Abstract
BackgroundBreathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort.MethodsA prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management.ResultsSixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness.ConclusionTreatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.
Highlights
Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD)
Chronic breathlessness is defined as severe breathlessness (modified Medical Research Council dyspnea scale ≥3) that persists despite optimal treatment of the underlying pathology, resulting in disability [2, 3], which is very similar to refractory breathlessness [4]
Since this cohort was performed in a tertiary care hospital and to have a wider view, we investigated the knowledge and beliefs of pulmonologists, working in the same region, regarding the management of severe breathlessness with a special interest in the use of opioids and pulmonary rehabilitation for COPD patients
Summary
Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort. Breathlessness is the first reported symptomin patients with chronic obstructive pulmonary disease (COPD) [1]. Chronic breathlessness is defined as severe breathlessness (modified Medical Research Council dyspnea (mMRC) scale ≥3) that persists despite optimal treatment of the underlying pathology, resulting in disability [2, 3], which is very similar to refractory breathlessness [4]. There is an important reluctance to prescribe this treatment [11,12,13]
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