-
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 -
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 -
The American Journal of Hospice &... Feb 2023Fibrotic interstitial lung diseases (F-ILDs) have a high symptom burden with progressive dyspnea as a primary feature. Breathlessness is underrecognized and... (Observational Study)
Observational Study
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. 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. 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. 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. Our clinic's approach allows early and systematic dyspnea management.
Topics: Humans; Retrospective Studies; Lung Diseases, Interstitial; Dyspnea; Oxygen
PubMed: 35484838
DOI: 10.1177/10499091221096416 -
European Journal of Oncology Nursing :... Aug 2019This study developed a comprehensive measurement tool for assessing dyspnea in cancer patients and examined its reliability and validity.
PURPOSE
This study developed a comprehensive measurement tool for assessing dyspnea in cancer patients and examined its reliability and validity.
METHODS
This cross-sectional study included 239 cancer patients with awareness of cancer-related dyspnea from outpatient/inpatient wards of six general hospitals in Japan. Items for the Total Dyspnea Scale for Cancer Patients (TDSC) were developed based on qualitative research and a literature review on patients with dyspnea. Ten cancer experts confirmed the scale's content validity. Factor analysis established construct validity. Internal consistency was analyzed by Cronbach's α. Study variables were the effects of dyspnea, worry, and quality of life.
RESULTS
Factor analysis identified 2 factors (11 items): effects on "daily living activities and psychology" and on "social life." Cronbach's α of the whole scale was 0.952 (p < 0.01), confirming high reliability. The scale showed high correlation with existing measures. TDSC can comprehensively and multidimensionally evaluate cancer-related dyspnea.
CONCLUSIONS
The TDSC consists of 11 items within two factors. Cronbach's α coefficient of the scale was 0.952 in this study, and thus, an acceptable level of reliability was confirmed. In addition, reference-related validity and discriminant validity were verified and confirmed. In future clinical practice, this scale can be utilized as a useful tool for comprehensively and multidimensionally evaluating cancer-related dyspnea.
Topics: Aged; Cross-Sectional Studies; Dyspnea; Factor Analysis, Statistical; Female; Humans; Japan; Male; Middle Aged; Neoplasms; Psychometrics; Qualitative Research; Reproducibility of Results; Surveys and Questionnaires
PubMed: 31358244
DOI: 10.1016/j.ejon.2019.05.007 -
BMC Infectious Diseases Jun 2022The SARS-COV2 pandemic has been ongoing worldwide since at least 2 years. In severe cases, this infection triggers acute respiratory distress syndrome and...
BACKGROUND
The SARS-COV2 pandemic has been ongoing worldwide since at least 2 years. In severe cases, this infection triggers acute respiratory distress syndrome and quasi-systemic damage with a wide range of symptoms. Long-term physical and psychological consequences of this infection are therefore naturally present among these patients. The aim of this study was to describe the state of health of these patients at 6 (M6) and 12 months (M12) after infection onset, and compare quality-of-life (QOL) and fatigue at these time-points.
METHODS
A prospective cohort study was set up at Reims University Hospital. Patients were clinically assessed at M6 and M12. Three scores were calculated to describe patient's status: the modified Medical Research Council score (mMRC) used to determine dyspnoea state, the Fatigue Severity Scale (FSS) and the Short Form 12 (SF12) that was carried out to determine the QOL both mentally and physically (MCS12 and PCS12). Descriptive analysis and comparison of scores between M6 and M12 were made.
RESULTS
120 patients completed both follow-up consultations. Overall, about 40% of the patients presented dyspnoea symptoms. The median mMRC score was 1 Interquartile ranges (IQR) = [0-2] at the two assessment. Concerning FSS scores, 35% and 44% of patients experienced fatigue at both follow-ups. The two scores of SF12 were lower than the general population standard scores. The mean PCS12 score was 42.85 (95% confidence interval (95% CI [41.05-44.65])) and mean MCS12 score of 46.70 (95% CI [45.34-48.06]) at 6 months. At 12 months, the mean PCS12 score was 42.18 (95% confidence interval (95% CI [40.46-43.89])) and mean MCS12 score of 47.13 (95% CI [45.98-48.28]). No difference was found between SF12 scores at 6 and 12 months.
CONCLUSIONS
This study pinpoints the persistence of fatigue and a low mental and physical QOL compared to population norms even after 1 year following infection. It also supports the claims of mental or psychological alterations due to infection by this new virus, hence a lower overall QOL in patients.
Topics: COVID-19; Dyspnea; Fatigue; Humans; Prospective Studies; Quality of Life; RNA, Viral; SARS-CoV-2
PubMed: 35698068
DOI: 10.1186/s12879-022-07517-w -
BMC Geriatrics Jun 2022The Dyspnoea-12 (D12) and Multidimensional dyspnea profile (MDP) are commonly used instruments for assessing multiple dimensions of breathlessness but have not been...
BACKGROUND
The Dyspnoea-12 (D12) and Multidimensional dyspnea profile (MDP) are commonly used instruments for assessing multiple dimensions of breathlessness but have not been validated in older people in the population. The aim of this study was to validate the D12 and MDP in 73-years old men in terms of the instruments' underlying factor structures, internal consistency, and validity.
METHODS
A postal survey was sent out to a population sample of 73-years old men (n = 1,193) in southern Sweden. The two-factor structures were evaluated with confirmatory factor analysis, internal consistency with Cronbach's alpha, and validity using Pearson´s correlations with validated scales of breathlessness, anxiety, depression, fatigue, physical/mental quality of life, body mass index (BMI), and cardiorespiratory disease.
RESULTS
A total 684 men were included. Respiratory and cardiovascular disease were reported by 17% and 38%, respectively. For D12 and MDP, the proposed two-factor structure was not fully confirmed in this population. Internal consistency was excellent for all D12 and MDP domain scores (Cronbach's alpha scores > 0.92), and the instruments' domains showed concurrent validity with other breathlessness scales, and discriminant validity with anxiety, depression, physical/mental quality of life, BMI, and cardiorespiratory disease.
CONCLUSIONS
In a population sample of 73-years old men, the D12 and MDP had good psychometrical properties in terms of reliability and validity, which supports that the instruments are valid for use in population studies of older men.
Topics: Aged; Dyspnea; Humans; Male; Psychometrics; Quality of Life; Reproducibility of Results; Sweden
PubMed: 35655151
DOI: 10.1186/s12877-022-03166-5 -
Journal of Hospital Medicine Oct 2016Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions.
BACKGROUND
Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions.
OBJECTIVE
To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment.
DESIGN, SETTINGS AND PARTICIPANTS
Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital.
INTERVENTION AND MEASUREMENTS
A numerical rating scale (0-10) was used to assess dyspnea severity as perceived by patients and assessed by providers. Agreement was defined as a score within ±1 between patient and healthcare provider; differences of ≥2 points were considered over- or underestimations. The relationship between patient self-perceived dyspnea severity and provider rating was assessed using a weighted kappa coefficient.
RESULTS
Of the 138 patients enrolled, 33% had a diagnosis of heart failure, 30% chronic obstructive pulmonary disease, and 13% pneumonia; median age was 72 years, and 57% were women. In all, 96 patient-physician and 138 patient-nurses pairs were included in the study. The kappa coefficient for agreement was 0.11 (95% confidence interval [CI]: 0.01 to 0.21) between patients and physicians and 0.18 (95% CI: 0.12 to 0.24) between patients and nurses. Physicians underestimated patients' dyspnea 37.9% of the time and overestimated it 25.8% of the time, whereas nurses underestimated it 43.5% of the time and overestimated it 12.4% of the time. Admitting diagnosis was the only patient factor associated with discordance.
CONCLUSIONS
Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701-707. © 2016 Society of Hospital Medicine.
Topics: Aged; Dyspnea; Female; Health Personnel; Humans; Male; Physician-Patient Relations; Self Report; Severity of Illness Index; Surveys and Questionnaires
PubMed: 27130579
DOI: 10.1002/jhm.2600 -
Pulmonology Dec 2023The diagnosis and severity assessment of COPD relies on spirometry, and in particular the FEV1. However, it has been proposed that hyperinflation and air-trapping are... (Observational Study)
Observational Study
INTRODUCTION
The diagnosis and severity assessment of COPD relies on spirometry, and in particular the FEV1. However, it has been proposed that hyperinflation and air-trapping are better predictors of exercise capacity and mortality than the FEV1.
RESEARCH
QUESTION: Does static hyperinflation predict exercise capacity?
METHODS
We conducted an observational prospective study. Patients with COPD referred to the lung function laboratory were consecutively recruited. Patients with hyperinflation (the experimental group) were compared to patients without hyperinflation (the control group). The sample sizes were determined assuming an effect size of 0.5 and a power of 0.80.
RESULTS
We recruited 124 participants, of whom 87% were male, the mean age was 66.1 ± 8.8 years. 67% were symptomatic (GOLD B or D). Airflow limitation was moderate to severe in the majority of patients (median FEV1 47%, IQR 38-65%) and 43% of patients had static hyperinflation. The median 6MWD was 479 meters (404-510) and peak workload in CPET was 64 watts (46-88) with peak VO2 1.12 L/min, 0.89-1.31 L/min. Patients with lower FEV1, DLCO and IC/TLC and higher RV/TLC had reduced exercise capacity in both 6MWT and CPET, measured as lower distance, greater desaturation and ∆Borg dyspnoea, and reduced workload, peak VO2 and peak VE and higher desaturation and ventilatory limitation (VE/MVV). An IC/TLC < 0.33 predicted reduced exercise performance (peak O2 <60%). Dyspnoea assessed by mMRC and QoL measured by CAT and CCQ were also worse in the hyperinflation in COPD patients.
CONCLUSION
In COPD patients, IC/TLC and RV/TLC are valuable predictors of exercise performance in both 6MWT and CPET and PRO.
Topics: Humans; Male; Middle Aged; Aged; Female; Pulmonary Disease, Chronic Obstructive; Prospective Studies; Exercise Tolerance; Quality of Life; Dyspnea
PubMed: 34629326
DOI: 10.1016/j.pulmoe.2021.08.011 -
International Journal of Chronic... 2021Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral... (Review)
Review
Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assessment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multidimensional instruments are available. Borg's 0-10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field-based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assessment in daily life and in relation to exertion in people with COPD.
Topics: Dyspnea; Exercise; Exercise Test; Humans; Pulmonary Disease, Chronic Obstructive; Walking
PubMed: 34113091
DOI: 10.2147/COPD.S277523 -
Annali Di Igiene : Medicina Preventiva... 2022The severe acute respiratory syndrome (COVID-19) due to SARS-CoV-2 was first reported in China in December 2019 and has generated a worldwide pandemic. The objective of...
OBJECTIVES
The severe acute respiratory syndrome (COVID-19) due to SARS-CoV-2 was first reported in China in December 2019 and has generated a worldwide pandemic. The objective of the research is to examine and describe (a) the symptoms that persist after the end of the acute stage and (b) their relationship with the severity of the disease.
STUDY DESIGN
This study is a cross-sectional study conducted in the Kingdom of Bahrain on COVID-19 infected patients using an online survey questionnaire with a total number of 52 patient responses (29 females and 23 males).
METHOD
A scale (0 no symptoms to 10 very high symptoms intensity) was assessed in patients after 3 months to detect the relevance of specific symptoms post-COVID-19 such as emotional and physical health, headache, dyspnoea, pain (muscles/joints/chest), anosmia, vertigo, neurologic symptoms, sarcopenia, delirium.
RESULTS
The most common COVID-19 symptoms were reported to be fever (69.2%), headache (59.6%), and cough (50.0%). Data analysis showed that BMI was not correlated with any post-acute COVID-19 symptoms. Regarding the post-acute COVID-19 symptoms, this study showed that an increase of intensity of headache was associated with an increase of delirium; an increase of intensity of dyspnoea was associated with an increase of pulmonary dysfunction. The increase of anosmia and dysgeusia was associated with an increase in delirium. In addition, the increase of neurological symptoms and delirium were associated with the increase of sarcopenia. The most common persistent post-COVID-19 symptoms observed in this study were emotional stress, followed by loss of smell and taste, and neurological symptoms.
CONCLUSIONS
Therefore, follow-up and rehabilitation care for COVID-19 patients must be focused on addressing the needs of these people in the longer term.
Topics: Anosmia; COVID-19; Cross-Sectional Studies; Delirium; Dyspnea; Female; Headache; Humans; Male; SARS-CoV-2; Sarcopenia
PubMed: 35861720
DOI: 10.7416/ai.2022.2508