Episodic Breathlessness in Patients With Advanced Disease: A Systematic Review

Context. Although episodic breathlessness (EB) is reported to be highly prevalent in advanced disease, our understanding about it is limited. Objectives. The aim of this study was to systematically review and synthesize the evidence on EB regarding definition, characteristics, and patients' experiences. Methods. Systematic review using searches in six databases, hand search, and personal contacts with authors in the field. Search terms included the combination of "episodic" and "breathlessness" (and synonyms) with five different diseases. Selection criteria included patients with advanced disease and information about EB based on original research. All retrieved studies were reviewed by two independent investigators. Results. Twenty-seven studies (of 7584) were included in this review. Only eight studies explored EB as a primary outcome. EB is poorly defined. It is characterized by high prevalence (81%-85%), high frequency (daily), short duration (often less than 10 minutes), and severe peak intensity. EB either develops without any known trigger or is triggered by physical exertion, emotions, or environmental influences. Conclusion. EB is a common symptom in patients with advanced disease, but information about characteristics and experiences is limited. As there is no common terminology, an agreed definition is needed to foster research to develop effective treatments for EB. J Pain Symptom Manage 2013;45:561-578. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.