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Ugeskrift For Laeger Sep 2020Dyspnoea is cardinal symptom in chronic obstructive lung disease and common in palliative phases of cancer and other chronic medical diseases. Low-dose opioids is... (Review)
Review
Dyspnoea is cardinal symptom in chronic obstructive lung disease and common in palliative phases of cancer and other chronic medical diseases. Low-dose opioids is frequently used off-label. This review examines the evidence and safety as well as administration forms and pharmacokinetics using low dose opioids for dyspnoea. Conclusively, there seems to be clinical efficacy although further studies are needed. Furthermore, the authors recommend Danish Medical Agency to legislate low-dose morphine to palliative patients with refractory dyspnoea.
Topics: Analgesics, Opioid; Dyspnea; Humans; Morphine; Palliative Care; Pulmonary Disease, Chronic Obstructive
PubMed: 33000737
DOI: No ID Found -
Chronic Respiratory Disease 2022
Topics: Acute Disease; Disease Progression; Dyspnea; Humans; Pain; Pain Measurement; Pulmonary Disease, Chronic Obstructive
PubMed: 35699076
DOI: 10.1177/14799731221105516 -
Annals of Physical and Rehabilitation... Mar 2022Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD). (Review)
Review
BACKGROUND
Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD).
OBJECTIVE
This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures.
METHODS
PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100.
RESULTS
We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0-10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO vs metabolic equivalent of task [MET];%HR vs Fatigue Borg; MET vs walking speed) to 100% (%HR vs dyspnoea Borg; fatigue and exertion Borg vs walking speed).%VO elicited the highest intensity. Hence, Borg scores,%HR and MET may underestimate PA-related intensity.
CONCLUSIONS
Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.
Topics: Aged; Dyspnea; Exercise; Fatigue; Female; Humans; Male; Pulmonary Disease, Chronic Obstructive; Quality of Life
PubMed: 34818590
DOI: 10.1016/j.rehab.2021.101607 -
Revista Clinica Espanola 2022This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for...
BACKGROUND AND OBJECTIVES
This work aims to assess whether symptoms/signs of congestion in patients with acute heart failure (AHF) evaluated in hospital emergency departments (HED) allows for predicting short-term progress.
PATIENTS AND METHODS
The study group comprised consecutive patients diagnosed with AHF in 45 HED from EAHFE Registry. We collected clinical variables of systemic congestion (edema in the lower extremities, jugular vein distention, hepatomegaly) and pulmonary congestion (dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary crackles) and analysed their individual and group association with all-cause 30-day of mortality crudely and adjusted for differences between groups.
RESULTS
We analysed 18,120 patients (median = 83 years, interquartile range [IQR] = 76-88; women = 55.7%). Of them, 44.6% had > 3 congestive symptoms/signs. Individually, the 30-day adjusted risk of death increased 14% for jugular vein distention (hazard ratio [HR] = 1.14, 95% confidence interval [95%CI] = 1.01-1.28) and 96% for dyspnea on exertion (HR = 1.96, 95% CI = 1.55-2.49). Assessed jointly, the risk progressively increased with the number of symptoms/signs present; compared to patients without symptoms/signs of congestion, the risk increased by 109%, 123 %, and 156% in patients with 1-2, 3-5, and 6-7 symptoms/signs, respectively. These associations did not show interaction with the final disposition of the patient after their emergency care (discharge/hospitalization) with the exception of edema in the lower extremities, which had a better prognosis in discharged patients (HR = 0.66, 95% CI = 0.49-0.89) than hospitalised patients (HR = 1.01, 95% CI = 0.65-1.57; interaction p < 0.001).
CONCLUSION
The presence of a greater number of congestive symptoms/signs was associated with greater all-cause 30-day mortality. Individually, jugular vein distention and dyspnea on exertion were associated with higher short-term mortality.
Topics: Acute Disease; Dyspnea; Edema; Emergency Service, Hospital; Female; Heart Failure; Humans; Prognosis
PubMed: 34756646
DOI: 10.1016/j.rceng.2021.07.004 -
International Journal of Chronic... 2021Previous research has indicated that female and male patients may experience different levels of symptoms. However, no studies of chronic obstructive pulmonary disease...
PURPOSE
Previous research has indicated that female and male patients may experience different levels of symptoms. However, no studies of chronic obstructive pulmonary disease (COPD) patients have compared the number and types of symptom clusters identified in male and female patients. Therefore, the purpose of this study was to investigate gender differences in symptom clusters among COPD patients.
PATIENTS AND METHODS
A total of 371 eligible patients were enrolled in the study. We assessed nine COPD symptoms, namely, dyspnea, cough, sputum, chest tightness, sleep quality, fatigue, frailty, anxiety, and depression. Exploratory factor analyses were used to explore the underlying clusters of the COPD symptoms.
RESULTS
Underlying the nine symptoms, female patients had 2 clusters, and male patients had 3 clusters. Specifically, the three general symptoms poor sleep, fatigue, and frailty loaded on the same symptom cluster with anxiety and depression in female patients, while the same 3 general symptoms loaded on the same symptom cluster with chest tightness and dyspnea in male patients. Moreover, cough and sputum not only were more common in male patients but also loaded together on a separate symptom cluster.
CONCLUSION
Our findings suggest that in order to improve fatigue, frailty, and poor sleep quality, symptom management strategies should more closely address anxiety and depression in female patients as well as chest tightness and dyspnea in male patients. Smoking cessation is particularly important in male COPD patients because they account for a much higher proportion of smokers and are more likely to have cough and sputum. These findings signify the importance of identifying and implementing gender-tailored symptom management strategies to relieve symptom burden in COPD patients to enhance their quality of life.
Topics: Dyspnea; Female; Humans; Male; Pulmonary Disease, Chronic Obstructive; Quality of Life; Sex Factors; Syndrome
PubMed: 33907396
DOI: 10.2147/COPD.S302877 -
Current Opinion in Supportive and... Dec 2023The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this... (Review)
Review
PURPOSE OF THE REVIEW
The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this review, the authors summarize the evidence for nocturnal NIV and NIV during exercise. The authors discuss the multidisciplinary and advanced care of patients with end-stage COPD treated with NIV.
RECENT FINDINGS
Nocturnal NIV improves gas exchange, health-related quality of life and survival in stable hypercapnic COPD patients. Improvements in care delivery have been achieved by relocating care from the hospital to home based; home initiation of chronic NIV is feasible, non-inferior regarding efficacy and cost-effective compared to in-hospital initiation. However, the effect of NIV on symptoms is variable, and applying optimal NIV for end-stage COPD is complex. While exercise-induced dyspnoea is a prominent complaint in end-stage COPD, nocturnal NIV will not change this. However, NIV applied solely during exercise might improve exercise tolerance and dyspnoea. While chronic NIV is often a long-standing treatment, patient expectations should be discussed early and be managed continuously during the treatment. Further, integration of advance care planning requires a multidisciplinary approach.
SUMMARY
Although chronic NIV is an effective treatment in end-stage COPD with persistent hypercapnia, there are still important questions that need to be answered to improve care of these severely ill patients.
Topics: Humans; Quality of Life; Pulmonary Disease, Chronic Obstructive; Lung; Noninvasive Ventilation; Hypercapnia; Dyspnea
PubMed: 37646583
DOI: 10.1097/SPC.0000000000000671 -
Japanese Journal of Clinical Oncology Mar 2022Dyspnea is a common and distressing symptom in patients with cancer. To improve its management, multicenter confirmatory studies are necessary. Research policy would be...
BACKGROUND
Dyspnea is a common and distressing symptom in patients with cancer. To improve its management, multicenter confirmatory studies are necessary. Research policy would be useful in conducting these studies. Here, we propose a new research policy for the management of dyspnea in patients with cancer.
METHODS
The first draft was developed by a policy working group of 11 specialists in the field of supportive care or palliative care for dyspnea. Then, a provisional draft was developed after review by a research support group (the Japanese Supportive, Palliative and Psychosocial Care Study Group) and five Japanese scientific societies (Japanese Association of Supportive Care in Cancer, Japanese Society of Medical Oncology, Japanese Society of Palliative Medicine, Japanese Association of Rehabilitation Medicine and Japanese Society of Clinical Oncology), and receipt of public comments.
RESULTS
The policy includes the following components of research policy on dyspnea: (i) definition of dyspnea, (ii) scale for assessment of dyspnea, (iii) reason for dyspnea or factors associated with dyspnea and (iv) treatment effectiveness outcomes/adverse events. The final policy (Ver1.0) was completed on 1 March 2021.
CONCLUSIONS
This policy could help researchers plan and conduct studies on the management of cancer dyspnea.
Topics: Dyspnea; Humans; Medical Oncology; Neoplasms; Palliative Care; Policy
PubMed: 34894136
DOI: 10.1093/jjco/hyab193 -
Chronic Respiratory Disease 2021
Topics: Dyspnea; Exercise Test; Exercise Tolerance; Humans; Obesity; Pulmonary Disease, Chronic Obstructive; Pulmonary Ventilation
PubMed: 34823379
DOI: 10.1177/14799731211059172 -
BMJ Open Respiratory Research Nov 2021Breathlessness is prevalent in severe disease and consists of different dimensions that can be measured using the Multidimensional Dyspnea Profile (MDP) and Dyspnea-12...
BACKGROUND
Breathlessness is prevalent in severe disease and consists of different dimensions that can be measured using the Multidimensional Dyspnea Profile (MDP) and Dyspnea-12 (D-12). We aimed to evaluate the feasibility of MDP and D-12 over telephone interviews in oxygen-dependent patients, compared with other patient-reported outcomes (modified Medical Research Council (mMRC) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT)) and with completion by hand.
METHODS
Cross-sectional, telephone study of 50 patients with home oxygen therapy. Feasibility was assessed as completion time (self-reported by patients and measured), difficulty (self-reported) and help required to complete the instruments (staff). Completion time was compared with mMRC and CAT, and feasibility was compared with completion by hand in cardiopulmonary outpatients (n=182). Feasibility by age and gender was analysed using logistic regression.
RESULTS
Of 136 patients approached, 50 (37%) participated (mean age: 72±10 years, 66% women). Completion times (in minutes) were relatively short for MDP (self-reported 6 (IQR 5-10), measured 8 (IQR 6-10)) and D-12 (self-reported 5 (IQR 3-8), measured 3 (IQR 3-4)), and slightly longer than mMRC (median 1 (IQR 1-1)) and CAT (median 3 (IQR 2-5)). Even though the majority of patients required no help, more assistance was required by older patients. Compared with patients reporting by hand, completion over the telephone required somewhat longer time and more assistance.
CONCLUSION
Many patients with severe oxygen-dependent disease were unable or unwilling to assess symptoms over the telephone. However, among those able to participate, MDP and D-12 are feasible to measure multiple dimensions of breathlessness over the telephone.
Topics: Cross-Sectional Studies; Dyspnea; Feasibility Studies; Humans; Oxygen; Pulmonary Disease, Chronic Obstructive; Telephone
PubMed: 34836925
DOI: 10.1136/bmjresp-2021-001027 -
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