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Cross-linkage and analysis of large registry-based databases help us conduct research on breathlessness

Magnus Ekström. Photo
Associate professor Magnus Ekström

Associate professor Magnus Ekström is using cross-linked databases to develop a new standard method that can measure the severity of breathlessness in the population and find treatments to provide patients relief from symptoms.

Magnus is Associate professor at Respiratory Medicine, Allergology, and Palliative Medicine, Department of Clinical Sciences, Lund, at the Faculty of Medicine, Lund University. He is also head of the Swedish Registry for Respiratory Failure (Swedevox) which is a database of patients with chronic respiratory failure that is cross-linked with national registries. It is the largest in this field and using machine learning techniques in this and other large databases underlying symptom and morbidity patterns can be identified.

- Investigating breathlessness requires a standardized method to assess the symptoms properly. Our research on these symptoms covers everything from physiological, emotional, cognitive, and social factors and how they interact with each other. Using machine learning techniques can help us detect patterns of breathlessness to also estimate prognosis, explains Magnus.

SRA EpiHealth is interested in knowing what the signs and symptoms of breathlessness are and what the possible causes are. – Breathlessness can occur for lots of reasons, but it often makes people scared or anxious and typical signs are difficulties catching your breath, noisy breathing, very fast and shallow breaths, and in severe respiratory distress pale or cold and clammy skin, using your shoulders and the muscles in your upper chest to help you breathe, anxiety or panicky feelings, says Magnus. He continues,

- Healthy individuals can also experience breathlessness, most often due to very strenuous exercise, extreme temperatures, and higher altitude. Apart from these examples, breathlessness is likely a sign of a medical problem, says Magnus. -Breathlessness as such is a symptom that can have many underlying causes. But the main causes are lung conditions, heart conditions, anxiety, being unfit or having an unhealthy weight.

- We try to divide the symptoms into profiles or phenotypes which are an individual's observable traits, such as types of qualities of the sensations , as well as the genotypes which are the genetic distribution of the phenotypes. Traits that are determined by these as well as environmental factors are investigated. 

- I am involved in several research studies that cover the epidemiology of breathlessness from parent to child, throughout adulthood and at the end of life in men and women. About 25% of people 65+ are breathless in daily life and as many as 95% of patients with advanced respiratory disease suffer from chronic breathlessness. Data on which factors that contribute to breathlessness in the population and in severe disease is limited. And there is currently no registered treatment for relieving chronic breathlessness. We are currently investigating the effects of several interventions such as oxygen therapy which will be exciting to see, explains Magnus. 

- My goal is to establish a standard set of validated scales for measuring breathlessness across languages, settings, and populations which is why I have established international collaborations with leading researchers in breathlessness and palliative medicine in Australia, Canada, France, UK, and USA. We have also built strong research collaborations in Sweden to contribute within the international network and data from Swedevox is used to facilitate our research and improve clinical guidelines.

- When a standard measurement method has been developed it will be possible to build a cohort of patients with chronic breathlessness for translational research that would investigate molecular, immunologic, physiological, and neurobiological mechanisms. This could help us find novel treatments to relieve breathlessness, says Magnus.