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Journal of Pain and Symptom Management Apr 2016The trajectory of dyspnea for patients hospitalized with acute cardiopulmonary disease, who are not terminally ill, is poorly characterized.
CONTEXT
The trajectory of dyspnea for patients hospitalized with acute cardiopulmonary disease, who are not terminally ill, is poorly characterized.
OBJECTIVES
To investigate the natural history of dyspnea during hospitalization and examine the role that admission diagnosis, and patient factors play in altering symptom resolution.
METHODS
Prospective cohort study of patients hospitalized for an acute cardiopulmonary condition at a large tertiary care center. Dyspnea levels and change in dyspnea score were the main outcomes of interest and were assessed at admission, 24 and 48 hours, and at discharge using the verbal 0-10 numeric scale.
RESULTS
Among 295 patients enrolled, the median age was 68 years, and the most common admitting diagnoses were heart failure (32%), chronic obstructive pulmonary disease (COPD) (39%), and pneumonia (13%). The median dyspnea score at admission was 9 (interquartile range [IQR] 7-10); decreased to 4 (IQR 2-7) within the first 24 hours; and subsequently plateaued at 48 hours. At discharge, the median score had decreased to 2.75 (IQR 1-4). Compared to patients with heart failure, patients with COPD had higher median dyspnea score at baseline and admission and experienced a slower resolution of dyspnea symptoms. After adjusting for patient characteristics, the change in dyspnea score from admission to discharge was not significantly different between patients hospitalized with congestive heart failure, COPD, or pneumonia.
CONCLUSION
Most patients admitted with acute cardiopulmonary conditions have severe dyspnea on presentation, and their symptoms improve rapidly after admission. The trajectory of dyspnea is associated with the underlying disease process. These findings may help set expectations for the resolution of dyspnea symptoms in hospitalized patients with acute cardiopulmonary diseases.
Topics: Aged; Aged, 80 and over; Cardiovascular Diseases; Disease Progression; Dyspnea; Female; Hospitalization; Humans; Male; Massachusetts; Middle Aged; Prospective Studies; Severity of Illness Index; Tertiary Care Centers; Treatment Outcome
PubMed: 26620232
DOI: 10.1016/j.jpainsymman.2015.11.005 -
International Journal of Chronic... 2021Previous research has indicated that female and male patients may experience different levels of symptoms. However, no studies of chronic obstructive pulmonary disease...
PURPOSE
Previous research has indicated that female and male patients may experience different levels of symptoms. However, no studies of chronic obstructive pulmonary disease (COPD) patients have compared the number and types of symptom clusters identified in male and female patients. Therefore, the purpose of this study was to investigate gender differences in symptom clusters among COPD patients.
PATIENTS AND METHODS
A total of 371 eligible patients were enrolled in the study. We assessed nine COPD symptoms, namely, dyspnea, cough, sputum, chest tightness, sleep quality, fatigue, frailty, anxiety, and depression. Exploratory factor analyses were used to explore the underlying clusters of the COPD symptoms.
RESULTS
Underlying the nine symptoms, female patients had 2 clusters, and male patients had 3 clusters. Specifically, the three general symptoms poor sleep, fatigue, and frailty loaded on the same symptom cluster with anxiety and depression in female patients, while the same 3 general symptoms loaded on the same symptom cluster with chest tightness and dyspnea in male patients. Moreover, cough and sputum not only were more common in male patients but also loaded together on a separate symptom cluster.
CONCLUSION
Our findings suggest that in order to improve fatigue, frailty, and poor sleep quality, symptom management strategies should more closely address anxiety and depression in female patients as well as chest tightness and dyspnea in male patients. Smoking cessation is particularly important in male COPD patients because they account for a much higher proportion of smokers and are more likely to have cough and sputum. These findings signify the importance of identifying and implementing gender-tailored symptom management strategies to relieve symptom burden in COPD patients to enhance their quality of life.
Topics: Dyspnea; Female; Humans; Male; Pulmonary Disease, Chronic Obstructive; Quality of Life; Sex Factors; Syndrome
PubMed: 33907396
DOI: 10.2147/COPD.S302877 -
Current Opinion in Supportive and... Dec 2023The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this... (Review)
Review
PURPOSE OF THE REVIEW
The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this review, the authors summarize the evidence for nocturnal NIV and NIV during exercise. The authors discuss the multidisciplinary and advanced care of patients with end-stage COPD treated with NIV.
RECENT FINDINGS
Nocturnal NIV improves gas exchange, health-related quality of life and survival in stable hypercapnic COPD patients. Improvements in care delivery have been achieved by relocating care from the hospital to home based; home initiation of chronic NIV is feasible, non-inferior regarding efficacy and cost-effective compared to in-hospital initiation. However, the effect of NIV on symptoms is variable, and applying optimal NIV for end-stage COPD is complex. While exercise-induced dyspnoea is a prominent complaint in end-stage COPD, nocturnal NIV will not change this. However, NIV applied solely during exercise might improve exercise tolerance and dyspnoea. While chronic NIV is often a long-standing treatment, patient expectations should be discussed early and be managed continuously during the treatment. Further, integration of advance care planning requires a multidisciplinary approach.
SUMMARY
Although chronic NIV is an effective treatment in end-stage COPD with persistent hypercapnia, there are still important questions that need to be answered to improve care of these severely ill patients.
Topics: Humans; Quality of Life; Pulmonary Disease, Chronic Obstructive; Lung; Noninvasive Ventilation; Hypercapnia; Dyspnea
PubMed: 37646583
DOI: 10.1097/SPC.0000000000000671 -
Japanese Journal of Clinical Oncology Mar 2022Dyspnea is a common and distressing symptom in patients with cancer. To improve its management, multicenter confirmatory studies are necessary. Research policy would be...
BACKGROUND
Dyspnea is a common and distressing symptom in patients with cancer. To improve its management, multicenter confirmatory studies are necessary. Research policy would be useful in conducting these studies. Here, we propose a new research policy for the management of dyspnea in patients with cancer.
METHODS
The first draft was developed by a policy working group of 11 specialists in the field of supportive care or palliative care for dyspnea. Then, a provisional draft was developed after review by a research support group (the Japanese Supportive, Palliative and Psychosocial Care Study Group) and five Japanese scientific societies (Japanese Association of Supportive Care in Cancer, Japanese Society of Medical Oncology, Japanese Society of Palliative Medicine, Japanese Association of Rehabilitation Medicine and Japanese Society of Clinical Oncology), and receipt of public comments.
RESULTS
The policy includes the following components of research policy on dyspnea: (i) definition of dyspnea, (ii) scale for assessment of dyspnea, (iii) reason for dyspnea or factors associated with dyspnea and (iv) treatment effectiveness outcomes/adverse events. The final policy (Ver1.0) was completed on 1 March 2021.
CONCLUSIONS
This policy could help researchers plan and conduct studies on the management of cancer dyspnea.
Topics: Dyspnea; Humans; Medical Oncology; Neoplasms; Palliative Care; Policy
PubMed: 34894136
DOI: 10.1093/jjco/hyab193 -
American Journal of Respiratory and... Dec 2015
Topics: Dyspnea; Female; Humans; Male; Nurses; Physicians; Self Report; Ventilator Weaning
PubMed: 26669467
DOI: 10.1164/rccm.201508-1637ED -
European Respiratory Review : An... Sep 2016http://ow.ly/fLT0300uHgw
http://ow.ly/fLT0300uHgw
Topics: Dyspnea; Exercise; Exercise Test; Humans; Lung; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive; Respiration; Risk Factors
PubMed: 27581822
DOI: 10.1183/16000617.0044-2016 -
NPJ Primary Care Respiratory Medicine Jan 2017Breathlessness is a common symptom that may have multiple causes in any one individual and causes that may change over time. Breathlessness campaigns encourage people to... (Review)
Review
Breathlessness is a common symptom that may have multiple causes in any one individual and causes that may change over time. Breathlessness campaigns encourage people to see their General Practitioner if they are unduly breathless. Members of the London Respiratory Network collaborated to develop a tool that would encourage a holistic approach to breathlessness, which was applicable both at the time of diagnosis and during ongoing management. This has led to the development of the aide memoire "Breathing SPACE", which encompasses five key themes-smoking, pulmonary disease, anxiety/psychosocial factors, cardiac disease, and exercise/fitness. A particular concern was to ensure that high-value interventions (smoking cessation and exercise interventions) are prioritised across the life-course and throughout the course of disease management. The approach is relevant both to well people and in those with an underling diagnosis or diagnoses. The inclusion of anxiety draws attention to the importance of mental health issues. Parity of esteem requires the physical health problems of people with mental illness to be addressed. The SPACE mnemonic also addresses the problem of underdiagnosis of heart disease in people with lung disease and vice versa, as well as the systematic undertreatment of these conditions where they do co-occur.
Topics: Anxiety; Disease Management; Dyspnea; Exercise; Heart Diseases; Humans; Lung Diseases; Physical Fitness; Smoking; Smoking Cessation
PubMed: 28138132
DOI: 10.1038/s41533-016-0006-6 -
Respiratory Research Jan 2021Happy hypoxemia is an unspecified definition that is used in COVID-19 patients to define hypoxemia without dyspnoea. Dyspnoea is a very complex symptom, and although...
Happy hypoxemia is an unspecified definition that is used in COVID-19 patients to define hypoxemia without dyspnoea. Dyspnoea is a very complex symptom, and although hypoxemia can cause breathlessness, dyspnoea is not related to hypoxemia, but is more closely related to inspiratory drive and mechanical alterations. The lack of dyspnoea in the early stages of the disease is likely related to the absence of increased inspiratory drive due to compensatory mechanisms of hypoxemia, while in the advanced stages there is no evidence of a lack of dyspnoea in COVID-19 patients.
Topics: COVID-19; Dyspnea; Humans; Hypoxia; Respiration; SARS-CoV-2
PubMed: 33407457
DOI: 10.1186/s12931-020-01604-9 -
BMJ Case Reports May 2021Platypnoea-orthodeoxia syndrome (POS) is a rare entity characterised by respiratory distress and/or hypoxia developing in the sitting/upright posture, which is relieved...
Platypnoea-orthodeoxia syndrome (POS) is a rare entity characterised by respiratory distress and/or hypoxia developing in the sitting/upright posture, which is relieved in the supine posture. It is caused by cardiac, pulmonary and non-cardiopulmonary diseases. COVID-19 can have varying respiratory manifestations including acute respiratory distress syndrome (ARDS) and sequelae-like pulmonary fibrosis. POS has been rarely reported in patients with COVID-19. Here we report a case of POS in a patient recovering from severe COVID-19 ARDS. As he was gradually mobilised after his improvement, he had worsening dyspnoea in the sitting position with significant relief on assuming a supine posture. He was diagnosed with POS after ruling out other causes of POS. He was treated with oxygen support in upright posture and chest physiotherapy was continued, to which he showed improvement. POS is a rare manifestation of COVID-19 which needs awareness as it can be diagnosed easily and can respond to continued supportive care.
Topics: COVID-19; Dyspnea; Foramen Ovale, Patent; Humans; Hypoxia; Male; SARS-CoV-2
PubMed: 33952573
DOI: 10.1136/bcr-2021-243016 -
The European Respiratory Journal Apr 2019
Topics: Dyspnea; Heart Failure; Humans; Pulmonary Disease, Chronic Obstructive
PubMed: 31000669
DOI: 10.1183/13993003.00487-2019