Dyspnea assessment

Multiple studies and surveys indicate the high prevalence of dyspnea with a diagnosis of end-stage COPD or lung cancer. Measures to evaluate dyspnea and assess efficacy of treatment are needed wherever dying patients are being cared for, be it home, hospice, or acute care. Many assessment scales have been published, but may not be accessible or widely distributed. Depending on the patients' functional ability, different scales would be applicable. Reassessment of dyspnea is also important to consider as the patient's disease progresses. An acute-on-chronic situation could lead to sudden changes in the level of dyspnea. If assessed in a timely manner, the sensations might be more effectively managed. Daily and as-needed symptom assessments are recommended in palliative care. Despite the high prevalence of dyspnea, it has not yet attained the same status as other symptoms. When a patient during a physical exam complains of pain, much attention is given to severity, duration, location, and associated causality. The same has not always been true for dyspnea. As more is learned about dyspnea, more deference should be given to the language that describes this very subjective symptom. Good palliative care requires a concerted effort on the part of the family and health care providers to work together as a unit. The use of a simple symptom/dyspnea assessment instrument can be a valuable starting point for obtaining information about how to best comfort and support patients and families.