Chronic breathlessness: symptom or syndrome?

Abstract

@ERSpublications Chronic breathlessness needs more attention than it presently receives

Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic

“…He also makes a very convincing case for the importance of empowerment in the management of dyspnoea. Still in the same issue of the ERJ, CALVERLEY [9] comments on the new syndrome and, like us, concurs with JOHNSON et al [1] about the relevance of making breathlessness a foremost concern of every clinician.…”

Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic

“…In order to contribute to the discussion called for in the article by JOHNSON et al [1], we (a French speaking group of physicians with a special interest in dyspnoea) would like to make a few comments about this article and the accompanying Editorial by CALVERLEY [9]. These comments mostly pertain to the choice of words that has been made to name the new syndrome.…”

“…Our third comment pertains to the choice of the term "syndrome" itself. In his Editorial, CALVERLEY [9] challenges this choice and seems to suggest that "syndrome" should only be used to identify "consistent groups of patients" with a "likely primary condition". Another reason to challenge the term "syndrome" is related to its very definition as "a group of signs and symptoms that occur together and characterise a particular abnormality or condition" (https://www.merriam-webster.com/dictionary/syndrome).…”

“…It suggests that all respiratory physicians (and beyond that, all physicians caring for patients with dyspnogenic diseases, and there are many of them) should be familiar with the principles of dyspnoea management in addition to the management of the underlying disease (of note, this is explicitly stated in the 2017 edition of the GOLD statement, which indicates that "all clinicians managing patients with COPD should be aware of the effectiveness of palliative approaches to symptom control and use these in their practice" (see table 4.9 in [10])). Using "symptom" instead of "syndrome" (or omitting "syndrome"), as suggested by CALVERLEY [9], would carry the risk of neglecting the multidimensional and pervasive nature of dyspnoea [11][12][13][14][15]. The process initiated by JOHNSON et al [1] is designed to convince caregivers, and others, that the care of dyspnoea cannot be limited to the treatment of the symptom, but should address its behavioural and socio-psychological consequences.…”

“…With this in mind, we are afraid that "chronic breathlessness syndrome" could be a misnomer because it would "miss" many "non-chronic" but nonetheless clinically relevant situations. JOHNSON et al [1] and CALVERLEY [9] briefly refer to this issue, but perhaps do not attribute sufficient importance to what could possibly be seen as a major gap by many practitioners. The name "persistent breathlessness" would have avoided this problem, because it would have covered all acute and chronic situations.…”