Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

Abstract

Background: Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. Methods: Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. Results: The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]). Conclusion: Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.

Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study

“…"How often do you become short of breath while awake?"). Greater prevalence of multimorbidities 10 and polypharmacy, 28 reduced physical fitness 3 and decreased efficiency of the respiratory system 11 make older adults more susceptible to dyspnea, which corroborate the increasing prevalence of dyspnea among older age ranges.…”

“…A cross-sectional study conducted in Brazil also showed that community-dwelling older adults with dyspnea, assessed using the modified Medical Research Council Dyspnea Scale, had more diseases than those without this symptom. 4 Regarding polypharmacy, Akgün et al 28 observed that it was strongly related to dyspnea (as measured on a shortness-of-breath scale from 0 to 10 scale within the Edmonton Symptom Assessment System) among older adults with serious life-limiting diseases. After adjusting for different factors (age, sex, diagnosis and statin discontinuation), each additional medication was associated with 8% and 16% increased risk of mild and moderate-to-severe dyspnea, respectively.…”

Factors related to adherence to drug treatment in public university workers

“…Evidencia-se a frequência, na rotina terapêutica de indivíduos com doenças crônicas, do regime terapêutico de alta complexidade, envolvendo a classe das estatinas, que por si só, apresentam como efeito adverso sensação de dificuldade para respirar (11) . Ainda, encontrou-se em estudo longitudinal, do tipo ensaio clínico, relação entre regime terapêutico de alta complexidade e dispneia, no qual cada medicamento adicional foi associado à frequência aumentada de ris-co de 8,0% e 16,0% para dispneia leve e moderada--grave, respectivamente (12) , podendo ser hipóteses que expliquem a relação entre adesão medicamentosa e dispneia encontrada no presente estudo.…”

Patients’ self-reported overall wellbeing correlates with concurrent reported symptoms: analysis of the Edmonton Symptom Assessment System

“…Symptom and wellbeing scores were stratified into four categories of no symptom or best wellbeing (0), mild (1-3), moderate (4-6) and severe symptom or worst wellbeing (7-10) consistent with other studies. 8,9,11,16,[18][19][20][21][22][23][24][25][26]30,36,39,40,54,55 We calculated the ESAS physical (ESAS-PHY, range: 0-60) symptom distress score by adding the individual scores from each of the six physical symptoms. Similarly, the individual scores from the two psychological symptoms were also summed to generate the ESAS psychological (ESAS-PSY, range: 0-20) symptom distress score.…”

“…Stacked bar chart of prevalence and severity of ESAS symptoms, ESAS-PHY and ESAS-PSY from patient responses. ESAS symptom scores are stratified as none (0), mild (1-3), moderate (4-6) and severe (7-10).ESAS-PHY scores are stratified as low (0-5), mild(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), moderate(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) and severe(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)…”