Is 'better' enough? Prevalence and multidimensional portrait of persistent dyspnea upon discharge from a respiratory medicine ward: a prospective, single-center observational study.

Abstract

Background: During unplanned respiratory-related hospitalizations, gradual improvement in physiological variables and reduced dependence on treatment are crucial for discharge decisions, possibly supported by discharge care bundles designed to reduce post-hospitalization readmission and mortality. However, patients prioritize symptom relief. This study tested the hypothesis that a significant proportion of patients admitted to a pulmonology ward for an acute respiratory episode experience dyspnea on the day of discharge. It further aimed to describe this dyspnea in a multidimensional manner.

Methods: This 10-week prospective study was conducted at a single center and included patients admitted for acute respiratory conditions such as COPD or asthma exacerbation, pneumonia, pulmonary embolism, or pleural disease, who, on admission, reported a rating of 3 or higher on the "immediate breathing discomfort" item of the Multidimensional Dyspnea Profile (MDP-A1). Dyspnea was assessed both at admission and at discharge using a multidimensional recall-based tool (MDP) and an instant unidimensional tool, the 10-cm visual analog scale (D-VAS).

Results: Seventy consecutive patients were included in the study. Although dyspnea ratings showed a statistically significant decrease during the hospital stay, dyspnea remained both frequent and intense at discharge. At discharge, 84% of patients provided MDP-A1 recall ratings above 0, with 70% rating their MDP-A1 at 3 or more. In contrast, only 22% provided D-VAS instant ratings of 3 or higher. The median MDP-A1 score was 4.0 [2.0-6.0]. "Air hunger" was the most frequently selected sensory descriptor.

Conclusions: Persistent dyspnea remains frequent and intense among patients being discharged after an acute respiratory episode.