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Treating Air Hunger at End-of-Life

Walter Reed Army Medical Center, Washington, DC

PURPOSE: Air hunger in the severely ill challenges providers who attempt to comfort without hastening death. We performed a prospective survey of severely ill dyspneic patients, the treatments selected, and the effect of the interventions.

METHODS: For one month, consecutive admissions to general medicine and oncology services at our tertiary care hospital were surveyed for severe illness using a tool to identify patients at high-risk for short term death. Severely ill patients with dyspnea completed dyspnea questionnaires and a mini-mental exam (MME) on the first and second days of admission. Treatment interventions were recorded.

RESULTS: For 198 consecutive patients, mean age was 62 years (range 19-97 years). 58% of patients were Caucasian, 35% African-American, 4% Hispanic and 4% Asian. 78/198 (39%) met high-risk screening criteria and 60/78 were able to participate. 32/60 participants (53%) reported difficulty breathing. Treatments included inhalers (69%), oxygen (65%), antibiotics (38%), respiratory therapy (34%), opiates (31%), tube thoracostomy (6%), thoracentesis (3%), and others (18%). Patients showed statistically significant improvement in their dyspnea (Borg improved by 2.6/10 points, P=0.007). Improvement in Borg did not correlate with age, race, gender, smoking history, specific treatments or number of treatments. The median MME was 29 on admission and 28.5 for day #2.

CONCLUSION: Dyspnea in severely ill patients is common and improves with hospitalization. Improvement in dyspnea did not correlate with demographic variables or treatments. MME showed minimal change after treatment.

CLINICAL IMPLICATIONS: Dyspnea in severely ill patients appears to improve with hospitalization. Improvement may be due to multiple factors not measured in this study. The minimal change in MME may indicate little compromise in mental status by therapies or may show that this test is not sensitive in detecting changes in patient sensorium in our study.

DISCLOSURE: R.L. Wilson, None.