Prevalence and assessment of breathlessness in the clinical setting

Abstract

Breathlessness is a common symptom in the general population and a frequent reason for presentation in all healthcare settings. It causes serious functional limitations, distress for both patient and carer, and predicts poor clinical outcomes. Traditionally, clinical care focuses on investigation, diagnosis and treatment of the conditions causing breathlessness. Breathlessness itself is often not seen as a target for therapeutic interventions by either clinician or patient, and so breathlessness which persists despite optimum treatment of the condition is self-managed by the patient without medical help. There are evidence based interventions which benefit breathlessness, irrespective of its cause; systematic assessment should lead to individually tailored management plans. A simple measure of severity (intensity) and assessment of bother or distress caused by breathlessness in addition to the impact on quality of life should be routinely sought in a proactive manner so that appropriate management plans can be put in place.

Keywords::

• assessment
• breathlessness
• dyspnea
• palliation
• prevalence

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Breathlessness is common in the general population and in all healthcare settings.

• Breathlessness is a distressing symptom that greatly and progressively restricts activity, performance status and ability to maintain independent home living.

• It is a predictor of poor health outcomes such as attendance at the emergency department, hospital admission and death.

• If we only target the underlying pathology, the opportunity to treat the symptom is missed.

• Refractory breathlessness requires an approach to assessment that is directed at breathlessness as a clinical symptom that affects all domains of the patient's daily experience.

• As this symptom is so prevalent and has far-reaching effects on patients, their carers and the healthcare service, assessment of breathlessness should be ‘proactively seeking’ and systematically embedded in daily clinical practice.

• Such systematic assessment should include at least a simple measure of intensity and some assessment of its impact on the individual concerned.

• Breathlessness should be signaled as a therapeutic target to clinicians and patients.

• Management of breathlessness should include complex interventions directed at the symptom as well as treatments of the underlying condition.

Notes