Missed opportunity? Worsening breathlessness as a harbinger of death: A cohort study

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Missed opportunity? Worsening breathlessness as a harbinger of death : A cohort study. / Currow, David C.; Smith, Joanna M.; Chansriwong, Phichai; Noble, Simon I.R.; Nikolaidou, Theodora; Ferreira, Diana; Johnson, Miriam J.; Ekström, Magnus.

In: European Respiratory Journal, Vol. 52, No. 3, 1800684, 2018.

Research output: Contribution to journalArticle

Harvard

Currow, DC, Smith, JM, Chansriwong, P, Noble, SIR, Nikolaidou, T, Ferreira, D, Johnson, MJ & Ekström, M 2018, 'Missed opportunity? Worsening breathlessness as a harbinger of death: A cohort study', European Respiratory Journal, vol. 52, no. 3, 1800684. https://doi.org/10.1183/13993003.00684-2018

APA

Currow, D. C., Smith, J. M., Chansriwong, P., Noble, S. I. R., Nikolaidou, T., Ferreira, D., ... Ekström, M. (2018). Missed opportunity? Worsening breathlessness as a harbinger of death: A cohort study. European Respiratory Journal, 52(3), [1800684]. https://doi.org/10.1183/13993003.00684-2018

CBE

MLA

Vancouver

Currow DC, Smith JM, Chansriwong P, Noble SIR, Nikolaidou T, Ferreira D et al. Missed opportunity? Worsening breathlessness as a harbinger of death: A cohort study. European Respiratory Journal. 2018;52(3). 1800684. https://doi.org/10.1183/13993003.00684-2018

Author

Currow, David C. ; Smith, Joanna M. ; Chansriwong, Phichai ; Noble, Simon I.R. ; Nikolaidou, Theodora ; Ferreira, Diana ; Johnson, Miriam J. ; Ekström, Magnus. / Missed opportunity? Worsening breathlessness as a harbinger of death : A cohort study. In: European Respiratory Journal. 2018 ; Vol. 52, No. 3.

RIS

TY - JOUR

T1 - Missed opportunity? Worsening breathlessness as a harbinger of death

T2 - European Respiratory Journal

AU - Currow, David C.

AU - Smith, Joanna M.

AU - Chansriwong, Phichai

AU - Noble, Simon I.R.

AU - Nikolaidou, Theodora

AU - Ferreira, Diana

AU - Johnson, Miriam J.

AU - Ekström, Magnus

PY - 2018

Y1 - 2018

N2 - The aim of the study was to explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients. A prospective, consecutive cohort study obtained point-of-care data of patients of Silver Chain Hospice Care Service (Perth, Australia) over the period 2011–2014 (n=6801; 51494 data-points). Breathlessness intensity (0–10 numerical rating scale) and physical function (Australia-modified Karnofsky Performance Status (AKPS)) were measured at each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression. Mean±SD age was 71.5±15.1 years and 55.2% were male, most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardiorespiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p<0.0001). Breathlessness is more intense and increases more in people with better function and cardiorespiratory disease immediately before death. Whether there are reversible causes for these people should be explored prospectively. Omitting function from previous population estimates may have overestimated breathlessness intensity for many patients in the days preceding death.

AB - The aim of the study was to explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients. A prospective, consecutive cohort study obtained point-of-care data of patients of Silver Chain Hospice Care Service (Perth, Australia) over the period 2011–2014 (n=6801; 51494 data-points). Breathlessness intensity (0–10 numerical rating scale) and physical function (Australia-modified Karnofsky Performance Status (AKPS)) were measured at each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression. Mean±SD age was 71.5±15.1 years and 55.2% were male, most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardiorespiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p<0.0001). Breathlessness is more intense and increases more in people with better function and cardiorespiratory disease immediately before death. Whether there are reversible causes for these people should be explored prospectively. Omitting function from previous population estimates may have overestimated breathlessness intensity for many patients in the days preceding death.

U2 - 10.1183/13993003.00684-2018

DO - 10.1183/13993003.00684-2018

M3 - Article

VL - 52

JO - European Respiratory Journal

JF - European Respiratory Journal

SN - 1399-3003

IS - 3

M1 - 1800684

ER -