Missed opportunity? Worsening breathlessness as a harbinger of death: a cohort study

Currow, David C.; Smith, Joanna M.; Chansriwong, Phichai; Noble, Simon I.R.; Nikolaidou, Theodora; Ferreira, Diana; Johnson, Miriam J.; Ekström, Magnus

Abstract

Introduction: To explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients.

Methods: Prospective, consecutive cohort with point-of-care data of patients of Silver Chain Hospice Care 2011–2014 (n=4638; 51,494 data points). Breathlessness intensity (0–10 Numerical Rating Scale (NRS)) and physical function (Australia-modified Karnofsky Performance Scale (AKPS)) were measured each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression.

Results: Mean age was 71.5 (sd 15.1) years; 55.2% males; most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardio-respiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p

Citation

Currow, D. C., Smith, J. M., Chansriwong, P., Noble, S. I., Nikolaidou, T., Ferreira, D., Johnson, M. J., & Ekström, M. (2018). Missed opportunity? Worsening breathlessness as a harbinger of death: a cohort study. European respiratory journal, 52(3), Article 1800684. https://doi.org/10.1183/13993003.00684-2018

• Journal Article Type: Article
• Acceptance Date: Jul 12, 2018
• Online Publication Date: Jul 26, 2018
• Publication Date: Sep 6, 2018
• Deposit Date: Aug 9, 2018
• Publicly Available Date: Jan 27, 2020
• Journal: European Respiratory Journal
• Print ISSN: 0903-1936
• Electronic ISSN: 1399-3003
• Publisher: European Respiratory Society
• Peer Reviewed: Peer Reviewed
• Volume: 52
• Issue: 3
• Article Number: 1800684
• DOI: https://doi.org/10.1183/13993003.00684-2018
• Keywords: Pulmonary and Respiratory Medicine
• Public URL: https://hull-repository.worktribe.com/output/973795
• Publisher URL: http://erj.ersjournals.com/content/52/3/1800684
• Contract Date: Aug 9, 2018