Routine Dyspnea Assessment on Unit Admission

Dyspnea, which is defined by the American Thoracic Society as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity,”1, 2 is an important prognostic indicator of adverse outcomes, including death. In a study of nearly 18,000 patients undergoing cardiac stress testing, the risk of death from any cause was higher among patients with dyspnea than among those without.3 A five-year, prospective, multicenter Japanese study of 227 patients with chronic obstructive pulmonary disease (COPD) found that the level of dyspnea was a stronger predictor of five-year survival than forced expiratory volume in one second (FEV1), a test long regarded as the gold standard for predicting outcome and measuring COPD severity.4 A health-related quality of life study involving 216 patients undergoing treatment for esophagogastric cancer demonstrated that a 10-point poorer dyspnea rating prior to surgery was associated with an 18% higher risk of death within the five-year follow-up period.5