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Journal of General Internal Medicine Oct 2022Dyspnea is associated with functional impairment and impaired quality of life. There is limited information on the potential risk factors for dyspnea in an older adult...
BACKGROUND
Dyspnea is associated with functional impairment and impaired quality of life. There is limited information on the potential risk factors for dyspnea in an older adult population.
OBJECTIVES
Among older adults aged 45 to 85 years of age, what sociodemographic, environmental, and disease related factors are correlated with dyspnea?
DESIGN
We used cross-sectional questionnaire data collected on 28,854 participants of the Canadian Longitudinal Study of Aging (CLSA). Multinomial regression was used to assess the independent effect of individual variables adjusting for the other variables of interest.
KEY RESULTS
The adjusted odds ratios for dyspnea "walking on flat surfaces" were highest for obesity (OR, 5.71; 95%CI, 4.71-6.93), lung disease (OR, 3.91; 95%CI, 3.41-4.49), and depression (OR, 3.68; 95%CI, 3.15-4.29), and were greater than 2 for lower income, and heart disease. The effect of diabetes remained significant after adjusting for sociodemographics, heart disease and BMI (OR, 1.61; 95%CI, 1.39-1.86). Those with both respiratory disease and depression had a 12.78-fold (95%CI, 10.09-16.19) increased odds of exertional dyspnea, while the corresponding OR for the combination of heart disease and depression was 18.31 (95%CI, 13.4-25.01).
CONCLUSIONS
In a community sample of older adults, many correlates of dyspnea exist which have significant independent and combined effects. These factors should be considered in the clinical context where dyspnea is out of proportion to the degree of heart and lung disease. Whether or not diabetes may possibly be a risk factor for dyspnea merits further investigation.
Topics: Aged; Aging; Canada; Cross-Sectional Studies; Diabetes Mellitus; Dyspnea; Heart Diseases; Humans; Longitudinal Studies; Lung Diseases; Quality of Life
PubMed: 35819684
DOI: 10.1007/s11606-021-07374-4 -
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 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 Pain and Symptom Management Aug 2020There is no evidence-based treatment for fatigue in amyotrophic lateral sclerosis (ALS), and identification of treatable causes determines management strategies....
CONTEXT
There is no evidence-based treatment for fatigue in amyotrophic lateral sclerosis (ALS), and identification of treatable causes determines management strategies. Although dyspnea is a key symptom of ALS and effectively treatable, it has not been sufficiently investigated whether dyspnea may be a fatigue-promoting factor.
OBJECTIVES
To determine the level of fatigue in dyspneic ALS patients and whether fatigue is promoted by dyspnea. We further evaluated the correlation of fatigue with respiratory function tests.
METHODS
About 101 dyspneic patients and 20 matched controls completed the ALS Functional Rating Scale-Extension and the Fatigue Severity Scale. Dyspneic patients additionally completed the Dyspnea-ALS Scale and the ALS Assessment Questionnaire and underwent respiratory function tests (forced vital capacity, sniff nasal inspiratory pressure, mean inspiratory and expiratory pressure with respective relaxation rates, and blood gases). Multiple regression and correlation analyses were conducted.
RESULTS
Dyspneic patients had significantly higher fatigue scores than nondyspneic patients, and their fatigue significantly affected quality of life. Dyspnea alone explained up to 24% of the variance in fatigue. No associations were observed between fatigue and respiratory function tests. Patients with noninvasive ventilation reported significantly more dyspnea and fatigue.
CONCLUSION
Fatigue is a frequent and bothersome symptom in dyspneic ALS patients. Dyspnea-related distress is, in contrast to objective indicators of respiratory impairment, a determining factor of experienced fatigue. There is an urgent need for further symptom relief beyond noninvasive ventilation. Adequate treatment of dyspnea has the potential for synergies in symptom management arising from the association between fatigue and dyspnea.
Topics: Amyotrophic Lateral Sclerosis; Dyspnea; Fatigue; Humans; Quality of Life; Respiratory Insufficiency
PubMed: 32145336
DOI: 10.1016/j.jpainsymman.2020.02.021 -
Respirology (Carlton, Vic.) Apr 2023
Topics: Humans; Dyspnea; Obesity
PubMed: 36437515
DOI: 10.1111/resp.14421 -
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 -
Autonomic Neuroscience : Basic &... Nov 2021An intriguing feature recently unveiled in some COVID-19 patients is the "silent hypoxemia" phenomenon, which refers to the discrepancy of subjective well-being...
BACKGROUND
An intriguing feature recently unveiled in some COVID-19 patients is the "silent hypoxemia" phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea.
OBJECTIVE
To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients.
METHODS
We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia).
RESULTS
We studied 470 cases (64.4% men; median age 55 years, interquartile range 46-64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101-7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024-9.89; P = 0.045).
CONCLUSIONS
Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.
Topics: COVID-19; Dyspnea; Female; Hospitalization; Humans; Hypoxia; Inpatients; Male; Middle Aged; Prospective Studies
PubMed: 34293703
DOI: 10.1016/j.autneu.2021.102855 -
Advances in Clinical and Experimental... Nov 2023Shortand long-term lung damage after coronavirus disease 2019 (COVID-19) has been emphasized in many studies, but pulmonary-specific health-related quality of life...
BACKGROUND
Shortand long-term lung damage after coronavirus disease 2019 (COVID-19) has been emphasized in many studies, but pulmonary-specific health-related quality of life (HRQOL) has been examined only in a limited capacity.
OBJECTIVES
In this study, we aimed to assess pulmonary-specific HRQOL and dyspnea among patients hospitalized for COVID-19 by applying the St George's Respiratory Questionnaire (SGRQ) to patient groups 1, 3 and 6 months following discharge (groups T1, T3 and T6).
MATERIAL AND METHODS
This cross-sectional study was conducted between April 2020 and December 2020 at a tertiary hospital in Turkey. A total of 345 patients with a definite diagnosis of COVID-19 were included in our research.
RESULTS
Total SGRQ score was significantly lower in the T6 group than in the T1 group (p < 0.001). The SGRQ-Symptom score was similar in the T3 and T6 groups, while the T1 group had significantly higher values (p < 0.001). The SGRQ-Activity score was significantly lower in the T6 group than in the T1 and T3 groups (p = 0.001), while the SGRQ-Impact score was significantly higher in the T6 group compared to the other 2 groups (p < 0.001). When the patients were analyzed statistically in terms of dyspnea, the difference between the baseline and 6-month results was found to be statistically significant (p < 0.001).
CONCLUSIONS
Although long-term consequences are still not fully known, the SGRQ scores and dyspnea outcomes of our patients show that pulmonary-specific HRQOL and dyspnea remain at a similar level from discharge until the 6th month after discharge. Studies with extended and longitudinal follow-up are required.
Topics: Humans; Quality of Life; Pulmonary Disease, Chronic Obstructive; Cross-Sectional Studies; Patient Discharge; COVID-19; Lung; Dyspnea; Surveys and Questionnaires
PubMed: 37093090
DOI: 10.17219/acem/161766 -
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 -
Journal of General Internal Medicine Apr 2021Internists frequently care for patients who suffer from breathlessness in both the inpatient and the outpatient settings. Patients may experience chronic refractory... (Review)
Review
Internists frequently care for patients who suffer from breathlessness in both the inpatient and the outpatient settings. Patients may experience chronic refractory breathlessness despite thorough evaluation and management of their underlying medical illnesses. Left unmanaged, chronic breathlessness is associated with worsened quality of life, more frequent visits to the emergency room, and decreased activity levels, as well as increased levels of depression and anxiety. This narrative review summarizes recent research on interventions for the relief of breathlessness, including both non-pharmacologic and pharmacologic options.
Topics: Anxiety; Chronic Disease; Dyspnea; Humans; Physicians; Quality of Life
PubMed: 33469757
DOI: 10.1007/s11606-020-06439-0