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Prevalence and Pharmacologic Treatment of Breathlessness in Severe Chronic Obstructive Pulmonary Disease

Ahmadi, Zainab LU (2019) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2019(58).
Abstract
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.
Aims
•... (More)
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.
Aims
• To evaluate the prevalence of symptoms and their management at the end of life in patients with oxygen-dependent COPD in Sweden, compared to those with cancer (Study I).
• To quantify the reported indications for opioid prescriptions in oxygen-dependent COPD in Sweden (Study II).
• To investigate the efficacy of supplemental oxygen therapy for breathlessness in COPD patients with no or mild hypoxemia (Study III).
• To assess potential recognition and treatment of chronic breathlessness as compared to chronic pain by physicians in Sweden, using a case-based survey (Study IV).
Study Design
Nationwide register-based cohort study of patients with oxygen-dependent COPD recorded in the Swedevox register linked with the Swedish Register of Palliative Care (Study I) and with the Swedish Prescribed Drug Register (Study II). Cochrane systematic review and meta-analysis of the efficacy of supplemental oxygen therapy for breathlessness (Study III). Randomized, controlled, double-blind, parallel-group, web-based trial of Swedish physicians treating a hypothetical patient with COPD and severe breathlessness versus a patient with severe pain (Study IV).
Results and conclusions
At the end of life, breathlessness was three times more common in patients with COPD than in those with cancer (Study I). Opioids were commonly prescribed for pain in oxygen-dependent COPD patients but rarely to treat breathlessness, which represented 2% of the stated indications (Study II). Supplemental oxygen therapy modestly reduced breathlessness during exercise in COPD with no or mild hypoxemia, but there was no evidence of an effect in daily life or on quality of life (Study III). In a case presentation of a COPD patient, severe chronic breathlessness was less likely to be identified by physicians as requiring symptomatic treatment and also less likely to be treated with opioids as compared to a patient with chronic pain (Study IV).
(Less)
Abstract (Swedish)
Background
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.

Aims
• To... (More)
Background
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.

Aims
• To evaluate the prevalence of symptoms and their management at the end of life in patients with oxygen-dependent COPD in Sweden, compared to those with cancer (Study I).
• To quantify the reported indications for opioid prescriptions in oxygen-dependent COPD in Sweden (Study II).
• To investigate the efficacy of supplemental oxygen therapy for breathlessness in COPD patients with no or mild hypoxemia (Study III).
• To assess potential recognition and treatment of chronic breathlessness as compared to chronic pain by physicians in Sweden, using a case-based survey (Study IV).

Study Design
Nationwide register-based cohort study of patients with oxygen-dependent COPD recorded in the Swedevox register linked with the Swedish Register of Palliative Care (Study I) and with the Swedish Prescribed Drug Register (Study II). Cochrane systematic review and meta-analysis of the efficacy of supplemental oxygen therapy for breathlessness (Study III). Randomized, controlled, double-blind, parallel-group, web-based trial of Swedish physicians treating a hypothetical patient with COPD and severe breathlessness versus a patient with severe pain (Study IV).

Results and conclusions
At the end of life, breathlessness was three times more common in patients with COPD than in those with cancer (Study I). Opioids were commonly prescribed for pain in oxygen-dependent COPD patients but rarely to treat breathlessness, which represented 2% of the stated indications (Study II). Supplemental oxygen therapy modestly reduced breathlessness during exercise in COPD with no or mild hypoxemia, but there was no evidence of an effect in daily life or on quality of life (Study III). In a case presentation of a COPD patient, severe chronic breathlessness was less likely to be identified by physicians as requiring symptomatic treatment and also less likely to be treated with opioids as compared to a patient with chronic pain (Study IV). (Less)
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author
supervisor
opponent
  • assistant professor Janssen, Daisy J.A., Maastrichts University Medical Center, Netherlands
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Chronic obstructive pulmonary disease, Breathlessness, Treatment, End of life care, Symptoms, Oxygen, Opioids, Chronic obstructive pulmonary disease, Breathlessness, Treatment, End of life care, Symptoms, Oxygen, Opioids
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2019
issue
58
pages
90 pages
publisher
Lund University: Faculty of Medicine
defense location
Föreläsningssal 3, Centralblocket, Entrégatan 7, Skånes Universitetssjukhus i Lund
defense date
2019-06-07 09:00:00
ISSN
1652-8220
ISBN
978-91-7619-787-5
language
English
LU publication?
yes
id
6b033d9c-4cbf-47bd-8f56-33aaeb9c043f
date added to LUP
2019-05-08 10:45:11
date last changed
2019-11-19 13:49:49
@phdthesis{6b033d9c-4cbf-47bd-8f56-33aaeb9c043f,
  abstract     = {Abstract<br/>Background<br/>Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.<br/>Aims<br/>•	To evaluate the prevalence of symptoms and their management at the end of life in patients with oxygen-dependent COPD in Sweden, compared to those with cancer (Study I).<br/>•	To quantify the reported indications for opioid prescriptions in oxygen-dependent COPD in Sweden (Study II).<br/>•	To investigate the efficacy of supplemental oxygen therapy for breathlessness in COPD patients with no or mild hypoxemia (Study III).<br/>•	To assess potential recognition and treatment of chronic breathlessness as compared to chronic pain by physicians in Sweden, using a case-based survey (Study IV).<br/>Study Design<br/>Nationwide register-based cohort study of patients with oxygen-dependent COPD recorded in the Swedevox register linked with the Swedish Register of Palliative Care (Study I) and with the Swedish Prescribed Drug Register (Study II). Cochrane systematic review and meta-analysis of the efficacy of supplemental oxygen therapy for breathlessness (Study III). Randomized, controlled, double-blind, parallel-group, web-based trial of Swedish physicians treating a hypothetical patient with COPD and severe breathlessness versus a patient with severe pain (Study IV).<br/>Results and conclusions<br/>At the end of life, breathlessness was three times more common in patients with COPD than in those with cancer (Study I). Opioids were commonly prescribed for pain in oxygen-dependent COPD patients but rarely to treat breathlessness, which represented 2% of the stated indications (Study II). Supplemental oxygen therapy modestly reduced breathlessness during exercise in COPD with no or mild hypoxemia, but there was no evidence of an effect in daily life or on quality of life (Study III). In a case presentation of a COPD patient, severe chronic breathlessness was less likely to be identified by physicians as requiring symptomatic treatment and also less likely to be treated with opioids as compared to a patient with chronic pain (Study IV).<br/>},
  author       = {Ahmadi, Zainab},
  isbn         = {978-91-7619-787-5},
  issn         = {1652-8220},
  language     = {eng},
  number       = {58},
  publisher    = {Lund University: Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Prevalence and Pharmacologic Treatment of Breathlessness in Severe Chronic Obstructive Pulmonary Disease},
  url          = {https://lup.lub.lu.se/search/ws/files/63920975/Zainab_Ahmadi_komplett.pdf},
  volume       = {2019},
  year         = {2019},
}