Prevalence of Dyspnea
Points to Ponder
- Prevalence ranges from 20 to 60% of all cancer patients.
- Dyspnea is much more prevalent in end stage heart (Anderson 2001) and lung diseases for patients in their final years.
- Many HIV positive patients suffer from dyspnea (owing to comorbid conditions like Pneumocystis Carinii pneumonia, Kaposi’s sarcoma with lung infiltration, tuberculosis etc.)
- Dyspnea tends to become more severe and more frequent toward the end of life (Ripamonti 1999) (Higginson 1989) (Conill 1997).
- Prevalence and intensity increase with lung, pleural and mediastinal involvements in cancer patients (Reuben 1986) (Dudgeon 2001).
- Low functional status (Karnofsky Performance Scale) is associated with an increase in severity and incidence of dyspnea (Reuben 1986) (Chang 2000) (Mercadante 2000).
- Dyspnea is often unreported by patients and unnoticed by healthcare professionals (Roberts 1993) (Kutner 2001).
Evidence of Dyspnea by Disease |
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Author |
Setting |
Patients# |
Prevalence |
Comments |
| Ripamonti | Medline Search 1966-1999 | — | 21-79% | 10-63% moderate-severe increase frequency and severity when close to death, different causes may coexist. |
| Higginson | Community | 86 | 21% | became the most severe symptom at death |
| Reuben | National hospice study | 1754 | 50% | Incidence 70%, significantly associated with lung & pleura tumor involvement, lowKarnofsky Performance Scale, and underlying lung disease. Lung, colorectal, and breast carcinomas are the most common tumor sites. |
| Grond | Pain clinic | 1635 | 24% | Pain plus 3.3 symptoms on average. |
| Muers | Specialist clinic | 289 | 60% | NSCLC, symptom worsened with time. |
| Donnelly | Palliative care consult | 1000 | 28% | Advanced cancers, moderate to severe in 63%. |
| Chang | VA In/outpatients | 240 | 50% | Median # of symptoms 8, # of intense symptoms increased as Karnofsky Performance Scale decreased. Disease free patients may still experience intense symptoms. |
| Dudgeon | Outpatient | 923 | 46% | General cancer, 4% lung cancer, 5.4% lung mets. |
| Potter | Palliative care referral | 400 | 31% | 95% of patients were with cancer. |
| Conill | Home and inpatients | 176 | 40% | Increased to 46% in the last week of life. |
| Bruera | Pain clinic | 135 | 55%* | Lung involvement and anxiety were independently correlated with intensity of dyspnea. (* Moderate). |
| Edmonds | Post bereavement interview | 449 | 78% | Lung cancer. |
| Claessens | Five academic centers | 939 | 32%* | NSCLC (* Severe). |
| COPD | ||||
| Edmonds | Post bereavement interview | 87 | 94% | Chronic lung disease, dyspnea increased in final year and final weeks. |
| Claessens | Five academic centers | 1008 | 56% * | COPD (* Severe). |
| CHF | ||||
| Nordgren | Review of hospitalized | 80 | men 90%, women 86% | Last 6 months of life CHF patients. |
| HIV/AIDS | ||||
| Fantoni | Inpatient and outpatients | 266 | 68% | Last 3 months of life. |
| Diaz | Academic medical center | 327 | 41% | Positive HIV without AIDS. |
| General Home Hospice Population | ||||
| Syrett | St. Christopher’s home | 470 | 43% | Home hospice audit. |
| Elderly Population | ||||
| Ho | General patients at home | 500 | 32% | Community-based study in South Wales. |
