Missed opportunity? Worsening breathlessness as a harbinger of death : A cohort study

The aim of the study was to explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients. A prospective, consecutive cohort study obtained point-of-care data of patients of Silver Chain Hospice Care Service (Perth, Australia) over the period 2011–2014 (n=6801; 51494 data-points). Breathlessness intensity (0–10 numerical rating scale) and physical function (Australia-modified Karnofsky Performance Status (AKPS)) were measured at each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression. Mean±SD age was 71.5±15.1 years and 55.2% were male, most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardiorespiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p<0.0001). Breathlessness is more intense and increases more in people with better function and cardiorespiratory disease immediately before death. Whether there are reversible causes for these people should be explored prospectively. Omitting function from previous population estimates may have overestimated breathlessness intensity for many patients in the days preceding death.

Smith, Joanna M.Silver Chain Group, Perth (author)
Chansriwong, PhichaiMahidol University (author)
Noble, Simon I.R.Cardiff University (author)
Nikolaidou, TheodoraUniversity of Hull (author)
Ferreira, DianaFlinders University (author)
Johnson, Miriam J.University of Hull (author)
Ekström, MagnusLund University,Lunds universitet,Lungmedicin, allergologi och palliativ medicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Andfåddhet och kronisk andningssvikt,Forskargrupper vid Lunds universitet,Respiratory Medicine, Allergology, and Palliative Medicine,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Breathlessness and chronic respiratory failure,Lund University Research Groups,University of Technology Sydney(Swepub:lu)med-mue (author)
University of HullUniversity of Technology Sydney (creator_code:org_t)

In:European Respiratory Journal: European Respiratory Society (ERS)52:30903-19361399-3003

By the author/editor: Currow, David C.; Smith, Joanna M.; Chansriwong, Phi ...; Noble, Simon I.R ...; Nikolaidou, Theo ...; Ferreira, Diana; show more...; Johnson, Miriam ...; Ekström, Magnus; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Respiratory Medi ...

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