-
Journal of Public Health Management and...New Mexico has the largest number of former uranium workers, mostly racial/ethnic minorities. Uranium workers are at risk for dyspnea secondary to mine dust exposure....
New Mexico has the largest number of former uranium workers, mostly racial/ethnic minorities. Uranium workers are at risk for dyspnea secondary to mine dust exposure. The association between dyspnea and depressive symptoms has not been well examined in occupational minority cohorts. This study evaluated the associations between dyspnea (measured by the modified Medical Research Council Questionnaire) and depressive symptoms (measured by the Patient Health Questionnaire-2) in former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program. The subjects were mostly elderly, rural-residing, minority males. Dyspnea was commonly reported; however, depressive symptoms were uncommon. At baseline, former workers experiencing higher levels of dyspnea were more than 3 times likely to endorse depressive symptoms than those with no or mild dyspnea. Longitudinal analysis failed to determine an association between change in dyspnea and concomitant change in depressive symptoms. Dyspnea and depressive symptoms were associated cross-sectionally in former uranium workers.
Topics: Aged; Depression; Dyspnea; Humans; Male; New Mexico; Occupational Exposure; Self Report; Uranium
PubMed: 33785695
DOI: 10.1097/PHH.0000000000001310 -
The Indian Journal of Medical Research Nov 2020
Topics: Dyspnea; Humans; Vascular Diseases
PubMed: 35345110
DOI: 10.4103/ijmr.IJMR_1732_19 -
Respiratory Medicine 2023This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic...
INTRODUCTION AND OBJECTIVES
This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
MATERIAL AND METHODS
We included randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care regardless of setting. In March 2022, we searched MEDLINE, Scopus, CENTRAL, CINAHL and Web of Sciences, and trial registries. Record screening, data extraction and risk of bias assessment were undertaken by two reviewers. We assessed the certainty of the evidence using the GRADE approach.
RESULTS
This systematic review included 18 studies (n = 1465), involving a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies were at high risk of performance, detection, and reporting biases. Compared to usual care, pulmonary rehabilitation probably improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggests that pulmonary rehabilitation may be beneficial on re-exacerbations, dyspnoea, and impact of disease. The evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality is very uncertain (very low certainty evidence).
CONCLUSION
Our results indicate that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, irrespective of setting. Our certainty in this evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and a poor reporting of findings that were inconsistent with each other. Trialists should adhere to the latest reporting standards to strengthen this body of evidence.
REGISTRATION
The study protocol was registered in Open Science Framework (https://osf.io/amgbz/).
Topics: Humans; Quality of Life; Pulmonary Disease, Chronic Obstructive; Patient Readmission; Dyspnea; Treatment Outcome
PubMed: 37858727
DOI: 10.1016/j.rmed.2023.107425 -
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 -
Cleveland Clinic Journal of Medicine Jun 2022
Topics: Cough; Dyspnea; Humans; Lung; Lung Transplantation; Transplant Recipients
PubMed: 35649569
DOI: 10.3949/ccjm.89a.20137 -
Circulation. Heart Failure Jun 2022Current guidelines recommend interpreting concentrations of NPs (natriuretic peptides) irrespective of the time of presentation to the emergency department. We...
BACKGROUND
Current guidelines recommend interpreting concentrations of NPs (natriuretic peptides) irrespective of the time of presentation to the emergency department. We hypothesized that diurnal variations in NP concentration may affect their diagnostic accuracy for acute heart failure.
METHODS
In a secondary analysis of a multicenter diagnostic study enrolling patients presenting with acute dyspnea to the emergency department and using central adjudication of the final diagnosis by 2 independent cardiologists, the diagnostic accuracy for acute heart failure of BNP (B-type NP), NT-proBNP (N-terminal pro-B-type NP), and MR-proANP (midregional pro-atrial NP) was compared among 1577 daytime presenters versus 908 evening/nighttime presenters. In a validation study, the presence of a diurnal rhythm in BNP and NT-proBNP concentrations was examined by hourly measurements in 44 stable individuals.
RESULTS
Among patients adjudicated to have acute heart failure, BNP, NT-proBNP, and MR-proANP concentrations were comparable among daytime versus evening/nighttime presenters (all =nonsignificant). Contrastingly, among patients adjudicated to have other causes of dyspnea, evening/nighttime presenters had lower BNP (median, 44 [18-110] versus 74 [27-168] ng/L; <0.01) and NT-proBNP (median, 212 [72-581] versus 297 [102-902] ng/L; <0.01) concentrations versus daytime presenters. This resulted in higher diagnostic accuracy as quantified by the area under the curve of BNP and NT-proBNP among evening/nighttime presenters (0.97 [95% CI, 0.95-0.98] and 0.95 [95% CI, 0.93-0.96] versus 0.94 [95% CI, 0.92-0.95] and 0.91 [95% CI, 0.90-0.93]) among daytime presenters (both <0.01). These differences were not observed for MR-proANP. Diurnal variation of BNP and NT-proBNP with lower evening/nighttime concentration was confirmed in 44 stable individuals (<0.01).
CONCLUSIONS
BNP and NT-proBNP, but not MR-proANP, exhibit a diurnal rhythm that results in even higher diagnostic accuracy among evening/nighttime presenters versus daytime presenters.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifiers: NCT01831115, NCT02091427, and NCT02210897.
Topics: Atrial Natriuretic Factor; Biomarkers; Circadian Rhythm; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Vasodilator Agents
PubMed: 35670217
DOI: 10.1161/CIRCHEARTFAILURE.121.009165 -
The American Journal of Hospice &... Feb 2023Fibrotic interstitial lung diseases (F-ILDs) have a high symptom burden with progressive dyspnea as a primary feature. Breathlessness is underrecognized and... (Observational Study)
Observational Study
Fibrotic interstitial lung diseases (F-ILDs) have a high symptom burden with progressive dyspnea as a primary feature. Breathlessness is underrecognized and undertreated primarily due to lack of consensus on how to best measure and manage it. Several nonpharmacologic and pharmacologic strategies are published in the literature, however there is a paucity of real-world data describing their systematic implementation. We describe the types of breathlessness interventions and timing of implementation in our multidisciplinary collaborative care (MDC) ILD clinic and the impact of our approach on dyspnea trajectory and acute care use in ILD. A retrospective, observational study of deceased ILD patients seen in our clinic (2012-2018) was conducted. Patients were grouped by baseline medical research council (MRC) grade and dyspnea interventions from clinic enrolment until death were examined. Healthcare usage in the last 6 months of life was collected through Alberta's administrative database. Eighty-one deceased ILD patients were identified. Self management advice was provided to 100% of patients. Pulmonary rehabilitation (PR) and home care (HC) referrals were made in 40% and 57% of patients, respectively. Eighty percent were treated with oxygen and 53% with opioids during the study. MDC-initiated referral to PR and HC, oxygen and opioid prescriptions were provided a median of 13, 9, 11, and 4 months prior to death, respectively. Stepwise implementation of interventions was observed more commonly in MRC 1-2 and concurrent implementation in MRC 4-5. Our clinic's approach allows early and systematic dyspnea management.
Topics: Humans; Retrospective Studies; Lung Diseases, Interstitial; Dyspnea; Oxygen
PubMed: 35484838
DOI: 10.1177/10499091221096416 -
Journal of Pain and Symptom Management Jan 2021Dyspnea is one of the most distressing symptoms encountered by advanced cancer patients. In this study, we aimed to evaluate the role of opioids in the management of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dyspnea is one of the most distressing symptoms encountered by advanced cancer patients. In this study, we aimed to evaluate the role of opioids in the management of cancer-related dyspnea.
METHODS
A systematic review and meta-analysis based on Randomized Controlled Trials was conducted in the databases PUBMED, EMBASE, and Cochrane Central Register of Controlled Trials testing the effect of opioids in relieving cancer-related dyspnea. Subgroup and sensitivity analyses were performed to evaluate various types of opioids in dyspnea management and stabilization of the study respectively.
RESULTS
Eleven RCTs fulfilled the eligibility criteria and had a total of 290 participants. Nine of these studies were included in meta-analyses. Compared with control, opioid therapy showed a small positive effect in dyspnea, SMD-0.82 (95%CI = -1.54 to -0.10) and Borg score, WMD-0.95 (95%CI = -1.83 to -0.06); Opioid therapy did not increase the risk of somnolence, OR0.93 (95%CI = 0.34 to 2.58), whereas a negative effect on respiratory rate was observed,WMD-1.89 (95%CI = -3.36 to -0.43); Also, there was no evidence to suggest improved performance of the 6MWT test, WMD6.49 (95%CI = -34.23 to 47.21), or the level of peripheral oxygen saturation, WMD0.33 (95%CI = -0.59 to 1.24) after opioid therapy. Subgroup analysis yielded a small positive effect for morphine on dyspnea, SMD-0.78 (95%CI = -1.45 to -0.10), whereas fentanyl showed no improvement in dyspnea, SMD-0.44 (95%CI = -0.89 to 0.02). Sensitivity analysis showed no changes in the direction of effect when any one study was excluded from the meta-analyses.
CONCLUSIONS
Our systematic review and meta-analysis indicated low quality evidence for a small positive effect of opioids in cancer-related dyspnea. Evidence for safety is insufficient as comprehensive adverse events were not adequately reported in studies.
Topics: Analgesics, Opioid; Dyspnea; Humans; Morphine; Neoplasms; Randomized Controlled Trials as Topic
PubMed: 32730950
DOI: 10.1016/j.jpainsymman.2020.07.021 -
Circulation. Heart Failure Jun 2022
Topics: COVID-19; Dyspnea; Heart Failure; Humans; Post-Acute COVID-19 Syndrome
PubMed: 35440166
DOI: 10.1161/CIRCHEARTFAILURE.121.009346 -
Turkish Journal of Medical Sciences Jun 2023The long-term effects of pulmonary rehabilitation (PR) and maintenance programs in obstructive pulmonary diseases have not been sufficiently investigated, particularly...
BACKGROUND
The long-term effects of pulmonary rehabilitation (PR) and maintenance programs in obstructive pulmonary diseases have not been sufficiently investigated, particularly in diseases other than COPD. This retrospective study aimed to examine the long-term results of individualized comprehensive outpatient pulmonary rehabilitation in patients with obstructive pulmonary disease.
METHODS
This study is a single-center, retrospective cohort study. Between 2010 and 2019, 269 patients with chronic airway obstruction were treated in our multidisciplinary PR center at a tertiary training and research hospital, and they were divided into three groups based on their diagnosis: COPD, bronchiectasis, and asthma. Patients' perceptions of dyspnea, exercise capacity, inspiratory and peripheral muscle strength, body composition, quality of life, and psychosocial status were compared at the beginning, end, and 12th and 24th months of PR.
RESULTS
Improvements in dyspnea perception remained longer in asthmatics than in the other two groups. The increases in exercisecapacity in the bronchiectasis and asthma groups lasted two years. All groups maintained their respiratory muscle strength gains at the end of the second year. Improvements in hand grip strength in the COPD and bronchiectasis groups have been sustained for two years, but in the asthma group, enhancements were lost in the second year. Even after the second year, quality of life was still better than the baseline in all groups, despite a worsening in the first year. However, groups anxiety and depression improvements were not sustained after the first year.
DISCUSSION
The long-term effectiveness of PR in patients with bronchiectasis and asthma was similar to that of COPD patients. Therefore,multidisciplinary, comprehensive PR programs should be integrated into the management of patients with bronchiectasis and asthma. We also recommend structured follow-up programs to maintain gains and to detect the need for rerehabilitation.
Topics: Humans; Retrospective Studies; Quality of Life; Hand Strength; Exercise Therapy; Pulmonary Disease, Chronic Obstructive; Asthma; Bronchiectasis; Dyspnea
PubMed: 37476889
DOI: 10.55730/1300-0144.5644