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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 -
European Journal of Heart Failure Aug 2022Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as...
Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy - A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology.
Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype-specific treatments.
Topics: Cardiology; Dyspnea; Exercise Test; Exercise Tolerance; Heart Failure; Humans; Stroke Volume
PubMed: 35775383
DOI: 10.1002/ejhf.2601 -
Annals of the American Thoracic Society Apr 2021Dyspnea in low-preload states is an underrecognized but growing diagnosis in patients with unexplained dyspnea. Patients can often experience debilitating symptoms at... (Review)
Review
Dyspnea in low-preload states is an underrecognized but growing diagnosis in patients with unexplained dyspnea. Patients can often experience debilitating symptoms at rest and with exertion, as low measured preload often leads to decreased cardiac output and ultimately dyspnea. In the present article, we performed a review of the literature and a multidisciplinary evaluation to understand the pathophysiology, diagnosis, and treatment of dyspnea in low-preload states. We explored selected etiologies and suggested an algorithm to approach unexplained dyspnea. The mainstay of diagnosis remains as invasive cardiopulmonary exercise testing. We concluded with a variety of nonpharmacological and pharmacological therapies, highlighting that a multifactorial approach may lead to the best results.
Topics: Dyspnea; Exercise Test; Humans
PubMed: 33792518
DOI: 10.1513/AnnalsATS.202005-581CME -
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 -
American Journal of Respiratory and... Apr 2022
Topics: Dyspnea; Humans; Respiration, Artificial
PubMed: 35134318
DOI: 10.1164/rccm.202201-0078ED -
Annals of Physical and Rehabilitation... Jun 2023COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition.
OBJECTIVES
To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS.
METHODS
In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores.
RESULTS
Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10).
CONCLUSION
People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).
Topics: Adult; Humans; COVID-19; SARS-CoV-2; Post-Acute COVID-19 Syndrome; Quality of Life; Dyspnea; Respiratory Distress Syndrome; Exercise; Treatment Outcome
PubMed: 37271020
DOI: 10.1016/j.rehab.2023.101765 -
Ugeskrift For Laeger Dec 2019Chronic dyspnoea without obvious cause is termed unexplained dyspnoea and is associated with a reduced functional capacity and increased mortality. The diagnostic path... (Review)
Review
Chronic dyspnoea without obvious cause is termed unexplained dyspnoea and is associated with a reduced functional capacity and increased mortality. The diagnostic path for patients with unexplained dyspnoea is far from uniform, which leads to numerous encounters with healthcare professionals, multiple diagnostic tests, and possible medication errors. In this review, the evaluation of unexplained dyspnoea is explained as well as possible pathophysiological mechanisms leading to chronic dyspnoea.
Topics: Chronic Disease; Dyspnea; Humans
PubMed: 31928623
DOI: No ID Found -
Nederlands Tijdschrift Voor Geneeskunde Feb 2020Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during...
Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies. We propose a strategy to assess dyspnoea in clinical practice. Key points are determining the severity of the problem, forming a differential diagnosis, thinking about the mechanism of dyspnoea and intervening in a timely manner. We conclude that the assessment and treatment of dyspnoea often requires a multidisciplinary approach.
Topics: Cardiovascular Diseases; Diagnosis, Differential; Dyspnea; Female; Humans; Lung; Lung Diseases; Male
PubMed: 32186810
DOI: No ID Found -
Australian Critical Care : Official... Jul 2023In patients who are ventilator-dependent in the intensive care unit, inspiratory muscle training may improve inspiratory muscle strength and accelerate liberation from... (Randomized Controlled Trial)
Randomized Controlled Trial
Does mechanical threshold inspiratory muscle training promote recovery and improve outcomes in patients who are ventilator-dependent in the intensive care unit? The IMPROVE randomised trial.
BACKGROUND
In patients who are ventilator-dependent in the intensive care unit, inspiratory muscle training may improve inspiratory muscle strength and accelerate liberation from the ventilator, but optimal training parameters are yet to be established, and little is known about the impact of inspiratory muscle training on quality of life or dyspnoea. Thus, we sought to ascertain whether inspiratory muscle training, commenced while ventilator-dependent, would improve outcomes for patients invasively ventilated for 7 days or longer.
METHODS
In this randomised trial with assessor blinding and intention-to-treat analysis, 70 participants (mechanically ventilated ≥7 days) were randomised to receive once-daily supervised high-intensity inspiratory muscle training with a mechanical threshold device in addition to usual care or to receive usual care (control). Primary outcomes were inspiratory muscle strength (maximum inspiratory pressure % predicted) and endurance (fatigue resistance index) at ventilator liberation and 1 week later. Secondary outcomes included quality of life (SF-36v2, EQ-5D), dyspnoea, physical function, duration of ventilation, and in-hospital mortality.
RESULTS
Thirty-three participants were randomly allocated to the training group, and 37 to the control group. There were no statistically significant differences in strength (maximum inspiratory pressure) (95% confidence interval [CI]: -7.4 to 14.0) or endurance (fatigue resistance index) (95% CI: -0.003 to 0.436). Quality of life improved significantly more in the training group than in the control group (EQ-5D: 17.2; 95% CI: 1.3-33.0) (SF-36-PCS: 6.97; 95% CI: 1.96-12.00). Only the training group demonstrated significant reductions in dyspnoea (-1.5 at rest, -1.9 during exercise). There were no between-group differences in duration of ventilation or other measures. In-hospital mortality was higher in the control group than in the training group (9 vs 4, 24% vs 12%, p = 0.23).
CONCLUSIONS
In patients who are ventilator-dependent, mechanical threshold loading inspiratory muscle training improves quality of life and dyspnoea, even in the absence of strength improvements or acceleration of ventilator liberation.
Topics: Humans; Respiration, Artificial; Ventilator Weaning; Breathing Exercises; Quality of Life; Respiratory Muscles; Intensive Care Units; Ventilators, Mechanical; Dyspnea
PubMed: 36041982
DOI: 10.1016/j.aucc.2022.07.002 -
Annals of Emergency Medicine Oct 2022
Topics: Diagnosis, Differential; Dyspnea; Fever; Humans; Male
PubMed: 36153049
DOI: 10.1016/j.annemergmed.2022.04.017