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Therapeutische Umschau. Revue... Aug 2023Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its...
Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its status as «normal», essential element of conditio humana, to representing a symptom of another (somatic or mental) illness and to constituting a psychiatric disorder of its own. In any case of acute dyspnoea it is important to «normalize» the patient's anxiety, i.e. to contextualize it as a comprehensible reaction to the stressing experience and not as proof of personal weakness. If dyspnoea and anxiety occur in a patient with a preexisting psychiatric disorder, defining the appropriate therapeutic steps will be more complex and demanding, especially with regard to a targeted interdisciplinary cooperation (consultation liaison psychiatry). The paper highlights the principles of psychopharmacological and psychotherapeutical interventions, a stable therapeutical relationship always defining the center of any treatment procedure.
Topics: Humans; Anxiety; Anxiety Disorders; Emotions; Dyspnea; Psychiatry; Referral and Consultation
PubMed: 37855533
DOI: No ID Found -
Ugeskrift For Laeger Dec 2019Chronic dyspnoea without obvious cause is termed unexplained dyspnoea and is associated with a reduced functional capacity and increased mortality. The diagnostic path... (Review)
Review
Chronic dyspnoea without obvious cause is termed unexplained dyspnoea and is associated with a reduced functional capacity and increased mortality. The diagnostic path for patients with unexplained dyspnoea is far from uniform, which leads to numerous encounters with healthcare professionals, multiple diagnostic tests, and possible medication errors. In this review, the evaluation of unexplained dyspnoea is explained as well as possible pathophysiological mechanisms leading to chronic dyspnoea.
Topics: Chronic Disease; Dyspnea; Humans
PubMed: 31928623
DOI: No ID Found -
Nederlands Tijdschrift Voor Geneeskunde Feb 2020Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during...
Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies. We propose a strategy to assess dyspnoea in clinical practice. Key points are determining the severity of the problem, forming a differential diagnosis, thinking about the mechanism of dyspnoea and intervening in a timely manner. We conclude that the assessment and treatment of dyspnoea often requires a multidisciplinary approach.
Topics: Cardiovascular Diseases; Diagnosis, Differential; Dyspnea; Female; Humans; Lung; Lung Diseases; Male
PubMed: 32186810
DOI: No ID Found -
The European Respiratory Journal Jan 2018The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very... (Randomized Controlled Trial)
Randomized Controlled Trial
The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMT PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase of after IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement of in the IMT group.
Topics: Aged; Breathing Exercises; Dyspnea; Exercise Therapy; Female; France; Humans; Inspiratory Capacity; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Quality of Life; Respiratory Muscles; Single-Blind Method; Treatment Outcome; Walk Test
PubMed: 29371379
DOI: 10.1183/13993003.01107-2017 -
European Journal of Heart Failure Jun 2019Although acute decompensated heart failure (ADHF) is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
Although acute decompensated heart failure (ADHF) is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool, but its diagnostic performance for ADHF has not been evaluated in randomized studies. We evaluated, in patients with acute dyspnoea, accuracy and clinical usefulness of combining LUS with clinical assessment compared to the use of chest radiography (CXR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation.
METHODS AND RESULTS
This was a randomized trial conducted in two emergency departments. After initial clinical evaluation, patients with acute dyspnoea were classified by the treating physician according to presumptive aetiology (ADHF or non-ADHF). Patients were subsequently randomized to continue with either LUS or CXR/NT-proBNP. A new diagnosis, integrating the results of both initial assessment and the newly obtained findings, was then recorded. Diagnostic accuracy and clinical usefulness of LUS and CXR/NT-proBNP approaches were calculated. A total of 518 patients were randomized. Addition of LUS had higher accuracy [area under the receiver operating characteristic curve (AUC) 0.95] than clinical evaluation alone (AUC 0.88) in identifying ADHF (P < 0.01). In contrast, use of CXR/NT-proBNP did not significantly increase the accuracy of clinical evaluation alone (AUC 0.87 and 0.85, respectively; P > 0.05). The diagnostic accuracy of the LUS-integrated approach was higher then that of the CXR/Nt-proBNP-integrated approach (AUC 0.95 vs. 0.87, p < 0.01). Combining LUS with the clinical evaluation reduced diagnostic errors by 7.98 cases/100 patients, as compared to 2.42 cases/100 patients in the CXR/Nt-proBNP group.
CONCLUSION
Integration of LUS with clinical assessment for the diagnosis of ADHF in the emergency department seems to be more accurate than the current diagnostic approach based on CXR and NT-proBNP.
Topics: Acute Disease; Aged; Aged, 80 and over; Biomarkers; Dyspnea; Emergency Service, Hospital; Female; Heart Failure; Humans; Lung; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; ROC Curve; Radiography, Thoracic; Ultrasonography
PubMed: 30690825
DOI: 10.1002/ejhf.1379 -
Annals of Physical and Rehabilitation... Jun 2023COVID-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... (Randomized Controlled Trial)
Randomized Controlled Trial
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).
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).
Topics: Adult; Humans; COVID-19; SARS-CoV-2; Post-Acute COVID-19 Syndrome; Quality of Life; Dyspnea; Respiratory Distress Syndrome; Exercise; Treatment Outcome
PubMed: 37271020
DOI: 10.1016/j.rehab.2023.101765 -
Australian Critical Care : Official... Jul 2023In patients who are ventilator-dependent in the intensive care unit, inspiratory muscle training may improve inspiratory muscle strength and accelerate liberation from... (Randomized Controlled Trial)
Randomized Controlled Trial
Does mechanical threshold inspiratory muscle training promote recovery and improve outcomes in patients who are ventilator-dependent in the intensive care unit? The IMPROVE randomised trial.
BACKGROUND
In patients who are ventilator-dependent in the intensive care unit, inspiratory muscle training may improve inspiratory muscle strength and accelerate liberation from the ventilator, but optimal training parameters are yet to be established, and little is known about the impact of inspiratory muscle training on quality of life or dyspnoea. Thus, we sought to ascertain whether inspiratory muscle training, commenced while ventilator-dependent, would improve outcomes for patients invasively ventilated for 7 days or longer.
METHODS
In this randomised trial with assessor blinding and intention-to-treat analysis, 70 participants (mechanically ventilated ≥7 days) were randomised to receive once-daily supervised high-intensity inspiratory muscle training with a mechanical threshold device in addition to usual care or to receive usual care (control). Primary outcomes were inspiratory muscle strength (maximum inspiratory pressure % predicted) and endurance (fatigue resistance index) at ventilator liberation and 1 week later. Secondary outcomes included quality of life (SF-36v2, EQ-5D), dyspnoea, physical function, duration of ventilation, and in-hospital mortality.
RESULTS
Thirty-three participants were randomly allocated to the training group, and 37 to the control group. There were no statistically significant differences in strength (maximum inspiratory pressure) (95% confidence interval [CI]: -7.4 to 14.0) or endurance (fatigue resistance index) (95% CI: -0.003 to 0.436). Quality of life improved significantly more in the training group than in the control group (EQ-5D: 17.2; 95% CI: 1.3-33.0) (SF-36-PCS: 6.97; 95% CI: 1.96-12.00). Only the training group demonstrated significant reductions in dyspnoea (-1.5 at rest, -1.9 during exercise). There were no between-group differences in duration of ventilation or other measures. In-hospital mortality was higher in the control group than in the training group (9 vs 4, 24% vs 12%, p = 0.23).
CONCLUSIONS
In patients who are ventilator-dependent, mechanical threshold loading inspiratory muscle training improves quality of life and dyspnoea, even in the absence of strength improvements or acceleration of ventilator liberation.
Topics: Humans; Respiration, Artificial; Ventilator Weaning; Breathing Exercises; Quality of Life; Respiratory Muscles; Intensive Care Units; Ventilators, Mechanical; Dyspnea
PubMed: 36041982
DOI: 10.1016/j.aucc.2022.07.002 -
The Journal of Small Animal Practice Jan 2016Tracheal collapse occurs most commonly in middle-aged, small breed dogs. Clinical signs are usually proportional to the degree of collapse, ranging from mild airway... (Review)
Review
Tracheal collapse occurs most commonly in middle-aged, small breed dogs. Clinical signs are usually proportional to the degree of collapse, ranging from mild airway irritation and paroxysmal coughing to respiratory distress and dyspnoea. Diagnosis is made by documenting dynamic airway collapse with radiographs, bronchoscopy or fluoroscopy. Most dogs respond well to medical management and treatment of any concurrent comorbidities. Surgical intervention may need to be considered in dogs that do not respond or have respiratory compromise. A variety of surgical techniques have been reported although extraluminal ring prostheses or intraluminal stenting are the most commonly used. Both techniques have numerous potential complications and require specialised training and experience but are associated with good short- and long-term outcomes.
Topics: Animals; Dog Diseases; Dogs; Dyspnea; Fluoroscopy; Laryngoscopy; Prostheses and Implants; Prosthesis Implantation; Tracheal Stenosis; Tracheostomy
PubMed: 26780854
DOI: 10.1111/jsap.12436 -
Journal of Clinical Nursing Oct 2019To examine the effects of the two-month breathing-based walking intervention and its follow-up on anxiety, depression, dyspnoea and quality of life in patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS AND OBJECTIVES
To examine the effects of the two-month breathing-based walking intervention and its follow-up on anxiety, depression, dyspnoea and quality of life in patients with chronic obstructive pulmonary disease.
BACKGROUND
Mind-body-related exercises improve bio-psychological symptoms and quality of life in chronic diseases, but these improvements are not proven for chronic obstructive pulmonary disease.
DESIGN
This was a randomised controlled study and applied the Consolidated Standards of Reporting Trials (CONSORT) statement.
METHODS
Outpatients diagnosed with chronic obstructive pulmonary disease were recruited from a medical centre in Taiwan and randomly assigned to two groups. The walking group (n = 42) received breathing, meditation and walking for two months, and the control group (n = 42) did not. Data from the outcomes of anxiety, depression, dyspnoea and quality of life were collected at baseline and in Month 1, Month 2 and Month 3. Clinical trial registration was done (ClinicalTrials.gov.: NCT03388489).
FINDINGS
The results showed significant changes in anxiety, depression, dyspnoea and quality of life in the walking group across three months, compared to those in the control group and at baseline.
CONCLUSION
This breathing-based walking intervention is promising to achieve bio-psychological well-being for patients with chronic obstructive pulmonary disease.
RELEVANCE TO CLINICAL PRACTICE
This breathing-based walking, as a mind-body exercise, could serve as an evidence-based nursing care that contributes to improving anxiety, depression, dyspnoea and quality of life in stable chronic obstructive pulmonary disease outpatients. The feasibility and acceptability of the breathing-based walking were met the requirement of the chronic obstructive pulmonary disease outpatients, which could be considered as home-based exercise.
Topics: Aged; Anxiety; Breathing Exercises; Depression; Dyspnea; Female; Humans; Male; Middle Aged; Mind-Body Therapies; Pulmonary Disease, Chronic Obstructive; Quality of Life; Taiwan; Walking
PubMed: 31192478
DOI: 10.1111/jocn.14960 -
Respiratory Investigation Jan 2021Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. It is a common symptom... (Review)
Review
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. It is a common symptom among patients with respiratory diseases that reduces daily activities, induces deconditioning, and is self-perpetuating. Although clinical interventions are needed to reduce dyspnea, its underlying mechanism is poorly understood depending on the intertwined peripheral and central neural mechanisms as well as emotional factors. Nonetheless, experimental and clinical observations suggest that dyspnea results from dissociation or a mismatch between the intended respiratory motor output set caused by the respiratory neuronal network in the lower brainstem and the ventilatory output accomplished. The brain regions responsible for detecting the mismatch between the two are not established. The mechanism underlying the transmission of neural signals for dyspnea to higher sensory brain centers is not known. Further, information from central and peripheral chemoreceptors that control the milieu of body fluids is summated at higher brain centers, which modify dyspneic sensations. The mental status also affects the sensitivity to and the threshold of dyspnea perception. The currently used methods for relieving dyspnea are not necessarily fully effective. The search for more effective therapy requires further insights into the pathophysiology of dyspnea.
Topics: Brain Stem; Dyspnea; Emotions; Female; Humans; Hypoxia; Male; Nerve Net; Respiratory Physiological Phenomena; Sensation; Sensory Receptor Cells
PubMed: 33277231
DOI: 10.1016/j.resinv.2020.10.007