A Multidimensional Profile of Dyspnea in Hospitalized Patients

Abstract

Background: Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital.

Methods: We selected patients who reported breathing discomfort of at least 4/10 on admission (10 = unbearable). Research staff recruited 156 patients within 24 hours of admission and evaluated daily patients' current and worst dyspnea with the Multidimensional Dyspnea Profile; patients participated in the study 2.6 days on average. The Multidimensional Dyspnea Profile assesses overall breathing discomfort (A₁), intensity of five sensory qualities of dyspnea, and 5 negative emotional responses to dyspnea. Patients were also asked to rate whether current levels of dyspnea were "acceptable."

Results: At the time of the first research interview, patients reported slight to moderate dyspnea (A₁ median 4); however, most patients reported experiencing severe dyspnea in the 24 hours before the interview (A₁ mean 7.8). A total of 54% of patients with dyspnea ≥4 on day 1 found the symptom unacceptable. The worst dyspnea each day in the prior 24 hours usually occurred at rest. Dyspnea declined but persisted through hospitalization for most patients. "Air hunger" was the dominant sensation, especially when dyspnea was strong (>4). Anxiety and frustration were the dominant emotions associated with dyspnea.

Conclusions: This first multidimensional portrait of dyspnea in a general inpatient population characterizes the sensations and emotions dyspneic patients endure. The finding that air hunger is the dominant sensation of severe dyspnea has implications for design of laboratory models of these sensations and may have implications for targets of palliation of symptoms.

Keywords: dyspnea; hospitalized patients; inpatients; symptoms.

Figure 1

Multidimensional profile of 129 subjects describing breathing discomfort associated with their highest A₁ rating on study day 1; either their dyspnea in the past 24 hours or their current dyspnea, whichever was worst. Columns depict mean ± standard error. Each patient contributed one MDP; thus, patients are given equal weight, and this is a cross-sectional comparison. A, A₁ rating of 8.0 to 10.0 was classed as severe dyspnea (82/129 subjects). B, An A₁ rating of 4.0 to 7.9 was classed as moderate dyspnea (47/129 subjects). Five additional patients provided a completed ‘worst’ dyspnea profile for this day, but rated A₁ < 4. The remainder of patients (23) did not provide a full profile on the initial day. A₁ = overall breathing discomfort; A₂ = emotional responses to dyspnea; MDP = Multidimensional Dyspnea Profile; SQ = sensory quality.

Figure 2

Progression of dyspnea with time for patients with two consecutive study days. Sixty-four patients provided full MDP data for “worst breathing discomfort in past day” on both study days 1 and 2. A, The average profile of these patients on study day 1 and (B) the profile of the same patients on study day 2. Mean A₁ fell from 8.1 to 5.8, and all ratings fell, but not equally; air hunger became clearly less prominent at lower dyspnea levels. It is notable that these profile differences for high and moderate A₁ within-group are very similar to those in the across-groups comparison shown in Figure 1. See Figure 1 legend for expansion of abbreviations.

Figure 3

Profile of all 460 subject responses across all study days when asked to choose the sensory quality that most accurately describes their worst dyspnea in the past 24 hours. Subjects who remained in hospital longer contributed more data; thus, this graph would represent prevalence in the hospital on any day, not prevalence among individuals (as presented in Fig 1). On the x-axis, half ratings for A₁ are rounded down and are included in the appropriate cluster (ie, an A₁ rating of 5.5 will be included in the 4-5 grouping). There are 22 study days in the A₁ = 2-3 group, 53 study days in the A₁ = 4-5 group, 118 study days in the A₁ = 6-8 group, and 81 subjects study days in the A₁ = 9-10 group. See Figure 1 legend for expansion of abbreviation.

Figure 4

Plot of acceptability of breathing discomfort vs current A₁ rating on study day 1 (n = 137 participants who provided data on acceptability). See Figure 1 legend for expansion of abbreviation.