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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 -
The Cochrane Database of Systematic... Jul 2016A large subgroup of people with interstitial lung disease (ILD) are normoxic at rest, but rapidly desaturate on exertion. This can limit exercise capacity and worsen... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A large subgroup of people with interstitial lung disease (ILD) are normoxic at rest, but rapidly desaturate on exertion. This can limit exercise capacity and worsen dyspnoea. The use of ambulatory or short-burst oxygen when mobilising or during other activities, may improve exercise capacity and relieve dyspnoea.
OBJECTIVES
To determine the effects of ambulatory and short-burst oxygen therapy, separately, on exercise capacity, dyspnoea and quality of life in people who have interstitial lung disease (ILD), particularly those with idiopathic pulmonary fibrosis (IPF).
SEARCH METHODS
We conducted searches in the Cochrane Airways Group Specialised Register (all years to May 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (all years to May 2016), MEDLINE (Ovid) (1950 to 4th May 2016) and EMBASE (Ovid) (1974 to 4th May 2016). We also searched the reference lists of relevant studies, international clinical trial registries and respiratory conference abstracts for studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) or quasi-RCTs that compared ambulatory or short-burst oxygen with a control group in people with ILD of any origin.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for inclusion and assessed risk of bias in the included studies. We extracted data from included studies using a prepared checklist, including study characteristics and results. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to assess the quality of the included studies.
MAIN RESULTS
Three studies (including 98 participants, all of whom had IPF) met the inclusion criteria of this review. These studies were conducted in hospital respiratory physiology laboratories. Two studies did not demonstrate any beneficial effect of supplemental oxygen on exercise capacity or exertional dyspnoea. Neither of these studies titrated oxygen requirements to prevent ongoing exertional desaturation. One study showed an increase in exercise capacity as assessed by endurance time with supplemental oxygen. We did not identify any studies that examined the effect of ambulatory oxygen on health-related quality of life, survival, costs or time to exacerbation or hospitalisation. No study reported any adverse events. The quality of evidence for all three studies, as assessed by GRADE criteria, was low.
AUTHORS' CONCLUSIONS
This review found no evidence to support or refute the use of ambulatory or short burst oxygen in ILD due to the limited number of included studies and data. Further research is needed to examine the role of this treatment.
Topics: Ambulatory Care; Dyspnea; Exercise Tolerance; Humans; Idiopathic Pulmonary Fibrosis; Lung Diseases, Interstitial; Oxygen Inhalation Therapy; Randomized Controlled Trials as Topic
PubMed: 27383922
DOI: 10.1002/14651858.CD011716.pub2 -
Heart & Lung : the Journal of Critical... 2020Dyspnea is a common symptom of heart failure (HF) but dyspnea burden is highly variable.
BACKGROUND
Dyspnea is a common symptom of heart failure (HF) but dyspnea burden is highly variable.
OBJECTIVES
Identify distinct profiles of dyspnea burden and identify predictors of dyspnea symptom profile.
METHODS
A secondary analysis of data from five studies completed at Oregon Health and Science University was conducted. The Heart Failure Somatic Perception Scale was used to measure dyspnea burden. Latent class mixture modeling identified distinct profiles of dyspnea burden in a sample of HF patients (n = 449). Backwards stepwise multinomial logistic regression identified predictors of latent profile membership.
RESULTS
Four profiles of dyspnea burden were identified: no dyspnea/not bothered by dyspnea, mild dyspnea, moderate exertional dyspnea, and moderate exertional dyspnea with orthopnea and PND. Higher age was associated with greater likelihood of not being bothered by dyspnea than having moderate exertional dyspnea with orthopnea and PND. Higher NYHA class, anxiety, and depression were associated with greater likelihood of greater dyspnea burden.
CONCLUSIONS
Burden of dyspnea is highly variable among HF patients. Clinicians should account for the nuances of dyspnea and the activities that induce dyspnea when assessing HF patients.
Topics: Anxiety; Dyspnea; Heart Failure; Humans; Logistic Models
PubMed: 32434702
DOI: 10.1016/j.hrtlng.2020.03.026 -
Medicine Oct 2022Dyspnea is one of the most common symptoms of chronic respiratory disease (CRD) and is closely related to increased functional disability and mortality, resulting in...
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.
Topics: Acupuncture Therapy; Dyspnea; Humans; Meta-Analysis as Topic; Quality of Life; Randomized Controlled Trials as Topic; Research Design; Systematic Reviews as Topic
PubMed: 36253986
DOI: 10.1097/MD.0000000000030909 -
Deutsches Arzteblatt International Feb 2022
Topics: Diagnosis, Differential; Dyspnea; Humans
PubMed: 35410669
DOI: 10.3238/arztebl.m2021.0166 -
Wiener Klinische Wochenschrift Apr 2021Clinical manifestations of COVID-19 are varied in the general population. This study aimed to systematize the literature regarding clinical manifestations of patients... (Review)
Review
Clinical manifestations of COVID-19 are varied in the general population. This study aimed to systematize the literature regarding clinical manifestations of patients with confirmed COVID-19. A systematic review of the literature was conducted. A total of 8070 scientific productions were found in the databases. Among the studies, 184 met the initial inclusion criteria, with a total of 114,046 patients. After complete reading, 32 studies that did not report clinical manifestations were excluded. The 152 publications finally included a total of 41,409 individuals from at least 23 countries and 26 different clinical manifestations were reported. In percentage terms, 6 symptoms had a general prevalence greater than or equal to 25%, namely, fever (58.66%), cough (54.52%), dyspnea (30.82%), malaise (29.75%), fatigue (28.16%) and sputum/secretion (25.33%). Neurological symptoms (20.82%), dermatological manifestations (20.45%), anorexia (20.26%), myalgia (16.9%), sneezing (14.71%), sore throat (14.41%), rhinitis (14.29%), goosebumps (13.49%), headache (12.17%), chest pain (11.49%) and diarrhea (9.59%) were other common symptoms. Only one study reported dermatological manifestations. The least frequent sign/symptom was hemoptysis (1.65%). In studies with more than 100 patients, the 3 main symptoms were fever (57.93%), cough (54.21%), and dyspnea (30.64%). Dermatological manifestations do not appear among the main symptoms. The identification of all clinical manifestations of COVID-19 is essential for an early diagnosis and the adoption of preventive measures.
Topics: COVID-19; Cough; Dyspnea; Fever; Humans; SARS-CoV-2
PubMed: 33242148
DOI: 10.1007/s00508-020-01760-4 -
Otolaryngology--head and Neck Surgery :... Sep 2022The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in...
OBJECTIVE
The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects.
STUDY DESIGN
Prospective cohort study.
SETTING
Tertiary referral center.
METHOD
Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements.
RESULTS
The Cotton-Myer classification correlated weakly with peak expiratory flow ( = -0.35, = .012), expiratory disproportion index ( = 0.32, = .022), peak inspiratory flow ( = -0.32, = .022), and total peak flow ( = -0.36, = .01). The DI showed an excellent area under the curve (0.99, < .001), and among PFTs, the expiratory disproportion index demonstrated the best area under the curve (0.89, < .001), followed by total peak flow (0.88, < .001), peak expiratory flow (0.87, < .001), and peak inspiratory flow (0.84, < .001). Patients treated endoscopically with balloon dilatation showed a 53% decrease in expiratory disproportion index (95% CI, 41%-66%; < .001) and a 37% improvement in peak expiratory flow (95% CI, 31%-43%; < .001).
CONCLUSION
Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI.
Topics: Adult; Constriction, Pathologic; Dyspnea; Humans; Laryngostenosis; Prospective Studies; Spirometry
PubMed: 34813409
DOI: 10.1177/01945998211060817 -
Chest Sep 2019Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. We sought to characterize the multiple sensations...
BACKGROUND
Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital.
METHODS
We selected patients who reported breathing discomfort of at least 4/10 on admission (10 = unbearable). Research staff recruited 156 patients within 24 hours of admission and evaluated daily patients' current and worst dyspnea with the Multidimensional Dyspnea Profile; patients participated in the study 2.6 days on average. The Multidimensional Dyspnea Profile assesses overall breathing discomfort (A), intensity of five sensory qualities of dyspnea, and 5 negative emotional responses to dyspnea. Patients were also asked to rate whether current levels of dyspnea were "acceptable."
RESULTS
At the time of the first research interview, patients reported slight to moderate dyspnea (A median 4); however, most patients reported experiencing severe dyspnea in the 24 hours before the interview (A mean 7.8). A total of 54% of patients with dyspnea ≥4 on day 1 found the symptom unacceptable. The worst dyspnea each day in the prior 24 hours usually occurred at rest. Dyspnea declined but persisted through hospitalization for most patients. "Air hunger" was the dominant sensation, especially when dyspnea was strong (>4). Anxiety and frustration were the dominant emotions associated with dyspnea.
CONCLUSIONS
This first multidimensional portrait of dyspnea in a general inpatient population characterizes the sensations and emotions dyspneic patients endure. The finding that air hunger is the dominant sensation of severe dyspnea has implications for design of laboratory models of these sensations and may have implications for targets of palliation of symptoms.
Topics: Adult; Dyspnea; Emotions; Female; Hospitalization; Humans; Male; Prevalence; Surveys and Questionnaires
PubMed: 31128117
DOI: 10.1016/j.chest.2019.04.128 -
The Indian Journal of Medical Research Nov 2020
Topics: Dyspnea; Humans; Vascular Diseases
PubMed: 35345110
DOI: 10.4103/ijmr.IJMR_1732_19 -
Annals of Palliative Medicine Oct 2018More than 70% of patients with advanced cancer experience dyspnea. Dyspnea is predictive of shorter survival and interferes with quality of life (QOL). The present study...
BACKGROUND
More than 70% of patients with advanced cancer experience dyspnea. Dyspnea is predictive of shorter survival and interferes with quality of life (QOL). The present study aimed to identify predictors of the presence and severity of dyspnea in advanced cancer patients.
METHODS
A prospective database collected from patients attending a palliative radiotherapy clinic was analyzed for patient demographics, Edmonton Symptom Assessment System (ESAS) scores, Patient-Reported Functional Status (PRFS), history of smoking and respiratory conditions, pulse oximetry readings, and primary cancer site. Using the ESAS shortness of breath item, dyspnea was classified as mild [1-3], moderate [4-6] or severe [7-10]. Logistic regression analysis and generalized estimating equations (GEEs) were used to identify predictors of the severity of dyspnea and presence of moderate/severe dyspnea (ESAS ≥4) at patients' first visit and over time, respectively.
RESULTS
A total of 252 patients with dyspnea data were included (median age 71.3 years, 61.5% male, 44.4% had dyspnea) in a demographic analysis. Multivariable analysis showed liver metastases (P=0.01, OR =2.04), a history of respiratory conditions (P=0.03, OR =2.09) and PRFS ≥3 (P=0.03, OR =1.75) were predictive of the severity of dyspnea at the first visit. Analyzed over time, liver metastases (P=0.02, OR =1.80), lymph node metastases (P=0.02, OR =1.79), a history of respiratory conditions (P=0.006, OR =2.50) and pulse oximetry <90 (P=0.003, OR =3.32) were predictive of greater severity of dyspnea symptoms. Patients with multiple radiation treatments in the thorax region were less likely to have severe dyspnea symptoms over time (P=0.01, OR =0.32). Lung metastases (P=0.04, OR =2.03), a history of respiratory conditions (P=0.01, OR =2.60) and PRFS ≥3 (P=0.009, OR =2.30) were predictive of moderate/severe dyspnea at the first visit. Over time, lymph node metastases (P=0.003, OR =2.51), a history of respiratory conditions (P=0.04, OR =2.37) and pulse oximetry <90 (P=0.0004, OR =5.15) were predictive of moderate/severe dyspnea.
CONCLUSIONS
Liver, lung and lymph node metastases, a history of respiratory conditions, pulse oximetry <90 and PRFS ≥3 were predictive of the severity of dyspnea and moderate/severe dyspnea. Physicians should be aware of predictive factors that could lead to dyspnea to promote early intervention for improved patient care and the creation of screening tools for clinical practice.
Topics: Aged; Aged, 80 and over; Databases, Factual; Dyspnea; Female; Humans; Logistic Models; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Prognosis; Prospective Studies; Quality of Life; Severity of Illness Index
PubMed: 30180735
DOI: 10.21037/apm.2018.06.09