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Published on: June 16, 2020
Frequency and characteristics of refractory dyspnea in idiopathic fibrosing interstitial pneumonia
Nathalie Bautin1, Juliette Ferlin2, Gaelle Terce3
1Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France.
Abstract:
Patients with idiopathic fibrosing interstitial pneumonias (f-IIPs) mainly suffer from dyspnea. Refractory dyspnea, defined as persistent dyspnea despite optimal treatment, could be the signal to prescribe dyspnea relievers. We aimed to examine the prevalence and characteristics of refractory dyspnea in consecutive patients with f-IIPs. Refractory dyspnea was defined by an mMRC≥3 and also by a VAS dyspnea score≥2 at rest. The sensory and affective characteristics of refractory dyspnea (mMRC≥3) and associated quality of life (QoL) anxiety and depression were compared with non-refractory dyspnea (mMRC1-2) using the Multidimensional Dyspnea Profile (MDP), King's Brief Interstitial Lung Disease (KBILD) and Hospital Anxiety and Depression scale (HADs). We included 40 patients (24 men), aged 72 [68-79], FVC of 71 % [59-86] and DLCO 47 % [40-49]. Refractory dyspnea, was found in 38 % (95%CI:23-54) when defined by mMRC≥3 and in 67 % (95%CI:50-81) using a resting VAS dyspnea score ≥2. The agreement between the two definitions was low. Patients with refractory dyspnea (mMRC≥3) were more often women (60 % vs.28 %, p = 0.046), had a lower DLCO (24 % [22-43] vs.47 % [43-51], p = 0.014) and more frequently used oxygen (60 % vs.12 %, p = 0.003); they experience more intense air hunger (5/10 [3-6] vs.2/10 [0-5], p = 0.018)). No significant differences were observed in VAS, MDP, KBILD, or HADs scores between refractory and non-refractory dyspnea patients. Our results indicate a significant frequency of refractory dyspnea in patients with f-IIPs and an association with air hunger but no impact on the affective dimension of dyspnea, anxiety, depression and QoL, suggesting that the mMRC score might not accurately identify patients distressed by their breathlessness.
Insights
Refractory dyspnea, persistent breathlessness in idiopathic fibrosing interstitial pneumonias (f-IIPs), affects 38% of patients. While linked to air hunger, it doesn't impact quality of life, anxiety, or depression, suggesting current measures may be insufficient.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Research
Background:
- Idiopathic fibrosing interstitial pneumonias (f-IIPs) are characterized by progressive lung scarring.
- Dyspnea is a primary symptom, significantly impacting patient quality of life.
- Refractory dyspnea, persisting despite treatment, necessitates further investigation for effective management.
Purpose of the Study:
- To determine the prevalence and characteristics of refractory dyspnea in patients with f-IIPs.
- To compare sensory and affective dimensions of dyspnea, quality of life, anxiety, and depression between refractory and non-refractory groups.
- To evaluate the utility of different definitions for refractory dyspnea.
Main Methods:
- Consecutive patients with f-IIPs were assessed for refractory dyspnea using modified Medical Research Council (mMRC) scale (≥3) and visual analog scale (VAS) (≥2 at rest).
- Multidimensional Dyspnea Profile (MDP), King's Brief Interstitial Lung Disease (KBILD), and Hospital Anxiety and Depression Scale (HADs) were used for comprehensive assessment.
- Statistical analyses compared characteristics between refractory (mMRC≥3) and non-refractory (mMRC 1-2) dyspnea groups.
Main Results:
- Refractory dyspnea prevalence was 38% (mMRC≥3) and 67% (VAS≥2), with low agreement between definitions.
- Patients with refractory dyspnea (mMRC≥3) were more often female, had lower DLCO, and higher oxygen use.
- Refractory dyspnea correlated with increased air hunger but showed no significant differences in VAS, MDP, KBILD, or HADs scores compared to non-refractory dyspnea.
Conclusions:
- A significant proportion of f-IIPs patients experience refractory dyspnea.
- The mMRC scale may not fully capture the distress associated with breathlessness in f-IIPs patients.
- Further research is needed to refine the definition and management of refractory dyspnea in interstitial lung diseases.
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