PT - JOURNAL ARTICLE AU - David C. Currow AU - Joanna M. Smith AU - Phichai Chansriwong AU - Simon I. R. Noble AU - Theodora Nikolaidou AU - Diana Ferreira AU - Miriam J. Johnson AU - Magnus Ekström TI - Missed opportunity? Worsening breathlessness as a harbinger of death. A cohort study AID - 10.1183/13993003.00684-2018 DP - 2018 Jan 01 TA - European Respiratory Journal PG - 1800684 4099 - http://erj.ersjournals.com/content/early/2018/07/12/13993003.00684-2018.short 4100 - http://erj.ersjournals.com/content/early/2018/07/12/13993003.00684-2018.full AB - Introduction: To explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients.Methods: Prospective, consecutive cohort with point-of-care data of patients of Silver Chain Hospice Care 2011–2014 (n=4638; 51,494 data points). Breathlessness intensity (0–10 Numerical Rating Scale (NRS)) and physical function (Australia-modified Karnofsky Performance Scale (AKPS)) were measured each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression.Results: Mean age was 71.5 (sd 15.1) years; 55.2% males; most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardio-respiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p<0.0001).Conclusions: Breathlessness is more intense and increases more in people with better function and cardio-respiratory disease immediately before death. Whether there are reversible causes for these people should be explored prospectively. Omitting function from previous population estimates may have over-estimated breathlessness intensity for many patients in the days preceding death.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Currow reports and unrestricted research grant from Mundipharma, is an unpaid member of an advisory board for Helsinn Pharmaceuticals, and has consulted Specialist Therapeutics and to Mayne Pharma and received intellectual property payments from Mayne Pharma.Conflict of interest: Ms Smith has nothing to disclose.Conflict of interest: Phichai ChansriwongConflict of interest: Dr. NOBLE has nothing to disclose.Conflict of interest: Dr. Nikolaidou has nothing to disclose.Conflict of interest: Dr. Ferreira has nothing to disclose.Conflict of interest: Dr. Johnson has nothing to disclose.Conflict of interest: Dr. Ekström has nothing to disclose.