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Journal of General Internal Medicine Aug 2022Dyspnea is a common and debilitating symptom that affects many different patient populations. Dyspnea measures should assess multiple domains. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Dyspnea is a common and debilitating symptom that affects many different patient populations. Dyspnea measures should assess multiple domains.
OBJECTIVE
To evaluate the reliability, validity, and responsiveness of an ultra-brief, multi-dimensional dyspnea measure.
DESIGN
We adapted the DEG from the PEG, a valid 3-item pain measure, to assess average dyspnea intensity (D), interference with enjoyment of life (E), and dyspnea burden with general activity (G).
PARTICIPANTS
We used data from a multi-site randomized clinical trial among outpatients with heart failure.
MAIN MEASURES
We evaluated reliability (Cronbach's alpha), concurrent validity with the Memorial-Symptom-Assessment-Scale (MSAS) shortness-of-breath distress-orbothersome item and 7-item Generalized-Anxiety-Disorder (GAD-7) scale, knowngroups validity with New-York-Heart-Association-Functional-Classification (NYHA) 1-2 or 3-4 and presence or absence of comorbid chronic obstructive pulmonary disease (COPD), responsiveness with the MSAS item as an anchor, and calculated a minimal clinically important difference (MCID) using distribution methods.
KEY RESULTS
Among 312 participants, the DEG was reliable (Cronbach's alpha 0.92). The mean (standard deviation) DEG score was 5.26 (2.36) (range 0-10) points. DEG scores correlated strongly with the MSAS shortness of breath distress-or-bothersome item (r=0.66) and moderately with GAD-7 categories (ρ=0.36). DEG scores were statistically significantly lower among patients with NYHA 1-2 compared to 3-4 [mean difference (standard error): 1.22 (0.27) points, p<0.01], and those without compared to with comorbid COPD [0.87 (0.27) points, p<0.01]. The DEG was highly sensitive to change, with MCID of 0.59-1.34 points, or 11-25% change.
CONCLUSIONS
The novel, ultra-brief DEG measure is reliable, valid, and highly responsive. Future studies should evaluate the DEG's sensitivity to interventions, use anchor-based methods to triangulate MCID estimates, and determine its prognostic usefulness among patients with chronic cardiopulmonary and other diseases.
Topics: Dyspnea; Humans; Psychometrics; Pulmonary Disease, Chronic Obstructive; Quality of Life; Reproducibility of Results; Surveys and Questionnaires
PubMed: 34981344
DOI: 10.1007/s11606-021-07307-1 -
The American Journal of Hospice &... Oct 2023Despite the lack of evidence to support the use of palliative oxygen to relieve dyspnea at the end of life, its prescription is widespread and often supported by local...
Despite the lack of evidence to support the use of palliative oxygen to relieve dyspnea at the end of life, its prescription is widespread and often supported by local and national practice guidelines. The objectives of this study were (1) to determine to what extent oxygen prescriptions meet the proposed prescription criteria in our institution, (2) to examine the indication of individual prescriptions in relation to the severity of dyspnea and (3) to review the utilization of opioids in patients receiving palliative oxygen. Retrospective chart review of cancer patients who were prescribed palliative oxygen between April 2015 and January 2020 through a respiratory home care program in Quebec City, Canada. According to provincial prescription guidelines, palliative oxygen was provided and reimbursed in case of severe hypoxemia (pulse oximetry saturation at rest < 88%) in cancer patients with an estimated prognosis of less than 3 months. 134 patients receiving palliative oxygen were included; 25 (19%) did not fulfill reimbursement criteria. Median survival was 44 days. At initiation of palliative oxygen, 48 patients (36%) had only mild or moderate dyspnea (Medical Research Council dyspnea score 1-3), 26 (19%) did not receive opioids, and 9 (7%) were prescribed palliative oxygen without being dyspneic or receiving opioids. Most prescriptions of palliative oxygen met the proposed prescription criteria in our institution. Half of those who received palliative oxygen were only mildly dyspneic and/or were not receiving opioids at the time of the prescription.
Topics: Humans; Oxygen; Analgesics, Opioid; Retrospective Studies; Palliative Care; Neoplasms; Dyspnea
PubMed: 36452992
DOI: 10.1177/10499091221144005 -
Ugeskrift For Laeger Jul 2021Patients with emphysema often have limited treatment options. Lung volume reduction is an effective treatment to carefully selected patients with emphysema. Most... (Review)
Review
Patients with emphysema often have limited treatment options. Lung volume reduction is an effective treatment to carefully selected patients with emphysema. Most importantly, the primary care physician should refer patients with COPD and refractory dyspnoea and/or with emphysema to departments specialised in respiratory medicine for further treatment and assessment, which is discussed in this review.
Topics: Dyspnea; Emphysema; Humans; Pneumonectomy; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Treatment Outcome
PubMed: 34356024
DOI: No ID Found -
NPJ Primary Care Respiratory Medicine Mar 2022Dyspnoea or breathlessness is a common presenting symptom among patients attending primary care services. This review aimed to determine whether there are clinical tools... (Review)
Review
Dyspnoea or breathlessness is a common presenting symptom among patients attending primary care services. This review aimed to determine whether there are clinical tools that can be incorporated into a clinical decision support system for primary care for efficient and accurate diagnosis of causes of chronic dyspnoea. We searched MEDLINE, EMBASE and Google Scholar for all literature published between 1946 and 2020. Studies that evaluated a clinical algorithm for assessment of chronic dyspnoea in patients of any age group presenting to physicians with chronic dyspnoea were included. We identified 326 abstracts, 55 papers were reviewed, and eight included. A total 2026 patients aged between 20-80 years were included, 60% were women. The duration of dyspnoea was three weeks to 25 years. All studies undertook a stepwise or algorithmic approach to the assessment of dyspnoea. The results indicate that following history taking and physical examination, the first stage should include simply performed tests such as pulse oximetry, spirometry, and electrocardiography. If the patient remains undiagnosed, the second stage includes investigations such as chest x-ray, thyroid function tests, full blood count and NT-proBNP. In the third stage patients are referred for more advanced tests such as echocardiogram and thoracic CT. If dyspnoea remains unexplained, the fourth stage of assessment will require secondary care referral for more advanced diagnostic testing such as exercise tests. Utilising this proposed stepwise approach is expected to ascertain a cause for dyspnoea for 35% of the patients in stage 1, 83% by stage 3 and >90% of patients by stage 4.
Topics: Adult; Aged; Aged, 80 and over; Decision Support Systems, Clinical; Dyspnea; Female; Humans; Middle Aged; Spirometry; Young Adult
PubMed: 35260575
DOI: 10.1038/s41533-022-00271-1 -
European Respiratory Review : An... Jun 2023The effect of meditative movement, which includes yoga, tai chi and qi gong, on breathlessness in advanced disease is unknown. This systematic review aims to... (Meta-Analysis)
Meta-Analysis Review
The effect of meditative movement, which includes yoga, tai chi and qi gong, on breathlessness in advanced disease is unknown. This systematic review aims to comprehensively assess the evidence on the effect of meditative movement on breathlessness (primary outcome), health-related quality of life, exercise capacity, functional performance and psychological symptoms (secondary outcomes) in advanced disease. 11 English and Chinese language databases were searched for relevant trials. Risk of bias was assessed using the Cochrane tool. Standardised mean differences (SMDs) with 95% confidence intervals were computed. 17 trials with 1125 participants (n=815 COPD, n=310 cancer), all with unclear or high risk of bias, were included. Pooled estimates (14 studies, n=671) showed no statistically significant difference in breathlessness between meditative movement and control interventions (SMD (95% CI) 0.10 (-0.15-0.34); Chi=30.11; I=57%; p=0.45), irrespective of comparator, intervention or disease category. Similar results were observed for health-related quality of life and exercise capacity. It was not possible to perform a meta-analysis for functional performance and psychological symptoms. In conclusion, in people with advanced COPD or cancer, meditative movement does not improve breathlessness, health-related quality of life or exercise capacity. Methodological limitations lead to low levels of certainty in the results.
Topics: Humans; Quality of Life; Dyspnea; Neoplasms; Pulmonary Disease, Chronic Obstructive
PubMed: 37343961
DOI: 10.1183/16000617.0243-2022 -
Revue Medicale de Liege May 2021The perception of ventilatory effort is common in oncology, especially but not exclusively in the advanced stages of neoplastic disease. Dyspnea is a symptom whose...
The perception of ventilatory effort is common in oncology, especially but not exclusively in the advanced stages of neoplastic disease. Dyspnea is a symptom whose discomfort and anguish it generates in the patient and his/ her entourage require constant management throughout the illness. The first step is to identify and optimize the treatment of comorbidities associated with tumour disease. Relief of respiratory oppression as a symptom requires a multidisciplinary approach. Opiates and benzodiazepines are at the forefront of pharmacological management. The mechanical obstruction that limits ventilatory flow and/or chest ampliation may justify more invasive management, including endoscopic techniques. Oxygen therapy will be considered on a case-by-case basis. Finally, global management includes respiratory revalidation, psychological support and improvement of environmental quality.
Topics: Analgesics, Opioid; Anxiety; Benzodiazepines; Dyspnea; Female; Humans; Neoplasms
PubMed: 34080376
DOI: No ID Found -
European Respiratory Review : An... Sep 2023A proportion of coronavirus disease 2019 (COVID-19) survivors experience persistent dyspnoea without measurable impairments in lung function. We performed a systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A proportion of coronavirus disease 2019 (COVID-19) survivors experience persistent dyspnoea without measurable impairments in lung function. We performed a systematic review and meta-analysis to determine relationships between dyspnoea and imaging abnormalities over time in post-COVID-19 patients.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we analysed studies published prior to 15 September 2022 and indexed by Google Scholar, PubMed and LitCOVID which assessed chest imaging in adults ≥3 months after COVID-19. Demographic, chest imaging, spirometric and post-COVID-19 symptom data were extracted. The relationships between imaging abnormalities and dyspnoea, sex and age were determined using a random effects model and meta-regression.
RESULTS
47 studies were included in the meta-analysis (n=3557). The most prevalent computed tomography (CT) imaging abnormality was ground-glass opacities (GGOs) (44.9% (95% CI 37.0-52.9%) at any follow-up time-point). Occurrence of reticulations significantly decreased between early and late follow-up (p=0.01). The prevalence of imaging abnormalities was related to the proportion of patients with dyspnoea (p=0.012). The proportion of females was negatively correlated with the presence of reticulations (p=0.001), bronchiectasis (p=0.001) and consolidations (p=0.025). Age was positively correlated with imaging abnormalities across all modalities (p=0.002) and imaging abnormalities present only on CT (p=0.001) (GGOs (p=0.004) and reticulations (p=0.001)). Spirometric values improved during follow-up but remained within the normal range at all time-points.
CONCLUSIONS
Imaging abnormalities were common 3 months after COVID-19 and their occurrence was significantly related to the presence of dyspnoea. This suggests that CT imaging is a sensitive tool for detecting pulmonary abnormalities in patients with dyspnoea, even in the presence of normal spirometric measurements.
Topics: Adult; Female; Humans; COVID-19; SARS-CoV-2; Lung; Dyspnea; Lung Diseases
PubMed: 37558261
DOI: 10.1183/16000617.0253-2022 -
IEEE Transactions on Bio-medical... Jan 2022Dyspnea, also known as the patient's feeling of difficult or labored breathing, is one of the most common symptoms for respiratory disorders. Dyspnea is usually...
OBJECTIVE
Dyspnea, also known as the patient's feeling of difficult or labored breathing, is one of the most common symptoms for respiratory disorders. Dyspnea is usually self-reported by patients using, for example, the Borg scale from 0 - 10, which is however subjective and problematic for those who refuse to cooperate or cannot communicate. The objective of this paper was to develop a learning-based model that can evaluate the correlation between the self-report Borg score and the respiratory metrics for dyspnea induced by exertion and increased airway resistance.
METHODS
A non-invasive wearable radio-frequency sensor by near-field coherent sensing was employed to retrieve continuous respiratory data with user comfort and convenience. Self-report dyspnea scores and respiratory features were collected on 32 healthy participants going through various physical and breathing exercises. A machine learning model based on the decision tree and random forest then produced an objective dyspnea score.
RESULTS
For unseen data as well as unseen participants, the objective dyspnea score can be in reasonable agreement with the self-report score, and the importance factor of each respiratory metrics can be assessed.
CONCLUSION
An objective dyspnea score can potentially complement or substitute the self-report for physiologically induced dyspnea.
SIGNIFICANCE
The method can potentially formulate a baseline for clinical dyspnea assessment and help caregivers track dyspnea continuously, especially for patients who cannot report themselves.
Topics: Caregivers; Dyspnea; Humans
PubMed: 34255624
DOI: 10.1109/TBME.2021.3096462 -
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 -
Benefits of tolvaptan on early dyspnea relief in patients with acute heart failure: A meta-analysis.Clinical Cardiology Oct 2022Considering the prevalence of dyspnea in acute heart failure (AHF), its reduction is important to both patients and caregivers. This meta-analysis was performed to... (Meta-Analysis)
Meta-Analysis Review
Considering the prevalence of dyspnea in acute heart failure (AHF), its reduction is important to both patients and caregivers. This meta-analysis was performed to determine the efficacy and safety of tolvaptan on early dyspnea relief in patients with AHF. A systematic search was made of PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of AHF with tolvaptan, compared with placebo or blank, were reviewed. Studies were pooled to relative risk (RR), with 95% confidence interval (CI). Five RCTs (enrolling 4857 participants) met the inclusion criteria. Tolvaptan presented significant effects on 12 h dyspnea relief (RR: 1.98; 95% CI: 1.24-3.15; p = .004), 24 h/day 1 dyspnea relief (RR: 1.15; 95% CI: 1.07-1.24; p = .0003), 48 h dyspnea relief (RR: 1.20; 95% CI: 1.06-1.36; p = .004), and 72 h dyspnea relief (RR: 1.18; 95% CI: 1.02-1.37; p = .03). No significant increase was noticed in the incidence of worsening renal function in tolvaptan group (RR: 1.10; 95% CI: 0.87-1.39; p = .43). Tolvaptan treatment significantly improved patient-assessed dyspnea early and persistently in patients with AHF.
Topics: Antidiuretic Hormone Receptor Antagonists; Dyspnea; Heart Failure; Humans; Tolvaptan
PubMed: 35916355
DOI: 10.1002/clc.23889