New scoring tool developed to manage chronic lung condition

A new scoring system has been developed at our hospital to help manage and predict when a chronic lung condition may require further hospital treatment and to reduce emergency admissions.

Eleanor Mishra, Consultant in Respiratory Medicine and Clinical Associate Professor, has led the work at NNUH, with support from the University of East Anglia (UEA), to create the RED score clinical tool which predicts how quickly fluid will reaccumulate in patients with malignant pleural effusion (MPE). The condition can cause serious breathing problems when fluid containing cancer cells builds up between the tissues lining the lungs and the chest wall.

The goal is to have the scoring tool adopted nationally to help patients with pleural disease manage their condition. The project has achieved major milestones by being published in Thorax, one of the leading international respiratory journals, as well as being presented at the European Respiratory Society (ERS) and British Thoracic Society conferences.

The scoring system has been trialled at NNUH for almost a year with 13 other UK hospitals using it to help better plan and personalise patient care.

Dr Mishra said: “Patients with malignant pleural effusion get a build of fluid around their lungs, which causes breathing difficulties and often leads to a lot of emergency admissions. We can drain the fluid to relieve the symptoms in hospital – this scoring system can predict how quickly it will come back. When a patient has a high score, we know that they will need to be readmitted within two weeks and can plan for further treatment to help them.”

“The scoring system is deliberately designed to be as easy as possible to use and does not require any blood tests or special tests. It measures a patient’s respiratory rate, infusion depth using ultrasound scan and breathlessness using a zero to 10 scale.”

Following its initial success with a service review that demonstrated use of the score was feasible in clinical practice, Dr Mishra and the team will be applying for funding to run a randomised control trial to further test the RED tool.

She added: “We have been using the scoring to predict reoccurrence – we want to use it for changing people’s management and better support their anti-cancer treatment. Patients appreciate knowing what is likely to happen in the future and what their options are whilst also reducing the risk of emergency admissions.”

Patients with pleural disease can have a long-term catheter inserted to drain fluid off at home or have a pleurodesis procedure, which involves placing a mineral powder into the space between the lung and the chest wall to help prevent the re-accumulation of fluid.