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The Indian Journal of Medical Research Nov 2020
Topics: Dyspnea; Humans; Vascular Diseases
PubMed: 35345110
DOI: 10.4103/ijmr.IJMR_1732_19 -
Respirology (Carlton, Vic.) Sep 2019Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnoea in patients with COPD and other lung conditions. Once PR is... (Review)
Review
Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnoea in patients with COPD and other lung conditions. Once PR is completed, the benefits gained begin to decline unless patients continue to exercise regularly. Due to limited evidence in other lung conditions, this review aims to examine the current evidence regarding maintenance exercise programmes for patients with COPD and to determine the types of programmes that are able to maintain the benefits gained from PR to 12 months and longer. A number of factors may affect the ability to maintain exercise capacity and HRQoL in the long term including: frequency of supervised maintenance exercise; strategies used to improve adherence to maintenance exercise; facilitators and barriers to long-term exercise training; and initial PR programme itself. The current evidence for maintenance exercise programmes that included supervised maintenance exercise was weak, and for those programmes that included unsupervised maintenance exercise (with and without support) were difficult to interpret and in many instances were no better than usual care. New research using technology has provided some promising results for the future and surveys have revealed important features that may help in the development of maintenance programmes from a participant perspective such as ongoing therapist support. How to best maintain the benefits gained from PR remains unclear. Therefore, it is likely that no one model of maintenance is ideal for all patients with COPD and that individually adapted maintenance exercise programmes need to be considered.
Topics: Dyspnea; Exercise Therapy; Exercise Tolerance; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Surveys and Questionnaires
PubMed: 30891887
DOI: 10.1111/resp.13518 -
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 -
Respiratory Medicine Aug 2023Cardiopulmonary exercise testing (CPET) remains poorly understood and, consequently, largely underused in respiratory medicine. In addition to a widespread lack of... (Review)
Review
Cardiopulmonary exercise testing (CPET) remains poorly understood and, consequently, largely underused in respiratory medicine. In addition to a widespread lack of knowledge of integrative physiology, several tenets of CPET interpretation have relevant controversies and limitations which should be appropriately recognized. With the intent to provide a roadmap for the pulmonologist to realistically calibrate their expectations towards CPET, a collection of deeply entrenched beliefs is critically discussed. They include a) the actual role of CPET in uncovering the cause(s) of dyspnoea of unknown origin, b) peak O uptake as the key metric of cardiorespiratory capacity, c) the value of low lactate ("anaerobic") threshold to differentiate cardiocirculatory from respiratory causes of exercise limitation, d) the challenges of interpreting heart rate-based indexes of cardiovascular performance, e) the meaning of peak breathing reserve in dyspnoeic patients, f) the merits and drawbacks of measuring operating lung volumes during exercise, g) how best interpret the metrics of gas exchange inefficiency such as the ventilation-CO output relationship, h) when (and why) measurements of arterial blood gases are required, and i) the advantages of recording submaximal dyspnoea "quantity" and "quality". Based on a conceptual framework that links exertional dyspnoea to "excessive" and/or "restrained" breathing, I outline the approaches to CPET performance and interpretation that proved clinically more helpful in each of these scenarios. CPET to answer clinically relevant questions in pulmonology is a largely uncharted research field: I, therefore, finalize by highlighting some lines of inquiry to improve its diagnostic and prognostic yield.
Topics: Humans; Exercise Test; Pulmonary Medicine; Dyspnea; Anaerobic Threshold; Exercise; Exercise Tolerance
PubMed: 37100256
DOI: 10.1016/j.rmed.2023.107249 -
Pneumologie (Stuttgart, Germany) Oct 2023In rheumatic diseases the possibility of pulmonary manifestation must always be considered and checked. Interstitial lung disease can often be fatal in these cases. In...
In rheumatic diseases the possibility of pulmonary manifestation must always be considered and checked. Interstitial lung disease can often be fatal in these cases. In the presented case, the link between progressive dyspnea and newly occurring skin irritation is to be seen as particularly important. A good outcome can be achieved by immediate therapy with immunosuppression and plasmapheresis.
Topics: Humans; Dyspnea; Lung; Lung Diseases, Interstitial
PubMed: 36958340
DOI: 10.1055/a-2016-7215 -
Emergency Medicine Journal : EMJ Sep 2022
Topics: Abdominal Pain; Chest Pain; Dyspnea; Electrocardiography; Female; Humans
PubMed: 35998934
DOI: 10.1136/emermed-2021-211520 -
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 -
Respiratory Care Nov 2023Dyspnea is an unpleasant subjective symptom and is associated with decreased physical activity level (PAL). Effect of blowing air toward the face has received a great... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Dyspnea is an unpleasant subjective symptom and is associated with decreased physical activity level (PAL). Effect of blowing air toward the face has received a great deal of attention as a symptomatic therapy for dyspnea. However, little is known about the duration of its effect and its impact on PAL. Therefore, this study aimed to measure dyspnea severity and changes in dyspnea and PALs with air blasts to the face.
METHODS
The trial conducted was open-label, randomized, and controlled. This study included out-patients with dyspnea caused by chronic respiratory deficiency. Subjects were provided a small fan and instructed to blow air toward their faces either twice a day or when having trouble breathing. Subsequently, severity of dyspnea and PALs was measured using visual analog scale and physical activity scale for the elderly (PASE), respectively, before and after 3-week treatment. Amounts of changes in dyspnea and PALs before and after treatment were compared using analysis of covariance.
RESULTS
Overall, 36 subjects were randomized, and 34 were analyzed. Mean age was 75.4 y (26 males [76.5%] and 8 females [23.5%]). Visual analog scale score for dyspnea (SD) before treatment was 33 (13.9) mm and 42 (17.5) mm in the control and intervention groups, respectively. PASE score before treatment was 78.0 (45.1) and 57.7 (38.0) in the control and intervention groups, respectively. No significant difference in changes in dyspnea severity and PAL was observed between the 2 groups.
CONCLUSIONS
No significant difference was observed for dyspnea and PALs in subjects after blowing air toward their own faces with a small fan for 3 weeks at home. Disease variability and impact of protocol violations were high due to small number of cases. Further studies with a design focused on subject protocol adherence and measurement methods are required to understand impact of air flow on dyspnea and PAL.
Topics: Male; Female; Humans; Aged; Palliative Care; Exercise; Dyspnea
PubMed: 37197801
DOI: 10.4187/respcare.10715 -
BMJ (Clinical Research Ed.) Sep 2023
Topics: Humans; Pacemaker, Artificial; Dyspnea
PubMed: 37770081
DOI: 10.1136/bmj-2023-076240 -
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