Prevalence and management of chronic breathlessness in COPD in a tertiary care center

H. Carette , M. Zysman (1) , C. Morélot-Panzini (2) , J. Perrin , E. Gomez , A. Guillaumot , P. R Burgel (3, 4) , G. Deslée (5) , P. Surpas , O. Le Rouzic (6, 7, 8) , T. Perez (8, 6, 7) , A. Chaouat , N. Roche , F. Chabot (3, 4)

1 IMRB - Institut Mondor de Recherche Biomédicale
2 CHU Pitié-Salpêtrière [AP-HP]
3 Hôpital Cochin [AP-HP]
4 USPC - Université Sorbonne Paris Cité
5 Hôpital Maison Blanche
6 Institut Pasteur de Lille
7 CIIL - Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204
8 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]

BACKGROUND : Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort. METHODS : A prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management. RESULTS : Sixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness. CONCLUSION : Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.

Mots clés: Breathlessness; Chronic obstructive pulmonary disease; Doctors ‘attitude; Opioid

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie; Pneumologie et système respiratoire

H. Carette, M. Zysman, C. Morélot-Panzini, J. Perrin, E. Gomez, et al.. Prevalence and management of chronic breathlessness in COPD in a tertiary care center. BMC Pulmonary Medicine, 2019, 19 (1), pp.95. ⟨10.1186/s12890-019-0851-5⟩. ⟨hal-02147672⟩