Simon Steffen T, Weingärtner Vera, Higginson Irene J, Voltz Raymond, Bausewein Claudia
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology Cologne/Bonn, Clinical Trials Centre Cologne (BMBF 01KN1106), Cologne, Germany.
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.
J Pain Symptom Manage. 2014 May;47(5):828-38. doi: 10.1016/j.jpainsymman.2013.06.013. Epub 2013 Oct 2.
Episodic breathlessness is a common and distressing symptom in patients with advanced disease. Still, it is not yet clearly defined.
The aim of this work was to develop an international definition, categorization, and terminology of episodic breathlessness.
An online Delphi survey was conducted with international breathlessness experts. We used a structured questionnaire to identify specific aspects and reach agreement on a definition, categorization, and terminology (five-point Likert scale). Consensus was defined in advance as ≥70% agreement.
Thirty-one of 68 (45.6%), 29 of 67 (43.3%), and 33 of 67 (49.3%) experts responded in the first, second, and third rounds, respectively. Participants were 20-79 years old, about 60% male, and more than 75% rated their own breathlessness expertise as moderate to high. After three rounds, consensus was reached on a definition, categorization, and terminology (84.4%, 96.3%, and 92.9% agreement). The final definition includes general and qualitative aspects of the symptom, for example, time-limited severe worsening of intensity or unpleasantness of breathlessness in the patient's perception. Categories are predictable or unpredictable, depending on whether any triggers can be identified.
There is high agreement on clinical and operational aspects of episodic breathlessness in advanced disease among international experts. The consented definition and categorization may serve as a catalyst for clinical and basic research to improve symptom control and patients' quality of life.
发作性呼吸困难是晚期疾病患者常见且令人痛苦的症状。然而，其定义仍不明确。
本研究旨在制定发作性呼吸困难的国际定义、分类和术语。
对国际呼吸困难专家进行了在线德尔菲调查。我们使用结构化问卷来确定具体方面，并就定义、分类和术语达成一致（五点李克特量表）。预先将共识定义为≥70%的一致意见。
68名专家中有31名（45.6%）、67名专家中有29名（43.3%）和67名专家中有33名（49.3%）分别在第一轮、第二轮和第三轮中做出回应。参与者年龄在20至79岁之间，约60%为男性，超过75%将自己的呼吸困难专业知识评为中等到高水平。经过三轮后，就定义、分类和术语达成了共识（一致率分别为84.4%、96.3%和92.9%）。最终定义包括该症状的一般和定性方面，例如，在患者感知中，呼吸困难强度或不适感在时间上有限的严重恶化。根据是否能识别出任何触发因素，分类为可预测或不可预测。
国际专家对晚期疾病发作性呼吸困难的临床和操作方面高度一致。商定的定义和分类可能会促进临床和基础研究，以改善症状控制和患者生活质量。
