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The Medical Clinics of North America Sep 2016The high prevalence of dyspnea at the end of life carries with it significant health and economic burden. Given the complex mechanism of dyspnea, management should be... (Review)
Review
The high prevalence of dyspnea at the end of life carries with it significant health and economic burden. Given the complex mechanism of dyspnea, management should be tailored to the individual patient experience and the underlying disease process. No clear role for supplemental oxygen has been established in the treatment of dyspnea in patients without no hypoxemia, and providers should consider the negative effects of oxygen supplementation. Symptom control with medications, exercise, behavioral therapy, treatment of associated anxiety, and the use of fans may be more effective and less costly than oxygen therapy. Further research is needed in the assessment and treatment of this symptom to more effectively treat patients.
Topics: Dyspnea; Humans; Hypoxia; Oxygen Inhalation Therapy; Quality of Life
PubMed: 27542431
DOI: 10.1016/j.mcna.2016.04.018 -
Nutrients Apr 2023Chronic Obstructive Pulmonary Disease (COPD) is a disease that is spreading worldwide and is responsible for a huge number of deaths annually. It is characterized by... (Review)
Review
Chronic Obstructive Pulmonary Disease (COPD) is a disease that is spreading worldwide and is responsible for a huge number of deaths annually. It is characterized by progressive and often irreversible airflow obstruction, with a heterogeneous clinical manifestation based on disease severity. Along with pulmonary impairment, COPD patients display different grades of malnutrition that can be linked to a worsening of respiratory function and to a negative prognosis. Nutritional impairment seems to be related to a reduced exercise tolerance and to dyspnoea becoming a major determinant in patient-perceived quality of life. Many strategies have been proposed to limit the effects of malnutrition on disease progression, but there are still limited data available to determine which of them is the best option to manage COPD patients. The purpose of this review is to highlight the main aspects of COPD-related malnutrition and to underline the importance of poor nutritional state on muscle energetics, exercise tolerance and dyspnoea.
Topics: Humans; Quality of Life; Exercise Tolerance; Pulmonary Disease, Chronic Obstructive; Dyspnea; Malnutrition
PubMed: 37049625
DOI: 10.3390/nu15071786 -
Intensive Care Medicine Feb 2024This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in... (Review)
Review
This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society (ERS) and the European Society of Intensive Care Medicine (ESICM). Dyspnoea ranks among the most distressing experiences that human beings can endure. Approximately 40% of patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) report dyspnoea, with an average intensity of 45 mm on a visual analogue scale from 0 to 100 mm. Although it shares many similarities with pain, dyspnoea can be far worse than pain in that it summons a primal fear response. As such, it merits universal and specific consideration. Dyspnoea must be identified, prevented and relieved in every patient. In the ICU, mechanically ventilated patients are at high risk of experiencing breathing difficulties because of their physiological status and, in some instances, because of mechanical ventilation itself. At the same time, mechanically ventilated patients have barriers to signalling their distress. Addressing this major clinical challenge mandates teaching and training, and involves ICU caregivers and patients. This is even more important because, as opposed to pain which has become a universal healthcare concern, very little attention has been paid to the identification and management of respiratory suffering in mechanically ventilated ICU patients.
Topics: Adult; Humans; Respiration, Artificial; Medicine; Intensive Care Units; Dyspnea; Pain
PubMed: 38388984
DOI: 10.1007/s00134-023-07246-x -
The Lancet. Respiratory Medicine Nov 2016Chronic obstructive pulmonary disease (COPD) is an umbrella term that covers many clinical subtypes with clearly different pulmonary and extra-pulmonary characteristics,... (Review)
Review
Chronic obstructive pulmonary disease (COPD) is an umbrella term that covers many clinical subtypes with clearly different pulmonary and extra-pulmonary characteristics, but with persistent airflow limitation in common. This insight has led to the development of a more personalised approach in bronchodilator therapy, prevention of exacerbations, and advanced treatments (such as non-invasive ventilation and lung volume reduction techniques). However, systemic manifestations and comorbidities of COPD also contribute to different clinical phenotypes and warrant an individualised approach as part of integrated disease management. Alterations in bodyweight and composition, from cachexia to obesity, demand specific management. Psychological symptoms are highly prevalent, and thorough diagnosis and treatment are necessary. Moreover, prevention of exacerbations requires interventions beyond the lungs, including treatment of gastro-oesophageal reflux disease, reduction of cardiovascular risks, and management of dyspnoea and anxiety. In this Review, we discuss the management of COPD beyond the respiratory system and propose treatment strategies on the basis of the latest research and best practices.
Topics: Cardiovascular Diseases; Disease Management; Disease Progression; Dyspnea; Gastroesophageal Reflux; Humans; Pulmonary Disease, Chronic Obstructive
PubMed: 27264777
DOI: 10.1016/S2213-2600(16)00097-7 -
Emergency Medicine Journal : EMJ Nov 2023
Topics: Male; Humans; Dyspnea; Asthma
PubMed: 38016723
DOI: 10.1136/emermed-2023-213304 -
The Indian Journal of Medical Research Nov 2020
Topics: Dyspnea; Humans; Vascular Diseases
PubMed: 35345110
DOI: 10.4103/ijmr.IJMR_1732_19 -
Respirology (Carlton, Vic.) Sep 2019Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnoea in patients with COPD and other lung conditions. Once PR is... (Review)
Review
Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnoea in patients with COPD and other lung conditions. Once PR is completed, the benefits gained begin to decline unless patients continue to exercise regularly. Due to limited evidence in other lung conditions, this review aims to examine the current evidence regarding maintenance exercise programmes for patients with COPD and to determine the types of programmes that are able to maintain the benefits gained from PR to 12 months and longer. A number of factors may affect the ability to maintain exercise capacity and HRQoL in the long term including: frequency of supervised maintenance exercise; strategies used to improve adherence to maintenance exercise; facilitators and barriers to long-term exercise training; and initial PR programme itself. The current evidence for maintenance exercise programmes that included supervised maintenance exercise was weak, and for those programmes that included unsupervised maintenance exercise (with and without support) were difficult to interpret and in many instances were no better than usual care. New research using technology has provided some promising results for the future and surveys have revealed important features that may help in the development of maintenance programmes from a participant perspective such as ongoing therapist support. How to best maintain the benefits gained from PR remains unclear. Therefore, it is likely that no one model of maintenance is ideal for all patients with COPD and that individually adapted maintenance exercise programmes need to be considered.
Topics: Dyspnea; Exercise Therapy; Exercise Tolerance; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Surveys and Questionnaires
PubMed: 30891887
DOI: 10.1111/resp.13518 -
Respiratory Medicine Aug 2023Cardiopulmonary exercise testing (CPET) remains poorly understood and, consequently, largely underused in respiratory medicine. In addition to a widespread lack of... (Review)
Review
Cardiopulmonary exercise testing (CPET) remains poorly understood and, consequently, largely underused in respiratory medicine. In addition to a widespread lack of knowledge of integrative physiology, several tenets of CPET interpretation have relevant controversies and limitations which should be appropriately recognized. With the intent to provide a roadmap for the pulmonologist to realistically calibrate their expectations towards CPET, a collection of deeply entrenched beliefs is critically discussed. They include a) the actual role of CPET in uncovering the cause(s) of dyspnoea of unknown origin, b) peak O uptake as the key metric of cardiorespiratory capacity, c) the value of low lactate ("anaerobic") threshold to differentiate cardiocirculatory from respiratory causes of exercise limitation, d) the challenges of interpreting heart rate-based indexes of cardiovascular performance, e) the meaning of peak breathing reserve in dyspnoeic patients, f) the merits and drawbacks of measuring operating lung volumes during exercise, g) how best interpret the metrics of gas exchange inefficiency such as the ventilation-CO output relationship, h) when (and why) measurements of arterial blood gases are required, and i) the advantages of recording submaximal dyspnoea "quantity" and "quality". Based on a conceptual framework that links exertional dyspnoea to "excessive" and/or "restrained" breathing, I outline the approaches to CPET performance and interpretation that proved clinically more helpful in each of these scenarios. CPET to answer clinically relevant questions in pulmonology is a largely uncharted research field: I, therefore, finalize by highlighting some lines of inquiry to improve its diagnostic and prognostic yield.
Topics: Humans; Exercise Test; Pulmonary Medicine; Dyspnea; Anaerobic Threshold; Exercise; Exercise Tolerance
PubMed: 37100256
DOI: 10.1016/j.rmed.2023.107249 -
The European Respiratory Journal Jun 2015There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea... (Review)
Review
There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea Profile (MDP) assesses overall breathing discomfort, sensory qualities, and emotional responses in laboratory and clinical settings. Here we provide the MDP, review published evidence regarding its measurement properties and discuss its use and interpretation. The MDP assesses dyspnoea during a specific time or a particular activity (focus period) and is designed to examine individual items that are theoretically aligned with separate mechanisms. In contrast, other multidimensional dyspnoea scales assess recalled recent dyspnoea over a period of days using aggregate scores. Previous psychophysical and psychometric studies using the MDP show that: 1) subjects exposed to different laboratory stimuli could discriminate between air hunger and work/effort sensation, and found air hunger more unpleasant; 2) the MDP immediate unpleasantness scale (A1) was convergent with common dyspnoea scales; 3) in emergency department patients, two domains were distinguished (immediate perception, emotional response); 4) test-retest reliability over hours was high; 5) the instrument responded to opioid treatment of experimental dyspnoea and to clinical improvement; 6) convergent validity with common instruments was good; and 7) items responded differently from one another as predicted for multiple dimensions.
Topics: Dyspnea; Humans; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 25792641
DOI: 10.1183/09031936.00038914 -
Pneumologie (Stuttgart, Germany) Oct 2023In rheumatic diseases the possibility of pulmonary manifestation must always be considered and checked. Interstitial lung disease can often be fatal in these cases. In...
In rheumatic diseases the possibility of pulmonary manifestation must always be considered and checked. Interstitial lung disease can often be fatal in these cases. In the presented case, the link between progressive dyspnea and newly occurring skin irritation is to be seen as particularly important. A good outcome can be achieved by immediate therapy with immunosuppression and plasmapheresis.
Topics: Humans; Dyspnea; Lung; Lung Diseases, Interstitial
PubMed: 36958340
DOI: 10.1055/a-2016-7215