title: Characteristics of episodic breathlessness as reported by patients with advanced chronic obstructive pulmonary disease and lung cancer: Results of a descriptive cohort study.
abstract: BACKGROUND
  Episodic breathlessness is one form of refractory breathlessness. Better understanding of the symptom is necessary for effective management.
  
  
  OBJECTIVE
  The aim was to describe the characteristics of episodic breathlessness in patients with advanced chronic obstructive pulmonary disease or lung cancer.
  
  
  METHODS
  This is a longitudinal cohort study. Outcomes were assessed monthly by up to 13 telephone interviews: peak severity (modified Borg scale: 0-10), duration, frequency, and timing of breathlessness episodes. Data from each episode were pooled and analyzed using descriptive statistics. Associations between outcomes were explored by correlation coefficients.
  
  
  METHODS
  Patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease classification stage III or IV) or primary lung cancer (any stage) were recruited in two inpatient units (internal medicine) and two outpatient clinics in Oldenburg, Germany.
  
  
  RESULTS
  A total of 82 patients (50 chronic obstructive pulmonary disease, 32 lung cancer), mean age (standard deviation) 67 years (8 years) and 36% female, were included reporting on 592 breathlessness episodes (chronic obstructive pulmonary disease: 403, lung cancer: 189). Peak severity was perceived significantly higher in chronic obstructive pulmonary disease patients than in lung cancer patients (mean (standard deviation) Borg scale: 6.2 (2.1) vs 4.2 (1.9); p < 0.001). Episodes described by chronic obstructive pulmonary disease patients were longer than those described by lung cancer patients (median (range): 7 min (0-600) vs 5 min (0.3-120), p = 0.002)). Frequency was similar and most often daily in both groups. Severity and frequency of episodes were correlated in lung cancer patients (r = 0.324, p = 0.009).
  
  
  CONCLUSIONS
  Most breathlessness episodes are short (minutes) and severe with significant differences between chronic obstructive pulmonary disease and lung cancer patients. Effective management strategies are warranted to improve symptom relief and coping.
authors: Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany Institute of Palliative Care (ipac) e.V. (BMBF 16KT0951), Oldenburg, Germany.
authors: Vera
authors: V
authors: Weingärtner
authors: Institute of Palliative Care (ipac) e.V. (BMBF 16KT0951), Oldenburg, Germany Department of Palliative Medicine, Protestant Hospital Oldenburg, Oldenburg, Germany.
authors: Christine
authors: C
authors: Scheve
authors: Institute of Palliative Care (ipac) e.V. (BMBF 16KT0951), Oldenburg, Germany.
authors: Verena
authors: V
authors: Gerdes
authors: Department of Palliative Medicine, Protestant Hospital Oldenburg, Oldenburg, Germany.
authors: Michael
authors: M
authors: Schwarz-Eywill
authors: Clinic for Internal Medicine, Pius-Hospital Oldenburg, Oldenburg, Germany.
authors: Regina
authors: R
authors: Prenzel
authors: Oncological Practice Oldenburg, Oldenburg, Germany.
authors: Burkhard
authors: B
authors: Otremba
authors: Department of Palliative Medicine, Protestant Hospital Oldenburg, Oldenburg, Germany.
authors: Juliane
authors: J
authors: Mühlenbrock
authors: Institute of Palliative Care (ipac) e.V. (BMBF 16KT0951), Oldenburg, Germany Department for Palliative Medicine, University Hospital Munich, Munich, Germany.
authors: Claudia
authors: C
authors: Bausewein
authors: Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation-WHO Collaborating Centre for Palliative Care and Older People, King's College London, London, UK.
authors: Irene J
authors: IJ
authors: Higginson
authors: Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany Clinical Trials Unit (BMBF 01KN1106), University Hospital of Cologne, Cologne, Germany Centre for Integrated Oncology (CIO) Köln Bonn, University Hospital of Cologne, Cologne, Germany.
authors: Raymond
authors: R
authors: Voltz
authors: Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University Hospital of Cologne, Cologne, Germany.
authors: Lena
authors: L
authors: Herich
authors: Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany Institute of Palliative Care (ipac) e.V. (BMBF 16KT0951), Oldenburg, Germany Clinical Trials Unit (BMBF 01KN1106), University Hospital of Cologne, Cologne, Germany Centre for Integrated Oncology (CIO) Köln Bonn, University Hospital of Cologne, Cologne, Germany steffen@steffensimon.de.
authors: Steffen T
authors: ST
authors: Simon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012720:Severity of Illness Index
keywords: Chronic obstructive pulmonary disease; cohort studies; dyspnea; episodic breathlessness; lung neoplasms; palliative care