- Modules
Dyspnea:
How to Assess and Palliate Dyspnea (Air-Hunger)
Prevalence of Dyspnea
Points to Ponder
Prevalence ranges from 20 to 60% of all cancer patients.
Dyspnea is much more prevalent in end stage heart (Anderson
2001 ) and lung diseases for patients in their final years.
Many HIV positive patients suffer from dyspnea (owing to comorbid conditions
like Pneumocystis Carinii pneumonia, Kaposi's sarcoma with lung infiltration,
tuberculosis etc.)
Dyspnea tends to become more severe and more frequent toward the end of
life (Ripamonti 1999 ) (Higginson
1989 ) (Conill 1997 ).
Prevalence and intensity increase with lung, pleural and mediastinal involvements
in cancer patients (Reuben 1986 ) (Dudgeon
2001 ).
Low functional status (Karnofsky
Performance Scale ) is associated with an increase in severity and incidence
of dyspnea (Reuben 1986 ) (Chang
2000 ) (Mercadante 2000 ).
Dyspnea is often unreported by patients and unnoticed by healthcare professionals
(Roberts 1993 ) (Kutner
2001 ).
Evidence of Dyspnea by Disease
Author
Setting
Patients#
Prevalence
Comments
Ripamonti Medline Search 1966-1999
--
21-79%
10-63% moderate-severe increase frequency and severity when close
to death, different causes may coexist.
Higginson Community
86
21%
became the most severe symptom at death
Reuben National hospice study
1754
50%
Incidence 70%, significantly associated with lung & pleura tumor involvement,
low Karnofsky
Performance Scale , and underlying lung disease. Lung, colorectal, and breast carcinomas
are the most common tumor sites.
Grond Pain clinic
1635
24%
Pain plus 3.3 symptoms on average.
Muers Specialist clinic
289
60%
NSCLC, symptom worsened with time.
Donnelly Palliative care consult
1000
28%
Advanced cancers, moderate to severe in 63%.
Chang VA In/outpatients
240
50%
Median # of symptoms 8, # of intense symptoms increased as Karnofsky
Performance Scale decreased.
Disease free patients may still experience intense symptoms.
Dudgeon Outpatient
923
46%
General cancer, 4% lung cancer, 5.4% lung mets.
Potter Palliative care referral
400
31%
95% of patients were with cancer.
Conill Home and inpatients
176
40%
Increased to 46% in the last week of life.
Bruera Pain clinic
135
55%*
Lung involvement and anxiety were independently correlated with intensity
of dyspnea. (* Moderate).
Edmonds Post bereavement interview
449
78%
Lung cancer.
Claessens Five academic centers
939
32%*
NSCLC (* Severe).
COPD
Edmonds Post bereavement interview
87
94%
Chronic lung disease, dyspnea increased in final year and final weeks.
Claessens Five academic centers
1008
56% *
COPD (* Severe).
CHF
Nordgren Review of hospitalized
80
men 90%, women 86%
Last 6 months of life CHF patients.
HIV/AIDS
Fantoni Inpatient and outpatients
266
68%
Last 3 months of life.
Diaz Academic medical center
327
41%
Positive HIV without AIDS.
General Home Hospice Population
Syrett St. Christopher’s home
470
43%
Home hospice audit.
Elderly Population
Ho General patients at home
500
32%
Community-based study in South Wales.
Top
©End
of Life Curriculum Project , a joint project of the US Veterans Administration
and SUMMIT,
Stanford University Medical School . Veterans
Administration Nationwide Palliative Care Network by
the National Library of Medicine. VJ Periyakoil, MD, Director.
