Patient Distress

Patient Distress

Dyspnea exerts negative impact on all domains of a patient’s quality of life. To address these issues, multidimensional scales measuring multiple symptoms including dyspnea have been developed and validated.

Effects of Dyspnea (Breathlessness)

On Physical well being

Fatigue and tiredness correlates with intensity of dyspnea (Bruera 2000)

Decrease in functional status (low Karnofsky Performance Scale) (Reuben, 1986) (Ho 2001).

In patients with symptomatic (advanced) COPD, dyspnea ratings are better predictors of general health status than physiologic measurements (Mahler 1992).

On Emotional well being

Perceived by patients and family as life threatening and anxiety provoking.

Patients with dyspnea are more likely to be anxious and depressed (Ho 2001).

Anxiety correlates with intensity of dyspnea (Bruera 2000).

Other symptoms include depression, anger, helplessness, and loneliness.

Dyspneic patients frequently seek medical care, are hospitalized more often and are at higher risk for dying in a institutional setting (Edmonds 2000)(Dahlen 2002).

On Social well being

Dyspnea rather than lung function correlates highly with disability (Williams 1989).

Dyspnea and decrease functional status prevent patients from activities, and in severe cases, even from eating, bathing and talking.

Many feel hopeless, with strong sense of isolation and dependence.

On Spiritual well being

Data collected from six home palliative care teams in Ireland indicated that the presence of dyspnea at referral was positively correlated with severity of patient spiritual distress (Edmonds 2000).

On Survival

In cancer patients, the presence of dyspnea is a predictor of shorter lengths of survival (Maltoni 1995). Lung cancer patients presenting to the ER with dyspnea have much shorter survival than patients with other malignancies (Escalante 1996).

In study of 227 patients with COPD by Nishimura, the 5-year cumulative survival rate was 73%. More importantly, the intensity of dyspnea had a more significant effect on survival than disease severity based on FEV1 (Nishimura 2002).

The physical symptom subscale score of the Memorial Symptom Assessment Scale (MSAS)significantly predicts survival and adds to the prognostic information provided by theKarnofsky Performance Scale and extent of disease (Chang 1998).

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