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. 2019 May 16;19(1):95.
doi: 10.1186/s12890-019-0851-5.

Prevalence and management of chronic breathlessness in COPD in a tertiary care center

H Carette  1 , M Zysman  2   3 , C Morelot-Panzini  4 , J Perrin  1 , E Gomez  1 , A Guillaumot  1 , P R Burgel  5 , G Deslee  6 , P Surpas  7 , O Le Rouzic  8 , T Perez  8 , A Chaouat  1 , N Roche  5 , F Chabot  1 ; Initiatives BPCO (bronchopneumopathie chronique obstructive) Scientific Committee and Investigators
Collaborators, Affiliations

Prevalence and management of chronic breathlessness in COPD in a tertiary care center

H Carette et al. BMC Pulm Med. .

Abstract

Background: 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. 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.

Methods: A 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.

Results: Sixty 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.

Conclusion: Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.

Keywords: Breathlessness; Chronic obstructive pulmonary disease; Doctors ‘attitude; Opioid.

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Conflict of interest statement

HC reports grants and personal fees from France Oxygène, personal fees from RIRL reseau d’insuffisance respiratoire de Lorraine, outside the submitted work.

MZ reports grants and personal fees from BoehringerIngelheim, personal fees from Novartis, personal fees from Chiesi, personal fees from GSK outside the submitted work.

CMP declares that she have no competing interests.

JP declares that she have no competing interests.

EG declares that she have no competing interests.

AG declares that she have no competing interests.

PRB reports personal fees from Aptalis, personal fees from Astra-Zeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GSK, personal fees from Novartis, personal fees from Pfizer, personal fees from Vertex, personal fees from Zambon, outside the submitted work;

GD reports personal fees from Novartis, personal fees from Astra Zeneca, personal fees from BTG/PneumRx, personal fees from Chiesi, personal fees from Boehringer Ingelheim, outside the submitted work.

PS reports grants and personal fees from Boehringer Ingelheim outside the submitted work.

OLR reports grants and personal fees personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Chiesi, Lilly and Novartis; non-financial support from GlaxoSmithKline, MundiPharma, Pfizer, Teva, Santelys Association, Vertex and Vitalaire, all outside the submitted work.

TP reports personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from GSK, personal fees from Chiesi, personal fees from Pierre Fabre, outside the submitted work.

AC reports grants and personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Actelion, personal fees from GSK outside the submitted work.

NR reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from Teva, personal fees from GSK, personal fees from AstraZeneca, personal fees from Chiesi, personal fees from Mundipharma, personal fees from Cipla, grants and personal fees from Pfizer, personal fees from Sanofi, personal fees from Sandoz, personal fees from 3 M, personal fees from Zambon, outside the submitted work.

FC reports grants and personal fees from AGEVIE, grants from ARAIRLOR, grants from Air Liquide, grants from Breas, grants from Covidien, grants from Philips, grants from Resmed, grants from Respironics, grants from Weinman and personal fees from Astra-Zeneca, personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees from Novartis, outside the submitted work.

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