Multicomponent services for symptoms in serious respiratory illness: a systematic review and meta-analysis

Abstract

Background: People living with serious respiratory illness experience a high burden of symptoms. This review aimed to determine whether multicomponent services reduce symptoms in people with serious illness related to respiratory disease.

Methods: Electronic databases were searched to identify randomised controlled trials (RCTs) evaluating multicomponent services that enrolled patients due to symptoms, rather than underlying disease, and provided at least one nonpharmacological intervention. The primary outcome was chronic breathlessness and secondary outcomes were health-related quality of life (HRQoL), cough, fatigue and adverse events. At least two authors independently screened studies, assessed risk of bias and extracted data.

Results: Five RCTs, involving 439 patients, were included. In comparison to usual care, multicomponent services improved breathlessness mastery (Chronic Respiratory Questionnaire (CRQ) mastery scale, mean difference (MD) 0.43 points, 95% CI 0.20-0.67, three RCTs, 327 participants) and HRQoL (CRQ total score, MD 0.24 points, 95% CI 0.04-0.40, two RCTs, 237 participants). Fatigue did not improve with multicomponent services and no studies evaluated cough. No serious adverse events were reported. The one study evaluating mortality found increased survival in those accessing a multicomponent service. The certainty of evidence was very low, mainly due to detection and reporting bias.

Conclusion: Multicomponent services improve breathlessness mastery and HRQoL, with minimal risk. These findings support the use of multicomponent symptom-directed services for people living with serious respiratory illness.

FIGURE 1

Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) flow chart.

FIGURE 2

Risk of bias graph: judgement on each risk of bias item (percentages across all included studies).

FIGURE 3

Forest plots. a) Average breathlessness intensity over last 24 hours by numerical rating scale 0–10. b) Chronic Respiratory Questionnaire mastery domain. c) Chronic Respiratory Questionnaire dyspnoea domain. d) Chronic Respiratory Questionnaire fatigue domain. e) Chronic Respiratory Questionnaire total score. df: degree of freedom; IV: inverse variance.