title: Persistent disabling breathlessness in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To determine the prevalence, change in breathlessness status over time, and risk factors for disabling and persistent disabling breathlessness in relation to treatments in chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Longitudinal analysis of data from the Swedish National Register of COPD with breathlessness measured using modified Medical Research Council (mMRC) scores at two subsequent visits. Prevalence of disabling breathlessness (mMRC ≥2 at baseline) and persistent disabling breathlessness (disabling breathlessness at baseline and follow-up) was investigated in relation to COPD treatment. Risk factors for disabling breathlessness, change from non-disabling to disabling breathlessness, and persistent disabling breathlessness were analyzed using multiple logistic regression.
  
  
  RESULTS
  A total of 1,689 patients were included in the study with a median follow-up of 12 months (interquartile range: 4 months). Prevalence of disabling breathlessness was 54% at baseline. Persistent disabling breathlessness was present in 43% of patients despite treatment and in 74% of patients despite combined inhaled triple therapy and physiotherapy. Risk factors for disabling breathlessness or change to disabling breathlessness were higher age, lower lung function, frequent exacerbations, obesity, heart failure, depression, and hypoxic respiratory failure (allP<0.05). Persistent disabling breathlessness was associated with lower lung function and ischemic heart disease (allP<0.05).
  
  
  CONCLUSIONS
  Disabling breathlessness is common in COPD despite treatment, which calls for improved symptomatic treatments and consideration of factors influencing disabling breathlessness. Factors influencing disabling breathlessness should be considered for COPD management.
authors.affiliation: Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Josefin
authors.initials: J
authors.lastname: Sundh
authors.affiliation: Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Ekström
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: COPD; breathlessness; dyspnea; longitudinal analysis; risk factors; treatment