A simple assessment of dyspnoea as a prognostic indicator in idiopathic pulmonary fibrosis

Abstract

The prognosis in idiopathic pulmonary fibrosis (IPF) is poor. No therapy has been shown to prolong survival. The objective of this study was to examine the prognostic significance of dyspnoea in daily living at baseline in IPF using a simple assessment tool.93 consecutive patients with IPF, who had undergone evaluation at diagnosis, were included. The level of dyspnoea was assessed using the modified Medical Research Council (MRC) scale. The relationship between data at baseline and survival was examined.A univariate Cox proportional-hazard model showed that forced vital capacity % predicted (hazard ratio (HR) 0.965, 95% CI 0.948-0.982; p,0.0001), diffusing capacity of the lung for carbon monoxide % predicted (HR 0.978, 95% CI 0.963-0.993; p50.0041), baseline arterial oxygen tension (HR 0.963, 95% CI 0.938-0.989; p50.0060) and modified MRC score (HR 2.402, 95% CI 1.495-3.858; p50.0003) were significantly predictive of survival. All variables of the 6-min walk test, including walk distance (HR 0.995, 95% CI 0.992-0.998; p50.0020), the lowest arterial oxygen saturation measured by pulse oximetry (Sp,O 2 ) (HR 0.944, 95% CI 0.918-0.972; p,0.0001) and the Borg scale (HR 1.285, 95% CI 1.091-1.514; p50.0027), were also significant. With stepwise, multivariate Cox proportional analysis, the modified MRC score (HR 2.181, 95% CI 1.333-3.568; p50.0019) and the lowest Sp,O 2 during the 6-min walk test (HR 0.952, 95% CI 0.924-0.981; p50.0014) were the most significant. Dyspnoea in daily living, assessed with the modified MRC scale at baseline, provides additional prognostic information for patients with IPF.

Dyspnoea: a prognostic marker for idiopathic pulmonary fibrosis

“…This feature has inadvertently not been considered by NISHIYAMA et al [1] while prognosticating regarding patients with IPF, and has possibly led to inaccurate disease assessment. Serial evaluation of dyspnoea could have solved this issue and strengthened its prognostic role, but was not carried out during the study.…”

“…Mohapatra, in which they commented on our article demonstrating the relationship between daily dyspnoea and survival in idiopathic pulmonary fibrosis (IPF) [1].…”

“…NISHIYAMA et al [1] have nicely evaluated the role of dyspnoea in daily life as an independent prognostic marker in idiopathic pulmonary fibrosis (IPF). However, a few patient-and diseaserelated confounding factors should be kept in mind while evaluating this distressing symptom.…”

Salivary diurnal cortisol profiles in patients suffering from chronic breathlessness receiving supportive and palliative care services: A cross-sectional study

“…For example, it has been shown to be related to both disease-specific and generic health-related quality of life in COPD patients (Hajiro et al, 1999), and has been shown to be a significant predictor of survival in both COPD (Nishimura et al, 2002) and idiopathic pulmonary fibrosis (Nishiyama et al, 2010), independent of lung function. It was also shown to be a significant predictor of 2-year and 10-year mortality in a population study of elderly community-dwelling adults, independent of age, gender and underlying cardiorespiratory disease (Ahmed et al, 2012).…”

“…It is a considerable source of psychosocial and physical stress, being associated with fear, anxiety, social isolation and functional disability (Booth et al, 2003). It has also been shown to predict mortality, independent of lung function, in a range of conditions, including COPD (Nishimura et al, 2002), pulmonary fibrosis (Nishiyama et al, 2010), and older adulthood (Ahmed et al, 2012). These effects suggest a potential role for the stress hormone system in the experience of breathlessness.…”