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Karlsen J, Tandstad T, Steinshamn S, Salvesen Ø, Parlikar ND, Lundgren S, Reidunsdatter RJ. Pulmonary Function and Lung Fibrosis up to 12 Years After Breast Cancer Radiotherapy. Int J Radiat Oncol Biol Phys 2024; 118:1066-1077. [PMID: 38099884 DOI: 10.1016/j.ijrobp.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE Breast cancer (BC) treatment may affect pulmonary function, but evidence of long-term pulmonary toxicity is scarce. This study aimed to evaluate pulmonary function, radiation fibrosis (RF), and patient-reported dyspnea up to 12 years after different BC treatment modalities. METHODS AND MATERIALS Two hundred fifty patients with BC referred to postoperative radiotherapy (RT) were included in this study. High-resolution computed tomography, pulmonary function tests (PFTs), clinical examinations, and patient-reported dyspnea were assessed before RT and at 3, 6, and 12 months and up to 12 years after RT. RESULTS Vital capacity (VC), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and diffusion capacity of the lungs for carbon monoxide (DLCO) declined at 3 months after RT and remained low at long-term follow-up except for DLCO, which increased up to 12 years after RT. VC, FEV1, and FVC changes differed between patients treated with and without chemotherapy, and FEV1 differed between patients treated with locoregional and local RT. An early decline in VC, FEV1, and FVC predicted a late decline in PFT values up to 12 years after RT (P = .020, P = .004, and P = .020, respectively). RF, mainly grade 1, was observed in 91% of patients at long-term follow-up. Few patients reported severe dyspnea at long-term follow-up, and there was no statistically significant association with concurrent RF or decline in PFT values from baseline. CONCLUSIONS Chemotherapy and locoregional RT affected performance in PFTs up to 12 years after RT. Reduction in VC, FVC, and FEV1 3 months after RT predicted a decline in PFT values at long-term follow-up. However, a late decline in PFT values was not associated with long-term RF or patient-reported dyspnea.
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Affiliation(s)
- Jarle Karlsen
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Torgrim Tandstad
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Steinshamn
- Department og Thoracic Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nayan Deepak Parlikar
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Steinar Lundgren
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Randi J Reidunsdatter
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Young CA, Chaouch A, Mcdermott CJ, Al-Chalabi A, Chhetri SK, Talbot K, Harrower T, Orrell RW, Annadale J, Hanemann CO, Scalfari A, Tennant A, Mills R. Dyspnea (breathlessness) in amyotrophic lateral sclerosis/motor neuron disease: prevalence, progression, severity, and correlates. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-11. [PMID: 38465877 DOI: 10.1080/21678421.2024.2322545] [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: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
Objective: Dyspnea, or breathlessness, is an important symptom in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). We examined the measurement properties of the Dyspnea-12. Methods: Rasch analysis enabled conversion of raw Dyspnea-12 scores to interval level metric equivalents. Converted data were used to perform trajectory modeling; those following different trajectories were compared for demographic, clinical, symptom, and functioning characteristics. Logistic regression examined differences between distinct trajectories. Results: In 1022 people, at baseline, mean metric Dyspnea-12 was 7.6 (SD 9.3). 49.8% had dyspnea, severe in 12.6%. Trajectory analysis over 28 months revealed three breathlessness trajectories: group 1 reported none at baseline/follow-up (42.7%); group 2 significantly increased over time (9.4%); group 3 had a much higher level at baseline which rose over follow-up (47.9%). Group 3 had worse outcomes on all symptoms, functioning and quality of life; compared to group 1, their odds of: respiratory onset sixfold greater; King's stage ≥3 2.9 greater; increased odds of being bothered by choking, head drop, fasciculations, and muscle cramps; fatigue and anxiety also elevated (p < .01). Conclusion: Dyspnea is a cardinal symptom in ALS/MND and can be quickly measured using the Dyspnea-12. Raw scores can easily be converted to interval level measurement, for valid change scores and trajectory modeling. Dyspnea trajectories reveal different patterns, showing that clinical services must provide monitoring which is customized to individual patient need. Almost half of this large population had worsening dyspnea, confirming the importance of respiratory monitoring and interventions being integrated into routine ALS care.
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Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Amina Chaouch
- Greater Manchester Centre for Clinical Neurosciences, Salford, UK
| | | | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | | | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Joe Annadale
- Hywel Dda University Health Board, Carmarthen, UK
| | - C Oliver Hanemann
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Roger Mills
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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3
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Kalluri M, Cui Y, Wang T, Bakal JA. Validation of a Novel Clinical Dyspnea Scale - A Retrospective Pilot Study. Am J Hosp Palliat Care 2024; 41:253-261. [PMID: 36977656 PMCID: PMC10802087 DOI: 10.1177/10499091231167879] [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] [Indexed: 03/30/2023] Open
Abstract
Objective: to examine the validity of a novel dyspnea scale, Edmonton Dyspnea Inventory in idiopathic pulmonary fibrosis (IPF). Methods: Edmonton Dyspnea Inventory (EDI), is a clinical instrument to measure dyspnea severity with activities of daily living, exercise and rest using a numeric rating scale (0 -10). Consecutive IPF patients (2012-2018) with baseline MRC and EDI were included. To validate EDI, psychometric analysis was conducted. Correlations between EDI, MRC and lung function were examined. Group-based trajectory modeling was used to group patients based on dyspnea severity. Net Reclassification Improvement (NRI) was calculated to assess the improvement in 1-year mortality prediction by adding trajectory groups to MRC grade. Results: 100 consecutive IPF patients were identified; mean age 73 years (SD = 9) and 65% males; 73% were in MRC grades ≥3. Item analysis showed all 8 EDI components have excellent discrimination power with ability to differentiate patients with varying dyspnea severity. EDI has good internal consistency (Cronbach α = .92). Exploratory factor analysis showed a one-factor solution with loadings from .66 to .89 suggesting 8 EDI components measured essentially one dimension of dyspnea. All EDI components were correlated with MRC and some with lung function. Modeling data identified three EDI dyspnea severity groups with differing mortality (P = .009). The addition of EDI dyspnea severity groups to the MRC score improved 1-year mortality prediction (NRI = .66; 95% CI, .18-1.14). Conclusions: EDI is a valid dyspnea instrument, correlated with MRC and lung function. It can categorize IPF patients into 3 dyspnea severity groups associated with increased mortality. Key Message: We describe the development of a novel scale, Edmonton Dyspnea Inventory, that facilitates measurement of dyspnea severity in the context of daily activities in patients with IPF. The results indicate that the new instrument is valid and correlated to MRC. It identifies 3 categories of severity not recognized by MRC with impact on mortality. Knowledge of dyspnea severity can help triage patients and assign appropriate therapies.
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Affiliation(s)
- Meena Kalluri
- Department of Medicine, Pulmonary Division, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Ying Cui
- Faculty of Education, University of Alberta, Edmonton, 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
- Patient Health Outcomes and Clinical Effectiveness Unit, University of Alberta, Edmonton, AB, Canada
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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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Nakamura NH, Oku Y, Fukunaga M. "Brain-breath" interactions: respiration-timing-dependent impact on functional brain networks and beyond. Rev Neurosci 2024; 35:165-182. [PMID: 37651646 DOI: 10.1515/revneuro-2023-0062] [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: 06/05/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023]
Abstract
Breathing is a natural daily action that one cannot do without, and it sensitively and intensely changes under various situations. What if this essential act of breathing can impact our overall well-being? Recent studies have demonstrated that breathing oscillations couple with higher brain functions, i.e., perception, motor actions, and cognition. Moreover, the timing of breathing, a phase transition from exhalation to inhalation, modulates specific cortical activity and accuracy in cognitive tasks. To determine possible respiratory roles in attentional and memory processes and functional neural networks, we discussed how breathing interacts with the brain that are measured by electrophysiology and functional neuroimaging: (i) respiration-dependent modulation of mental health and cognition; (ii) respiratory rhythm generation and respiratory pontomedullary networks in the brainstem; (iii) respiration-dependent effects on specific brainstem regions and functional neural networks (e.g., glutamatergic PreBötzinger complex neurons, GABAergic parafacial neurons, adrenergic C1 neurons, parabrachial nucleus, locus coeruleus, temporoparietal junction, default-mode network, ventral attention network, and cingulo-opercular salience network); and (iv) a potential application of breathing manipulation in mental health care. These outlines and considerations of "brain-breath" interactions lead to a better understanding of the interoceptive and cognitive mechanisms that underlie brain-body interactions in health conditions and in stress-related and neuropsychiatric disorders.
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Affiliation(s)
- Nozomu H Nakamura
- Division of Physiome, Department of Physiology, Hyogo Medical University, 1-1, Mukogawa cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshitaka Oku
- Division of Physiome, Department of Physiology, Hyogo Medical University, 1-1, Mukogawa cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Masaki Fukunaga
- Section of Brain Function Information, National Institute of Physiological Sciences, 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585, Japan
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Bastas D, Brandão LR, Vincelli J, Wilson D, Perrem L, Guerra V, Wong G, Bentley RF, Tole S, Schneiderman JE, Amiri N, Williams S, Avila ML. Long-term outcomes of pulmonary embolism in children and adolescents. Blood 2024; 143:631-640. [PMID: 38134357 DOI: 10.1182/blood.2023021953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/24/2023] Open
Abstract
ABSTRACT Knowledge regarding the long-term consequences of pulmonary embolism (PE) in children is limited. This cohort study describes the long-term outcomes of PE in children who were followed-up at a single-center institution using a local protocol that included clinical evaluation, chest imaging, echocardiography, pulmonary function tests, and cardiopulmonary exercise tests at follow-up, starting 3 to 6 months after acute PE. Children objectively diagnosed with PE at age 0 to 18 years, who had ≥6 months of follow-up were included. Study outcomes consisted of PE resolution, PE recurrence, death, and functional outcomes (dyspnea, impaired pulmonary or cardiac function, impaired aerobic capacity, and post-PE syndrome). The frequency of outcomes was compared between patients with/without underlying conditions. In total, 150 patients were included; median age at PE was 16 years (25th-75th percentile, 14-17 years); 61% had underlying conditions. PE did not resolve in 29%, recurrence happened in 9%, and death in 5%. One-third of patients had at least 1 documented abnormal functional finding at follow-up (ventilatory impairments, 31%; impaired aerobic capacity, 31%; dyspnea, 26%; and abnormal diffusing capacity of the lungs to carbon monoxide, 22%). Most abnormalities were transient. When alternative explanations for the impairments were considered, the frequency of post-PE syndrome was lower, ranging between 0.7% and 8.5%. Patients with underlying conditions had significantly higher recurrence, more pulmonary function and ventilatory impairments, and poorer exercise capacity. Exercise intolerance was, in turn, most frequently because of deconditioning than to respiratory or cardiac limitation, highlighting the importance of physical activity promotion in children with PE.
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Affiliation(s)
- Denise Bastas
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leonardo R Brandão
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Vincelli
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Wilson
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lucy Perrem
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vitor Guerra
- Division of Cardiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gina Wong
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert F Bentley
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Soumitra Tole
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jane E Schneiderman
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nour Amiri
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Suzan Williams
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - M Laura Avila
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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7
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Zeng S, Nishihama M, Weldemichael L, Lozier H, Gold WM, Arjomandi M. Effect of twice daily inhaled albuterol on cardiopulmonary exercise outcomes, dynamic hyperinflation, and symptoms in secondhand tobacco-exposed persons with preserved spirometry and air trapping: a randomized controlled trial. BMC Pulm Med 2024; 24:44. [PMID: 38245665 PMCID: PMC10799390 DOI: 10.1186/s12890-023-02808-7] [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: 06/09/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND In tobacco-exposed persons with preserved spirometry (active smoking or secondhand smoke [SHS] exposure), air trapping can identify a subset with worse symptoms and exercise capacity. The physiologic nature of air trapping in the absence of spirometric airflow obstruction remains unclear. The aim of this study was to examine the underlying pathophysiology of air trapping in the context of preserved spirometry and to determine the utility of bronchodilators in SHS tobacco-exposed persons with preserved spirometry and air trapping. METHODS We performed a double-blinded placebo-controlled crossover randomized clinical trial in nonsmoking individuals at risk for COPD due to exposure to occupational SHS who had preserved spirometry and air trapping defined as either a residual volume-to-total lung capacity ratio (RV/TLC) > 0.35 or presence of expiratory flow limitation (EFL, overlap of tidal breathing on maximum expiratory flow-volume loop) on spirometry at rest or during cardiopulmonary exercise testing (CPET). Those with asthma or obesity were excluded. Participants underwent CPET at baseline and after 4-week trials of twice daily inhalation of 180 mcg of albuterol or placebo separated by a 2-week washout period. The primary outcome was peak oxygen consumption (VO2) on CPET. Data was analyzed by both intention-to-treat and per-protocol based on adherence to treatment prescribed. RESULTS Overall, 42 participants completed the entire study (66 ± 8 years old, 91% female; forced expiratory volume in 1 s [FEV1] = 103 ± 16% predicted; FEV1 to forced vital capacity [FVC] ratio = 0.75 ± 0.05; RV/TLC = 0.39 ± 0.07; 85.7% with EFL). Adherence was high with 87% and 93% of prescribed doses taken in the treatment and placebo arms of the study, respectively (P = 0.349 for comparison between the two arms). There was no significant improvement in the primary or secondary outcomes by intention-to-treat or per-protocol analysis. In per-protocol subgroup analysis of those with RV/TLC > 0.35 and ≥ 90% adherence (n = 27), albuterol caused an improvement in peak VO2 (parameter estimate [95% confidence interval] = 0.108 [0.014, 0.202]; P = 0.037), tidal volume, minute ventilation, dynamic hyperinflation, and oxygen-pulse (all P < 0.05), but no change in symptoms or physical activity. CONCLUSIONS Albuterol may improve exercise capacity in the subgroup of SHS tobacco-exposed persons with preserved spirometry and substantial air trapping. These findings suggest that air trapping in pre-COPD may be related to small airway disease that is not considered significant by spirometric indices of airflow obstruction.
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Affiliation(s)
- Siyang Zeng
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, Building 203, Room 3A-128, Mailstop 111-D, 4150 Clement Street, San Francisco, CA, 94121, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Melissa Nishihama
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, Building 203, Room 3A-128, Mailstop 111-D, 4150 Clement Street, San Francisco, CA, 94121, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Lemlem Weldemichael
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, Building 203, Room 3A-128, Mailstop 111-D, 4150 Clement Street, San Francisco, CA, 94121, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Helen Lozier
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, Building 203, Room 3A-128, Mailstop 111-D, 4150 Clement Street, San Francisco, CA, 94121, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
- Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Warren M Gold
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Mehrdad Arjomandi
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, Building 203, Room 3A-128, Mailstop 111-D, 4150 Clement Street, San Francisco, CA, 94121, USA.
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA.
- Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California, San Francisco, CA, USA.
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Pavy F, Torta DM, von Leupoldt A. The effect of unpredictability on the perception of breathlessness: a narrative review. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1339072. [PMID: 38264214 PMCID: PMC10803486 DOI: 10.3389/fresc.2023.1339072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
Breathlessness is an aversive bodily sensation impacting millions of people worldwide. It is often highly detrimental for patients and can lead to profound distress and suffering. Notably, unpredictable breathlessness episodes are often reported as being more severe and unpleasant than predictable episodes, but the underlying reasons have not yet been firmly established in experimental studies. This review aimed to summarize the available empirical evidence about the perception of unpredictable breathlessness in the adult population. Specifically, we examined: (1) effects of unpredictable relative to predictable episodes of breathlessness on their perceived intensity and unpleasantness, (2) potentially associated neural and psychophysiological correlates, (3) potentially related factors such as state and trait negative affectivity. Nine studies were identified and integrated in this review, all of them conducted in healthy adult participants. The main finding across studies suggested that unpredictable compared to predictable, breathlessness elicits more frequently states of high fear and distress, which may contribute to amplify the perception of unpredictable breathlessness, especially its unpleasantness. Trait negative affectivity did not seem to directly affect the perception of unpredictable breathlessness. However, it seemed to reinforce state fear and anxiety, hence possible indirect modulatory pathways through these affective states. Studies investigating neural correlates of breathlessness perception and psychophysiological measures did not show clear associations with unpredictability. We discuss the implication of these results for future research and clinical applications, which necessitate further investigations, especially in clinical samples suffering from breathlessness.
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Affiliation(s)
- Fabien Pavy
- Research Group Health Psychology, Department of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Matsuda Y, Hasuo H, Narita K, Matsuoka H, Morita R, Kiuchi D, Ikari T, Hori T, Okazaki K, Sakai K, Aiki S, Okabayashi H, Oyamada S, Ariyoshi K, Tokoro A, Fukunaga M. Relationship between dyspnoea and related factors in patients with cancer: a cross-sectional study. BMJ Support Palliat Care 2024; 13:e1126-e1132. [PMID: 38557730 DOI: 10.1136/bmjspcare-2021-003484] [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: 11/28/2021] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Dyspnoea is a common and distressing symptom in patients with cancer. We aimed to analyse the association between dyspnoea and related factors and to estimate their causal relationship. METHODS A cross-sectional study was conducted. Patients with cancer with dyspnoea and a mean Numerical Rating Scale (NRS) of ≥3 over 24 hours were enrolled at 10 institutions in Japan from December 2019 to February 2021. The outcomes included dyspnoea, cough and pain NRS over 24 hours, Eastern Cooperative Oncology Group Performance Status, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale, opioids for dyspnoea and respiratory failure. Path analyses were conducted to estimate the direct and indirect paths with reference to dyspnoea and related factors. RESULTS A total of 209 patients were enrolled and 208 patients were included in the analysis. Cough worsened dyspnoea (β=0.136), dyspnoea increased emotional distress (β=1.104), emotional distress increased somatosensory amplification (β=0.249) and somatosensory amplification worsened cough (β=0.053) according to path analysis. CONCLUSION There may be a vicious circle among dyspnoea and related factors: cough worsened dyspnoea, dyspnoea increased emotional distress, emotional distress increased somatosensory amplification and somatosensory amplification worsened cough. When treating dyspnoea in patients with cancer, managing these factors aimed at interrupting this vicious circle may be useful. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000038820).
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Keiichi Narita
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kosei Medical Center, Akita, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuo Hori
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Koya Okazaki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kiyohiro Sakai
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine Hospital, Osakasayama, Japan
| | - Sayo Aiki
- Department of Palliative Care, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroko Okabayashi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
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Sakaguchi T. Cancer-related breathlessness: opioids other than morphine - comprehensive literature review. BMJ Support Palliat Care 2024; 13:e715-e729. [PMID: 37468224 DOI: 10.1136/spcare-2022-004115] [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: 12/05/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Although there is low-quality evidence, there has been an increase in publications on the experience of evaluating and managing cancer-related breathlessness using opioids other than morphine. METHODS The author conducted a non-systematic literature review in the PubMed/Medline and Embase until 4 October 2022. Eligible studies have evaluated the efficacy of opioids other than morphine for cancer-related breathlessness. Studies focused on sedation, anaesthesia, paediatric patients, opioid toxicity or basic research were excluded. Reviews/meta-analyses and non-English language publications were also excluded. RESULTS A total of 1556 records were identified, of which 23 studies including 469 patients who were treated with fentanyl (n=223), oxycodone (n=171) and hydromorphone (n=75) were considered eligible. Six phase II randomised clinical trials (RCTs), four observational studies and four case reports of fentanyl were found. For breathlessness on exertion, fentanyl yielded promising results, but no RCT showed significant superiority of fentanyl to placebo or morphine. For terminal breathlessness, three RCTs, five non-randomised or observational studies and one case report on oxycodone or hydromorphone were found. Although the results of the observational studies suggested that oxycodone and hydromorphone might be effective alternatives to morphine, the superiority over placebo or non-inferiority to morphine had not been demonstrated in the RCTs. CONCLUSION As an alternative to morphine, the author recommends fentanyl for breathless crisis or breathlessness on exertion, and oxycodone or hydromorphone for terminal breathlessness in advanced cancer. Larger and well-designed studies based on firm research policies are needed to confirm this current knowledge.
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Affiliation(s)
- Tatsuma Sakaguchi
- Department of Palliative Care, Kitano Hospital, Osaka, Japan
- Palliative Care Centre, Aichi Medical University, Nagakute, Japan
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11
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Teixeira ICA, Carvas AMP, Silva RBD, Borges E, Corrêa-Faria P, Rabahi MF. Dyspnoea at the end of life: instrument development and validation-the CONFORTO Strategy. BMJ Support Palliat Care 2024; 13:e1103-e1109. [PMID: 35473755 DOI: 10.1136/bmjspcare-2021-003456] [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: 11/17/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the construction and validation of the algorithm for Criteria for inclusion; Objective of dyspnoea; Notification of patient/family/health professionals; Facial air flow; Oxygen; Relaxion and breathing; Treating causes of dyspnoea and Opioid (CONFORTO), an instrument to guide health professionals in managing dyspnoea in patients with an advance stage of the disease at the end-of-life. METHODS The study was carried out in three stages: (1) literature review and construction of CONFORTO; (2) semantic validation; (3) application of the CONFORTO Strategy to health professionals as a test (before video lessons) and post-test (20 days after watching video lessons) methodology. The scores obtained in the pretest and post-test were compared using the Wilcoxon test. RESULTS Seventy-four professionals from different internal medicine and intensive care units participated in the study. The CONFORTO Strategy involved eight acronym-forming items: Criteria for inclusion; Objective of dyspnoea; Notification of patient/family/health professionals; Facial air flow; Oxygen; Relaxion and breathing; Treating causes of dyspnoea and Opioid. The post-test indicated a significant increase in the score for the following items: facial air flow (p=0.016); oxygen (p=0.002); relaxation and breathing (p=0.002) and treating the causes of dyspnoea (p=0.011). The increase in score occurred after the training sessions with video lessons. CONCLUSION The CONFORTO Strategy proved valid and reliable for managing dyspnoea in patients with an advanced stage of the disease at the end-of-life. Because the instrument is easy-to-use, it can be used by the entire health team at any assistance-providing location, and can, thus, contribute to improving dyspnoea management for these patients.
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Affiliation(s)
| | | | - Ricardo Borges da Silva
- Internal Medicine Department, School of Medicine, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Eliza Borges
- Hospital Estadual Dr. Alberto Rassi, Goiânia, Brazil
| | - Patrícia Corrêa-Faria
- Dentistry Graduate Program, School of Dentistry, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Marcelo Fouad Rabahi
- Internal Medicine Department, School of Medicine, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
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12
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Julià-Torras J, Moreno-Alonso D, Porta-Sales J, Monforte-Royo C. Episodic breathlessness in patients with cancer: definition, terminology, clinical features - integrative systematic review. BMJ Support Palliat Care 2024; 13:e585-e596. [PMID: 36600405 DOI: 10.1136/spcare-2022-003653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Breatlessness flares directly impair quality of life of patients with cancer. The aim of this review was to analyse and synthesise the available information related to its terminology, definition and clinical features in patients with cancer. METHODS Integrative systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature search was conducted in MEDLINE PubMed, CINAHLPlus, Web of Science, Cochrane Central Register Controlled Trials CENTRAL, Scopus and OpenAire. RESULTS Data from 1065 patients with cancer included in 12 studies were analysed. The preferred term for breathlessness flares was episodic dyspnoea (ED). The reported frequency of ED was 20.4% (70.9% in patients reporting background dyspnoea (BD)). ED intensity was moderate to severe with short duration (<10 min) in >80% of patients. The most common trigger was exertion (>90%) followed by emotional or environmental factors. ED management consisted mainly of pharmacological and non-pharmacological measures. CONCLUSIONS This systematic review shows that ED is common in patients with cancer, especially in those with BD. Further studies are urgently needed to better understand this condition and to develop specific therapeutic management. PROSPERO REGISTRATION NUMBER CRD42019126708.
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Affiliation(s)
- Joaquim Julià-Torras
- Palliative Care Department, Institut Català d'Oncologia, Badalona, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Deborah Moreno-Alonso
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Palliative Care Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Palliative Care Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Cristina Monforte-Royo
- Department of Nursing, Universitat Internacional de Catalunya-Campus Sant Cugat, Sant Cugat del Valles, Spain
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13
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Erwander K, Ivarsson K, Olsson ML, Agvall B. Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality. BMC Geriatr 2024; 24:5. [PMID: 38172691 PMCID: PMC10762826 DOI: 10.1186/s12877-023-04621-7] [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: 06/16/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Older adults have complex medical needs that causes increased use of resources at the emergency department (ED). The prevalence of non-specific complaint (NSC) as a chief-complaint in the ED is common among older adults and is not prioritized even though possibly having worse clinical outcome. The objective was to study hospital admission and mortality for older adults visiting the ED with NSC compared to specific complaints such as dyspnea, chest pain and abdominal pain. METHODS A retrospective observational study of older adults visiting the ED with NSC and specific complaints; dyspnea, chest pain and abdominal pain was performed. Chief-complaint were collected from electronic medical records. Fatigue, confusion, non-specific complaints, generalized weakness and risk of falling were defined as non-specific complaint (NSC) when registered as chief-complaint at the ED. Admission rate and 30-days mortality were the primary outcomes. RESULTS A total of 4927 patients were included in the study based on chief-complaint; patients with chest pain 1599 (32%), dyspnea 1343 (27%), abdominal pain 1460 (30%) and NSC 525 (11%). Patients with dyspnea and NSC had the highest hospital admission rate 79% vs 70% compared to patients with chest pain (63%) and abdominal pain (61%) (p = < 0.001). Patients with NSC had a mean LOS 4.7 h at the ED which was significantly higher compared to chest pain, dyspnea and abdominal pain. Mean bed-days for the whole population was 4.2 days compared to patients with NSC who had a mean LOS of 5.6 days. NSC and dyspnea were both associated with the highest 30-day mortality. CONCLUSION Older patients who present with NSC at the ED are associated with a high risk for admission and 30-days mortality. In addition, patients with NSC have a longer LOS at the ED, a high admission rate and the highest number of bed-days once admitted. This study indicates that ED staff should be more vigilant when an elderly patient presents with NSC at the ED. Further studies and guidelines are needed to improve the management of these individuals.
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Affiliation(s)
- Karin Erwander
- Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Kjell Ivarsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Björn Agvall
- Department of Research and Development, Region Halland, Halmstad, Sweden
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14
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Mohamed AA, Abdallah AA, Jan YK. Role of Enhancing Aerobic Capacity in Countering COVID-19-induced Liver Injury in Elderlies. Endocr Metab Immune Disord Drug Targets 2024; 24:418-429. [PMID: 37937559 DOI: 10.2174/0118715303250788231018080821] [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: 03/08/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023]
Abstract
COVID-19 is still a world disaster; however, its vaccination is globally available. Liver and gastrointestinal disturbances occur in patients infected with COVID-19 at varying incidences. Aging decreases the functions of the liver. Thus, the elderly have a weaker response to the COVID-19 virus. The COVID-19 virus affects the liver directly through direct and indirect mechanisms. It directly affects the renin-angiotensin system or indirectly causes sepsis, uncontrolled immune reactions, drug-related hepatic injury, and cytokine storm. Also, COVID-19 vaccines and anti-drugs have adverse effects on the liver too. Thus, this review explores the effect of enhancing aerobic capacity as a nonpharmacological intervention on decreasing COVID- 19-induced liver injury. Enhancing aerobic capacity decreases COVID-19-induced liver injury through the following: 1) downregulating systemic and tissue ACE/ANG II/AT1R axis, upregulating ACE2/ANG 1-7/Mas axis, and moving the renin-angiotensin system to the direction of the ACE2/ANG (1-7)/Mas axis, 2) Improving mitochondrial function and oxygenation to body and lung tissues, causing a decrease in harmful oxidative reactions, 3) Increasing the processing of accumulated free radicals and inhibiting the acute respiratory distress syndrome, 4) Acting as an antioxidant to protect the liver from oxidative stress, 5) Increasing the effect of antiviral drugs and COVID-19 vaccines, which improves the function of immune biomarkers, decreases the viral load, and increases the body's defense against the virus, 6) Decreasing coagulation abnormalities and thrombosis. In conclusion, enhancing aerobic capacity may be an efficient nonpharmacological intervention to decrease COVID-19-induced liver injury in elderlies and regenerate the liver to its normal status after being infected by the COVID-19 virus. It also helps to strengthen the body's immunity for better effects of both COVID-19 vaccination and drugs.
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Affiliation(s)
- Ayman A Mohamed
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Department of Basic Sciences, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt
- Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
| | - Ahmed A Abdallah
- Department of Basic Sciences, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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15
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Howell I, Howell A, Ramakrishnan S, Bafadhel M, Pavord I. How have we measured trial outcomes of asthma attack treatment? A systematic review. ERJ Open Res 2024; 10:00660-2023. [PMID: 38410715 PMCID: PMC10895432 DOI: 10.1183/23120541.00660-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024] Open
Abstract
Background Asthma attacks are a common problem for people with asthma and are responsible for significant healthcare costs. There is interest in a precision medicine approach to treatment. However, the choice of trial outcome measures for asthma attack treatment is hampered by the absence of a consensus on suitability. We carried out a systematic review to understand the characteristics of outcome measures used in randomised controlled trials of asthma attack treatment. Have randomised controlled trials of asthma attack treatment measured outcomes that are useful to patients and healthcare providers? Methods The protocol was registered on PROSPERO (CRD42022311479). We searched for randomised controlled trials comparing treatments for adults with asthma attacks, published in English between 1972 and 2022 on MEDLINE, Embase and Cochrane Library databases. We recorded the outcome measures and study characteristics. Results We identified 208 eligible randomised controlled trials from 35 countries. Trials ranged from 12 to 1109 participants, with a median of 60. The most common settings were the emergency department (n=165) and hospital admission (n=33). Only 128 studies had primary and secondary outcomes defined clearly. In those that did, 73% of primary outcomes measured change in lung function or other physiological parameters over a short period (usually <24 h). Patient-reported and healthcare utilisation outcomes were the primary outcome in 27%. Conclusions Outcomes in randomised controlled trials of asthma attack treatment focus on short-term changes in lung function and may not capture patient-centred and economically important longer-term measures. More work is needed to investigate patient and other stakeholder preferences on core outcome sets.
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Affiliation(s)
- Imran Howell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aleksandra Howell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sanjay Ramakrishnan
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Mona Bafadhel
- King’s Centre of Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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16
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Kero J, Koivisto J, Lee SH, Haavisto E. Nurses' perceptions to alleviate dyspnoea in inpatients with advanced cancer while receiving palliative care. Nurs Open 2024; 11:e2038. [PMID: 38268248 PMCID: PMC10697120 DOI: 10.1002/nop2.2038] [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: 03/06/2022] [Revised: 06/05/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore nurses' perceptions to alleviate dyspnoea in inpatients with advanced cancer while receiving palliative care. DESIGN A descriptive qualitative design. METHODS Seven focus groups were conducted with nurses (n = 27) from five specialized palliative care wards in four hospitals in south and southwest Finland. The focus groups were conducted between June and November 2019, and the transcripts were analysed using inductive analysis. RESULTS The findings revealed three categories: recognizing dyspnoea is a multi-faceted problem, dealing with the complexity of assessment of dyspnoea and strategies for relieving dyspnoea. Nurses perceived the complexity of dyspnoea as a symptom and emphasized the importance of utilizing patients' subjective experiences and consistent assessment scales to determine its severity. Furthermore, nonpharmacological interventions are as pertinent as pharmacological and medical interventions. The findings can assist nurses in selecting appropriate interventions for dyspnoea care, ultimately enhancing the quality of patient care and patient safety.
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Affiliation(s)
- Johanna Kero
- Department of Nursing ScienceTampere UniversityTampereFinland
| | - Jaana‐Maija Koivisto
- Department of Nursing ScienceTampere UniversityTampereFinland
- Smart Services Research UnitHäme University of Applied SciencesHämeenlinnaFinland
| | - Siew Hwa Lee
- School of Nursing, Midwifery and Paramedic PracticeRobert Gordon UniversityAberdeenUK
| | - Elina Haavisto
- Department of Nursing ScienceTampere UniversityTampereFinland
- Tampere University HospitalTampereFinland
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17
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Watso JC, Cuba JN, Boutwell SL, Moss JE, Bowerfind AK, Fernandez IM, Cassette JM, May AM, Kirk KF. Acute nasal breathing lowers diastolic blood pressure and increases parasympathetic contributions to heart rate variability in young adults. Am J Physiol Regul Integr Comp Physiol 2023; 325:R797-R808. [PMID: 37867476 DOI: 10.1152/ajpregu.00148.2023] [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: 06/17/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect cardiovascular health. It is unknown whether the route of breathing (nasal vs. oral) affects prognostic cardiovascular variables. Because nasal breathing can improve other physiological variables (e.g., airway dilation), we hypothesized that nasal compared with oral breathing would acutely lower blood pressure (BP) and improve heart rate variability (HRV) metrics. We tested 20 adults in this study [13 females/7 males; age: 18(1) years, median (IQR); body mass index: 23 ± 2 kg·m-2, means ± SD]. We compared variables between nasal- and oral-only breathing (random order, five min each) using paired, two-tailed t tests or Wilcoxon signed-rank paired tests with significance set to P < 0.05. We report the median (interquartile range) for diastolic BP and means ± SD for all other variables. We found that nasal breathing was associated with a lower mean BP (nasal: 84 ± 7 vs. oral: 86 ± 5 mmHg, P = 0.006, Cohen's d = 0.70) and diastolic BP [nasal: 68(8) vs. oral: 72(5) mmHg, P < 0.001, Rank-biserial correlation = 0.89] but not systolic BP (nasal: 116 ± 11 vs. oral: 117 ± 9 mmHg, P = 0.48, Cohen's d = 0.16) or heart rate (HR; nasal: 74 ± 10 vs. oral: 75 ± 8 beats·min-1, P = 0.90, Cohen's d = 0.03). We also found that nasal breathing was associated with a higher high-frequency (HF) contribution to HRV (nasal: 59 ± 19 vs. oral: 52 ± 21%, P = 0.04, Cohen's d = 0.50) and a lower low frequency-to-HF ratio at rest (nasal: 0.9 ± 0.8 vs. oral: 1.2 ± 0.9, P = 0.04, Cohen's d = 0.49). These data suggest that nasal compared with oral breathing acutely 1) lowers mean and diastolic BP, 2) does not affect systolic BP or heart rate, and 3) increases parasympathetic contributions to HRV.NEW & NOTEWORTHY There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect prognostic cardiovascular variables. However, the potential effects of the breathing route on prognostic cardiovascular variables are unclear. These data suggest that nasal compared with oral breathing 1) lowers mean and diastolic blood pressure (BP), 2) does not affect systolic BP or heart rate (HR), and 3) increases parasympathetic contributions to heart rate variability (HRV). These data suggest that acute nasal breathing improves several prognostic cardiovascular variables.
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Affiliation(s)
- Joseph C Watso
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jens N Cuba
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Savannah L Boutwell
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Justine E Moss
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Allison K Bowerfind
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Isabela M Fernandez
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jessica M Cassette
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Allyson M May
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Katherine F Kirk
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
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18
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Souto-Miranda S, Saraiva I, Spruit MA, Marques A. Core outcome set for pulmonary rehabilitation of patients with COPD: results of a modified Delphi survey. Thorax 2023; 78:1240-1247. [PMID: 37758457 DOI: 10.1136/thorax-2023-220522] [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: 05/28/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION There is high heterogeneity of outcomes and measures reported in pulmonary rehabilitation (PR) trials of people with chronic obstructive pulmonary disease (COPD). This hinders study comparability and benchmarking of PR. We have developed a core outcome set (COS) to overcome these challenges. METHODS This study was informed by a systematic review and two qualitative studies and had patient involvement since its inception. A two-round Delphi survey was available in seven languages. Outcomes (n=63) scored 7-9 (crucial) by ≥70% of the participants and 1-3 (not that important) by ≤15% of participants from both groups in the Likert scale were automatically included in the COS, while outcomes that were considered crucial by only one of the groups were further discussed by the authors in a meeting. RESULTS A total of 299 people (n=229 healthcare professionals/researchers/policy-makers; n=70 people with COPD and informal caregivers) participated in the survey (83% retention), which covered 29 countries/five continents. After the second round, six outcomes were included and three were added in the meeting. The final COS contains dyspnoea, fatigue, functional exercise capacity, health-related quality of life, health behaviours/lifestyle, knowledge about the disease, lower limb muscle function, personal goals and problematic activities of daily living. CONCLUSION A COS for PR of people with COPD is now available and can be used by different stakeholders to improve consistency and comparability of studies, benchmark PR and improve the quality of care provided. Future research should establish the core measures and investigate the uptake of this COS.
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Affiliation(s)
- Sara Souto-Miranda
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences (DCM), University of Aveiro, Aveiro, Portugal
| | | | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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19
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Palmer T, Obst SJ, Aitken CR, Walsh J, Sabapathy S, Adams L, Morris NR. Fixed-intensity exercise tests to measure exertional dyspnoea in chronic heart and lung populations: a systematic review. Eur Respir Rev 2023; 32:230016. [PMID: 37558262 PMCID: PMC10410401 DOI: 10.1183/16000617.0016-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Exertional dyspnoea is the primary diagnostic symptom for chronic cardiopulmonary disease populations. Whilst a number of exercise tests are used, there remains no gold standard clinical measure of exertional dyspnoea. The aim of this review was to comprehensively describe and evaluate all types of fixed-intensity exercise tests used to assess exertional dyspnoea in chronic cardiopulmonary populations and, where possible, report the reliability and responsiveness of the tests. METHODS A systematic search of five electronic databases identified papers that examined 1) fixed-intensity exercise tests and measured exertional dyspnoea, 2) chronic cardiopulmonary populations, 3) exertional dyspnoea reported at isotime or upon completion of fixed-duration exercise tests, and 4) published in English. RESULTS Searches identified 8785 papers. 123 papers were included, covering exercise tests using a variety of fixed-intensity protocols. Three modes were identified, as follows: 1) cycling (n=87), 2) walking (n=31) and 3) other (step test (n=8) and arm exercise (n=2)). Most studies (98%) were performed on chronic respiratory disease patients. Nearly all studies (88%) used an incremental exercise test. 34% of studies used a fixed duration for the exercise test, with the remaining 66% using an exhaustion protocol recording exertional dyspnoea at isotime. Exertional dyspnoea was measured using the Borg scale (89%). 7% of studies reported reliability. Most studies (72%) examined the change in exertional dyspnoea in response to different interventions. CONCLUSION Considerable methodological variety of fixed-intensity exercise tests exists to assess exertional dyspnoea and most test protocols require incremental exercise tests. There does not appear to be a simple, universal test for measuring exertional dyspnoea in the clinical setting.
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Affiliation(s)
- Tanya Palmer
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Central Queensland University, School of Health, Medical and Applied Sciences, College of Health Sciences, Bundaberg, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
| | - Steven J Obst
- Central Queensland University, School of Health, Medical and Applied Sciences, College of Health Sciences, Bundaberg, Australia
| | - Craig R Aitken
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - James Walsh
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - Surendran Sabapathy
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Lewis Adams
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Norman R Morris
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
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MacAskill W, Hoffman B, Johnson MA, Sharpe GR, Rands J, Wotherspoon SE, Gevorkov Y, Kolbe‐Alexander TL, Mills DE. The effects of age on dyspnea and respiratory mechanical and neural responses to exercise in healthy men. Physiol Rep 2023; 11:e15794. [PMID: 37604647 PMCID: PMC10442526 DOI: 10.14814/phy2.15794] [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: 06/24/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga ) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro-transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end-expiration, Pga expiratory tidal swings, and the gastric pressure-time product (PTPga ) at absolute and relative minute ventilation were higher (p < 0.05) for older compared to younger men. There were no differences in EMG responses between older and younger men. Younger men were more likely to report shallow breathing (p = 0.005) than older men. Our findings showed younger and older men had similar respiratory neuromuscular activation patterns and reported different dyspnea descriptors, and that older men had greater expiratory muscle pressure generation during exercise. Greater expiratory muscle pressures in older men may be due to compensatory mechanisms designed to offset increasing airway resistance due to aging. These results may have implications for exercise-induced expiratory muscle fatigue in older men.
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Affiliation(s)
- William MacAskill
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
- Rural Clinical SchoolGriffith UniversityToowoombaQueenslandAustralia
| | - Ben Hoffman
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
| | - Michael A. Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamshireUK
| | - Graham R. Sharpe
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamshireUK
| | - Joshua Rands
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
| | | | - Yaroslav Gevorkov
- Institute of Vision Systems, Hamburg University of TechnologyHamburgGermany
| | - Tracy L. Kolbe‐Alexander
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Research Unit for Exercise Science and Sports Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Dean E. Mills
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
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21
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Muruganandan S, Mishra E, Singh B. Breathlessness with Pleural Effusion: What Do We Know? Semin Respir Crit Care Med 2023. [PMID: 37308113 DOI: 10.1055/s-0043-1769098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of breathlessness associated with pleural effusion. Thoracocentesis reduces diaphragm distortion and improves its movement; these changes appear to reduce respiratory drive and associated breathlessness by improving the neuromechanical efficiency of the diaphragm.
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Affiliation(s)
- Sanjeevan Muruganandan
- Department of Respiratory Medicine, The Northern Hospital, Melbourne, Australia
- School of Medicine, Health Sciences, Dentistry, University of Melbourne, Melbourne, Australia
| | - Eleanor Mishra
- Norwice Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
- Norwice Medical School, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Bhajan Singh
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- School of Human Sciences, University of Western Australia, Perth, Australia
- West Australian Sleep Disorders Research Institute, Perth, Australia
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22
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Romanet C, Wormser J, Fels A, Lucas P, Prudat C, Sacco E, Bruel C, Plantefève G, Pene F, Chatellier G, Philippart F. Effectiveness of exercise training on the dyspnoea of individuals with long COVID: A randomised controlled multicentre trial. Ann Phys Rehabil Med 2023; 66:101765. [PMID: 37271020 PMCID: PMC10237688 DOI: 10.1016/j.rehab.2023.101765] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition. OBJECTIVES To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS. METHODS In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores. RESULTS Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10-4). CONCLUSION People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).
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Affiliation(s)
- Christophe Romanet
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Johan Wormser
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Pauline Lucas
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Camille Prudat
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Emmanuelle Sacco
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Gaëtan Plantefève
- Department of Intensive Care, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Frédéric Pene
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Gilles Chatellier
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - François Philippart
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
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23
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Sethi DK, Rhodes J, Ferris R, Banka R, Clarke A, Mishra EK. Breathlessness Predicts Mortality in Adults: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e39192. [PMID: 37332470 PMCID: PMC10276653 DOI: 10.7759/cureus.39192] [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] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Breathlessness is a commonly encountered symptom, and although its relationship with mortality is well established for many conditions, less clear is this relationship in healthy adults. This systematic review and meta-analysis examines whether breathlessness is associated with mortality in a general population. This is important in understanding the impact of this common symptom on a patient's prognosis. This review was registered with PROSPERO (CRD42023394104). Medline, EMBASE, CINAHL and EMCARE were searched for the terms 'breathlessness' and 'survival' or 'mortality' on January 24, 2023. Longitudinal studies of >1,000 healthy adults comparing mortality between breathless and non-breathless controls were eligible for inclusion. If an estimate of effect size was provided, studies were included in the meta-analysis. Eligible studies underwent critical appraisal, data extraction and risk of bias assessment. A pooled effect size was estimated for the relationship between the presence of breathlessness and mortality and levels of severity of breathlessness and mortality. Of 1,993 studies identified, 21 were eligible for inclusion in the systematic review and 19 for the meta-analysis. Studies were of good quality with a low risk of bias, and the majority controlled for important confounders. Most studies identified a significant relationship between the presence of breathlessness and increased mortality. A pooled effect size was estimated, with the presence of breathlessness increasing the risk of mortality by 43% (risk ratio (RR): 1.43, 95% confidence interval (CI): 1.28-1.61). As breathlessness severity increased from mild to severe, mortality increased by 30% (RR: 1.30, 95% CI: 1.21-1.38) and 103%, respectively (RR: 2.03, 95% CI: 1.75-2.35). The same trend was seen when breathlessness was measured using the modified Medical Research Council (mMRC) Dyspnoea Scale: mMRC grade 1 conferred a 26% increased mortality risk (RR: 1.26, 95% CI: 1.16-1.37) compared with 155% for grade 4 (RR: 2.55, 95% CI: 1.86-3.50). We conclude that mortality is associated with the presence of breathlessness and its severity. The mechanism underlying this is unclear and may reflect the ubiquity of breathlessness as a symptom of many diseases.
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Affiliation(s)
- Dheeraj K Sethi
- Norwich Medical School, University of East Anglia, Norwich, GBR
- Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - James Rhodes
- Norwich Medical School, University of East Anglia, Norwich, GBR
| | - Rebecca Ferris
- Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Radhika Banka
- Respiratory Medicine, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, IND
| | - Allan Clarke
- Norwich Medical School, University of East Anglia, Norwich, GBR
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24
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Bülbüloğlu S, Kaplan Serin E. Effect of Perceived Dyspnea on Attitude Toward Death From the Perspective of COPD Patients. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:913-929. [PMID: 33567984 DOI: 10.1177/0030222821993629] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this study, it was aimed to examine attitudes toward dyspnea and death from the perspective of Chronic Obstructive Pulmonary Disease (COPD) patients and to determine the relationship between them. This descriptive research was carried out in the chest diseases clinic of a public hospital and with the participation of COPD patients (n = 124). The data were obtained from the Personal Information Form, Death Attitude Profile-Revised, and Medical Research Council Scale. The neutral acceptance and approach acceptance subscale is explained as believing that death is an inevitable part of life and a transition to life after death. The escape acceptance subscale is explained as believing that life will save from physical or psychological harms. It was determined that the Neutral Acceptance and Approach Acceptance sub-dimension of the predictors of dyspnea, comorbid diseases, and COPD had a significant effect at a rate of 33% (p = 0.000). Dyspnea, Comorbid diseases, and the predictors of the severity of COPD affect the Escape Acceptance sub-dimension by 57% (p = 0.000). This research has shown that fear of death is high in COPD patients with high perceived dyspnea. The psychological support provided to patients with COPD should be considered to relieve the fear of death. New studies are needed in which these should be reevaluated in the same context.
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Affiliation(s)
- Semra Bülbüloğlu
- Surgical Nursing Department, Health Sciences Faculty, Gaziosmanpasa University, Tokat, Turkey
| | - Emine Kaplan Serin
- Department of Nursing, Faculty of Health Science, Gaziantep University, Gaziantep, Turkey
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25
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Ustun O, Bayraktar D, Kurut Aysin I, Sarac DC, Akatay EA, Gucenmez S, Otman E, Ozmen M, Akar S. Assessing dyspnea-related kinesiophobia in patients with systemic sclerosis (SSc): validity and reliability of Turkish Breathlessness Beliefs Questionnaire for SSc. Clin Rheumatol 2023; 42:423-430. [PMID: 36525131 DOI: 10.1007/s10067-022-06475-7] [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: 11/03/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/OBJECTIVE The respiratory system is often affected by systemic sclerosis (SSc), a connective tissue disease characterized by fibrosis, vasculopathy, and inflammation. As a result, especially exertional dyspnea may occur in SSc patients. Evaluation of attitudes towards dyspnea is important in terms of preventing negative consequences such as kinesiophobia. However, no validated tool is available for assessing dyspnea-related kinesiophobia for patients with SSc. The aim of the present study was to perform the Turkish validation of the Breathlessness Beliefs Questionnaire for SSc (BBQ-SSc), which was adapted from the Tampa Kinesiophobia Scale, and to investigate its relationships with physical and clinical characteristics. METHOD Fifty patients with SSc (47 females) were included in the study. The patients were evaluated regarding pulmonary function tests, respiratory muscle strength, patient-reported dyspnea, quality of life related to respiratory problems, mood, and fatigue. The patients were re-evaluated 1 week later for the test-retest reliability of the BBQ-SSc. RESULTS Internal consistency (Cronbach's alpha: 0.862) and test-retest validity (ICC: 0.831; 95% CI: 0.702-0.907) of the 12-item Turkish BBQ-SSc were found to be good. Principal component analysis confirmed the two-dimensional structure of the questionnaire. The scores of the questionnaire were associated with duration of illness, patient-reported dyspnea, quality of life related to respiratory problems, mood, and fatigue (p < 0.05). CONCLUSIONS According to our results, the 12-item Turkish BBQ-SSc is a reliable and valid tool to assess dyspnea-related kinesiophobia in SSc patients. Key Points • There are no structured tools available for assessing dyspnea-related kinesiophobia in patients with systemic sclerosis (SSc) • The 12-item Turkish Breathlessness Beliefs Questionnaire for SSc (BBQ-SSc) is a reliable and valid tool to assess dyspnea-related kinesiophobia in SSc patients.
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Affiliation(s)
- Oğuz Ustun
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Idil Kurut Aysin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Emre Alp Akatay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Sercan Gucenmez
- Department of Rheumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Eda Otman
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Mustafa Ozmen
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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26
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Beaumont M, Latiers AC, Prieur G. [The role of the physiotherapist in the assessment and management of dyspnea]. Rev Mal Respir 2023; 40:169-187. [PMID: 36682956 DOI: 10.1016/j.rmr.2022.12.016] [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: 12/01/2021] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
The role of the physiotherapist in the assessment and management of dyspnea. Dyspnea is the most common symptom in cardio-respiratory diseases. Recently improved comprehension of dyspnea mechanisms have underlined the need for three-faceted assessment. The three key aspects correspond to the "breathing, thinking, functioning" clinical model, which proposes a multidimensional - respiratory, emotional and functional - approach. Before initiating treatment, it is essential for several reasons to assess each specific case, determining the type of dyspnea affecting the patient, appraising the impact of shortness of breath, and estimating the effectiveness of the treatment applied. The physiotherapist has a major role to assume in the care of dyspneic patients, not only in assessment followed by treatment but also as a major collaborator in a multidisciplinary team, especially with regard to pulmonary rehabilitation. The aim of this review is to inventory the existing assessment tools and the possible physiotherapies for dyspnea, using a holistic approach designed to facilitate the choice of techniques and to improve quality of care by fully addressing the patient's needs.
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Affiliation(s)
- M Beaumont
- Service de réadaptation respiratoire, Centre Hospitalier des Pays de Morlaix, Morlaix, France; Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France.
| | - A C Latiers
- Service ORL, Stomatologie et Soins Continus, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgique
| | - G Prieur
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, 1200 Brussels, Belgique; Université de Normandie, UNIROUEN, EA3830-GRHV, 76000 Rouen, France; Groupe Hospitalier du Havre, Service de pneumologie et de réadaptation respiratoire, avenue Pierre Mendes France, 76290 Montivilliers, France; Institut de Recherche et Innovation en Biomédecine (IRIB), 76000 Rouen, France
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27
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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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28
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Liu YH, Subeq YM, Lin PH. Clinical dyspnea scenario: Using high-fidelity situation simulation teaching program to evaluate learning effectiveness for clinical junior and pre-clinical nurses. Front Psychol 2023; 13:1015106. [PMID: 36698562 PMCID: PMC9869138 DOI: 10.3389/fpsyg.2022.1015106] [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: 08/09/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023] Open
Abstract
Background Confronting a patient's breathing difficulties, clinical junior nurses often do not know how to respond, and fail to give proper evaluation and treatment. Sudden changes in the condition make the clinical nursing novices feel pressured, and even, frustrated. Objectives This study aims at exploring the effectiveness of the high-realistic situational simulation of dyspnea teaching program for pre-clinical and clinical 1st year nurses after graduation. Design This study adopts a quasi-experimental repeated measure pre-post-test design study with nonequivalent control group pre- and post-test research design. A total of 135 subjects participated in the research: nurses, post graduate year (NPGY) (N = 69), have been employed in the adult ward of a medical center for less than 1 year; and pre-clinical nurses (N = 66), 3rd-year nursing students with nurse licenses from a university in the central part of Taiwan. Simulation-based education instructed and incorporated into the high-realistic situation simulation dyspnea teaching program. Questionnaires were used to measure the effectiveness of learning, data were analyzed with SPSS version 20.0, and the scores were repeatedly measured with the generalized estimating equation. Results For "cognition, skills, attitude, self-efficacy, teamwork," NPGY and pre-clinical nurses' post-tests are better than pre-tests, with statistically significant results. NPGY nurses' "skills," "attitude" and "teamwork" learning effectiveness are better than those of the pre-clinical nurses. Conclusion The high-realistic situational simulation of dyspnea teaching program can significantly improve the learning effectiveness of NPGY nurses and pre-clinical nurses in the clinical evaluation and treatment of dyspnea.
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Affiliation(s)
- Yu-Hsin Liu
- Department of Nursing, China Medical University Hospital, Taichung City, Taiwan
| | - Yi-Maun Subeq
- Department of Nursing, National Taichung University of Science and Technology, Taichung City, Taiwan,*Correspondence: Yi-Maun Subeq,
| | - Po-Han Lin
- Cardiovascular Surgery Division, Taichung Veterans General Hospital, Taichung City, Taiwan
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29
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Kiliç L, Tural Önür S, Gorek Dilektasli A, Ulubay G, Balcı A. Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1-10. [PMID: 36628301 PMCID: PMC9826605 DOI: 10.2147/copd.s384127] [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: 08/03/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. Patients and Methods This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Results Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. Conclusion We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.
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Affiliation(s)
- Lütfiye Kiliç
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonologist, Department of Pulmonary Rehabilitation, University of Health Sciences, Istanbul, Turkey,Correspondence: Lütfiye Kiliç, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, Tel +90 532 397 7172, Email
| | - Seda Tural Önür
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Associate Professor, Department of Chest Diseases, University of Health Sciences, Istanbul, Turkey
| | - Aslı Gorek Dilektasli
- Uludağ University, Faculty of Medicine, Associate professor, Department of Chest Diseases, Bursa, Turkey
| | - Gaye Ulubay
- Başkent University, Faculty of Medicine, Professor, Department of Chest Diseases, Ankara, Turkey
| | - Arif Balcı
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Physiotherapist, Department of Pulmonary Rehabilitation, University of Health Sciences, Istanbul, Turkey
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Li N, Cui M, Wang Y. Effect of Dexmedetomidine for Palliative Sedation for Refractory Dyspnoea in Patients with Terminal-Stage Cancer. Cancer Manag Res 2023; 15:291-299. [PMID: 36987523 PMCID: PMC10040164 DOI: 10.2147/cmar.s404934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Background Dyspnoea affects a considerable percentage of patients with terminal-stage cancer, and clinical guidelines recommend palliative sedation for patients with refractory dyspnoea. Midazolam is currently the most commonly used sedative; however, it can cause serious adverse reactions, such as respiratory/circulatory depression. Hence, there is a need for an alternative sedative. Dexmedetomidine (DEX) is a promising alternative as its "awake sedation" effect; however, little is known regarding its use in patients with end-stage dyspnoea. Therefore, the aim of this study was to determine the safety and usefulness of DEX for palliative sedation of patients with refractory dyspnoea. Methods This retrospective study included patients with terminal-stage cancer who received DEX for palliative sedation owing to refractory dyspnoea in the hospice ward from January 2018 to October 2022. We analysed their general data, dyspnoea conditions, sedation details, sedative treatment effect, dyspnoea relief, and changes in vital signs before and after sedation, via paired t-tests. Results We included 17 patients with terminal-stage cancer who received DEX palliative sedation at a dose of 0.2-0.9 µg/kg·h for refractory dyspnoea, among whom 6 (35%) received a loading dose of 1 µg/kg in 10 min. After 1 h of sedation and at the maximum sedation dose, the Respiratory Distress Observation Scale and Richmond Agitation-Sedation Scale scores decreased significantly compared with those before sedation (all P<0.001), as did the respiratory rate (P=0.024 and P=0.008, respectively). The heart rate and blood oxygen saturation did not significantly change, whereas the systolic and diastolic blood pressure after 1 h of sedation were significantly lower than those before sedation (both P=0.015). Conclusion DEX is a promising palliative sedative for patients with terminal-stage cancer, as it safely relieved the symptoms of refractory dyspnoea without inducing serious adverse reactions. Therefore, DEX may greatly enhance the quality of life for patients with terminal-stage cancer.
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Affiliation(s)
- Na Li
- Department of Hospice Care, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Meng Cui
- Department of Hospice Care, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
- Correspondence: Meng Cui; Yumei Wang, Department of Hospice Care, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang, Liaoning, People’s Republic of China, Tel +86 18940254587; +86 18940251490, Email ;
| | - Yumei Wang
- Department of Hospice Care, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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Ghoshal A, Damani A, Muckaden M, Singh P, Deodhar J, Mohanty S, Viswanath V, Grover A, Sanghavi P, Bhatnagar S. Prevalence of dyspnoea and usage of opioids in managing dyspnoea in advanced cancer patients: a longitudinal observational multi-centre study from India. Ecancermedicalscience 2022; 16:1482. [PMID: 36819796 PMCID: PMC9934974 DOI: 10.3332/ecancer.2022.1482] [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: 08/07/2022] [Indexed: 12/05/2022] Open
Abstract
Context Breathlessness is one of the devastating symptoms experienced by patients with advanced cancer and can be very challenging to manage. Objectives To find the point prevalence of dyspnoea in advanced cancer patients presenting to palliative care out-patient clinics, and the usage of opioids in palliation of dyspnoea. Methods We conducted a prospective observational study among all consecutive patients presenting to the outpatient clinics of six cancer centres in India from different parts of the country. In addition to routinely documented demographic and clinical data from patient charts, study investigators collected information on the Edmonton Symptom Assessment System, Cancer Dyspnoea Scale (CDS) and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15 Palliative Care. We calculated the prevalence of dyspnoea and documented the usage of opioids in palliation of dyspnoea using tests of differences across patient characteristics. Results Between May 1, 2019, and April 30, 2020, 5,541 patients were screened for eligibility, and 288 were enrolled (48 patients from each of the six centres). We analysed the data of 288 patients, of which 36.4% had dyspnoea, with 28.5% with moderate to a severe degree (>4/10). Tiredness and loss of appetite were found to have associations with dyspnoea which were statistically significant on multivariate analysis. Standard palliative care management and routine usage of opioids preceded improvement in dyspnoea scores, CDS scores and quality of life scores throughout 7 days. Conclusion Dyspnoea is a common symptom in advanced cancer patients, presenting to outpatient clinics, and routine documentation of dyspnoea with appropriate usage of opioids helps in mitigation. Key message The article suggests that breathlessness is a common problem in advanced cancer patients and opioid prescription preceded symptom improvements in such patients.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai 400012, India
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - MaryAnn Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai 400012, India
| | - Pallavi Singh
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhaba National Institute, Mumbai 400012, India
| | - Sumita Mohanty
- Regional Cancer Centre and SCB Medical College and Hospital, Cuttack, Odisha 753001, India
| | - Vidya Viswanath
- Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam 530053, India
| | - Amit Grover
- Dr. D. K. Gosavi Memorial, Siddhivinayak Ganpati Cancer Hospital, Miraj 416410, India
| | - Priti Sanghavi
- Department of Palliative Medicine, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat 380016, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia and Palliative Medicine, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
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Alshamari AHI, Deli F, Kadhum HI, Kadhim IJ. Assessment of thyroid function tests in patients with chronic obstructive pulmonary disease. J Med Life 2022; 15:1532-1535. [PMID: 36762334 PMCID: PMC9884349 DOI: 10.25122/jml-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/26/2022] [Indexed: 02/11/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD), a group of diseases of distinct aetio-pathological consideration with different phenotypic presentations where smoking is the leading cause, all share the ultimate result of airflow limitation. This study aimed to evaluate thyroid function tests (TFT) in patients with COPD. Pulmonary function tests (PFT) were performed for 30 patients with obstructive lung disease and fifteen healthy control individuals. We measured SPO2 to confirm COPD and assess the severity of the disease and assessed TT3, TT4, and TSH using the ELISA test. The values of VC, FVC, and FEV in the first second and PEF, TSH, and SPO2 were lower in the COPD group than in the control group (P-value=0.001). In severe COPD (FEV1<50%), there was a significant reduction in T3 but not T4 or TSH compared to mild-moderate COPD patients. Thyroid dysfunction was observed in patients with COPD pointing to a metabolic response; patients with lower weight indices had a lower TSH and, consequently, T3.
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Affiliation(s)
- Ali Hasan Ismaeel Alshamari
- Department of Medicine, College of Medicine, University of Kufa, Najaf, Iraq,Corresponding Author: Ali Hasan Ismaeel Alshamari, Department of Medicine, College of Medicine, University of Kufa, Najaf, Iraq. E-mail:
| | - Falah Deli
- Department of Medicine, College of Medicine, University of Kufa, Najaf, Iraq
| | | | - Iman Jabar Kadhim
- Department of Community Medicine, College of Medicine, University of Kufa, Najaf, Iraq
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Ovtcharenko N, Ho E, Alhazzani W, Cortegiani A, Ergan B, Scala R, Sotgiu G, Chaudhuri D, Oczkowski S, Lewis K. High-flow nasal cannula versus non-invasive ventilation for acute hypercapnic respiratory failure in adults: a systematic review and meta-analysis of randomized trials. Crit Care 2022; 26:348. [DOI: 10.1186/s13054-022-04218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Non-invasive ventilation (NIV) with bi-level positive pressure ventilation is a first-line intervention for selected patients with acute hypercapnic respiratory failure. Compared to conventional oxygen therapy, NIV may reduce endotracheal intubation, death, and intensive care unit length of stay (LOS), but its use is often limited by patient tolerance and treatment failure. High-flow nasal cannula (HFNC) is a potential alternative treatment in this patient population and may be better tolerated.
Research question
For patients presenting with acute hypercapnic respiratory failure, is HFNC an effective alternative to NIV in reducing the need for intubation?
Methods
We searched EMBASE, MEDLINE, and the Cochrane library from database inception through to October 2021 for randomized clinical trials (RCT) of adults with acute hypercapnic respiratory failure assigned to receive HFNC or NIV. The Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. We calculated pooled relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with corresponding 95% confidence intervals (CI) using a random-effects model.
Results
We included eight RCTs (n = 528) in the final analysis. The use of HFNC compared to NIV did not reduce the risk of our primary outcome of mortality (RR 0.86, 95% CI 0.48–1.56, low certainty), or our secondary outcomes including endotracheal intubation (RR 0.80, 95% CI 0.46–1.39, low certainty), or hospital LOS (MD − 0.82 days, 95% CI − 1.83–0.20, high certainty). There was no difference in change in partial pressure of carbon dioxide between groups (MD − 1.87 mmHg, 95% CI − 5.34–1.60, moderate certainty).
Interpretation
The current body of evidence is limited in determining whether HFNC may be either superior, inferior, or equivalent to NIV for patients with acute hypercapnic respiratory failure given imprecision and study heterogeneity. Further studies are needed to better understand the effect of HFNC on this population.
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Scaramuzzo G, Ronzoni L, Campo G, Priani P, Arena C, La Rosa R, Turrini C, Volta CA, Papi A, Spadaro S, Contoli M. Long-term dyspnea, regional ventilation distribution and peripheral lung function in COVID-19 survivors: a 1 year follow up study. BMC Pulm Med 2022; 22:408. [PMCID: PMC9643983 DOI: 10.1186/s12890-022-02214-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Dyspnea is common after COVID-19 pneumonia and can be characterized by a defective CO2 diffusion (DLCO) despite normal pulmonary function tests (PFT). Nevertheless, DLCO impairment tends to normalize at 1 year, with no dyspnea regression. The altered regional distribution of ventilation and a dysfunction of the peripheral lung may characterize dyspnea at 1 year after COVID-19 pneumonia. We aimed at assessing the pattern of airway resistance and inflammation and the regional ventilation inhomogeneity in COVID-19 pneumonia survivors at 12-months after hospital discharge.
Methods
We followed up at 1-year patients previously admitted to the respiratory units (intensive care or sub-intensive care unit) for COVID-19 acute respiratory failure at 1-year after hospital discharge. PFT (spirometry, DLCO), impulse oscillometry (IOS), measurements of the exhaled nitric oxide (FENO) and Electrical Impedance Tomography (EIT) were used to evaluate lung volumes, CO2 diffusion capacity, peripheral lung inflammation/resistances and the regional inhomogeneity of ventilation distribution. A full medical examination was conducted, and symptoms of new onset (not present before COVID-19) were recorded. Patients were therefore divided into two groups based on the presence/absence of dyspnea (defined as mMRC ≥1) compared to evaluate differences in the respiratory function derived parameters.
Results
Sixty-seven patients were admitted between October and December 2020. Of them, 42/67 (63%) patients were discharged alive and 33 were evaluated during the follow up. Their mean age was 64 ± 11 years and 24/33 (73%) were males. Their maximum respiratory support was in 7/33 (21%) oxygen, in 4/33 (12%) HFNC, in 14/33 (42%) NIV/CPAP and in 8/33 (24%) invasive mechanical ventilation. During the clinical examination, 15/33 (45%) reported dyspnea. When comparing the two groups, no significant differences were found in PFT, in the peripheral airway inflammation (FENO) or mechanical properties (IOS). However, EIT showed a significantly higher regional inhomogeneity in patients with dyspnea both during resting breathing (0.98[0.96–1] vs 1.1[1–1.1], p = 0.012) and during forced expiration (0.96[0.94–1] vs 1 [0.98–1.1], p = 0.045).
Conclusions
New onset dyspnea characterizes 45% of patients 1 year after COVID-19 pneumonia. In these patients, despite pulmonary function test may be normal, EIT shows a higher regional inhomogeneity both during quiet and forced breathing which may contribute to dyspnea.
Clinical trial registration
Clinicaltrials.gov NCT04343053, registration date 13/04/2020.
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Harenwall S, Heywood-Everett S, Henderson R, Smith J, McEnery R, Bland AR. The Interactive Effects of Post-Traumatic Stress Symptoms and Breathlessness on Fatigue Severity in Post-COVID-19 Syndrome. J Clin Med 2022; 11:jcm11206214. [PMID: 36294534 PMCID: PMC9604889 DOI: 10.3390/jcm11206214] [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: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Post-traumatic stress symptoms (PTSS) and breathlessness have been well documented in the acute phase of COVID-19 as well as in Post-COVID-19 Syndrome (PCS), commonly known as Long-COVID. The present study aimed to explore whether PTSS and breathlessness interact to exacerbate fatigue among individuals recovering from PCS, similar to the effects evidenced in other health conditions that feature respiratory distress.. Methods: Outcome measures were collected from 154 participants reporting persistent fatigue following acute COVID-19 infection who were enrolled in a 7-week rehabilitation course provided by the Primary Care Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT). Results: Hierarchical multiple linear regression revealed that fatigue severity was associated with a significant interaction between PTSS and breathlessness, even when controlling for pre-COVID health related quality of life (HRQoL), age, symptom duration and hospital admittance during the acute phase. Furthermore, improvements in fatigue following rehabilitation were significantly associated with improvements in PTSS. Conclusions: PTSS may be an important therapeutic target in multidisciplinary rehabilitation for reducing fatigue in the recovery from PCS. It is therefore important that treatment for PCS takes a biopsychosocial approach to recovery, putting emphasis on direct and indirect psychological factors which may facilitate or disrupt physical recovery. This highlights the need for all PCS clinics to screen for PTSD and if present, target as a priority in treatment to maximise the potential for successful rehabilitation.
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Affiliation(s)
- Sari Harenwall
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
- Correspondence:
| | - Suzanne Heywood-Everett
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Rebecca Henderson
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Joanne Smith
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Rachel McEnery
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Amy R. Bland
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
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Xiong C, Li Y, Li CY, Liu YF, Wei H, Fu JJ. Acupuncture for dyspnea and breathing physiology in chronic respiratory diseases: A protocol of a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e30909. [PMID: 36253986 PMCID: PMC9575781 DOI: 10.1097/md.0000000000030909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dyspnea is one of the most common symptoms of chronic respiratory disease (CRD) and is closely related to increased functional disability and mortality, resulting in substantial adverse outcomes on patients and imposing great social and economic burden. Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating COPD and lung cancer, little is known about its effects on dyspnea relief in patients with CRD. The present study aimed to use a systematic review approach to evaluate the effectiveness and safety of acupuncture in the treatment of dyspnea in patients with CRD. METHODS We will search the following 9 databases from inception to June 30, 2022, PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, WANFANG Database, Chinses Scientific and Technological Periodical Database, and Chinese Biomedical Database, and the Cochrane Library Database. Clinical randomized controlled trials in English or Chinese that evaluate invasive acupuncture versus control group in treatment of CRD with dyspnea will be included. The primary outcome will be dyspnea scores, breathing physiological function, and the secondary outcomes include exercise tolerance by six-minute walk distance quality of life, quality of life and adverse events. Two reviewers will independently conduct study selection, data extraction and quality assessment. The Review Manager software will be used for meta-analysis. This protocol will be carried out in accordance with the PRISMA-P guidance. CONCLUSION This systematic review and meta-analysis will provide the evidence of whether acupuncture is an effective and safe intervention for CRD with dyspnea. The results will be disseminated through peer-reviewed publication.
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Affiliation(s)
- Chan Xiong
- Department of Respiratory, No. 3 Affiliated Hospital of Chengdu University of TCM (West District), Chengdu Pidu District Hospital of TCM, Chengdu, Sichuan, China
| | - Yu Li
- Department of Respiratory, No. 3 Affiliated Hospital of Chengdu University of TCM (West District), Chengdu Pidu District Hospital of TCM, Chengdu, Sichuan, China
| | - Chen-Yi Li
- Department of Respiratory, No. 3 Affiliated Hospital of Chengdu University of TCM (West District), Chengdu Pidu District Hospital of TCM, Chengdu, Sichuan, China
| | - Ye-Fang Liu
- Department of Research, No. 3 Affiliated Hospital of Chengdu University of TCM (West District), Chengdu Pidu District Hospital of TCM, Chengdu, Sichuan, China
| | - Hua Wei
- Department of Respiratory, No. 3 Affiliated Hospital of Chengdu University of TCM (West District), Chengdu Pidu District Hospital of TCM, Chengdu, Sichuan, China
| | - Juan-Juan Fu
- Department of Integrated Traditional and Western Medicine, China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Juan-juan Fu, Department of Integrated Traditional and Western Medicine, China Hospital, Sichuan University, No. 37, Guo Xue Street, Wu Hou District, Chengdu, Sichuan, China (e-mail: )
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van der Velden RM, Hermans AN, Pluymaekers NA, Gawalko M, Elliott A, Hendriks JM, Franssen FM, Slats AM, van Empel VP, Van Gelder IC, Thijssen DH, Eijsvogels TM, Leue C, Crijns HJ, Linz D, Simons SO. Dyspnea in patients with atrial fibrillation: Mechanisms, assessment and an interdisciplinary and integrated care approach. IJC HEART & VASCULATURE 2022; 42:101086. [PMID: 35873859 PMCID: PMC9304702 DOI: 10.1016/j.ijcha.2022.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients.
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Affiliation(s)
- Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Astrid N.L. Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nikki A.H.A. Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Germany
- 1st Department of Cardiology, Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jeroen M. Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Annelies M. Slats
- Department of Respiratory Medicine, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Vanessa P.M. van Empel
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dick H.J. Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M.H. Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Corresponding author at: Maastricht UMC+, Maastricht Heart+Vascular Center, 6202 AZ Maastricht.
| | - Sami O. Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Alrabiah A, Aldriweesh B, Almujaiwel N, Alasqah MI, Alduraywish SA, Alammar A. The Reliability of the Arabic Version of the Dyspnea Index Questionnaire for Upper Airway-Related Dyspnea. Cureus 2022; 14:e29656. [PMID: 36320950 PMCID: PMC9612267 DOI: 10.7759/cureus.29656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives This study aimed to translate the Dyspnea Index (DI) questionnaire into the Arabic language and determine whether this version is valid and reliable for Arabic-speaking patients with upper airway-related dyspnea. Methods A cross-sectional study was conducted at the King Saud University Medical City otolaryngology clinics in Riyadh, Saudi Arabia. The DI questionnaire was translated into Arabic and then back-translated into the English language. Inclusion criteria were preoperative patients presenting to the otolaryngology clinic with upper airway-related dyspnea between November and December 2020. The results of internal consistency and factor analysis among the items were compared to the original DI development results to assess the reliability of the questionnaire. Results Among a total of 57 recruited patients, 50 questionnaires were completed with an 88% response rate. The mean age of the included patients was 38 ±14 years. Women constituted 58% of the patients. The most common diagnosis was subglottic stenosis (72%). Principle component extraction in factor analysis revealed a single underlying factor for all the questions. Factor loading ranged from 0.69 to 0.85. Reliability statistics showed a high value of internal consistency among the items. The mean inter-item correlation was 0.58. Conclusion Based on our findings, the Arabic version of the DI questionnaire is a reliable instrument for evaluating upper airway dyspnea.
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Rogal SS, Hansen L, Patel A, Ufere NN, Verma M, Woodrell CD, Kanwal F. AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis. Hepatology 2022; 76:819-853. [PMID: 35103995 PMCID: PMC9942270 DOI: 10.1002/hep.32378] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Shari S. Rogal
- Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare Center, Pittsburgh, Pennsylvania, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Nneka N. Ufere
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Manisha Verma
- Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Christopher D. Woodrell
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Fasiha Kanwal
- Sections of Gastroenterology and Hepatology and Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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SINFONIA study protocol: a phase II/III randomised controlled trial examining benefits of guided online group singing in people with chronic obstructive pulmonary disease and interstitial lung disease and their carers. Respir Res 2022; 23:208. [PMID: 35974347 PMCID: PMC9380685 DOI: 10.1186/s12931-022-02133-3] [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: 03/22/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and interstital lung disease (ILD) are incurable conditions characterised by airflow limitation, persisting respiratory symptoms, and progressive respiratory failure. People living with COPD or ILD often suffer from chronic and severe breathlessness, with limited treatment options and low engagement rates with current therapies. Group singing represents a potential community-based therapy to improve quality of life for patients with COPD or ILD and breathlessness. Methods This protocol papers describes SINFONIA, a parallel, double-arm, randomised, blinded-analysis, mixed-methods phase II/III trial of guided, online group singing that will be conducted over 24 months. Adults with confirmed COPD or ILD, on stable treatment for at least four weeks at time of recruitment, with a modified Medical Research Council (mMRC) dyspnoea score of two or greater, who are capable and willing to give consent, and not currently participating in pulmonary rehabilitation will be eligible to participate. Carers may optionally enrol in the trial. Data will be collected on quality of life, anxiety and depression, breathlessness, mastery of breathing, exercise tolerance, loneliness, healthcare utilisation, and carer quality of life (optional). Participants will be randomised 1:1 to intervention or control arms with intervention arm attending one 90 min, guided, online, group singing session per week for 12 weeks and control arm continuing routine care. Phase II of the trial aims to determine the feasibility and acceptability of guided, online group singing and will collect preliminary data on effectiveness. Phase III aims to determine whether guided, online group singing has an effect on quality of life with the primary outcome being a between arm difference in quality of life (36-item Short Form Survey) measured at 12 weeks. Discussion SINFONIA is the first study is the first of its kind in Australia and to our knowledge, the first to deliver the singing intervention program entirely online. Determining the feasibility, acceptability, and effectiveness of guided, online group singing is an important step towards improving low-cost, low-risk, community-based therapeutic options for patients living with COPD or ILD and breathlessness. Trial registration: Phase II—ACTRN12621001274864, registered 20th September 2021; Phase III—ACTRN12621001280897, registered 22nd September 2021.
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Polastri M, Carbonara P, Prediletto I, Gardini A, Venturoli F, Tagariello F, Neri L, Carpano M, Pacilli AMG, Nava S. Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background/Aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic. Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March–12 June 2020 and 2 November 2020–9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge. Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 ± 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH2O, and the maximal expiratory pressure was 59.1 cmH2O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH2O; and maximal expiratory pressure by 9.5 cmH2O. Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Carbonara
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Gardini
- Department of Statistical Sciences ‘P. Fortunati’, University of Bologna, Bologna, Italy
| | - Francesca Venturoli
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Tagariello
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lucia Neri
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Carpano
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Maria Grazia Pacilli
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Kako J, Kobayashi M, Kajiwara K, Kimura Y, Oosono Y, Takegata M, Nakano K, Matsuda Y, Nakamura N, Kawashima N, Hirano Y, Kitae M, Yamaguchi K, Iwamoto H, Hattori N, Sawatari H, Shiono S, Ogino H, Nishioka Y, Amano K, Yorke J. Validity and Reliability of the Japanese Version of the Dyspnea-12 Questionnaire in Patients With Lung Cancer. J Pain Symptom Manage 2022; 64:e83-e89. [PMID: 35452793 DOI: 10.1016/j.jpainsymman.2022.04.171] [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: 02/07/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The Dyspnea-12 questionnaire is a simple tool to assess dyspnea using qualitative descriptors that include both physical and emotional domains. However, the reliability and validity of the Japanese version in patients with lung cancer have not been assessed. OBJECTIVE To determine the reliability and validity of the Japanese version of the Dyspnea-12 questionnaire in patients with lung cancer. METHODS The assessment was based on the numerical rating scale (NRS), cancer dyspnea scale (CDS), and hospital anxiety and depression scale (HADS). Spearman's correlation assessed the convergent validity of Dyspnea-12 using these three scales. Exploratory factor analysis examined the construct validity. The reliability was verified using Cronbach's alpha. Anxiety, depression, clinical dyspnea, presence of chronic obstructive pulmonary disease (COPD), and patient status were identified by discriminating performance. RESULTS The analysis included 113 patients with lung cancer. A significant positive correlation was found between Dyspnea-12 and NRS, CDS, and HADS scores. Similar to the original version, factor analysis clearly classified Dyspnea-12 into two components (physical and emotional), thereby confirming its construct validity. Cronbach's alpha values for the total Dyspnea-12 and its physical and emotional components were 0.97, 0.95, and 0.96, respectively. Patients with anxiety, depression, and clinical dyspnea and those in the palliative phase had significantly higher Dyspnea-12 scores than their respective counterparts. The Dyspnea-12 scores of patients with and without COPD were similar. CONCLUSION The Japanese version of the Dyspnea-12 questionnaire is a useful and reliable tool to assess the multi-dimensional aspects of dyspnea in patients with lung cancer.
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Affiliation(s)
- Jun Kako
- College of Nursing Art and Science (J.K.), University of Hyogo, Akashi, Japan.
| | - Masamitsu Kobayashi
- Faculty of Nursing, National Defense Medical College (M.K.), Tokorozawa, Japan
| | - Kohei Kajiwara
- Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing (K.K.), Munakata, Japan
| | | | - Yasufumi Oosono
- Faculty of Nursing (Y.O.), Mejiro University, Saitama, Japan
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institution of Tropical Medicine (M.T.), Nagasaki University, Nagasaki, Japan
| | - Kimiko Nakano
- Clinical Research Center for Developmental Therapeutics (K.N.), Tokushima University Hospital, Tokushima, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center (Y.M.), Sakai, Japan
| | - Naomi Nakamura
- Department of Nursing, National Hospital Organization Kinki-Chuo Chest Medical Center (N.N.), Sakai, Japan
| | - Natsuki Kawashima
- Department of Nursing, National Cancer Center Hospital East (N.K., Y.H.), Kashiwa, Japan
| | - Yuta Hirano
- Department of Nursing, National Cancer Center Hospital East (N.K., Y.H.), Kashiwa, Japan
| | - Misako Kitae
- Faculty of Nursing (M.K.), Tokyo Healthcare University, Wakayama, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences (K.Y., H.I., N.H.), Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences (K.Y., H.I., N.H.), Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences (K.Y., H.I., N.H.), Hiroshima University, Hiroshima, Japan
| | | | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital (S.S.), Yamagata, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences (H.O., Y.N.), Tokushima University, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences (H.O., Y.N.), Tokushima University, Tokushima, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital (K.A.), Tokyo, Japan
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health (J.Y.), University of Manchester, Manchester M13 9PL, and The Christie NHS Foundation Trust, Manchester, United Kingdom
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Baretta ALR, Freitas ACTDE, Mocellin C, Cambi MPC, Ribeiro AR, Ferreira CGDAR, Baretta GAP. Comparison of respiratory muscle strength through manovacuometry in the early postoperative period of bariatric surgery by laparotomy and laparoscopy. Rev Col Bras Cir 2022; 49:e20223056. [PMID: 35858033 PMCID: PMC10578826 DOI: 10.1590/0100-6991e-20223056-en] [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: 05/06/2021] [Accepted: 04/06/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION surgical treatment of obesity causes important changes in respiratory mechanics. AIM Comparatively analyze respiratory muscle strength in post bariatric patients underwent to gastric bypass by laparotomy and laparoscopy during hospital stay. METHODS observational study with a non-randomized longitudinal design, of a quantitative character. Data were collected from 60 patients with BMI 40Kg/m2, divided in laparotomy group (n=30) and laparoscopy group (n=30). Smokers, patients with previous lung diseases and those unable to perform the exam correctly were excluded. Both groups were evaluated at immediate postoperative, first and second postoperative days with manovacuometry for respiratory muscle strength and visual analogue pain scale. RESULTS the sample was homogeneous in age, sex and BMI. Reduction in maximal respiratory pressures was observed after surgery for those operated on by laparotomy, no return to baseline values on discharge day on the second postoperative day. This group had also more severe pain and longer operative time. There was no difference in respiratory pressure measurements after surgery in the laparoscopy group. CONCLUSION conventional bariatric surgery reduces muscle strength in the postoperative period and leads to more intense pain during hospitalization when compared to the laparoscopy group.
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Affiliation(s)
- Arieli Luz Rodrigues Baretta
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Fisioterapia - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
- - Hospital São Lucas, Departamento de Cirurgia Bariátrica - Campo Largo - PR - Brasil
| | | | - Carolina Mocellin
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
| | - Maria Paula Carlini Cambi
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
| | - André Richter Ribeiro
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
| | | | - Giorgio Alfredo Pedroso Baretta
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
- - Hospital São Lucas, Departamento de Cirurgia Bariátrica - Campo Largo - PR - Brasil
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Azhar A, Hui D. Management of Physical Symptoms in Patients with Advanced Cancer During the Last Weeks and Days of Life. Cancer Res Treat 2022; 54:661-670. [PMID: 35790195 PMCID: PMC9296923 DOI: 10.4143/crt.2022.143] [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: 03/08/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Patients with advanced cancer are faced with many devastating symptoms in the last weeks and days of life, such as pain, delirium, dyspnea, bronchial hypersecretions (death rattle), and intractable seizures. Symptom management in the last weeks of life can be particularly challenging because of the high prevalence of delirium complicating symptom assessment, high symptom expression secondary to psychosocial and spiritual factors, limited life-expectancy requiring special considerations for prognosis-based decision-making, and distressed caregivers. There is a paucity of research involving patients in the last weeks of life, contributing to substantial variations in clinical practice. In this narrative review, we shall review the existing literature and provide a practical approach to in-patient management of several of the most distressing physical symptoms in the last weeks to days of life.
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Bartz-Overman C, Albanese AM, Fan V, Locke ER, Parikh T, Thielke S. Potential Explanatory Factors for the Concurrent Experience of Dyspnea and Pain in Patients with COPD. COPD 2022; 19:282-289. [PMID: 35666540 DOI: 10.1080/15412555.2022.2081540] [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: 10/18/2022]
Abstract
Previous research has identified unexpectedly strong associations between dyspnea and pain, but the reasons remain unclear. Ascertaining the underlying biological and psychological mechanisms might enhance the understanding of the experience of both conditions, and suggest novel treatments. We sought to elucidate whether demographic factors, disease severity, psychological symptoms and biomarkers might account for the association between pain and dyspnea in individuals with COPD. We analyzed data from 301 patients with COPD who were followed in a prospective longitudinal observational study over 2 years. Measures included self-reported dyspnea and pain, pulmonary function tests, serum levels of inflammatory cytokines, measures of physical deconditioning, and scales for depression and anxiety. Analyses involved cross-sectional and longitudinal linear regression models. Pain and dyspnea were strongly correlated cross-sectionally (r = 0.77, 95% CI 0.72-0.82) and simultaneously across time (r = 0.42, 95% CI 0.28-0.56). Accounting for any of the other health factors only slightly mitigated the associations. Symptoms of pain and dyspnea thus may be fundamentally linked in COPD, rather than being mediated by common biological, psychological, or functional factors. From the patient's perspective, pain and dyspnea may be part of the same essential experience. It is possible that treatments for one condition would improve the other.
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Affiliation(s)
| | - Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Vincent Fan
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Emily R Locke
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Toral Parikh
- Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry, University of Washington, Seattle, Washington, USA
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Barrett NA, Hart N, Daly KJR, Marotti M, Kostakou E, Carlin C, Lua S, Singh S, Bentley A, Douiri A, Camporota L. A randomised controlled trial of non-invasive ventilation compared with extracorporeal carbon dioxide removal for acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Ann Intensive Care 2022; 12:36. [PMID: 35445986 PMCID: PMC9021560 DOI: 10.1186/s13613-022-01006-8] [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: 11/29/2021] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background Patients presenting with acute hypercapnic respiratory failure due to exacerbations of chronic obstructive pulmonary disease (AECOPD) are typically managed with non-invasive ventilation (NIV). The impact of low-flow extracorporeal carbon dioxide removal (ECCO2R) on outcome in these patients has not been explored in randomised trials. Methods Open-label randomised trial comparing NIV (NIV arm) with ECCO2R (ECCO2R arm) in patients with AECOPD at high risk of NIV failure (pH < 7.30 after ≥ 1 h of NIV). The primary endpoint was time to cessation of NIV. Secondary outcomes included device tolerance and complications, changes in arterial blood gases, hospital survival. Results Eighteen patients (median age 67.5, IQR (61.5–71) years; median GOLD stage 3 were enrolled (nine in each arm). Time to NIV discontinuation was shorter with ECCO2R (7:00 (6:18–8:30) vs 24:30 (18:15–49:45) h, p = 0.004). Arterial pH was higher with ECCO2R at 4 h post-randomisation (7.35 (7.31–7.37) vs 7.25 (7.21–7.26), p < 0.001). Partial pressure of arterial CO2 (PaCO2) was significantly lower with ECCO2R at 4 h (6.8 (6.2–7.15) vs 8.3 (7.74–9.3) kPa; p = 0.024). Dyspnoea and comfort both rapidly improved with commencement of ECCO2R. There were no severe or life-threatening complications in the study population. There were no episodes of major bleeding or red blood cell transfusion in either group. ICU and hospital length of stay were longer with ECCO2R, and there was no difference in 90-day mortality or functional outcomes at follow-up. Interpretation There is evidence of benefit associated with ECCO2R with time to improvement in respiratory acidosis, in respiratory physiology and an immediate improvement in patient comfort and dyspnoea with commencement of ECCO2R. In addition, there was minimal clinically significant adverse events associated with ECCO2R use in patients with AECOPD at risk of failing or not tolerating NIV. However, the ICU and hospital lengths of stay were longer in the ECCO2R for similar outcomes. Trial registration The trial is prospectively registered on ClinicalTrials.gov: NCT02086084. Registered on 13th March 2014, https://clinicaltrials.gov/ct2/show/NCT02086084?cond=ecco2r&draw=2&rank=8 Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01006-8.
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Affiliation(s)
- Nicholas A Barrett
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK. .,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK.
| | - Nicholas Hart
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK.,Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK
| | - Kathleen J R Daly
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK
| | - Martina Marotti
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK
| | - Eirini Kostakou
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK
| | - Chris Carlin
- Dept. of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Stephanie Lua
- Dept. of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Suveer Singh
- Department of Respiratory and Critical Care Medicine, Chelsea & Westminster Hospital, London, SW10 9NH, UK
| | - Andrew Bentley
- Department of Intensive Care & Respiratory Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, WC2R 2LS, UK.,National Institute for Health Research Biomedical Research Centre, Guy's and St. Thomas' NHS Trust and King's College London, London, WC2R 2LS, UK
| | - Luigi Camporota
- Department of Critical Care, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Rd, London, SE1 7EH, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. Arch Bronconeumol 2022; 58:334-344. [PMID: 35315327 DOI: 10.1016/j.arbres.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Tarrasa, Tarrasa, Barcelona, España
| | | | - Eusebi Chiner
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - Leopoldo Palacios
- Unidad de Gestión Clínica El Torrejón, Distrito Sanitario Huelva-Costa y Condado-Campiña, Huelva, España
| | - Carme Hernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Dispositivo transversal hospitalización a domicilio, Dirección Médica y Enfermera, Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | | | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | | | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Borja G Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Baleares, España
| | - Ciro Casanova
- Unidad de Investigación, Servicio de Neumología, Hospital Universitario de La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Tenerife, España
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
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Harrison OK, Russell BR, Pattinson KTS. Perceptual and Ventilatory Responses to Hypercapnia in Athletes and Sedentary Individuals. Front Physiol 2022; 13:820307. [PMID: 35370804 PMCID: PMC8964958 DOI: 10.3389/fphys.2022.820307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Hypercapnic chemosensitivity traditionally captures the ventilatory response to elevated pressures of carbon dioxide in the blood. However, hypercapnia also contributes to subjective breathing perceptions, and previously we demonstrated a closer matching of perception to changes in ventilation in athletes compared to controls. Here we investigated any potential underlying hypercapnic chemosensitivity differences between groups, and explored whether these measures relate to ventilatory and perceptual responses during exercise as well as trait levels of affect. Methods A hypercapnic challenge, incremental maximal exercise test and affective questionnaires were completed by 20 endurance athletes and 20 age-/sex-matched sedentary controls. The hypercapnic challenge involved elevating end-tidal PCO2 by 0.8% (6.1 mmHg) and 1.5% (11.2 mmHg) for 3 min each (randomised), with constant end-tidal oxygen. Ventilatory and perceptual responses to hypercapnia were compared between groups, and within each group the relationships between hypercapnic chemosensitivity (slope analyses) and exercising ventilation and perceptions were calculated using Spearman’s non-parametric correlations. Results While absolute ventilation differences during hypercapnia and exercise were observed, no group differences were found across hypercapnic chemosensitivity (slope) measures. Correlation analyses revealed the anxiety hypercapnic response was related to maximal exercise anxiety, but only in sedentary individuals. Conclusion Ventilatory and perceptual hypercapnic chemosensitivity do not differ between athletes and sedentary individuals. However, ventilatory and anxiety hypercapnic chemosensitivities were related to ventilatory and anxiety responses during exercise in untrained individuals only. Athletes may employ additional strategies during exercise to reduce the influence of chemosensitivity on ventilatory and perceptual responses.
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Affiliation(s)
- Olivia K. Harrison
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative NeuroImaging, University of Oxford, Oxford, United Kingdom
- *Correspondence: Olivia K. Harrison,
| | | | - Kyle T. S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative NeuroImaging, University of Oxford, Oxford, United Kingdom
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Cajanding RJM. Silent Hypoxia in COVID-19 Pneumonia: State of Knowledge, Pathophysiology, Mechanisms, and Management. AACN Adv Crit Care 2022; 33:143-153. [PMID: 35113990 DOI: 10.4037/aacnacc2022448] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs of respiratory distress. Termed silent or happy hypoxia, it has puzzled clinicians and challenged and defied our understanding of normal respiratory physiology. A range of host- and pathogen-related factors appears to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes; induce endothelial damage and elicit a vascular distress response; invade cells of the central nervous system and disrupt normal interoception and response; and modulate transcription factors involved in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer survival, early detection and prompt treatment is essential to prevent potential complications. Interventions to prevent hypoxemia and improve oxygen delivery to the blood and the tissues include home pulse-oximetry monitoring, optimization of patient positioning, judicious use of supplemental oxygen, breathing control exercises, and timely and appropriate use of ventilatory modalities and adjuncts.
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Affiliation(s)
- Ruff Joseph Macale Cajanding
- Ruff Joseph Macale Cajanding is Senior Charge Nurse, Adult Critical Care Unit, 6th Floor, King George V Building, St Bartholomew's Hospital, Barts Health NHS Trust, 2 King Edward Street, London EC1A 1HQ, United Kingdom
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. [Translated article] Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. ARCHIVOS DE BRONCONEUMOLOGÍA 2022. [DOI: 10.1016/j.arbres.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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