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Strohacker K, Sudeck G, Keegan R, Ibrahim AH, Beaumont CT. Contextualising flexible nonlinear periodization as a person-adaptive behavioral model for exercise maintenance. Health Psychol Rev 2024; 18:285-298. [PMID: 37401403 DOI: 10.1080/17437199.2023.2233592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
There is a growing focus on developing person-adaptive strategies to support sustained exercise behaviour, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodisation (FNLP) - a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning - that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behaviour evidence and theory to propose a modified FNLP model and to show hypothesised pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation.
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Affiliation(s)
- Kelley Strohacker
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Gorden Sudeck
- Institute of Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Interfacultary Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | - Richard Keegan
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, Australia
| | - Adam H Ibrahim
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Cory T Beaumont
- Department of Allied Health, Sport, and Wellness, Baldwin Wallace University, Berea, OH, USA
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2
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Rafael Henriques H, Correia A, Santos T, Faria J, Sousa D, Portela J, Teixeira J. Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review. Int J Nurs Sci 2024; 11:241-257. [PMID: 38707687 PMCID: PMC11064592 DOI: 10.1016/j.ijnss.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Chronic dyspnea, a distressing symptom in patients with complex chronic conditions, is linked to higher risks of mortality. This study aimed to identify nursing interventions that could improve self-management for complex chronic patients, thereby enhancing control over chronic dyspnea. The findings intend to guide nursing care strategies that promote self-management among this population. Methods We searched the databases Medline, Scopus, Web of Science, CINAHL, Cochrane Database of Systematic Reviews (CDSR), and Joanna Briggs Institute (JBI) databases were searched in December 2023. We included adult patients with complex chronic conditions with chronic dyspnoea. The team screened articles collaboratively, using Rayyan software. A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools. The review protocol is registered under the number CRD42023456021. Results Our review included 18 studies that explored a variety of interventions for chronic dyspnea. We identified pharmacological interventions (such as oxygen therapy and inhalation treatments) and non-pharmacological approaches (including educational programs, breathing exercises, fluid intake management, body awareness techniques, peer support, emotional intelligence training, and the use of web applications). Those interventions empower patients, improve their ability to fulfill life roles, mitigate emotional distress, and improve overall quality of life. Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care. Conclusions Promoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach, encompassing multidisciplinary interventions, individualized self-care education, peer engagement, and technological support. Current research on self-management inadequately addresses interventions targeting patient behaviour change. It highlights the need to delve deeper into the self-management process. Further research is needed to expand the evidence base and refine these interventions.
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Affiliation(s)
- Helga Rafael Henriques
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
| | - Andreia Correia
- Nursing School of Lisbon, Lisbon, Portugal
- Unidade de Hemodiálise de Torres Vedras – Nephrocare, Torres Vedras, Portugal
| | - Tatiana Santos
- Nursing School of Lisbon, Lisbon, Portugal
- Unidade de Cuidados Continuados na AMETIC, Torres Vedras, Portugal
| | - José Faria
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
- Unidade Local de Saúde São José, Cardiology Department, Lisbon, Portugal
| | - Diana Sousa
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
| | - Joana Portela
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
- Unidade Local de Saúde da Arrábida, General Surgery Department, Setúbal, Portugal
| | - Joana Teixeira
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
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Cai S, Yao J, Han M, Luo X, Yu Y, Lu X, Xiang X, Huang L. The effect of cognition in combination with an ACBT on dyspnea-related kinesiophobia in patients with moderate to severe COPD: Quasirandomized controlled trial study. Geriatr Nurs 2024; 56:138-147. [PMID: 38342002 DOI: 10.1016/j.gerinurse.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 02/13/2024]
Abstract
Patients with moderate to severe COPD frequently experience dyspnea, which causes these patients to acquire a fear of dyspnea and a fear of activity. This study developed a cognitive intervention combined with active cycle of breathing technique (ACBT) intervention program based on the fear-avoidance model, with the goal of evaluating the program's effectiveness in improving dyspnea-related kinesiophobia in patients with moderate to severe COPD. This study had a total of 106 participants. For 8 weeks, the intervention group (N=53) received cognitive combined with ACBT, while the control group (N=53) received standard care. The findings of the four times the dyspnea belief questionnaire were collected indicated that the combined intervention had a better impact on reducing dyspnea-related kinesiophobia than did routine nursing (P<0.05), and the impact persisted even after the intervention. Additionally, it may enhance dyspnea and quality of life, increase exercise capacity, and lower the BODE index.
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Affiliation(s)
- Shasha Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Jinlan Yao
- School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, Zhejiang Province, China
| | - Maomao Han
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xiaolin Luo
- Zhejiang Evaluation Center for Medical Service and Administration, Hangzhou, Zhejiang Province, China
| | - Yudi Yu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Xiaorong Lu
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China.
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Liang KJ, Cheng CH, Liu CY, Hsu SC, von Leupoldt A, Jelinčić V, Chan PYS. Neural oscillations underlying the neural gating of respiratory sensations in generalized anxiety disorder. Respir Physiol Neurobiol 2024; 321:104215. [PMID: 38211904 DOI: 10.1016/j.resp.2024.104215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
Individuals with generalized anxiety disorder (GAD) have been shown to have altered neural gating of respiratory sensations (NGRS) using respiratory-related evoked potentials (RREP); however, corresponding neural oscillatory activities remain unexplored. The present study aimed to investigate altered NGRS in individuals with GAD using both time and time-frequency analysis. Nineteen individuals with GAD and 28 healthy controls were recruited. Paired inspiratory occlusions were delivered to elicit cortical neural activations measured from electroencephalography. The GAD group showed smaller N1 amplitudes to the first stimulus (S1), lower evoked gamma and larger evoked beta oscillations compared to controls. Both groups showed larger N1, P3, beta power and theta power in response to S1 compared to S2, suggesting a neural gating phenomenon. These findings suggest that N1, gamma and beta frequency oscillations may be indicators for altered respiratory sensation in GAD populations and that the N1, P3, beta and theta oscillations can reflect the neural gating of respiratory sensations.
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Affiliation(s)
- Kai-Jie Liang
- Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan; Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Department of Psychiatry, New Taipei City Municipal Tucheng Hospital
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Department of Psychiatry, New Taipei City Municipal Tucheng Hospital
| | | | | | - Pei-Ying S Chan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.
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Aldhahi MI, Bakhsh HR, Bin Sheeha BH, Alhasani R. Translation and cross-cultural adaptation of an Arabic version of PROMIS® of dyspnea activity motivation, requirement item pool and sleep-related impairments item bank. Health Qual Life Outcomes 2024; 22:11. [PMID: 38279166 PMCID: PMC10821257 DOI: 10.1186/s12955-023-02223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/20/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Patient-Reported Outcomes Measurement Information System (PROMIS®) Dyspnea Activity Motivation & Requirement item pool and sleep related impairments (SRI) item bank are designed in assessing the impact of dyspnea and sleep and guiding patient management. However, to effectively utilize this tool in Arabic-speaking populations, it is essential to perform a thorough translation and cultural adaptation process. Therefore, the aim of the study is to translate and cross-culturally adapt the translated items of the PROMIS® dyspnea activity motivation and requirement and SRI into Arabic. METHODS A universal approach to translation adopted from PROMIS guideline document for translation and cultural adaptation, and the Chronic Illness Therapy translation methodology. The forward translation step followed by back work translation and Harmonization and quality assurance. Cognitive interview and pilot testing was conducted among 30 Arabic respondents across 5 different countries of Arabic speaker to produce a single version for Arab countries. RESULTS A successful translation and cross-cultural adaptation into Arabic was achieved while maintaining equivalency. The translation was clear and more colloquial sentences were semantically equivalent and easy to understand. Equivalence of meaning of PROMIS® dyspnea activity motivation, requirement and SRI were achieved. All items were appropriate, relevant to culture and it measured the same concept as the original items. In Items 2 of the dyspnea activity motivation related to leisure activity "shopping", the term "catalog and website" was added instead of "catalog only" which makes item in line with the original source but more comprehensive and applicable to current shopping trends. CONCLUSIONS The PROMIS® dyspnea activity motivation, requirement items pool and SRI item bank are culturally and linguistically suitable to be used in Arab country. By extending the accessibility of this measure to Arabic-speaking population, this study contributes significantly to the advancement of management and patient-centered care in the region. Further studies are necessary to evaluate the psychometric properties of these instruments.
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Affiliation(s)
- Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh, P.O. Box 84428, 11671, Saudi Arabia.
| | - Hadeel R Bakhsh
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh, P.O. Box 84428, 11671, Saudi Arabia
| | - Bodor H Bin Sheeha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh, P.O. Box 84428, 11671, Saudi Arabia
| | - Rehab Alhasani
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh, P.O. Box 84428, 11671, Saudi Arabia.
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Cristea L, Olsson M, Sandberg J, Kochovska S, Currow D, Ekström M. Which breathlessness dimensions associate most strongly with fatigue?-The population-based VASCOL study of elderly men. PLoS One 2023; 18:e0296016. [PMID: 38117831 PMCID: PMC10732411 DOI: 10.1371/journal.pone.0296016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Breathlessness and fatigue are common symptoms in older people. We aimed to evaluate how different breathlessness dimensions (overall intensity, unpleasantness, sensory descriptors, emotional responses) were associated with fatigue in elderly men. METHODS This was a cross-sectional analysis of the population-based VAScular disease and Chronic Obstructive Lung Disease (VASCOL) study of 73-year old men. Breathlessness dimensions were assessed using the Dyspnoea-12 (D-12), Multidimensional Dyspnoea Profile (MDP), and the modified Medical Research Council (mMRC) scale. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. Clinically relevant fatigue was defined as FACIT-F≤ 30 units. Scores were compared standardized as z-scores and analysed using linear regression, adjusted for body mass index, smoking, depression, cancer, sleep apnoea, prior cardiac surgery, respiratory and cardiovascular disease. RESULTS Of 677 participants, 11.7% had clinically relevant fatigue. Higher breathlessness scores were associated with having worse fatigue; for D-12 total, -0.35 ([95% CI] -0.41 to -0.30) and for MDP A1, -0.24 (-0.30 to -0.18). Associations were similar across all the evaluated breathlessness dimensions even when adjusting for the potential confounders. CONCLUSION Breathlessness assessed using D-12 and MDP was associated with worse fatigue in elderly men, similarly across different breathlessness dimensions.
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Affiliation(s)
- Lucas Cristea
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Kallinge Health Center, Kallinge, Sweden
| | - Max Olsson
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jacob Sandberg
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Magnus Ekström
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Njøten KL, Espehaug B, Magnussen LH, Jürgensen M, Kvale G, Søfteland E, Aarli BB, Frisk B. Relationship between exercise capacity and fatigue, dyspnea, and lung function in non-hospitalized patients with long COVID. Physiol Rep 2023; 11:e15850. [PMID: 37984816 PMCID: PMC10659919 DOI: 10.14814/phy2.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
Long COVID is a global health problem that impairs patients' functional status. More than 200 reported symptoms have been identified where fatigue, dyspnea, and exercise impairment are most common. This study aimed to describe exercise capacity, fatigue, dyspnea, and lung function in previously non-hospitalized patients with long COVID, and examine the relationship between exercise capacity and fatigue, dyspnea, and lung function. Sixty-five patients, 54 women (83%), mean age of 39 standard deviation (12) years, were included and completed spirometry, cardiopulmonary exercise test, stair climbing test (SCT), 30 second sit-to-stand test (30STST), and questionnaires regarding fatigue and dyspnea. Fatigue was reported by 95% of the participants, whereas 65% reported severe fatigue, and 66% reported dyspnea. Mean exercise capacity measured with peak oxygen uptake (V̇O2peak % pred.) was ≥85% in 65% of the participants. Mean forced expiratory volume in 1 s. and forced vital capacity were 96.6 (10.7)% and 100.8 (10.9)%, respectively, while reduced diffusion capacity for carbon monoxide (DLCO ) was found in eight participants (13%). Reduced V̇O2peak kg-1 and increased time on SCT were significantly associated with increased dyspnea and reduced DLCO but not with fatigue, while 30STST was associated with increased fatigue and dyspnea in previously non-hospitalized patients with long COVID.
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Affiliation(s)
- Kiri Lovise Njøten
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Helse i HardangerØysteseNorway
| | - Birgitte Espehaug
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Liv Heide Magnussen
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Marte Jürgensen
- Helse i HardangerØysteseNorway
- Division of PsychiatryHaukeland University HospitalBergenNorway
| | - Gerd Kvale
- Helse i HardangerØysteseNorway
- Division of PsychiatryHaukeland University HospitalBergenNorway
- Department of Clinical PsychologyUniversity of BergenBergenNorway
| | - Eirik Søfteland
- Helse i HardangerØysteseNorway
- Department of MedicineHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Bernt Bøgvald Aarli
- Helse i HardangerØysteseNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
| | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Helse i HardangerØysteseNorway
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Müller A, Mraz T, Wouters EF, van Kuijk SM, Amaral AF, Breyer-Kohansal R, Breyer MK, Hartl S, Janssen DJ. Prevalence of dyspnea in general adult populations: A systematic review and meta-analysis. Respir Med 2023; 218:107379. [PMID: 37595674 DOI: 10.1016/j.rmed.2023.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Dyspnea is a commonly described symptom in various chronic and acute conditions. Despite its frequency, relatively little is known about the prevalence and assessment of dyspnea in general populations. The aims of this review were: 1) to estimate the prevalence of dyspnea in general adult populations; 2) to identify associated factors; and 3) to identify used methods for dyspnea assessment. METHODS A systematic literature search was conducted using MEDLINE/PubMed, Embase, CINAHL and JAMA network. Records were screened by two independent reviewers and quality was assessed by using the Joanna Briggs Institute checklist for risk of bias in prevalence studies. Multi-level meta-analysis was performed to estimate pooled prevalence. The protocol was registered on PROSPERO (CRD42021275499). RESULTS Twenty original articles, all from studies in high-income countries, met the criteria for inclusion. Overall, their quality was good. Pooled prevalence of dyspnea in general adult populations based on 11 studies was 10% (95% CI 7, 15), but heterogeneity across studies was high. The most frequently reported risk factors were increasing age, female sex, higher BMI and respiratory or cardiac disease. The MRC or the modified MRC scale was the most used tool to assess dyspnea in general populations. CONCLUSIONS Dyspnea is a common symptom in adults in high-income countries. However, the high heterogeneity across studies and the lack of data from low- and middle-income countries limit the generalizability of our findings. Therefore, more research is needed to unveil the prevalence of dyspnea and its main risk factors in general populations around the world.
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Affiliation(s)
- Alexander Müller
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
| | - Tobias Mraz
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna Healthcare Group, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Emiel Fm Wouters
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Peter Debyeplein 1, 6229 HA, Maastricht, the Netherlands
| | - André Fs Amaral
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK; NIHR Imperial Biomedical Research Centre, The Bays, Entrance 2, South Wharf Road, St. Mary's Hospital, London, W2 1NY, UK
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Wolkersbergenstrasse 1, 1130, Vienna, Austria
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna Healthcare Group, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Daisy Ja Janssen
- Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands; Department of Research & Development, Ciro, Hornerheide 1, 6085 NM, Horn, the Netherlands
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Fairman CM, Owens OL, Kendall KL, Steele J, Schumpp AR, Latella C, Jones MT, Marcotte L, Dawson JM, Peddle-McIntyre CMJ, McDonnell KK. Hybrid delivery of cluster-set resistance training for individuals previously treated for lung cancer: the results of a single-arm feasibility trial. Pilot Feasibility Stud 2023; 9:177. [PMID: 37848969 PMCID: PMC10580552 DOI: 10.1186/s40814-023-01405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Individuals with non-small cell lung cancer (NSCLC) are burdened by long-lasting symptoms (e.g., dyspnea and fatigue) post-treatment. These symptoms often reduce physical activity levels and increase the risk of functional decline. Though we have previously proposed cluster-set resistance training to mitigate symptom burden in lung cancer, there is currently no data on the feasibility or acceptability of this mode of exercise in cancer. Therefore, the purpose of this study was to investigate the feasibility and acceptability of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC stages I-III (i.e., early stage). METHODS This study aimed to recruit individuals with NSCLC stages I-III post-treatment to participate in 8 weeks of home-based resistance training, 3 days per week. The program included supervised sessions in the participants' homes and virtual supervision via videoconferencing. The primary outcome measure of feasibility was evaluated through recruitment, retention, and intervention fidelity (i.e., proportion of exercise completed, relative to what was prescribed). Intervention acceptability (i.e., ease and quality of virtual delivery, level of difficulty, and home-based approach) was assessed using a 4-point Likert-type scale from "strongly disagree" to "strongly agree". RESULTS Fourteen participants were recruited over a 6-month period, with 11 completing the intervention (2 withdrew due to unrelated illness, 1 withdrew due to requiring active treatment), yielding a retention rate of 79%. Characteristics of the participants who completed the intervention (n = 11) were as follows: mean age: 71 ± 10 years, mean BMI: 29.1 ± 6.5, and average time since diagnosis was 62 ± 51 months. Of completers, 27% were male, and 36% were Black; 10 were stage I (91%), and one was stage II (9%). Mean session attendance was 86.4 ± 9.5%. Mean intervention fidelity was 83.1 ± 13.1%. With regard to acceptability, > 90% of participants positively rated all aspects of the intervention delivery. No adverse events related to exercise were recorded. CONCLUSIONS The hybrid delivery of a home-based resistance exercise program for individuals previously treated for early-stage NSCLC was found to be safe and feasible. Adaptations to the program for future interventions are required, particularly surrounding resistance exercise programming, and intervention delivery with home visits. TRIAL REGISTRATION ClinicalTrials.gov: NCT05014035 . Registered January 20, 2021.
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Affiliation(s)
- C M Fairman
- Department of Exercise Science, University of South Carolina, Columbia, USA.
| | - O L Owens
- College of Social Work, University of South Carolina, Columbia, USA
| | - K L Kendall
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - J Steele
- Faculty of Sport, Health, and Social Science, Solent University, Southampton, UK
| | - A R Schumpp
- Department of Exercise Science, University of South Carolina, Columbia, USA
| | - C Latella
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - M T Jones
- Department of Exercise Science, University of South Carolina, Columbia, USA
- Department of Kinesiology, The University of Alabama, Tuscaloosa, USA
| | - L Marcotte
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J M Dawson
- Department of Exercise Science, University of South Carolina, Columbia, USA
| | - C M J Peddle-McIntyre
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - K K McDonnell
- College of Nursing, University of South Carolina, Columbia, USA
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Sezer H, Çınar D, Kılıç Akça N. The effect of prolonged use of surgical masks during face-to-face teaching on cognitive and physiological parameters of nursing students: A cross-sectional and descriptive study. Nurse Educ Pract 2023; 72:103779. [PMID: 37717408 DOI: 10.1016/j.nepr.2023.103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
AIMS This study was conducted to examine the effects of using surgical masks on nursing students' cognitive and physiological parameters during full-time face-to-face teaching during the pandemic. BACKGROUND It is known that the use of surgical masks has effects on health professionals' physiological parameters. DESIGN A descriptive cross-sectional study with a pretest-posttest design was conducted. The study was carried out at a state university. METHODS Sixty-one nursing students taking Internal Medicine Nursing course in the fall semester during the COVID-19 pandemic were included in the study. Study data were collected by using a Descriptive Information Form, the Cognitive Fatigue Scale, the One-way Dyspnea Scale and the Cognitive Reaction Time application in a theoretical course that took 310 min on 15 November 2021. Students' physiological parameters were measured by using a thermometer and pulse oximetry. RESULTS It was found that students' cognitive fatigue levels (p < 0.001) and body temperature increased (p < 0.001) and that cognitive reaction rates (p = 0.05) and pulse rates decreased (p < 0.001). It was determined that after the lesson, there was a weak positive correlation between nursing students' level of dyspnea and body temperature and their cognitive fatigue levels (p < 0.05). CONCLUSIONS It was determined that the use of surgical masks during full-time face-to-face teaching increased students' cognitive fatigue and decreased their cognitive reaction rates. The research will have an impact on redesigning the curriculum for face-to-face teaching. Lecturers should revise their teaching by taking these findings into account.
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Affiliation(s)
- Hale Sezer
- Izmir Bakırçay University Faculty of Health Science, Department of Nursing Education, Izmir, Turkey.
| | - Derya Çınar
- Izmir Bakırçay University Faculty of Health Science, Department of Oncology Nursing, Izmir, Turkey
| | - Nazan Kılıç Akça
- Izmir Bakırçay University Faculty of Health Science, Department of Internal Medicine Nursing, Izmir, Turkey
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11
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Vicent L, Rosillo N, Moreno G, Salguero-Bodes R, Goñi C, Bernal JL, Seara G, Bueno H. Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis. Front Cardiovasc Med 2023; 10:1202960. [PMID: 37588036 PMCID: PMC10425536 DOI: 10.3389/fcvm.2023.1202960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
Aims Women may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations. Methods and results Retrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017-2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P < 0.001) were referred for a first cardiology consultation. The age-related referral rates were higher in women. The most common reasons for consultation were palpitations in women (n = 676; 19.2%) and ECG abnormalities in men (n = 570; 23.2%). Delays to cardiology visits and additional tests were similar. During 24 months of follow-up, women had fewer cardiology hospitalisations (204; 5.8% vs. 229; 9.3%; P = 0.003) and lower mortality (65; 1.8% vs. 66; 2.7%; P = 0.028), but those aged <65 years had more emergency department visits (756; 48.5% vs. 560; 39.9%, P < 0.001) than men. Conclusion There are substantial sex differences in primary care cardiology referral patterns, including causes, rates, decisions and outcomes, which are only partially explained by age differences. Further research is needed to understand the reasons for these differences.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Nicolás Rosillo
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Preventive Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Guillermo Moreno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Clara Goñi
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - José Luis Bernal
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Control Management Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Germán Seara
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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12
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Hourican C, Peeters G, Melis R, Gill TM, Rikkert MO, Quax R. Understanding multimorbidity requires sign-disease networks and higher-order interactions, a perspective. FRONTIERS IN SYSTEMS BIOLOGY 2023; 3:1155599. [PMID: 37810371 PMCID: PMC10557993 DOI: 10.3389/fsysb.2023.1155599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background Count scores, disease clustering, and pairwise associations between diseases remain ubiquitous in multimorbidity research despite two major shortcomings: they yield no insight into plausible mechanisms underlying multimorbidity, and they ignore higher-order interactions such as effect modification. Objectives We argue that two components are currently missing but vital to develop novel multimorbidity metrics. Firstly, networks should be constructed which consists simultaneously of signs, symptoms, and diseases, since only then could they yield insight into plausible shared biological mechanisms underlying diseases.Secondly, learning pairwise associations is insufficient to fully characterize the correlations in a system. That is, synergistic (e.g., cooperative or antagonistic) effects are widespread in complex systems, where two or more elements combined give a larger or smaller effect than the sum of their individual effects. It can even occur that pairs of symptoms have no pairwise associations whatsoever, but in combination have a significant association. Therefore, higher-order interactions should be included in networks used to study multimorbidity, resulting in so-called hypergraphs. Methods We illustrate our argument using a synthetic Bayesian Network model of symptoms, signs and diseases, composed of pairwise and higher-order interactions. We simulate network interventions on both individual and population levels and compare the ground-truth outcomes with the predictions from pairwise associations. Conclusion We find that, when judged purely from the pairwise associations, interventions can have unexpected 'side-effects' or the most opportune intervention could be missed. The hypergraph uncovers links missed in pairwise networks, giving a more complete overview of sign and disease associations.
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Affiliation(s)
- Cillian Hourican
- Computational Science Lab, Institute of Informatics, University of Amsterdam, Amsterdam, The Netherlands
| | - Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Radboud university medical centre, Nijmegen, The Netherlands
| | - René Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas M. Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Radboud university medical centre, Nijmegen, The Netherlands
| | - Rick Quax
- Computational Science Lab, Institute of Informatics, University of Amsterdam, Amsterdam, The Netherlands
- Institute for Advanced Study, 1012 GC Amsterdam, The Netherlands
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13
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Luettich A, Sievers C, Alfaro Almagro F, Allen M, Jbabdi S, Smith SM, Pattinson KTS. Functional connectivity between interoceptive brain regions is associated with distinct health-related domains: A population-based neuroimaging study. Hum Brain Mapp 2023; 44:3210-3221. [PMID: 36939141 PMCID: PMC10171512 DOI: 10.1002/hbm.26275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
Interoception is the sensation, perception, and integration of signals from within the body. It has been associated with a broad range of physiological and psychological processes. Further, interoceptive variables are related to specific regions and networks in the human brain. However, it is not clear whether or how these networks relate empirically to different domains of physiological and psychological health at the population level. We analysed a data set of 19,020 individuals (10,055 females, 8965 males; mean age: 63 years, age range: 45-81 years), who have participated in the UK Biobank Study, a very large-scale prospective epidemiological health study. Using canonical correlation analysis (CCA), allowing for the examination of associations between two sets of variables, we related the functional connectome of brain regions implicated in interoception to a selection of nonimaging health and lifestyle related phenotypes, exploring their relationship within modes of population co-variation. In one integrated and data driven analysis, we obtained four statistically significant modes. Modes could be categorised into domains of arousal and affect and cardiovascular health, respiratory health, body mass, and subjective health (all p < .0001) and were meaningfully associated with distinct neural circuits. Circuits represent specific neural "fingerprints" of functional domains and set the scope for future studies on the neurobiology of interoceptive involvement in different lifestyle and health-related phenotypes. Therefore, our research contributes to the conceptualisation of interoception and may lead to a better understanding of co-morbid conditions in the light of shared interoceptive structures.
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Affiliation(s)
- Alexander Luettich
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Carolin Sievers
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Fidel Alfaro Almagro
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Micah Allen
- Center of Functionally Integrative NeuroscienceAarhus UniversityAarhusDenmark
- Aarhus Institute of Advanced StudiesAarhus UniversityAarhusDenmark
- Cambridge PsychiatryUniversity of CambridgeCambridgeUK
| | - Saad Jbabdi
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Stephen M. Smith
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Kyle T. S. Pattinson
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
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14
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van den Bosch L, Wang T, Bakal JA, Richman-Eisenstat J, Kalluri M. A Retrospective, Descriptive Study of Dyspnea Management in a Multidisciplinary Interstitial Lung Disease Clinic. Am J Hosp Palliat Care 2023; 40:153-163. [PMID: 35484838 PMCID: PMC9850391 DOI: 10.1177/10499091221096416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Fibrotic interstitial lung diseases (F-ILDs) have a high symptom burden with progressive dyspnea as a primary feature. Breathlessness is underrecognized and undertreated primarily due to lack of consensus on how to best measure and manage it. Several nonpharmacologic and pharmacologic strategies are published in the literature, however there is a paucity of real-world data describing their systematic implementation. Objectives: We describe the types of breathlessness interventions and timing of implementation in our multidisciplinary collaborative care (MDC) ILD clinic and the impact of our approach on dyspnea trajectory and acute care use in ILD. Methods: A retrospective, observational study of deceased ILD patients seen in our clinic (2012-2018) was conducted. Patients were grouped by baseline medical research council (MRC) grade and dyspnea interventions from clinic enrolment until death were examined. Healthcare usage in the last 6 months of life was collected through Alberta's administrative database. Results: Eighty-one deceased ILD patients were identified. Self management advice was provided to 100% of patients. Pulmonary rehabilitation (PR) and home care (HC) referrals were made in 40% and 57% of patients, respectively. Eighty percent were treated with oxygen and 53% with opioids during the study. MDC-initiated referral to PR and HC, oxygen and opioid prescriptions were provided a median of 13, 9, 11, and 4 months prior to death, respectively. Stepwise implementation of interventions was observed more commonly in MRC 1-2 and concurrent implementation in MRC 4-5. Conclusions: Our clinic's approach allows early and systematic dyspnea management.
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Affiliation(s)
- Laura van den Bosch
- Division of Pulmonary Medicine,
University
of Alberta, Edmonton, AB, Canada,Laura van den Bosch, Division of Pulmonary
Medicine, University of Alberta, 11350-83 Avenue, Edmonton, AB T6G 2G3, Canada.
| | - Ting Wang
- Provincial Research Data Services,
Alberta
Health Services, Edmonton, AB,
Canada
| | - Jeffrey A. Bakal
- Provincial Research Data Services,
Alberta
Health Services, Edmonton, AB,
Canada
| | - Janice Richman-Eisenstat
- Division of Pulmonary Medicine,
University
of Alberta, Edmonton, AB, Canada,Alberta Health
Services, Edmonton, AB, Canada
| | - Meena Kalluri
- Division of Pulmonary Medicine,
University
of Alberta, Edmonton, AB, Canada,Alberta Health
Services, Edmonton, AB, Canada,Meena Kalluri, Division of Pulmonary
Medicine, University of Alberta, 11350-83 Avenue, Edmonton, AB, T6E 2H8, Canada.
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15
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Guo YL, Ampon MR, Poulos LM, Davis SR, Toelle BG, Marks GB, Reddel HK. Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults. Respirology 2022; 28:350-356. [PMID: 36336647 DOI: 10.1111/resp.14400] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. METHODS A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. RESULTS Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. CONCLUSION Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.
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Affiliation(s)
- Yue Leon Guo
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Department of Environmental and Occupational Medicine National Taiwan University (NTU) College of Medicine and NTU Hospital Taipei Taiwan
- Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health Taipei Taiwan
| | - Maria R. Ampon
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Leanne M. Poulos
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Sharon R. Davis
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Brett G. Toelle
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Sydney Local Health District Sydney New South Wales Australia
| | - Guy B. Marks
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- School of Clinical Medicine UNSW Medicine & Health, University of New South Wales Sydney New South Wales Australia
| | - Helen K. Reddel
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
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Kelley RC, Lapierre SS, Muscato DR, Hahn D, Christou DD, Ferreira LF. Cardiac and respiratory muscle responses to dietary N-acetylcysteine in rats consuming a high-saturated fat, high-sucrose diet. Exp Physiol 2022; 107:1312-1325. [PMID: 35938289 PMCID: PMC9633399 DOI: 10.1113/ep090332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/22/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? This study addresses whether a high-fat, high-sucrose diet causes cardiac and diaphragm muscle abnormalities in male rats and whether supplementation with the antioxidant N-acetylcysteine reverses diet-induced dysfunction. What is the main finding and its importance? N-Acetylcysteine attenuated the effects of high-fat, high-sucrose diet on markers of cardiac hypertrophy and diastolic dysfunction, but neither high-fat, high-sucrose diet nor N-acetylcysteine affected the diaphragm. These results support the use of N-acetylcysteine to attenuate cardiovascular dysfunction induced by a 'Western' diet. ABSTRACT Individuals with overweight or obesity display respiratory and cardiovascular dysfunction, and oxidative stress is a causative factor in the general aetiology of obesity and of skeletal and cardiac muscle pathology. Thus, this preclinical study aimed to define diaphragmatic and cardiac morphological and functional alterations in response to an obesogenic diet in rats and the therapeutic potential of an antioxidant supplement, N-acetylcysteine (NAC). Young male Wistar rats consumed ad libitum a 'lean' or high-saturated fat, high-sucrose (HFHS) diet for ∼22 weeks and were randomized to control or NAC (2 mg/ml in the drinking water) for the last 8 weeks of the dietary intervention. We then evaluated diaphragmatic and cardiac morphology and function. Neither HFHS diet nor NAC supplementation affected diaphragm-specific force, peak power or morphology. Right ventricular weight normalized to estimated body surface area, left ventricular fractional shortening and posterior wall maximal shortening velocity were higher in HFHS compared with lean control animals and not restored by NAC. In HFHS rats, the elevated deceleration rate of early transmitral diastolic velocity was prevented by NAC. Our data showed that the HFHS diet did not compromise diaphragmatic muscle morphology or in vitro function, suggesting other possible contributors to breathing abnormalities in obesity (e.g., abnormalities of neuromuscular transmission). However, the HFHS diet resulted in cardiac functional and morphological changes suggestive of hypercontractility and diastolic dysfunction. Supplementation with NAC did not affect diaphragm morphology or function but attenuated some of the cardiac abnormalities in the rats receiving the HFHS diet.
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Affiliation(s)
- Rachel C. Kelley
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Stephanie S. Lapierre
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Derek R. Muscato
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Dongwoo Hahn
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Demetra D. Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Leonardo F. Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
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Arvig MD, Laursen CB, Jacobsen N, Gæde PH, Lassen AT. Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review. J Ultrasound 2022; 25:547-561. [PMID: 35040102 PMCID: PMC9402857 DOI: 10.1007/s40477-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The primary aim was to investigate if treatment guided by serial ultrasound of the inferior vena cava-collapsibility index (IVC-CI) and B-lines on lung ultrasound (LUS) could reduce mortality, readmissions, and length of stay (LOS) in acutely dyspneic patients admitted to a hospital, compared to standard monitoring. The secondary aim was to determine how the changes of B-lines and IVC-CI are correlated to vitals and symptoms. METHODS A systematic search was conducted on PubMed, Embase, Cochrane, Google Scholar, Web of Science, Scopus, OpenGrey, ProQuest, and databases for ongoing trials. The risk of bias was assessed according to study design. RESULTS Of the 8258 studies identified, 50 were selected for full-text screening, and 24 studies were chosen for data extraction (19 pre-post-, two non-randomized controlled-, two randomized controlled-, and one retrospective cohort study), covering 2040 patients. Most studies were single-center and had small study populations with only heart failure patients. The risk of bias was high. No studies evaluated how the difference between two ultrasound measurements correlated with the primary outcomes. Seven studies reported that a decline in either B-lines or IVC size, or an increased IVC-CI reduced mortality, readmissions, and LOS when correlated to a single ultrasound measurement. All studies showed changes in the IVC-CI and B-lines, but these were not related to vitals or symptoms. CONCLUSION B-lines and IVC-CI are dynamic variables that change over time and with treatment. A single ultrasound measurement can influence prognostic outcomes, but it remains uncertain if repeated scans can have the same impact.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, TechSim, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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18
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Does mechanical threshold inspiratory muscle training promote recovery and improve outcomes in patients who are ventilator-dependent in the intensive care unit? The IMPROVE randomised trial. Aust Crit Care 2022:S1036-7314(22)00092-3. [PMID: 36041982 DOI: 10.1016/j.aucc.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In patients who are ventilator-dependent in the intensive care unit, inspiratory muscle training may improve inspiratory muscle strength and accelerate liberation from the ventilator, but optimal training parameters are yet to be established, and little is known about the impact of inspiratory muscle training on quality of life or dyspnoea. Thus, we sought to ascertain whether inspiratory muscle training, commenced while ventilator-dependent, would improve outcomes for patients invasively ventilated for 7 days or longer. METHODS In this randomised trial with assessor blinding and intention-to-treat analysis, 70 participants (mechanically ventilated ≥7 days) were randomised to receive once-daily supervised high-intensity inspiratory muscle training with a mechanical threshold device in addition to usual care or to receive usual care (control). Primary outcomes were inspiratory muscle strength (maximum inspiratory pressure % predicted) and endurance (fatigue resistance index) at ventilator liberation and 1 week later. Secondary outcomes included quality of life (SF-36v2, EQ-5D), dyspnoea, physical function, duration of ventilation, and in-hospital mortality. RESULTS Thirty-three participants were randomly allocated to the training group, and 37 to the control group. There were no statistically significant differences in strength (maximum inspiratory pressure) (95% confidence interval [CI]: -7.4 to 14.0) or endurance (fatigue resistance index) (95% CI: -0.003 to 0.436). Quality of life improved significantly more in the training group than in the control group (EQ-5D: 17.2; 95% CI: 1.3-33.0) (SF-36-PCS: 6.97; 95% CI: 1.96-12.00). Only the training group demonstrated significant reductions in dyspnoea (-1.5 at rest, -1.9 during exercise). There were no between-group differences in duration of ventilation or other measures. In-hospital mortality was higher in the control group than in the training group (9 vs 4, 24% vs 12%, p = 0.23). CONCLUSIONS In patients who are ventilator-dependent, mechanical threshold loading inspiratory muscle training improves quality of life and dyspnoea, even in the absence of strength improvements or acceleration of ventilator liberation.
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19
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Ibsen S, Laursen BS, Christensen EF, Weinreich UM, Mikkelsen S, Lindskou TA. How Patients Who Are Transported by Ambulance Experience Dyspnea and the Use of a Dyspnea Scale: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10071208. [PMID: 35885735 PMCID: PMC9319940 DOI: 10.3390/healthcare10071208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Approximately 7% of all dispatched ambulances in Denmark are for patients for whom breathing difficulties are the main cause for using ambulance services. Objective measurements are routinely carried out in the ambulances, but little is known of the patients’ subjective experience of dyspnea. The purpose of this study was to investigate how patients with acute dyspnea, transported to hospital by ambulance, experience their situation, along with their experience of the use of a dyspnea scale. The study was carried out in the North Denmark Region. Transcribed patient interviews and field notes were analyzed and interpreted with inspiration from Paul Ricoeur. For interviews, we included 12 patients with dyspnea who were transported to the hospital by ambulance: six women and six men all aged 60 years or above. Observations were made over six ambulance transports related to dyspnea. Three themes emerged: “anxiety”, “reassurance in the ambulance” and “acceptance of the dyspnea measurements in the ambulance”. Several patients expressed anxiety due to their dyspnea, which was substantiated by observations in the ambulance. The patients expressed different perspectives on what improved the situation (treatment, reassurance by ambulance professionals). The patients and the ambulance personnel were, in general, in favor of the dyspnea scale.
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Affiliation(s)
- Stine Ibsen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, 9000 Aalborg, Denmark; (E.F.C.); (T.A.L.)
- Department of Physiotherapy, University College of Northern Denmark, 9000 Aalborg, Denmark
- Correspondence:
| | - Birgitte Schantz Laursen
- Clinical Nursing Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Sexology Research Centre, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, 9000 Aalborg, Denmark; (E.F.C.); (T.A.L.)
- Clinic of Internal and Emergency Medicine, Department of Emergency and Trauma Care, 9000 Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark;
- The Clinical Institute, Aalborg University, 9000 Aalborg, Denmark
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, 5000 Odense, Denmark;
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, 9000 Aalborg, Denmark; (E.F.C.); (T.A.L.)
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20
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Malpass A, Mcguire C, Macnaughton J. 'The body says it': the difficulty of measuring and communicating sensations of breathlessness. MEDICAL HUMANITIES 2022; 48:63-75. [PMID: 33509802 PMCID: PMC8867268 DOI: 10.1136/medhum-2019-011816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 06/12/2023]
Abstract
Breathlessness is a sensation affecting those living with chronic respiratory disease, obesity, heart disease and anxiety disorders. The Multidimensional Dyspnoea Profile is a respiratory questionnaire which attempts to measure the incommunicable different sensory qualities (and emotional responses) of breathlessness. Drawing on sensorial anthropology we take as our object of study the process of turning sensations into symptoms. We consider how shared cultural templates of 'what counts as a symptom' evolve, mediate and feed into the process of bodily sensations becoming a symptom. Our contribution to the field of sensorial anthropology, as an interdisciplinary collaboration between history, anthropology and the medical humanities, is to provide a critique of how biomedicine and cultures of clinical research have measured the multidimensional sensorial aspects of breathlessness. Using cognitive interviews of respiratory questionnaires with participants from the Breathe Easy groups in the UK, we give examples of how the wording used to describe sensations is often at odds with the language those living with breathlessness understand or use. They struggle to comprehend and map their bodily experience of sensations associated with breathlessness to the words on the respiratory questionnaire. We reflect on the alignment between cognitive interviewing as a method and anthropology as a disciplinary approach. We argue biomedicine brings with it a set of cultural assumptions about what it means to measure (and know) the sensorial breathless body in the context of the respiratory clinic (clinical research). We suggest the mismatch between the descriptions (and confusion) of those responding to the respiratory questionnaire items and those selecting the vocabularies in designing it may be symptomatic of a type of historical testimonial epistemic injustice, founded on the prioritisation of clinical expertise over expertise by experience.
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Affiliation(s)
- Alice Malpass
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
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21
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Alfano P, Cuttitta G, Audino P, Fazio G, La Grutta S, Marcantonio S, Bucchieri S. Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea. J Clin Med 2022; 11:jcm11030656. [PMID: 35160105 PMCID: PMC8837036 DOI: 10.3390/jcm11030656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.
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Affiliation(s)
- Pietro Alfano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
- Correspondence:
| | - Giuseppina Cuttitta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Palma Audino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
| | - Giovanni Fazio
- Triolo Zanca Clinic, Piazza Fonderia 23, 90133 Palermo, Italy;
| | - Sabina La Grutta
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy;
| | | | - Salvatore Bucchieri
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
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22
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Stubbs MA, Clark VL, Gibson PG, Yorke J, McDonald VM. Associations of symptoms of anxiety and depression with health-status, asthma control, dyspnoea, dysfunction breathing and obesity in people with severe asthma. Respir Res 2022; 23:341. [PMID: 36510255 PMCID: PMC9743554 DOI: 10.1186/s12931-022-02266-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety and depression are comorbidities of severe asthma. However, clinical characteristics associated with coexisting severe asthma and anxiety/depression are poorly understood. The study objective is to determine clinical characteristics associated with anxiety and depressive symptoms in severe asthma. METHODS Severe asthma participants (N = 140) underwent a multidimensional assessment. Categorization of symptoms of anxiety and depression were based on HADS scale sub-scores and divided into four groups (< 8 on both subscales; ≥ 8 on one subscale; ≥ 8 on both subscales). Clinical characteristics were compared between subgroups. Multivariate logistic regression determined associations of clinical characteristics and anxiety and/or depressive symptoms in people with severe asthma. RESULTS Participants were (mean ± SD) 59.3 ± 14.7 years old, and 62% female. There were 74 (53%) severe asthma participants without symptoms of anxiety/depression, 11 (7%) with symptoms of anxiety, 37 (26%) with symptoms of depression and 18 (13%) with symptoms of anxiety and depression. Quality of life impairment was greater in participants with symptoms of depression (4.4 ± 1.2) and combined symptoms of anxiety and depression (4.4 ± 1.1). Asthma control was worse in those with symptoms of depression (2.9 ± 1.1) and combined anxiety and depression (2.6 ± 1.0). In multivariate models, dysfunctional breathing was associated with symptoms of anxiety (OR = 1.24 [1.01, 1.53]). Dyspnoea was associated with symptoms of depression (OR = 1.90 [1.10, 3.25]). Dysfunctional breathing (OR 1.16 [1.04, 1.23]) and obesity (OR 1.17 [1.00, 1.35]) were associated with combined symptoms of anxiety and depression. CONCLUSION People with severe asthma and anxiety and/or depressive symptoms have poorer QoL and asthma control. Dyspnoea, dysfunctional breathing and obesity are associated with these symptoms. These key clinical characteristics should be targeted in severe asthma management.
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Affiliation(s)
- Michelle A. Stubbs
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Vanessa L. Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Peter G. Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.414724.00000 0004 0577 6676Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305 Australia
| | - Janelle Yorke
- grid.5379.80000000121662407School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.412917.80000 0004 0430 9259Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX UK
| | - Vanessa M. McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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23
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Tinti S, Parati M, De Maria B, Urbano N, Sardo V, Falcone G, Terzoni S, Alberti A, Destrebecq A. Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties. J Pain Symptom Manage 2022; 63:e46-e58. [PMID: 34358643 DOI: 10.1016/j.jpainsymman.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed. OBJECTIVES Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties. METHODS Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria. RESULTS Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales. CONCLUSION Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.
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Affiliation(s)
- Stefania Tinti
- Department of Biomedicine and Prevention (S.T.), University of Rome ''Tor Vergata'', Rome, Italy.
| | - Monica Parati
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory (M.P.), Politecnico di Milano, Milan, Italy; IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Nicla Urbano
- ASST-Rhodense (N.U.), Garbagnate Milanese, Milan, Italy
| | - Vivian Sardo
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Graziella Falcone
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Stefano Terzoni
- ASST-Santi Paolo e Carlo (S.T.), University of Milan, Milan, Italy
| | - Annalisa Alberti
- ASST-Rhodense Bachelor School of Nursing (A.A.), Rho, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health (A.D.), University of Milan, Milan, Italy
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24
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Harrison OK, Köchli L, Marino S, Luechinger R, Hennel F, Brand K, Hess AJ, Frässle S, Iglesias S, Vinckier F, Petzschner FH, Harrison SJ, Stephan KE. Interoception of breathing and its relationship with anxiety. Neuron 2021; 109:4080-4093.e8. [PMID: 34672986 PMCID: PMC8691949 DOI: 10.1016/j.neuron.2021.09.045] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023]
Abstract
Interoception, the perception of internal bodily states, is thought to be inextricably linked to affective qualities such as anxiety. Although interoception spans sensory to metacognitive processing, it is not clear whether anxiety is differentially related to these processing levels. Here we investigated this question in the domain of breathing, using computational modeling and high-field (7 T) fMRI to assess brain activity relating to dynamic changes in inspiratory resistance of varying predictability. Notably, the anterior insula was associated with both breathing-related prediction certainty and prediction errors, suggesting an important role in representing and updating models of the body. Individuals with low versus moderate anxiety traits showed differential anterior insula activity for prediction certainty. Multi-modal analyses of data from fMRI, computational assessments of breathing-related metacognition, and questionnaires demonstrated that anxiety-interoception links span all levels from perceptual sensitivity to metacognition, with strong effects seen at higher levels of interoceptive processes.
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Affiliation(s)
- Olivia K Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Psychology, University of Otago, Dunedin, New Zealand; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Laura Köchli
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Stephanie Marino
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Franciszek Hennel
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Katja Brand
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Alexander J Hess
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Stefan Frässle
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sandra Iglesias
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Fabien Vinckier
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Université de Paris, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Frederike H Petzschner
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Samuel J Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Max Planck Institute for Metabolism Research, Cologne, Germany
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25
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Tsai JJ, Chen KH, Fang HF, Huang TW. Relieving from Breathlessness in the Wind: A Meta-Analysis and Subjective Report of Effectiveness of Fan Blowing in Patients with Cardiorespiratory Diseases or Cancer. Am J Hosp Palliat Care 2021; 39:977-985. [PMID: 34866434 DOI: 10.1177/10499091211056327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Breathlessness is common among terminally ill patients with cardiorespiratory disease or cancer. The experience may induce secondary physiological and behavioral responses that limit patient well-being and independence and cause emotional distress. METHODS We conducted a meta-analysis on randomized controlled trials (RCTs) that examined the effectiveness of fan blowing on breathlessness among patients with cardiorespiratory diseases or cancer. The PubMed, Cochrane Library, Embase, SCOPUS, and CINAHL databases were searched to retrieve potential articles. The primary outcome was breathlessness severity. The secondary outcomes were SpO2, anxiety, depression, and quality of life. Also, we presented the changes of vital signs and subjective feeling of a male patient who used fan blowing for relieving his breathlessness. RESULTS Eight RCTs were available for analysis. The pooled results demonstrated no significant difference in breathlessness severity between fan-to-face blowing and control methods (standard mean difference: -0.21, 95% confidence interval: -.59 to .17); however, a significant reduction in breathlessness severity was observed in the short-time intervention compared with long-time intervention. A trend occurred toward significance in the reduction of respiratory rate in fan-to-face blowing compared with control methods (MD: -.64, 95% CI: -1.37 to .09). No differences were observed between groups in oxygen saturation, anxiety, depression, or QoL. The male patient who used fan blowing showed an improved vital signs and a satisfied subjective feeling. CONCLUSIONS Consistent short-time fan-to-face blowing is effective for relieving breathlessness among conscious terminally ill patients with cardiorespiratory diseases or cancer. The use of this convenient method for relieving breathlessness symptoms in terminally ill patients is recommended.
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Affiliation(s)
- Jing-Jing Tsai
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kee-Hsin Chen
- Post-Baccalaureate Program in Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, 38032Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, 38032Taipei Medical University, Taipei, Taiwan
| | - Hui-Fen Fang
- Deputy Director of Nursing Department, Taipei Cancer Center, 38032Taipei Medical University, Taipei, Taiwan.,Deputy Director of Cancer Center, 63474Taipei Medical University Hospital, Taipei, Taiwan.,Deputy Director of Nursing Service, 63474Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsai-Wei Huang
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, 38032Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, 38032Taipei Medical University, Taipei, Taiwan
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26
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Harrison OK, Hayen A, Wager TD, Pattinson KT. Investigating the specificity of the neurologic pain signature against breathlessness and finger opposition. Pain 2021; 162:2933-2944. [PMID: 33990110 PMCID: PMC8600542 DOI: 10.1097/j.pain.0000000000002327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Brain biomarkers of pain, including pain-predictive "signatures" based on brain activity, can provide measures of neurophysiological processes and potential targets for interventions. A central issue relates to the specificity of such measures, and understanding their current limits will both advance their development and explore potentially generalizable properties of pain to other states. Here, we used 2 data sets to test the neurologic pain signature (NPS), an established pain neuromarker. In study 1, brain activity was measured using high-field functional magnetic resonance imaging (7T fMRI, N = 40) during 5 to 25 seconds of experimental breathlessness (induced by inspiratory resistive loading), conditioned breathlessness anticipation, and finger opposition. In study 2, we assessed anticipation and breathlessness perception (3T, N = 19) under blinded saline (placebo) and remifentanil administration. The NPS responded to breathlessness, anticipation, and finger opposition, although no direct comparisons with painful events were possible. Local NPS patterns in anterior or midinsula, S2, and dorsal anterior cingulate responded to breathlessness and finger opposition and were reduced by remifentanil. Local NPS responses in the dorsal posterior insula did not respond to any manipulations. Therefore, significant global NPS activity alone is not specific for pain, and we offer insight into the overlap between NPS responses, breathlessness, and somatomotor demand.
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Affiliation(s)
- Olivia K. Harrison
- Translational Neuromodeling Unit, Institute of Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
- School of Pharmacy, University of Otago, New Zealand
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for NeuroImaging, University of Oxford, Oxford, United Kingdom
| | - Anja Hayen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for NeuroImaging, University of Oxford, Oxford, United Kingdom
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Tor D. Wager
- USA Department of Psychological and Brain Sciences, Dartmouth College, Hanover, United States.
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for NeuroImaging, University of Oxford, Oxford, United Kingdom
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27
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Karagiannis C, Savva C, Korakakis V, Adamide T, Georgiou A, Matheou I, Prodromou A, Xanthos T. Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2021; 41:426-431. [PMID: 34117184 DOI: 10.1097/hcr.0000000000000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. METHODS Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. RESULTS Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. CONCLUSIONS In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus (Drs Karagiannis and Savva and Ms Matheou); Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar (Dr Korakakis); Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus (Dr Adamide); Private Doctor, Nicosia, Cyprus (Dr Georgiou); Physiotherapy Department, Nicosia General Hospital, and Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus (Ms Prodromou); and School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Xanthos)
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28
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Abstract
Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.
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Affiliation(s)
- Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic, IOSI-EOC and Department of Internal Medicine, Ospedale Regionale di Lugano, Lugano
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Krause E, Benke C, Hamm AO, Pané-Farré CA. Hold your breath: Voluntary breath-holding time predicts defensive activation to approaching internal threat. Biol Psychol 2021; 166:108196. [PMID: 34601017 DOI: 10.1016/j.biopsycho.2021.108196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022]
Abstract
Bodily disturbances, like dyspnea, elicit responses to regain homeostasis and ensure survival. However, this life-saving function can become hyperreactive, which may lead to the emergence of psychopathology. This study investigated whether maximal voluntary breath-holding time (mvBHT), a biobehavioral marker that characterizes sensitivity to respiratory stimulation, predicts defensive mobilization to cues signaling the proximity of a mild electric shock vs. a respiratory threat (shortness of breath elicited by forced breath-holding) and the opportunity to avoid threat delivery in 60 healthy participants. While the startle reflex, a measure of defensive mobilization, generally increased with the proximity of an inevitable threat, shorter breath-holding time was specifically associated with greater startle potentiation when anticipating a respiratory threat but not an electric shock. In contrast, when both threats were avoidable, the startle reflex was comparably inhibited, irrespective of mvBHT. This study suggests that mvBHT specifically predicts hypersensitive responding to an anticipated inevitable respiratory threat.
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Affiliation(s)
- Elischa Krause
- Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487 Greifswald, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Christoph Benke
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Gutenbergstr. 18, 35037 Marburg, Germany
| | - Alfons O Hamm
- Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487 Greifswald, Germany
| | - Christiane A Pané-Farré
- Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487 Greifswald, Germany; Department of Clinical Psychology and Psychotherapy, University of Marburg, Gutenbergstr. 18, 35037 Marburg, Germany.
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Larsen KSR, Lisby M, Kirkegaard H, Petersen AK. Functional decline in emergency department patients with dyspnea: a register-based cohort. Int J Qual Health Care 2021; 33:6174034. [PMID: 33724379 DOI: 10.1093/intqhc/mzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably, patients acutely admitted to hospital with dyspnea have a high risk of functional decline. OBJECTIVE The aim of this study was to describe patient characteristics, hospital trajectory and use of physiotherapy services by dyspneic patients in an emergency department. The study also wanted to compare readmission and death among patients with and without a functional decline and to identify predictors of functional decline. METHODS Data originated from a historic cohort of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients who were treated at the emergency department (ED) for dyspnea in 2015. The main outcome measures were readmission, death and functional decline. RESULTS In total, 2048 dyspneic emergency treatments were registered. Within 30 days after discharge, 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, P < 0.001) and mortality (9.3% vs. 3.6%, P = 0.009) as well as mortality within 1 year (36.1% vs. 13.4%, P < 0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. CONCLUSION Patients suffering from acute dyspnea are seen at the ED at all hours. In total, one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seem to be particularly vulnerable.
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Affiliation(s)
- Karoline Stentoft Rybjerg Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, Aarhus 8200, Central Denmark Region, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark
| | - Marianne Lisby
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark.,Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, Aarhus 8200, Central Denmark Region, Denmark
| | - Hans Kirkegaard
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark.,Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, Aarhus 8200, Central Denmark Region, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, Aarhus 8200, Central Denmark Region, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark
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31
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Moy ML, Daniel RA, Cruz Rivera PN, Mongiardo MA, Goldstein RL, Higgins DM, Salat DH. Co-occurrence of pain and dyspnea in Veterans with COPD: Relationship to functional status and a pilot study of neural correlates using structural and functional magnetic resonance imaging. PLoS One 2021; 16:e0254653. [PMID: 34265003 PMCID: PMC8282042 DOI: 10.1371/journal.pone.0254653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
Persons with COPD experience co-occurring dyspnea and pain. Little is known about the relationship between symptom co-occurrence with physical activity (PA) and exercise. Novel diagnostic tools are needed for accurate symptom discrimination. In this secondary analysis, we examined relationships between baseline assessments of pain, dyspnea, objectively measured PA, and exercise capacity in persons with COPD who previously enrolled in three PA studies. Pain was assessed with the bodily pain domain of the Veterans RAND-36 (VR-36), and dyspnea with the modified Medical Research Council (mMRC) scale. Average daily step count was assessed with the Omron HJ-720ITC or FitBit Zip pedometer, and exercise capacity with 6-minute walk test (6MWT). We also conducted a pilot neuroimaging study. Neuroimaging data were acquired on a Siemens 3-Tesla Magnetom Prismafit whole-body scanner. Analysis of variance assessed trends in daily step count and 6MWT distance across categories of co-occurring pain and dyspnea. General linear models examined relationships between cortical thickness and resting state functional connectivity (fc) with symptoms and functional status. In 373 Veterans, 98% were male with mean age 70.5± 8.3 years and FEV1% predicted 59 ± 21%. Compared to those with no co-occurrence of pain and dyspnea, those with co-occurrence walked 1,291–1,444 fewer steps per day and had an 80–85 m lower 6MWT distance. Ten males participated in the pilot neuroimaging study. Predominant findings were that lower cortical thickness and greater fc were associated with higher pain and dyspnea, p<0.05. Greater cortical thickness and lower fc were associated with higher daily step count and 6MWT distance, p<0.05. Regional patterns of associations differed for pain and dyspnea, suggesting that cortical thickness and fc may discriminate symptoms. Co-occurring dyspnea and pain in COPD are associated with significant reductions in PA and exercise capacity. It may be feasible for neuroimaging markers to discriminate between pain and dyspnea.
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Affiliation(s)
- Marilyn L. Moy
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Rinu A. Daniel
- Boston University School of Medicine, Boston, MA, United States of America
| | - Paola N. Cruz Rivera
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - Maria A. Mongiardo
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - Rebekah L. Goldstein
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - Diana M. Higgins
- Boston University School of Medicine, Boston, MA, United States of America
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - David H. Salat
- Harvard Medical School, Boston, MA, United States of America
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
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Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions. Sports Med 2021; 51:1335-1351. [PMID: 33983613 DOI: 10.1007/s40279-021-01455-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.
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Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57030197. [PMID: 33669130 PMCID: PMC7996584 DOI: 10.3390/medicina57030197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022]
Abstract
Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient’s well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD.
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Anlló H, Herer B, Delignières A, Bocahu Y, Segundo I, Mach Alingrin V, Gilbert M, Larue F. Hypnosis for the Management of Anxiety and Dyspnea in COPD: A Randomized, Sham-Controlled Crossover Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:2609-2620. [PMID: 33122899 PMCID: PMC7591014 DOI: 10.2147/copd.s267019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) are prone to dyspnea, increased respiratory rate and other anxiety-inducing symptoms. Hypnosis constitutes a complementary procedure capable of improving subjective feelings of anxiety. Objective Assessing the efficacy of a 15-minute hypnosis intervention for immediate improvement of anxiety in severe COPD patients. Methods Twenty-one participants, COPD patients (mean FEV1 < 32.3%), were randomly assigned to two individual sessions in crossover (sham and hypnosis, 24-h washout period, arms: hypnosis-sham [n=11]/sham-hypnosis [n=10]). We tracked pre- and post-intervention anxiety (STAI-6 score) as primary endpoint. Results Nineteen (90.5%) participants completed the study. Anxiety diminished significantly after hypnosis (STAI-6 scores −23.8% [SD = 18.4%] hypnosis vs −3.1% [32.8%] sham; χ2=8, P<0.01, Bayes Factor 5.5). Respiratory rate also decreased after hypnosis. Improvements in SpO2 and Borg exertion scores were registered after both conditions. Conclusion A 15-minute hypnosis session improved participants’ anxiety and lowered respiratory rate (as opposed to sham). Improvements in anxiety were correlated with an alleviation in respiratory strain. Results imply that hypnosis can contribute to the improvement of anxiety levels and breathing mechanics in severe COPD patients. Registration Id ISRCTN10029862.
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Affiliation(s)
- Hernán Anlló
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Watanabe Cognitive Science Laboratory, School of Fundamental Science and Engineering. Waseda University, Tokyo, Japan
| | - Bertrand Herer
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Agathe Delignières
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Counselling and Psychological Care Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Yolaine Bocahu
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Isabelle Segundo
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Valérie Mach Alingrin
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Palliative Care Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Marion Gilbert
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - François Larue
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Palliative Care Unit, Bligny Hospital Center, Briis-sous-Forge, France
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Elmberg V, Ekström M. Effect of the trajectory of exertional breathlessness on symptom recall and anticipation: A randomized controlled trial. PLoS One 2020; 15:e0238937. [PMID: 32915891 PMCID: PMC7486077 DOI: 10.1371/journal.pone.0238937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Breathlessness is a major cause of physical limitation. Recalled breathlessness intensity may differ from experienced intensity and be influenced by the intensity trajectory including the ‘peak-end rule’. The primary aim was to test if adding two minutes of low intensity exercise at the end of an exercise test would change the recalled breathlessness. Secondary aims included to analyse the impact of the peak and end exertional breathlessness intensity on breathlessness recall. Methods Randomized controlled trial of 92 adults referred for exercise testing who were randomized (1:1), at test end, to 2 minutes of additional low intensity exercise (intervention; n = 47) or stopping at peak exertion (control; n = 45). Experienced breathlessness during the test and recalled intensity (30 min after the test) was assessed using the Borg CR10 scale. Results Participants were aged a mean 59 years; 61% men; 79% reported a mMRC ≥1. There was no between-group difference in recalled breathlessness intensity, 5.51 ([95% CI] 5.00 to 6.01) vs. 5.73 (5.27 to 6.20; p = 0.52) in controls, even though the intervention group had a significantly lower end breathlessness (mean difference 0.96; 0.24 to 1.67; p = 0.009). Recalled exertional breathlessness was most strongly related to peak breathlessness (r2 = 0.43). When analyzed together, end breathlessness did not add any explanatory value above that of peak breathlessness. Conclusion Adding an episode of two minutes of lower exercise and breathlessness intensity at the end of an exercise test did not affect symptom recall, which was most strongly related to peak breathlessness intensity. Trial registration ClinicalTrials.gov (NCT03468205).
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Affiliation(s)
- Viktor Elmberg
- Department of Clinical Physiology, Blekinge Hospital, Karlskrona, Sweden
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
- * E-mail:
| | - Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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36
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Interactions between Medicine and the Arts. Wien Klin Wochenschr 2020; 132:1-65. [DOI: 10.1007/s00508-020-01706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kauppi W, Herlitz J, Magnusson C, Palmér L, Axelsson C. Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study. BMC Emerg Med 2020; 20:67. [PMID: 32859155 PMCID: PMC7456019 DOI: 10.1186/s12873-020-00363-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN). Methods This retrospective observational study included patients aged > 16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the south-western part of Sweden by PENs during January and December, 2017. Of 7260 assignments (9% of all primary missions), 6354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis. Results The patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 h after symptom onset. Conclusions Among patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.
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Affiliation(s)
- Wivica Kauppi
- PreHospen- Centre for Prehospital Research, Faculty of Caring, Work Life and Social Welfare, University of Borås, SE- 501 90, Borås, Sweden. .,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Johan Herlitz
- PreHospen- Centre for Prehospital Research, Faculty of Caring, Work Life and Social Welfare, University of Borås, SE- 501 90, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Carl Magnusson
- PreHospen- Centre for Prehospital Research, Faculty of Caring, Work Life and Social Welfare, University of Borås, SE- 501 90, Borås, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Christer Axelsson
- PreHospen- Centre for Prehospital Research, Faculty of Caring, Work Life and Social Welfare, University of Borås, SE- 501 90, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Arvig MD, Lassen AT, Gæde PH, Laursen CB. Monitoring patients with acute dyspnoea with a serial focused ultrasound of the heart and the lungs (MODUS): a protocol for a multicentre, randomised, open-label, pragmatic and controlled trial. BMJ Open 2020; 10:e034373. [PMID: 32499263 PMCID: PMC7279664 DOI: 10.1136/bmjopen-2019-034373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Among patients admitted to an emergency department, dyspnoea is one of the most common symptoms. Patients with dyspnoea have high mortality and morbidity. Therefore, novel methods to monitor the patients are warranted. The aim is to investigate whether therapy guided by monitoring patients with acute dyspnoea with serial ultrasound examinations of the heart and the lungs together with standard care can change the severity of dyspnoea compared with treatment guided by standard monitoring alone. METHODS AND ANALYSIS The study will be conducted as a multicentre, randomised, pragmatic, open-label and controlled trial where patients admitted with acute dyspnoea to an emergency ward will be randomised into a standard care group and a serial ultrasound group with 103 patients in each. All patients will be examined with an ultrasound of the heart and the lungs upfront. In addition, the patients in the serial ultrasound group will be examined with an ultrasound of the heart and lungs two more times to guide further therapy during the admittance. The primary outcome is a change in dyspnoea on a verbal scale. After discharge, the patients are followed for 1 year to assess the number of readmissions, death and length of hospital stay. ETHICS AND DISSEMINATION The trial is conducted in accordance with the Declaration of Helsinki and approved by The Regional Committee on Health Research Ethics for Region Zealand, Denmark (identifier SJ-744). Data handling agreement with participating centres has been made (identifier REG-056-2019). The General Data Protection Regulation and the Danish Data Protection Act will be respected. The results of the trial will be reported in peer-reviewed scientific journals regardless of the outcomes. TRIAL REGISTRATION NUMBER NCT04091334.
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Affiliation(s)
- Michael D Arvig
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Annmarie T Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Peter H Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
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Macnaughton J. Making Breath Visible: Reflections on Relations between Bodies, Breath and World in the Critical Medical Humanities. BODY & SOCIETY 2020; 26:30-54. [PMID: 32587464 PMCID: PMC7263033 DOI: 10.1177/1357034x20902526] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Breath is invisible and yet ever present and vital for living beings. The concept of invisibility in relation to breath operates in concrete and metaphorical ways to extend ideas about breath and breathlessness across disciplines, in clinical spaces and in life experience. Using a critical medical humanities approach, I demonstrate that the poverty of narrative accounts and language for breath outside the health context have had a crucial influence enabling clinically mediated interpretations and accounts to dominate. These third-person accounts are important in the articulation of the 'lived body', but I balance this with a consideration of the subjective sensation of interoception, which has important implications for the visibility of breathlessness in both clinical and lay contexts. This article illustrates the rich potential of the subjects of breath and breathlessness within body studies and this special issue is a key step in making breath such an emergent topic.
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Kaido T, Hirabayashi H, Murase N, Sasaki R, Shimokawara T, Nagata K, Bando C, Aono Y. Deep slow nasal respiration with tight lip closure for immediate attenuation of severe tics. J Clin Neurosci 2020; 77:67-74. [PMID: 32417125 DOI: 10.1016/j.jocn.2020.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Severe intractable tics, which are associated with Tourette syndrome and chronic tic disorder (TS/CTD), severely affect the quality of life. Common less-invasive treatments are often unable to attenuate tics with deep brain stimulation currently being the only effective treatment. We aimed to assess the anti-tic effect of deep slow nasal respiration with tight lip closure using patients with TS/CTD. METHODS We retrospectively analyzed 10 consecutive patients (9 men, 1 woman; 23-41 years old). We instructed the patients to perform the procedure for 120 s and to obtain a video recording of before and during the procedure. The videos were used to count tics and determine lip competency or incompetency. The counted tics were rated using the modified Rush Video Rating Scale. RESULTS Compared with before the procedure, there were significantly lower frequencies of motor and phonic tics, as well as video scored, during the procedure. Eight patients presented with lip incompetency before the procedure and none after the procedure (P = 0.041). There were no side effects associated with the procedure. CONCLUSION Our findings indicate that deep slow nasal respiration with tight lip closure ameliorates tics in patients with TS/CTD. In accordance with our results, lip opening and oral breathing could be causes of tics, in addition to heritability. Therefore, this novel procedure could improve tics. Furthermore, our findings could contribute toward the development of tic treatments and elucidate their pathophysiology regarding the reward system, hypersensitivity, autonomic nerves, and nasal airway.
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Affiliation(s)
- Takanobu Kaido
- Department of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan; Anatomy and Physiology Laboratory, Department of Health and Nutrition, Osaka Shoin Women's University, Higashiosaka, Japan.
| | - Hidehiro Hirabayashi
- Department of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Nagako Murase
- Department of Neurology, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Ryota Sasaki
- Department of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Tatsuo Shimokawara
- Department of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Kiyoshi Nagata
- Department of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Chiaki Bando
- Department of Internal Medicine, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Yuka Aono
- Anatomy and Physiology Laboratory, Department of Health and Nutrition, Osaka Shoin Women's University, Higashiosaka, Japan
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42
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Bissett B, Gosselink R, van Haren FMP. Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach. Crit Care 2020; 24:103. [PMID: 32204719 PMCID: PMC7092518 DOI: 10.1186/s13054-020-2783-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Bruce, ACT, Australia
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, Health Science Campus Gasthuisberg O&N IV, Leuven, Belgium
| | - Frank M P van Haren
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia.
- Australian National University Medical School, Canberra, ACT, Australia.
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.
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43
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The effect of dyspnea on recognition memory. Int J Psychophysiol 2020; 148:50-58. [DOI: 10.1016/j.ijpsycho.2019.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
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44
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Raymond B, Luckett T, Johnson M, Hutchinson A, Lovell M, Phillips J. Low-intensity educational interventions supporting self-management to improve outcomes related to chronic breathlessness: a systematic review. NPJ Prim Care Respir Med 2019; 29:41. [PMID: 31784524 PMCID: PMC6884574 DOI: 10.1038/s41533-019-0152-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
Chronic breathlessness is debilitating and frightening, often resulting in emergency department presentations with acute-on-chronic breathlessness. Self-management is complex, involving 14 components as identified by the Practical Systematic Review in Self-Management Support (PRISMS). Low-intensity educational interventions that support breathlessness self-management through written/visual educational materials, alongside limited health professional support, are available. Our aim was to describe components of low-intensity educational interventions that support and improve self-management for adults with chronic breathlessness and evaluate their efficacy for improving breathlessness-related outcomes. A systematic review was conducted, including RCTs that compared these interventions with usual care in adults with chronic disease. Synthesis took a narrative approach utilizing the PRISMS taxonomy and Template for Intervention Description and Replication (TIDieR) checklist. Of the 1948 articles identified, 7 met criteria reporting 7 RCTs using 6 interventions. Studies utilized 12 out of 14 PRISMS components, the most frequent being training/rehearsal for psychological strategies. Evidence for effectiveness was inconsistent and attempts to identify beneficial components were confounded by intervention complexity and heterogeneity. The optimal content and delivery of low-intensity educational interventions that support self-management to improve chronic breathlessness-related outcomes in adults cannot be defined from current published literature. Future research should incorporate more detailed, standardized reporting to enable comparison and meta-analysis.
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Affiliation(s)
- Bronwyn Raymond
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Miriam Johnson
- Hull York Medical School, University of York, John Hughlings Jackson Building, Heslington, York, Y010 5DD, UK
| | - Ann Hutchinson
- Hull York Medical School, University of York, John Hughlings Jackson Building, Heslington, York, Y010 5DD, UK
| | - Melanie Lovell
- HammondCare, 95-115 River Road, Greenwich, NSW, 2065, Australia.,Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, NSW, 2050, Australia
| | - Jane Phillips
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia
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45
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Abdallah SJ, Faull OK, Wanigasekera V, Finnegan SL, Jensen D, Pattinson KTS. Opioids for breathlessness: psychological and neural factors influencing response variability. Eur Respir J 2019; 54:13993003.00275-2019. [PMID: 31073088 PMCID: PMC6751386 DOI: 10.1183/13993003.00275-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/27/2019] [Indexed: 12/15/2022]
Abstract
Chronic breathlessness is a multidimensional and aversive symptom, which is often poorly explained by underlying pathophysiology [1]. For many sufferers, breathlessness is refractory to maximal medical therapies that target disease processes [2]. However, opioids are thought to be a possible therapeutic avenue to treat symptomology independently of disease [3]. Importantly, research in chronic pain has demonstrated that qualities such as anxiety and depression (collectively termed negative affect here) can both exacerbate symptoms [4] and reduce opioid efficacy [5, 6]. Therefore, it may be pertinent to consider such behavioural factors when contemplating the use of opioids for breathlessness. Diminished opioid efficacy in the treatment of breathlessness is related to negative affect and anticipatory brain activity in the anterior cingulate and medial prefrontal cortex.http://bit.ly/2LXyyDo
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Affiliation(s)
- Sara J Abdallah
- Clinical Exercise & Respiratory Physiology Laboratory, Dept of Kinesiology & Physical Education, McGill University, Montréal, QC, Canada.,Joint first authors
| | - Olivia K Faull
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK.,Joint first authors
| | - Vishvarani Wanigasekera
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarah L Finnegan
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory, Dept of Kinesiology & Physical Education, McGill University, Montréal, QC, Canada
| | - Kyle T S Pattinson
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK
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Abstract
PURPOSE OF REVIEW Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. RECENT FINDINGS A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. SUMMARY A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.
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Affiliation(s)
- Lucy L. Marlow
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K. Faull
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sarah L. Finnegan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Lin F, Yeh M, Lai Y, Lin K, Yu C, Chang J. Two‐month breathing‐based walking improves anxiety, depression, dyspnoea and quality of life in chronic obstructive pulmonary disease: A randomised controlled study. J Clin Nurs 2019; 28:3632-3640. [DOI: 10.1111/jocn.14960] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Feng‐Lien Lin
- Department of Nursing National Taiwan University Hospital Taipei Taiwan, ROC
| | - Mei‐Ling Yeh
- Department of Nursing National Taipei University of Nursing and Health Sciences Taipei Taiwan, ROC
| | - Yeur‐Hur Lai
- School of Nursing National Taiwan University Taipei Taiwan, ROC
- Department of Nursing National Taiwan University Cancer Center Taipei Taiwan, ROC
| | - Kuan‐Chia Lin
- Institute of Hospital and Health Care Administration National Yang Ming University Taipei Taiwan, ROC
| | - Chong‐Jen Yu
- National Taiwan University Hospital Taipei Taiwan, ROC
- Department of Internal Medicine, College of Medicine National Taiwan University Taipei Taiwan, ROC
| | - Jung‐San Chang
- Department of Renal Care Kaohsiung Medical University Kaohsiung Taiwan, ROC
- Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan, ROC
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48
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Asano R, Mathai SC, Macdonald PS, Newton PJ, Currow DC, Phillips J, Yeung WF, Davidson PM. Oxygen use in chronic heart failure to relieve breathlessness: A systematic review. Heart Fail Rev 2019; 25:195-205. [DOI: 10.1007/s10741-019-09814-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Cacciola A, Bertino S, Basile GA, Di Mauro D, Calamuneri A, Chillemi G, Duca A, Bruschetta D, Flace P, Favaloro A, Calabrò RS, Anastasi G, Milardi D. Mapping the structural connectivity between the periaqueductal gray and the cerebellum in humans. Brain Struct Funct 2019; 224:2153-2165. [PMID: 31165919 PMCID: PMC6591182 DOI: 10.1007/s00429-019-01893-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023]
Abstract
The periaqueductal gray is a mesencephalic structure involved in modulation of responses to stressful stimuli. Structural connections between the periaqueductal gray and the cerebellum have been described in animals and in a few diffusion tensor imaging studies. Nevertheless, these periaqueductal gray–cerebellum connectivity patterns have yet to be fully investigated in humans. The objective of this study was to qualitatively and quantitatively characterize such pathways using high-resolution, multi-shell data of 100 healthy subjects from the open-access Human Connectome Project repository combined with constrained spherical deconvolution probabilistic tractography. Our analysis revealed robust connectivity density profiles between the periaqueductal gray and cerebellar nuclei, especially with the fastigial nucleus, followed by the interposed and dentate nuclei. High-connectivity densities have been observed between vermal (Vermis IX, Vermis VIIIa, Vermis VIIIb, Vermis VI, Vermis X) and hemispheric cerebellar regions (Lobule IX). Our in vivo study provides for the first time insights on the organization of periaqueductal gray–cerebellar pathways thus opening new perspectives on cognitive, visceral and motor responses to threatening stimuli in humans.
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Affiliation(s)
- Alberto Cacciola
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Salvatore Bertino
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianpaolo Antonio Basile
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Debora Di Mauro
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | | | - Antonio Duca
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Daniele Bruschetta
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Paolo Flace
- School of Medicine, University of Bari 'Aldo Moro', Bari, Italy
| | - Angelo Favaloro
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- School of Medicine, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Giuseppe Anastasi
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Demetrio Milardi
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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50
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Hanania NA, O'Donnell DE. Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Int J Chron Obstruct Pulmon Dis 2019; 14:1127-1138. [PMID: 31213793 PMCID: PMC6538882 DOI: 10.2147/copd.s188141] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/01/2019] [Indexed: 12/27/2022] Open
Abstract
Dyspnea is a distressing, debilitating, and near-ubiquitous symptom affecting patients with COPD. In addition to the functional consequences of dyspnea, which include activity limitation and reduced exercise tolerance, it is important to consider its psychological impact on patients with COPD, such as onset of depression or anxiety. Moreover, the anticipation of dyspnea itself can have a significant effect on patients' emotions and behavior, with patients frequently self-limiting physical activity to avoid what has become the hallmark symptom of COPD. Dyspnea is, therefore, a key target for COPD treatments. Pharmacologic treatments can optimize respiratory mechanics, provide symptom relief, and reduce patients' increased inspiratory neural drive to breathe. However, it is important to acknowledge the value of non-pharmacologic interventions, such as pulmonary rehabilitation and patient self-management education, which have proven to be invaluable tools for targeting the affective components of dyspnea. Furthermore, it is important to encourage maintenance of physical activity to optimize long-term patient outcomes. Here, we review the physiological and psychological consequences of activity-related dyspnea in COPD, assess the efficacy of modern management strategies in improving this common respiratory symptom, and discuss key unmet clinical and research needs that warrant further immediate attention.
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Affiliation(s)
- Nicola A Hanania
- Department of Medicine, Section of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX, USA
| | - Denis E O'Donnell
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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