Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases.
Kathleen M Akgün, Supriya Krishnan, Shelli L Feder and 3 others
PMID 31550901WHAT IT FOUND
Each additional chronic medication was associated with 8% increased risk of mild dyspnea and 16% increased risk of moderate-severe dyspnea in adults with serious life-limiting illness.
Stopping statins alone was not associated with dyspnea trajectory group membership.
Key findings
01Three dyspnea trajectory groups were identified: no dyspnea (n = 108), mild (n = 130), and moderate-severe (n = 70).
02Each additional medication was associated with 8% increased risk of mild dyspnea group membership and 16% increased risk of moderate-severe dyspnea group membership after adjustment.
03Statin discontinuation was not associated with dyspnea trajectory group membership.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Dyspnea was measured only with a general 0 to 10 symptom rating, not a lung-specific tool. Many patients did not complete repeated assessments: 73 of 381 completed none, 200 of 381 completed 4 or fewer, and only 25 completed all 8. The patients had different diagnoses, and most had cancer, so the results may not apply to people whose breathlessness comes mainly from lung or heart disease. The analysis did not include opioids or benzodiazepines that can be prescribed for breathlessness, so those medicines may be part of the medication count or symptom picture. Stratified analyses by statin discontinuation were likely underpowered. The study cannot show whether more medications cause worse dyspnea or whether sicker patients receive more medications.
The easy way to misread this
Do not conclude that reducing polypharmacy or stopping statins will relieve dyspnea. The study found an association between more medications and worse dyspnea, and statin discontinuation was not associated with dyspnea trajectory group membership. Sicker patients may also receive more medications, so the direction of the association is not settled.