In a research article published by the European Respiratory Society, Finnish scientists have found a potential avenue for identifying IPF patients with greater need for palliative (symptoms-oriented) care. *
Initiated in 2015, the researchers studied a cross section of roughly 250 IPF patients with two goals in mind: assess health-related quality of life and symptoms; and develop a way of spotting those who need symptoms care based on the association of HRQoL and symptoms with the modified Medical Research Council (mMRC) dyspnoea (breathlessness) scale. The patients were mostly male (65%) with an average age of 74 years and average disease duration of 3.9 years.
Using self-reported data, the mMRC measures disability from breathlessness during activity on a scale of 0 to 4. “0” is indicative of breathlessness only during strenuous activity; “1” indicating breathlessness when walking briskly or normally up a gradual incline; “2” for walking slower than one’s peers, or having to stop for breath if walking at the same pace; “3” for having to stop for breath after walking about 328 feet (100 meters), or after a few minutes; and “4” for too breathless to leave the house, or when dressing/undressing. HRQoL included questions on physical function; role limitations (example, can no longer mow the lawn); bodily pain; general health; vitality; social functioning; emotions and mental health.
More than 80% of reported symptoms were fatigue, breathlessness, cough and pain while moving. As mMRC scores increased, HRQoL in all areas decreased and symptoms burden increased in parallel. The authors write that at an mMRC score of “2” or more, HRQoL scores fell below that of non-diseased people. They found that chest pain and pain during activity and rest increased in unison with increasing mMRC score. In all, increasing mMRC scores were seen to correlate with negative HRQoL and intensified symptoms. Though the study has limitations, the authors note that it has a large sample population representing different disease stages, measured with several real-life assessment tools, and having a high response rate (250 out of an initial 300 patient queries).
The researchers conclude that mMRC reveals not only degree of breathlessness but also quality of life and symptoms in IPF. HRQoL was especially low and symptoms weight high with an mMRC score of 2 or greater, showing its potential role as a simple screen for palliative care need by IPF patients.
The article can be found at:
*Rajala, K., Lehto, J.T., Sutinen, E. et al. (2017). mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis. European Respiratory Journal Open Research, 3, 00084-2017.