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

David C Currow, Joanna M Smith, Phichai Chansriwong, et al.
Eur Respir J 2018;52:1800684.
doi: 10.1183/13993003.006844-2018

Breathlessness is often considered one of the most frightening symptoms experienced by patients, particularly towards the end of life. Many patients fear suffocation, and severe breathlessness is often associated with a feeling of impending death. In the palliative care population, breathlessness is reported to increase in intensity in the period leading up to death. This study aimed to further explore this association.

Data from 6,801 patients seen by a community palliative care provider in Australia were included. Patient-rated intensity of breathlessness and clinician-rated performance status using a modified Karnofsky Performance Status score from the 21 days prior to death were included in the analysis.

Unsurprisingly, breathlessness was higher at all time points among people with a cardiorespiratory disease compared to those without (who primarily had cancer diagnoses). Proximity to death was also an independent predictor of worsening breathlessness. More intriguingly, breathlessness was also higher among patients with a higher performance status. The greatest increase in breathlessness intensity was seen in patients with a cardiorespiratory disease and higher function level.

In summary, patients with a cardiorespiratory disease and higher performance status were seen to experience a “crescendo in breathlessness” in the 3 weeks prior to their death. The authors however warn that a larger study is needed, including patients admitted to hospital or the emergency department at the end of their life, to have a fuller picture of changes in breathlessness intensity in patients approaching death.

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