Prevalence, Clinical Characteristics, and Management of Episodic Dyspnea in Advanced Lung Cancer Outpatients: A Multicenter Nationwide Study-The INSPIRA-DOS Study.

Abstract

<b><i>Background:</i></b> Episodic dyspnea (ED) is a common problem in patients with advanced lung cancer (LC). However, the prevalence of ED and other related aspects in this patient population is not known. <b><i>Objectives:</i></b> To assess and describe the prevalence, clinical features, treatment, and risk factors for ED in outpatients with advanced LC. <b><i>Design:</i></b> Multicenter cross-sectional study. <b><i>Subjects:</i></b> Consecutive sample of adult outpatients with advanced LC. <b><i>Measurements:</i></b> We assessed background dyspnea (BD), the characteristics, triggers, and management of ED. Potential ED risk factors were assessed through multivariate logistic regression. <b><i>Results:</i></b> A total of 366 patients were surveyed. Overall, the prevalence of ED was 31.9% (90% in patients reporting BD). Patients reported a median of one episode per day (interquartile range [IQR]: 1-2), with a median intensity of 7/10 (IQR: 5-8.25). ED triggers were identified in 89.9% of patients. ED was significantly associated with chronic obstructive pulmonary disease (<i>p</i> = 0.011), pulmonary vascular disease (<i>p</i> = 0.003), cachexia (<i>p</i> = 0.002), and palliative care (<i>p</i> < 0.001). Continuous oxygen use was associated with higher risk of ED (odds ratio: 9.89; <i>p</i> < 0.001). Opioids were used by 44% patients with ED. <b><i>Conclusions:</i></b> ED is highly prevalent and severe in outpatients with advanced LC experiencing BD. The association between intrathoracic comorbidities and oxygen therapy points to alveolar oxygen exchange failure having a potential etiopathogenic role in ED in this population. Further studies are needed to better characterize ED in LC to better inform treatments and trial protocols.