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The European Respiratory Journal Jan 2024
Topics: Humans; Critical Illness; Respiration, Artificial; Dyspnea
PubMed: 38237994
DOI: 10.1183/13993003.01565-2023 -
Therapeutische Umschau. Revue... Aug 2023Often dyspnea is caused by cardiac disease which has a dismal prognosis if left untreated. This article is focused on primary care and provides an overview of the most...
Often dyspnea is caused by cardiac disease which has a dismal prognosis if left untreated. This article is focused on primary care and provides an overview of the most important etiologies, evaluation algorithms and therapies.
Topics: Humans; Dyspnea; Prognosis; Algorithms; Diagnosis, Differential
PubMed: 37855529
DOI: No ID Found -
The Journal of the Royal College of... Sep 2023Here we present a case of a patient with breathlessness and cough admitted to the COVID ward. Chest radiography demonstrates findings consistent with lobar collapse,...
Here we present a case of a patient with breathlessness and cough admitted to the COVID ward. Chest radiography demonstrates findings consistent with lobar collapse, giving rise to the 'Luftsichel sign'. This sign has been described in the literature and highlights the importance of recognition and prompt further investigation.
Topics: Humans; COVID-19; Pulmonary Atelectasis; Radiography; Cough; Dyspnea
PubMed: 37491790
DOI: 10.1177/14782715231188986 -
Current Opinion in Supportive and... Dec 2023Effective education enables people to modify the distress and impact of breathlessness by integrating evidence-informed breathlessness-related behaviours (knowledge,... (Review)
Review
PURPOSE OF THE REVIEW
Effective education enables people to modify the distress and impact of breathlessness by integrating evidence-informed breathlessness-related behaviours (knowledge, skill, attitude) into everyday life. This review considers recent studies of educational approaches focussed on chronic breathlessness as a modifiable, noxious and debilitating multidimensional experience.
RECENT FINDINGS
Systematic assessments of text-based patient education materials and mobile phone applications specific to breathlessness indicate that while these resources are readily available, issues continue to persist with quality, readability, usefulness and availability of non-English language versions. Various forms of educational interventions for breathlessness have proven feasible and valued by people living with breathlessness and their significant others (uptake/completion, personal benefit, ripple effect on health professionals). Health professional knowledge about the impact of chronic breathlessness and effective management can be altered through structured, educational interventions.
SUMMARY
Empiric studies of patient education for breathlessness are scarce despite persistent calls for better breathlessness education for people living with or providing care for someone living with this noxious symptom. In clinical practice, it is highly likely that there are effective and ineffective educational practices, both of which, if publicly disseminated, would inform future educational strategies to advance breathlessness self-management.
Topics: Humans; Patient Education as Topic; Health Personnel; Palliative Care; Dyspnea
PubMed: 37812384
DOI: 10.1097/SPC.0000000000000678 -
JACC. Cardiovascular Interventions Oct 2023Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases.
OBJECTIVES
The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI).
METHODS
In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The occurrence of dyspnea associated with ticagrelor discontinuation was evaluated among all patients enrolled in the trial. A landmark analysis was performed at 3 months after PCI, that is, the time of randomization. Predictors of dyspnea-related ticagrelor discontinuation were obtained from multivariable Cox regression with stepwise selection of candidate variables.
RESULTS
The incidence of dyspnea-related ticagrelor discontinuation was 6.4% and 9.1% at 3 and 15 months after PCI, respectively. Independent predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age. Among 179 patients who discontinued ticagrelor because of dyspnea after randomization, ticagrelor monotherapy was not associated with a higher risk of subsequent ischemic events (composite of all-cause death, myocardial infarction, or stroke) compared with ticagrelor plus aspirin (5.0% vs 7.1%; P = 0.566).
CONCLUSIONS
In the TWILIGHT trial, dyspnea-related ticagrelor discontinuation occurred in almost 1 in 10 patients and tended to occur earlier rather than late after PCI. Several demographic and clinical conditions predicted its occurrence, and their assessment may help identify subjects at risk for therapy nonadherence.
Topics: Humans; Ticagrelor; Platelet Aggregation Inhibitors; Percutaneous Coronary Intervention; Hemorrhage; Treatment Outcome; Drug Therapy, Combination; Aspirin; Dyspnea
PubMed: 37879803
DOI: 10.1016/j.jcin.2023.08.019 -
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 -
Deutsches Arzteblatt International Dec 2023Up to 1% of the world population and 10% of all persons over age 65 suffer from pulmonary hypertension (PH). The latency from the first symptom to the diagnosis is more... (Review)
Review
BACKGROUND
Up to 1% of the world population and 10% of all persons over age 65 suffer from pulmonary hypertension (PH). The latency from the first symptom to the diagnosis is more than one year on average, and more than three years in 20% of patients. 40% seek help from more than four different physicians until their condition is finally diagnosed.
METHODS
This review is based on publications retrieved by a selective literature search on pulmonary hypertension.
RESULTS
The most common causes of pulmonary hypertension are left heart diseases and lung diseases. Its cardinal symptom is exertional dyspnea that worsens as the disease progresses. Additional symptoms of right heart failure are seen in advanced stages. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare, difficult to diagnose, and of particular clinical relevance because specific treatments are available. For this reason, strategies for the early detection of PAH and CTEPH have been developed. The clinical suspicion of PH arises in a patient who has nonspecific symptoms, electrocardiographic changes, and an abnormal (NT-pro-)BNP concentration. Once the suspicion of PH has been confirmed by echocardiography and, if necessary, differential-diagnostic evaluation with a cardiopulmonary stress test, and after the exclusion of a primary left heart disease or lung disease, the patient should be referred to a PH center for further diagnostic assessment, classification, and treatment.
CONCLUSION
If both the (NT-pro-)BNP and the ECG are normal, PH is unlikely. Knowledge of the characteristic clinical manifestations and test results of PH is needed so that patients can be properly selected for referral to specialists and experts in PH.
Topics: Humans; Aged; Hypertension, Pulmonary; Exercise Test; Dyspnea; Echocardiography; Heart Diseases; Pulmonary Embolism; Chronic Disease
PubMed: 37882345
DOI: 10.3238/arztebl.m2023.0222 -
Journal of Cardiopulmonary... Nov 2023Patients with COVID-19 often report persistent respiratory symptoms. Limited data exist on how to mitigate long-term sequelae of exercise intolerance and dyspnea. We... (Observational Study)
Observational Study
PURPOSE
Patients with COVID-19 often report persistent respiratory symptoms. Limited data exist on how to mitigate long-term sequelae of exercise intolerance and dyspnea. We aimed to study the role of pulmonary rehabilitation (PR) in patients with post-COVID-19.
METHODS
This was an observational study. Consecutive patients with post-COVID-19, admitted to three separate outpatient PR programs, were enrolled. The program consisted of 8-12 wk of PR sessions (3 times/wk). Data were gathered at the initial visit and discharge. The primary outcome was the change in the 6-min walk test (6MWT) distance. Secondary outcomes included the Shortness of Breath Questionnaire (SOBQ), modified Borg dyspnea scale, Patient Health Questionnaire-9 (PHQ-9), and Lung Information Needs Questionnaire (LINQ).
RESULTS
A total of 56 patients completed the PR program (age 62.8 ± 14.7 yr, 57% were men). At baseline, the mean 6MWT was 313.3 ± 193.8 m. On average, the 6MWT improved by 84.3 m after PR ( P < .0001). Apart from the modified Borg dyspnea scale, there was improvement across secondary outcomes: SOBQ (-16.9 points), PHQ-9 (-2.6 points), and LINQ (-4.2 points); all P < .05.
CONCLUSION
Pulmonary rehabilitation showed a promising positive effect on patients with with post-COVID-19. It improved exercise capacity, perception of dyspnea, depressive symptoms, and patient knowledge needed to manage their lung disease. Pulmonary rehabilitation should be considered for post-COVID-19 patients.
Topics: Male; Humans; Middle Aged; Aged; Female; Treatment Outcome; Quality of Life; COVID-19; Lung; Dyspnea; Pulmonary Disease, Chronic Obstructive; Exercise Tolerance
PubMed: 37535550
DOI: 10.1097/HCR.0000000000000813 -
The European Respiratory Journal Feb 2024Dyspnoea and cough can have a profound impact on the lives of patients with pulmonary fibrosis. We investigated the effects of nintedanib on the symptoms and impact of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Dyspnoea and cough can have a profound impact on the lives of patients with pulmonary fibrosis. We investigated the effects of nintedanib on the symptoms and impact of pulmonary fibrosis in patients with progressive pulmonary fibrosis (PPF) in the INBUILD trial using the Living with Pulmonary Fibrosis (L-PF) questionnaire.
METHODS
Patients had a fibrosing interstitial lung disease (ILD) (other than idiopathic pulmonary fibrosis) of >10% extent on high-resolution computed tomography (HRCT) and met criteria for ILD progression within the prior 24 months. Patients were randomised 1:1 to receive nintedanib or placebo. Changes in L-PF questionnaire scores from baseline to week 52 were assessed using mixed models for repeated measures.
RESULTS
In total, 663 patients were treated. Compared with placebo, there were significantly smaller increases (worsenings) in adjusted mean L-PF questionnaire total (0.5 5.1), symptoms (1.3 5.3), dyspnoea (4.3 7.8) and fatigue (0.7 4.0) scores in the nintedanib group at week 52. L-PF questionnaire cough score decreased in the nintedanib group and increased in the placebo group (-1.8 4.3). L-PF questionnaire impacts score decreased slightly in the nintedanib group and increased in the placebo group (-0.2 4.6). Similar findings were observed in patients with a usual interstitial pneumonia-like fibrotic pattern on HRCT and in patients with other fibrotic patterns on HRCT.
CONCLUSION
Based on changes in L-PF questionnaire scores, nintedanib reduced worsening of dyspnoea, fatigue and cough and the impacts of ILD over 52 weeks in patients with PPF.
Topics: Humans; Vital Capacity; Disease Progression; Lung Diseases, Interstitial; Idiopathic Pulmonary Fibrosis; Fibrosis; Dyspnea; Cough; Double-Blind Method; Indoles
PubMed: 38135442
DOI: 10.1183/13993003.00752-2023 -
BMJ Case Reports Oct 2023Platypnoea-orthodeoxia syndrome is characterised by dyspnoea and oxygen desaturation in the upright position usually caused by an extracardiac shunt and less often due...
Platypnoea-orthodeoxia syndrome is characterised by dyspnoea and oxygen desaturation in the upright position usually caused by an extracardiac shunt and less often due to dynamic factors that accentuate an intracardiac right-to-left shunt. In our patient, the collapse of lower lobe of left lung secondary to bronchial stenosis due to endobronchial tuberculosis and resultant mediastinal shift was the factor that led to an otherwise unrecognised intracardiac right-to-left shunt leading to platypnoea-orthodeoxia. We postulate that there would have been an increased stretching and widening of a patent foramen ovale in the upright position due to gravity resulting in an increased shunt despite normal intracardiac pressures. Once the patency of the left main bronchus was restored by deploying a stent, the left lower lobe expanded, the mediastinum returned to its normal position and there was resultant resolution of the platypnoea-orthodeoxia. This interesting observation may be useful in managing similar scenarios in the future.
Topics: Humans; Platypnea Orthodeoxia Syndrome; Hypoxia; Foramen Ovale, Patent; Dyspnea
PubMed: 37907322
DOI: 10.1136/bcr-2023-255587