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. 2016 Nov 9:11:2805-2812.
doi: 10.2147/COPD.S119992. eCollection 2016.

Persistent disabling breathlessness in chronic obstructive pulmonary disease

Josefin Sundh  1 , Magnus Ekström  2
Affiliations

Persistent disabling breathlessness in chronic obstructive pulmonary disease

Josefin Sundh et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Objective: To determine the prevalence, change in breathlessness status over time, and risk factors for disabling and persistent disabling breathlessness in relation to treatments in chronic obstructive pulmonary disease (COPD).

Materials and methods: Longitudinal analysis of data from the Swedish National Register of COPD with breathlessness measured using modified Medical Research Council (mMRC) scores at two subsequent visits. Prevalence of disabling breathlessness (mMRC ≥2 at baseline) and persistent disabling breathlessness (disabling breathlessness at baseline and follow-up) was investigated in relation to COPD treatment. Risk factors for disabling breathlessness, change from non-disabling to disabling breathlessness, and persistent disabling breathlessness were analyzed using multiple logistic regression.

Results: A total of 1,689 patients were included in the study with a median follow-up of 12 months (interquartile range: 4 months). Prevalence of disabling breathlessness was 54% at baseline. Persistent disabling breathlessness was present in 43% of patients despite treatment and in 74% of patients despite combined inhaled triple therapy and physiotherapy. Risk factors for disabling breathlessness or change to disabling breathlessness were higher age, lower lung function, frequent exacerbations, obesity, heart failure, depression, and hypoxic respiratory failure (all P<0.05). Persistent disabling breathlessness was associated with lower lung function and ischemic heart disease (all P<0.05).

Conclusion: Disabling breathlessness is common in COPD despite treatment, which calls for improved symptomatic treatments and consideration of factors influencing disabling breathlessness. Factors influencing disabling breathlessness should be considered for COPD management.

Keywords: COPD; breathlessness; dyspnea; longitudinal analysis; risk factors; treatment.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of mMRC grades in the baseline COPD population. Note: Percentages of patients with different mMRC grades in the baseline population (n=1,689). Abbreviations: COPD, chronic obstructive pulmonary disease; mMRC, modified Medical Research Council.
Figure 2
Figure 2
Change in breathlessness status over time (n=1,689).
Figure 3
Figure 3
Persistent disabling breathlessness (PDB) in treatment groups. Note: Data presented as percentages of PDB in different treatment groups (n=1,689). Abbreviations: LAMA, long-acting muscarinic antagonists; LABA, long-acting beta- 2-agonists; ICS, inhalation corticosteroids; LTOT, long-term oxygen therapy.
Figure 4
Figure 4
Distribution of treatment groups within patients with persistent disabling breathlessness (PDB). Note: Data presented as percentages of patients in different treatment groups with PDB (n=732). Abbreviations: LAMA, long-acting muscarinic antagonists; LABA, long-acting beta-2-agonists; ICS, inhalation corticosteroids; LTOT, long-term oxygen therapy.
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References

    1. Global Initiative for Chronic Obstructive Lung Disease Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. [Accessed June 14, 2016]. Available from: http://www.goldcopd.com. - PubMed
    1. Miravitlles M, Ferrer J, Baro E, Lleonart M, Galera J. Differences between physician and patient in the perception of symptoms and their severity in COPD. Respir Med. 2013;107(12):1977–1985. - PubMed
    1. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93(3):580–586. - PubMed
    1. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–586. - PMC - PubMed
    1. Wilke S, Jones PW, Mullerova H, et al. One-year change in health status and subsequent outcomes in COPD. Thorax. 2015;70(5):420–425. - PubMed

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