio respiratory illness. Patients often have a degree of anxiety or depression and may pose a diagnostic and therapeutic challenge. Nijmegen questionnaire is suitable as a screening tool for early detection and also as an aid in diagnosis and therapy planning. Aim To test the correlation between the Nijmegen score and the hospital anxiety/depression score in patients diagnosed with dysfunctional breathlessness. Method The diagnosis was made on the basis of exclusion with a normal clinical examination, lung function and echocardiogram, or with symptoms disproportionate to measurements of severity of their respiratory illness. The physiotherapist further assessed patients with particular regard to their breathing pattern and the Nijmegen (Ni) score, with a score over 23 being regarded as diagnostic. Consecutive patients referred to the clinic over 24 months were reviewed. The following parameters were analysed- demographics, underlying respiratory illness, breathing and sleep pattern, Nijmegen score (Pre and Post Intervention), HAD scores and the interventional modalities. Results 51 patients (males 20, females 31) were assessed. The mean age at presentation was 60.2 (range 20–84). 26/51 patients had chronic cardio respiratory illness. 28/51 patients had an abnormal breathing pattern, the most common being frequent sighing. 23/51 patients reported abnormal sleep pattern, frequent awakening being the commonest. 37 patients (males 17, females 20) had a pre intervention Ni score over 23 (mean 29, range 23–42). Interventions included patient education, cognitive–behavioural therapy, breathing exercises and training in a physiotherapist led clinic. The interventional period was 6 weeks and post 6 weeks the Nijmegen score fell below the diagnostic threshold in 29/37 patients (mean reduction 14, range 3–22, p value<0.001). HAD scores was used to assess the degree of mood impairment and there was no linear correlation (Pearson correlation) (Abstract P203 table 1) with the pre intervention Nijmegen score. Conclusion There was no correlation between the Nijmegen score and the hospital anxiety/depression score in patients with dysfunctional breathlessness. A physiotherapy led dysfunctional breathlessness clinic was able to improve symptoms in 78% of the referred cases as measured by Ni score.