MMRC Dyspnoea Scale Indicates Impaired Quality of Life and Increased Pain in Patients with Idiopathic Pulmonary Fibrosis

Overview

Journal ERJ Open Res

Specialty Pulmonary Medicine

Date 2017 Dec 20

PMID 29255720

Citations 40

Authors

Kaisa Rajala

Juho T Lehto

Eva Sutinen

Hannu Kautiainen

Marjukka Myllarniemi

Tiina Saarto

Affiliations

Soon will be listed here.

Abstract

This study was undertaken to investigate idiopathic pulmonary fibrosis (IPF) patients' health-related quality of life (HRQoL) and symptoms in a real-life cross-sectional study. Our secondary aim was to create a simple identification method for patients with increased need for palliative care by studying the relationship between modified Medical Research Council (mMRC) dyspnoea scale, HRQoL and symptoms. We sent a self-rating HRQoL questionnaire (RAND-36) and modified Edmonton Symptom Assessment Scale (ESAS) to 300 IPF patients; 84% of the patients responded to these questionnaires. The most prevalent (>80%) symptoms were tiredness, breathlessness, cough and pain in movement. An increasing mMRC score showed a linear relationship (p<0.001) to impaired HRQoL in all dimensions of RAND-36 and the severity of all symptoms in ESAS. Dimensions of RAND-36 fell below general population reference values in patients with mMRC score ≥2. The intensity of pain in movement (p<0.001) and at rest (p=0.041), and the prevalence of chest pain (p<0.001) had a positive linear relationship to increased mMRC score. An increasing mMRC score reflects impaired HRQoL and a high symptom burden. In clinical practice, the mMRC scale could be used for screening and identification of IPF patients with increased need for palliative care.

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References

Hendrick D, Blackwood R, Black J . Chest pain in the presentation of sarcoidosis. Br J Dis Chest. 1976; 70(3):206-10. DOI: 10.1016/0007-0971(76)90030-9. View

Hyldgaard C, Hilberg O, Bendstrup E . How does comorbidity influence survival in idiopathic pulmonary fibrosis?. Respir Med. 2014; 108(4):647-53. DOI: 10.1016/j.rmed.2014.01.008. View

King Jr T, Bradford W, Castro-Bernardini S, Fagan E, Glaspole I, Glassberg M . A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med. 2014; 370(22):2083-92. DOI: 10.1056/NEJMoa1402582. View

Hannon B, Dyck M, Pope A, Swami N, Banerjee S, Mak E . Modified Edmonton Symptom Assessment System including constipation and sleep: validation in outpatients with cancer. J Pain Symptom Manage. 2014; 49(5):945-52. DOI: 10.1016/j.jpainsymman.2014.10.013. View

Martinez T, Pereira C, Dos Santos M, Ciconelli R, Guimaraes S, Martinez J . Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with idiopathic pulmonary fibrosis. Chest. 2000; 117(6):1627-32. DOI: 10.1378/chest.117.6.1627. View

Yount S, Beaumont J, Chen S, Kaiser K, Wortman K, Van Brunt D . Health-Related Quality of Life in Patients with Idiopathic Pulmonary Fibrosis. Lung. 2016; 194(2):227-34. DOI: 10.1007/s00408-016-9850-y. View

Bestall J, Paul E, Garrod R, Garnham R, Jones P, Wedzicha J . Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7):581-6. PMC: 1745516. DOI: 10.1136/thx.54.7.581. View

Hubbard R, Smith C, Le Jeune I, Gribbin J, Fogarty A . The association between idiopathic pulmonary fibrosis and vascular disease: a population-based study. Am J Respir Crit Care Med. 2008; 178(12):1257-61. DOI: 10.1164/rccm.200805-725OC. View

Behr J, Richeldi L . Recommendations on treatment for IPF. Respir Res. 2013; 14 Suppl 1:S6. PMC: 3643543. DOI: 10.1186/1465-9921-14-S1-S6. View

10.

Janssen D, Wouters E, Parra Y, Stakenborg K, Franssen F . Prevalence of thoracic pain in patients with chronic obstructive pulmonary disease and relationship with patient characteristics: a cross-sectional observational study. BMC Pulm Med. 2016; 16:47. PMC: 4823883. DOI: 10.1186/s12890-016-0210-8. View

11.

Kreuter M, Ehlers-Tenenbaum S, Palmowski K, Bruhwyler J, Oltmanns U, Muley T . Impact of Comorbidities on Mortality in Patients with Idiopathic Pulmonary Fibrosis. PLoS One. 2016; 11(3):e0151425. PMC: 4811578. DOI: 10.1371/journal.pone.0151425. View

12.

Richeldi L, du Bois R, Raghu G, Azuma A, Brown K, Costabel U . Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med. 2014; 370(22):2071-82. DOI: 10.1056/NEJMoa1402584. View

13.

Bruera E, Kuehn N, Miller M, Selmser P, Macmillan K . The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991; 7(2):6-9. View

14.

Nathan S, Basavaraj A, Reichner C, Shlobin O, Ahmad S, Kiernan J . Prevalence and impact of coronary artery disease in idiopathic pulmonary fibrosis. Respir Med. 2010; 104(7):1035-41. DOI: 10.1016/j.rmed.2010.02.008. View

15.

Hays R, Morales L . The RAND-36 measure of health-related quality of life. Ann Med. 2001; 33(5):350-7. DOI: 10.3109/07853890109002089. View

16.

Kaunisto J, Kelloniemi K, Sutinen E, Hodgson U, Piilonen A, Kaarteenaho R . Re-evaluation of diagnostic parameters is crucial for obtaining accurate data on idiopathic pulmonary fibrosis. BMC Pulm Med. 2015; 15:92. PMC: 4541726. DOI: 10.1186/s12890-015-0074-3. View

17.

Chang V, Hwang S, Feuerman M . Validation of the Edmonton Symptom Assessment Scale. Cancer. 2000; 88(9):2164-71. DOI: 10.1002/(sici)1097-0142(20000501)88:9<2164::aid-cncr24>3.0.co;2-5. View

18.

Raghu G, Collard H, Egan J, Martinez F, Behr J, Brown K . An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011; 183(6):788-824. PMC: 5450933. DOI: 10.1164/rccm.2009-040GL. View

19.

Tomioka H, Imanaka K, Hashimoto K, Iwasaki H . Health-related quality of life in patients with idiopathic pulmonary fibrosis--cross-sectional and longitudinal study. Intern Med. 2007; 46(18):1533-42. DOI: 10.2169/internalmedicine.46.6218. View

20.

Nishiyama O, Taniguchi H, Kondoh Y, Kimura T, Kato K, Kataoka K . A simple assessment of dyspnoea as a prognostic indicator in idiopathic pulmonary fibrosis. Eur Respir J. 2010; 36(5):1067-72. DOI: 10.1183/09031936.00152609. View