Should we measure dyspnoea in everyone?

Abstract

The paper by Nielsen et al in this journal reports the prevalence of dyspnea in 15 countries throughout the world as 27%. Dyspnea is a powerfully aversive sensation frequently overlooked despite its prevalence and the severity of distress it causes. Despite its ‘subjective’ nature, dyspnea is a powerful predictor of morbidity and mortality. We suggest that this is because the information provided by enteroceptors is so rich that it is as valuable as the more precise but relatively sparse information provided by clinical tests. Relatively simple measures of dyspnea, such as the Medical Research Council Breathlessness Scale used by Nielsen et al, can provide meaningful information at very little cost.

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

“…6) It is also a factor in the low adherence to exercise training programmes in sedentary adults and in patients with COPD. 7) The effective management of exertional dyspnoea remains a major challenge for caregivers and modern treatment strategies that are based on attempts to reverse the underlying chronic condition are only partially successful [1][2][3][4][5][6][7].…”

“…6) It is also a factor in the low adherence to exercise training programmes in sedentary adults and in patients with COPD. 7) The effective management of exertional dyspnoea remains a major challenge for caregivers and modern treatment strategies that are based on attempts to reverse the underlying chronic condition are only partially successful [1][2][3][4][5][6][7].The perception of dyspnoea involves the integration of afferent and efferent inputs at a cortical level and is modulated by affective, emotional and behavioural components. The recent statements of the American Thoracic Society (ATS) [8] and European Respiratory Society [1] have underlined the multidimensional nature of dyspnoea which comprises three major dimensions: 1) the sensory-perceptual domain, 2) the affective distress and 3) the symptom impact or burden.…”

What's trending in breathlessness research? Proceedings from the 8th Annual Meeting of the Breathlessness Research Interest Group

“…20 Professor Banzett discussed the important evidence that dyspnoea is a better predictor of mortality and other adverse effects than FEV1 or other objective data. 21,22 He described a pilot study in the USA involving nurses in a large teaching hospital in Boston recording dyspnoea in conjunction with the traditional vital signs. Efforts are being made to improve the methods used to measure dyspnoea and determine the ideal frequency of measurement.…”

Should we use gait speed in COPD, FEV1in frailty and dyspnoea in both?

“…Of note, dyspnoea spontaneous self-report is reduced and qualitatively modified in older aged [63,64] in a manner similar to pain [65,66]. This has two clinical consequences: 1) a spontaneous complaint of dyspnoea in older aged adults should represent as an important alert and be considered carefully; and 2) dyspnoea should probably be sought proactively and in a systematic manner by all caregivers dealing with older aged adults [67]. This could have positive impacts beyond symptom management, by improving the identification of both specific diseases and frailty.…”