Finnish IPF Study Suggests Dyspnea Scale to Identify Patients Needing Palliative Care

Chest pain may be a neglected symptom of idiopathic pulmonary fibrosis (IPF), finds a Finnish study that also suggests using the modified Medical Research Council (mMRC) dyspnea (shortness of breath) scale to identify IPF patients needing palliative care.

The study, “mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis,” appeared in the journal ERJ Open Research.

Despite advances in drug treatments for IPF, no cure yet exists — and medication can only slow the decline in lung function. For now, lung transplant is the only treatment of proven benefit for patients with the disease. Current guidelines recommend early-integrated palliative care as well as early referrals for lung transplant and drug treatment.

IPF limits patients’ activities, reducing their health-related quality of life (HRQOL). However, few researchers have studied how this affects IPF patients in a real-life setting.

For this reason, researchers in Finland recently aimed to investigate HRQOL and symptom burden among IPF patients listed in the FinnishIPF Registry. They also wanted to create a simple identification method for patients needing palliative care, by studying the link between dyspnea score and HRQOL.

The team evaluated patients’ quality of life through a self-rating mMRC breathlessness scale and the RAND 36-Item Health Survey (RAND-36), and the frequency and mean intensity of symptoms by a modified Edmonton Symptom Assessment Scale (ESAS). Of the 300 patients who received these questionnaires, 84 percent responded.

The study revealed that 65 percent of patients needed no help in their everyday lives, 26 percent had received the assistance they needed, and 9 percent needed help for their daily activities but never received it. The most common symptoms were tiredness, shortness of breath and cough, similar to what was described in other studies.

The team also found that one in three patients reported chest pain. The intensity of pain in movement and at rest, and the occurrence of chest pain, correlated significantly with an increasing mMRC score (increased shortness of breath).

“Pain and, more importantly, chest pain, may be an underdiagnosed symptom of IPF,” researchers wrote. “This finding should be taken into account when considering diagnostic tests and treatment strategies for patients with advanced IPF.”

An increasing breathlessness score also correlated with a significant deterioration of HRQOL and elevated symptom burden. Patients with moderate shortness of breath (mMRC ≥2) showed a decrease in all areas of HRQOL, particularly in physical function, compared to the general population in Finland.

The team concluded that “mMRC not only reflects breathlessness in patients with IPF but indicates HRQOL and overall symptom burden. It suggested that “in clinical practice, the mMRC scale could be used for screening and identification of IPF patients with increased need for palliative care.”