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

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. Electronic supplementary material The online version of this article (10.1186/s12890-019-0851-5) contains supplementary material, which is available to authorized users.

Indications and patterns of use of benzodiazepines and opioids in severe interstitial lung disease: a population-based longitudinal study

“…In line with the present findings, opioids are also rarely prescribed for breathlessness in COPD in Sweden, where the incidence of opioids was only 4% in the last six months of life [21]. Similar findings were seen in in COPD patients at a hospital in France where, despite having chronic breathlessness, none of the included patients received opioids [23].…”

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“…published the findings of their COPD cohort study showing a chronic breathlessness syndrome (disabling [modified Medical Research Council scale 3 or 4 breathlessness] on optimal inhaled therapy) prevalence of 50%. [ 36 ] Few of these patients had evidence that their chronic breathlessness was being managed, consistent with our findings. The impact of changed clinical attitudes when a syndrome gains an evidenced-based standard of care, along with sufficient resources, can be seen from the field of stroke medicine.…”

The Combination of Upper Limb Exercise and Respiratory Muscle Stretch Gymnastics on Dyspnea Among COPD Patients

“…COPD patients also have respiratory muscle weakness that is quadriceps muscle associated with exercise capacity, which affects the severity of COPD (Singer et al, 2011). The severity of dyspnea increased the limitations of the airway so that it is associated with an increase in symptoms of anxiety and depression (Carette et al, 2019). Management of COPD, in principle, should encourage patients to increase their physical activity so that dyspnea is treated and validated (Hanania & O' donnell, 2019).…”