1
|
Santos S, Manito N, Sánchez-Covisa J, Hernández I, Corregidor C, Escudero L, Rhodes K, Nordon C. Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00194-4. [PMID: 38936468 DOI: 10.1016/j.rec.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION AND OBJECTIVES This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD). METHODS We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion). RESULTS During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82). CONCLUSIONS The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.
Collapse
Affiliation(s)
- Salud Santos
- Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Kirsty Rhodes
- Real World Science & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Clementine Nordon
- Epidemiology Medical Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| |
Collapse
|
2
|
Burki NK. Treatment of dyspnoea. Eur Respir J 2024; 63:2301565. [PMID: 38237994 DOI: 10.1183/13993003.01565-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Nausherwan K Burki
- Dept of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| |
Collapse
|
3
|
Kibbler J, Wade C, Mussell G, Ripley DP, Bourke SC, Steer J. Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD. ERJ Open Res 2023; 9:00548-2023. [PMID: 38020568 PMCID: PMC10680032 DOI: 10.1183/23120541.00548-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. Methods A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. Results In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Conclusion Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.
Collapse
Affiliation(s)
- Joseph Kibbler
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Clare Wade
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| | - Grace Mussell
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - David P. Ripley
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - Stephen C. Bourke
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - John Steer
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Mooney L, Hawkins NM, Jhund PS, Redfield MM, Vaduganathan M, Desai AS, Rouleau JL, Minamisawa M, Shah AM, Lefkowitz MP, Zile MR, Van Veldhuisen DJ, Pfeffer MA, Anand IS, Maggioni AP, Senni M, Claggett BL, Solomon SD, McMurray JJV. Impact of Chronic Obstructive Pulmonary Disease in Patients With Heart Failure With Preserved Ejection Fraction: Insights From PARAGON-HF. J Am Heart Assoc 2021; 10:e021494. [PMID: 34796742 PMCID: PMC9075384 DOI: 10.1161/jaha.121.021494] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022]
Abstract
Background Little is known about the impact of chronic obstructive pulmonary disease (COPD) in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results We examined outcomes in patients with heart failure with preserved ejection fraction, according to COPD status, in the PARAGON-HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and cardiovascular death. Of 4791 patients, 670 (14%) had COPD. Patients with COPD were more likely to be men (58% versus 47%; P<0.001) and had worse New York Heart Association functional class (class III/IV 24% versus 19%), worse Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores (69 versus 76; P<0.001) and more frequent history of heart failure hospitalization (54% versus 47%; P<0.001). The decrement in Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores with COPD was greater than for other common comorbidities. Patients with COPD had echocardiographic right ventricular enlargement, higher serum creatinine (100 μmol/L versus 96 μmol/L) and neutrophil-to-lymphocyte ratio (2.7 versus 2.5), than those without COPD. After multivariable adjustment, COPD was associated with worse outcomes: adjusted rate ratio for the primary outcome 1.51 (95% CI, 1.25-1.83), total heart failure hospitalization 1.54 (95% CI, 1.24-1.90), cardiovascular death (adjusted hazard ratio [HR], 1.42; 95% CI, 1.10-1.82), and all-cause death (adjusted HR, 1.52; 95% CI, 1.25-1.84). COPD was associated with worse outcomes than other comorbidities and Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores declined more in patients with COPD than in those without. Conclusions Approximately 1 in 7 patients with heart failure with preserved ejection fraction had concomitant COPD, which was associated with greater functional limitation and a higher risk of heart failure hospitalization and death. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
Collapse
Affiliation(s)
- Leanne Mooney
- BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowUnited Kingdom
| | | | - Pardeep S. Jhund
- BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowUnited Kingdom
| | | | | | - Akshay S. Desai
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMA
| | | | | | - Amil M. Shah
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMA
| | | | - Michael R. Zile
- Department of MedicineMedical University of South CarolinaCharlestonSC
| | | | - Marc A. Pfeffer
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMA
| | | | | | - Michele Senni
- Cardiovascular Department & Cardiology UnitPapa Giovanni XXIII HospitalBergamoItaly
| | - Brian L. Claggett
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMA
| | - Scott D. Solomon
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMA
| | - John J. V. McMurray
- BHF Glasgow Cardiovascular Research CentreUniversity of GlasgowUnited Kingdom
| |
Collapse
|
5
|
|
6
|
Vijayan S, Singh B, Ghosh S, Stell R, Mastaglia FL. Dyspnea in Parkinson's disease: an approach to diagnosis and management. Expert Rev Neurother 2020; 20:619-626. [PMID: 32419523 DOI: 10.1080/14737175.2020.1763795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Dyspnea is a complex and debilitating non-motor symptom experienced by a significant proportion of PD patients which results in limitations to physical ability and a reduction in quality of life. AREAS COVERED The authors highlight the underlying pathophysiological mechanisms that can contribute to dyspnea in PD patients, and provide the clinician with a practical working algorithm for the management of such patients. The authors further highlight important clinical red flags that should be heeded in dyspneic PD patients and discuss therapeutic strategies for managing dyspnea. EXPERT OPINION Although awareness of dyspnea in PD is increasing, further studies of its prevalence and natural history at different stages of the disease are needed. In particular, it is important to determine whether dyspnea could be an early or prodromal disease manifestation. Although peripheral mechanisms are likely to play a major role in the pathophysiology of dyspnea, the possibility that central changes in brainstem ventilatory control may also play a part warrants further investigation.
Collapse
Affiliation(s)
- Srimathy Vijayan
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia.,Faculty of Health and Medical Sciences, University of Western Australia , Nedlands, Perth, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital , Nedlands, Perth, Australia.,School of Human Sciences, University of Western Australia , Crawley, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands , Perth, Australia
| | - Soumya Ghosh
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| | - Rick Stell
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| | - Frank L Mastaglia
- The Perron Institute for Neurological and Translational sciences, QEII Medical Centre , Nedlands, Perth, Australia
| |
Collapse
|
7
|
Gohar A, Rutten FH, den Ruijter H, Kelder JC, von Haehling S, Anker SD, Möckel M, Hoes AW. Mid-regional pro-atrial natriuretic peptide for the early detection of non-acute heart failure. Eur J Heart Fail 2019; 21:1219-1227. [PMID: 31209992 DOI: 10.1002/ejhf.1495] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/20/2019] [Accepted: 04/19/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnosing non-acute heart failure (HF) remains challenging, notably in the early stages of the syndrome. The diagnostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP) has been proven in acute onset HF, but its role in early non-acute HF is unknown. We aimed to determine the diagnostic value of MR-proANP in suspected non-acute HF. METHODS AND RESULTS In total, 721 people suspected of non-acute HF in primary care underwent standardised diagnostic work-up including chest X-ray, electrocardiogram, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement and echocardiography. Of these, 245 people underwent additional MR-proANP measurements. The outcome of HF was assessed by an expert panel comprised of two cardiologists and one expert physician, who used all available diagnostic information including echocardiography, but were blinded to biomarker results. Of the 245 people (mean age 71.0 years, 62.9% female), 72 (29.4%) were diagnosed with HF. The c-statistics of MR-proANP and NT-proBNP as single diagnostic test were 0.77 [95% confidence interval (CI) 0.70-0.84] and 0.79 (95% CI 0.73-0.86), respectively. The cut-point with the highest accuracy for MR-proANP was 120 pmol/L [sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) 0.72, 0.69, 0.46, and 0.86, respectively], and the best exclusionary cut-point was 40 pmol/L (sensitivity/specificity/PPV/NPV 0.99, 0.06, 0.30, and 0.92, respectively). After addition of MR-proANP on top of a previously validated clinical model, the c-statistic rose from 0.82 (95% CI 0.76-0.88) to 0.86 (95% CI 0.80-0.92), and with the addition of NT-proBNP to 0.87 (95% CI 0.81-0.92). No sex interactions between the biomarkers and HF were found in the multivariable models. CONCLUSION MR-proANP provides added diagnostic value in suspected non-acute HF, similar to NT-proBNP.
Collapse
Affiliation(s)
- Aisha Gohar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hester den Ruijter
- Department of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism at Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Martin Möckel
- Division of Emergency and Acute Medicine and Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arno W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
8
|
Kievit RF, Gohar A, Hoes AW, Bots ML, van Riet EES, van Mourik Y, Bertens LCM, Boonman-de Winter LJM, den Ruijter HM, Rutten FH. Efficient selective screening for heart failure in elderly men and women from the community: A diagnostic individual participant data meta-analysis. Eur J Prev Cardiol 2018; 25:437-446. [PMID: 29327942 PMCID: PMC5818024 DOI: 10.1177/2047487317749897] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/01/2017] [Indexed: 12/23/2022]
Abstract
Background Prevalence of undetected heart failure in older individuals is high in the community, with patients being at increased risk of morbidity and mortality due to the chronic and progressive nature of this complex syndrome. An essential, yet currently unavailable, strategy to pre-select candidates eligible for echocardiography to confirm or exclude heart failure would identify patients earlier, enable targeted interventions and prevent disease progression. The aim of this study was therefore to develop and validate such a model that can be implemented clinically. Methods and results Individual patient data from four primary care screening studies were analysed. From 1941 participants >60 years old, 462 were diagnosed with heart failure, according to criteria of the European Society of Cardiology heart failure guidelines. Prediction models were developed in each cohort followed by cross-validation, omitting each of the four cohorts in turn. The model consisted of five independent predictors; age, history of ischaemic heart disease, exercise-related shortness of breath, body mass index and a laterally displaced/broadened apex beat, with no significant interaction with sex. The c-statistic ranged from 0.70 (95% confidence interval (CI) 0.64-0.76) to 0.82 (95% CI 0.78-0.87) at cross-validation and the calibration was reasonable with Observed/Expected ratios ranging from 0.86 to 1.15. The clinical model improved with the addition of N-terminal pro B-type natriuretic peptide with the c-statistic increasing from 0.76 (95% CI 0.70-0.81) to 0.89 (95% CI 0.86-0.92) at cross-validation. Conclusion Easily obtainable patient characteristics can select older men and women from the community who are candidates for echocardiography to confirm or refute heart failure.
Collapse
Affiliation(s)
- Rogier F Kievit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Aisha Gohar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
- Department of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Arno W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Michiel L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Evelien ES van Riet
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Yvonne van Mourik
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Loes CM Bertens
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Leandra JM Boonman-de Winter
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
- Amphia Academy, Amphia, Breda, The Netherlands
| | - Hester M den Ruijter
- Department of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Frans H Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| |
Collapse
|
9
|
Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
Collapse
Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
10
|
Associação dos tipos de dispneia e da “flexopneia” com as patologias cardiopulmonares nos cuidados de saúde primários. Rev Port Cardiol 2017; 36:179-186. [DOI: 10.1016/j.repc.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/21/2022] Open
|
11
|
Martínez Cerón DM, Garcia Rosa ML, Lagoeiro Jorge AJ, de Andrade Martins W, Tinoco Mesquita E, Di Calafriori Freire M, da Silva Correia DM, Kang HC. Association of types of dyspnea including ‘bendopnea’ with cardiopulmonary disease in primary care. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
12
|
Bektas S, Franssen FME, van Empel V, Uszko-Lencer N, Boyne J, Knackstedt C, Brunner-La Rocca HP. Impact of airflow limitation in chronic heart failure. Neth Heart J 2017; 25:335-342. [PMID: 28244013 PMCID: PMC5405029 DOI: 10.1007/s12471-017-0965-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Comorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF. Methods 205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV1/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated. Results Almost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different. Conclusion COPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.
Collapse
Affiliation(s)
- S Bektas
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - F M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research and Education, CIRO+, Center of expertise for chronic organ failure, Horn, The Netherlands
| | - V van Empel
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research and Education, CIRO+, Center of expertise for chronic organ failure, Horn, The Netherlands
| | - J Boyne
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C Knackstedt
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H P Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
13
|
Ambrosino N, Serradori M. Determining the cause of dyspnoea: linguistic and biological descriptors. Chron Respir Dis 2016; 3:117-22. [PMID: 16916005 DOI: 10.1191/1479972306cd110ra] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dyspnoea is the most common symptom of patients with cardio-respiratory diseases. It is a generic term related to different pathophysiological abnormalities that may result in different qualities of respiratory discomfort, defined by specific verbal descriptors for a specific diagnosis. Often it is difficult to distinguish the underlying pathology of dyspnoea, eg, either from chronic heart failure (CHF) or from other respiratory causes. The discovery of the endocrine function of the heart, as well as the development of accurate and feasible assay methods allow the use of cardiac natriuretic hormones in the assessment of cardiovascular diseases, namely acute coronary syndromes and heart failure. It is advisable to measure cardiac natriuretic hormones in order to exclude or suggest the diagnosis of CHF in patients with a suspicious diagnosis, but with ambiguous signs and symptoms or manifestations that can be confused with other pathologies (like chronic obstructive pulmonary disease). The most common symptom of patients with cardio-respiratory diseases is dyspnoea, a 'difficult, laboured, uncomfortable breathing'. Dyspnoea has been defined as 'a term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social and environmental factors, and may induce secondary physiological and behavioural responses'. Breathlessness is characterized by measurable intensity and qualitative dimensions, which may vary depending on the individual, the underlying disease, and other circumstances.3 The neurophysiological basis of dyspnoea relies on receptors in the airways lung parenchyma, respiratory muscles together with chemoreceptors providing sensory feedback via vagal, phrenic and intercostal nerves to the spinal cord, medulla and higher centres. Breathlessness is based on different pathophysiolagical abnormalities that may result in different qualities of respiratory discomfort, which are defined by specific verbal descriptors related to a specific diagnosis. Nevertheless different diseases may share the same descriptors. There is no clear relationship between the qualitative descriptors of dyspnoea and the quantitative intensity among the patient groups: different diseases may be distinguished by quality but not intensity of the sensation. Differences in languages, in races, cultures, gender, and in the manner in which concepts or symptoms are held can all influence the idea, quality and intensity of dyspnoea.
Collapse
|
14
|
Oxley R, Macnaughton J. Inspiring change: humanities and social science insights into the experience and management of breathlessness. Curr Opin Support Palliat Care 2016; 10:256-61. [PMID: 27490147 PMCID: PMC4974063 DOI: 10.1097/spc.0000000000000221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Breathlessness can be debilitating for those with chronic conditions, requiring continual management. Yet, the meaning of breathlessness for those who live with it is poorly understood in respect of its subjective, cultural, and experiential significance. This article discusses a number of current issues in understanding the experience of breathlessness. RECENT FINDINGS Effective communication concerning the experience of breathlessness is crucial for diagnosis, to identify appropriate treatment, and to provide patients with the capacity to self-manage their condition. However, there is an evident disconnect between the way breathlessness is understood between clinical and lay perspectives, in terms of awareness of breathlessness, the way symptoms are expressed, and acknowledgement of how it affects the daily lives of patients. SUMMARY The review highlights the need for integrated multidisciplinary work on breathlessness, and suggests that effective understanding and management of breathlessness considers its wider subjective and social significance.
Collapse
Affiliation(s)
- Rebecca Oxley
- Department of Anthropology, Centre for Medical Humanities
| | - Jane Macnaughton
- Centre for Medical Humanities, School of Medicine, Pharmacy and Health, Durham University, Durham, England, UK
| |
Collapse
|
15
|
Burström M, Boman K, Strandberg G, Brulin C. Manliga patienter med hjärtsvikt och deras erfarenhet av att vara trygga och otrygga. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/010740830702700306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
16
|
Huang TY, Moser DK, Hwang SL. The Short-Term and Long-Term Effects of Biofeedback-Assisted Relaxation Therapy in Patients With Heart Failure. SAGE Open Nurs 2016. [DOI: 10.1177/2377960816680825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Relaxation techniques can reduce sympathetic nervous system activation and stress, potentially improving heart failure patients’ physical and psychological outcomes. Purpose To examine the effects of biofeedback-assisted relaxation (BFAR) therapy in patients with heart failure. Methods A prospective randomized control study was conducted. Participants in the treatment group received BFAR therapy, while participants in the control group received standard of care. Short-term outcomes were physical symptoms and psychosocial variables measured at baseline and 3 months; long-term outcomes were cardiac events and mortality assessed at 12 months. Results Fifty-two heart failure patients participated in the study: 23 (mean age 60.0 ± 13.7 years; 60.9% male; 39.1% New York Heart Association III/IV) in the treatment group and 29 (mean age 59.2 ± 12.2 years; 72.4% male; 48.3% New York Heart Association III/IV) in the control group. Short-term effects of BFAR on outcome variables were not significantly different between treatment and control groups. However, longer event-free survival was found in the treatment group compared with the control group ( p = .019). Conclusions/Implications for Practices BFAR therapy is effective to improve cardiac event-free survival of heart failure patients and can be applied to clinical setting.
Collapse
Affiliation(s)
- Tsuey-Yuan Huang
- Chang Gung University of Science and Technology, Kweishan, Taiwan
| | | | | |
Collapse
|
17
|
|
18
|
Eckerblad J, Tödt K, Jakobsson P, Unosson M, Skargren E, Kentsson M, Theander K. Symptom burden in stable COPD patients with moderate or severe airflow limitation. Heart Lung 2014; 43:351-7. [PMID: 24856227 DOI: 10.1016/j.hrtlng.2014.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations. BACKGROUND Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation. METHODS A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations. RESULTS The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups. CONCLUSIONS Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.
Collapse
Affiliation(s)
- J Eckerblad
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linkoping University, 581 85 Linkoping, Sweden.
| | - K Tödt
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linkoping University, 581 85 Linkoping, Sweden; Department of Pulmonary Medicine, University Hospital, 581 85 Linkoping, Sweden
| | - P Jakobsson
- Department of Pulmonary Medicine, University Hospital, 581 85 Linkoping, Sweden
| | - M Unosson
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linkoping University, 581 85 Linkoping, Sweden
| | - E Skargren
- Department of Medicine and Health Sciences, Faculty of Health Sciences, Linkoping University, 581 85 Linkoping Sweden
| | - M Kentsson
- Department of Pulmonary Medicine, Ryhov Hospital, Jonkoping S-551 85, Sweden
| | - K Theander
- Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University, 656 37 Karlstad, Sweden; Primary Care Research Unit, Varmland County Council, Karlstad, Sweden
| |
Collapse
|
19
|
Neves LMT, Karsten M, Neves VR, Beltrame T, Borghi-Silva A, Catai AM. Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients. Braz J Phys Ther 2014; 18:1-8. [PMID: 24675907 PMCID: PMC4183236 DOI: 10.1590/s1413-35552012005000134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 06/18/2013] [Indexed: 11/22/2022] Open
Abstract
Background Reduced respiratory muscle endurance (RME) contributes to increased dyspnea
upon exertion in patients with cardiovascular disease. Objective The objective was to characterize ventilatory and metabolic responses during
RME tests in post-myocardial infarction patients without respiratory muscle
weakness. Method Twenty-nine subjects were allocated into three groups: recent myocardial
infarction group (RG, n=9), less-recent myocardial infarction group (LRG,
n=10), and control group (CG, n=10). They underwent two RME tests
(incremental and constant pressure) with ventilatory and metabolic analyses.
One-way ANOVA and repeated measures one-way ANOVA, both with Tukey post-hoc,
were used between groups and within subjects, respectively. Results Patients from the RG and LRG presented lower metabolic equivalent and
ventilatory efficiency than the CG on the second (50± 06, 50±
5 vs. 42± 4) and third part (50± 11, 51± 10 vs.
43± 3) of the constant pressure RME test and lower metabolic
equivalent during the incremental pressure RME test. Additionally, at the
peak of the incremental RME test, RG patients had lower oxygen uptake than
the CG. Conclusions Post-myocardial infarction patients present lower ventilatory efficiency
during respiratory muscle endurance tests, which appears to explain their
inferior performance in these tests even in the presence of lower pressure
overload and lower metabolic equivalent.
Collapse
Affiliation(s)
- Laura M T Neves
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Universidade Federal de Sao Carlos, Sao Carlos, SP, Brazil
| | - Marlus Karsten
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Universidade Federal de Sao Carlos, Sao Carlos, SP, Brazil
| | - Victor R Neves
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Universidade Federal de Sao Carlos, Sao Carlos, SP, Brazil
| | - Thomas Beltrame
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Universidade Federal de Sao Carlos, Sao Carlos, SP, Brazil
| | - Audrey Borghi-Silva
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Universidade Federal de Sao Carlos, Sao Carlos, SP, Brazil
| | - Aparecida M Catai
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Universidade Federal de Sao Carlos, Sao Carlos, SP, Brazil
| |
Collapse
|
20
|
Kaplan A, Gruffydd-Jones K, van Gemert F, Kirenga BJ, Medford ARL. A woman with breathlessness: a practical approach to diagnosis and management. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:468-76. [PMID: 24270362 PMCID: PMC6442845 DOI: 10.4104/pcrj.2013.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/26/2013] [Indexed: 02/05/2023]
Abstract
Worsening breathless in a patient with severe chronic obstructive pulmonary disease (COPD) is a common diagnostic and management challenge in primary care. A systematic approach to history-taking and examination combined with targeted investigation of pulmonary, cardiovascular, thromboembolic and systemic causes is essential if co-morbidities are to be identified and managed. Distinguishing between heart failure and COPD is a particular challenge as symptoms and signs overlap. In low and middle income countries additional priorities are the detection of infections such as tuberculosis and human immunodeficiency virus (HIV). Clinicians need to be alert to the possibility of atypical presentations (such as pain-free variants of angina) and less common conditions (including chronic thromboembolic pulmonary hypertension) in order not to overlook important potentially treatable conditions.
Collapse
Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, Richmond Hill, Ontario, Canada
| | | | - Frederik van Gemert
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce J Kirenga
- Department of Medicine, School of Medicine, Makerere University, Kampala, Uganda
| | - Andrew RL Medford
- Consultant & Honorary Senior Lecturer in Thoracic Medicine & Interventional Pulmonology, North Bristol Lung Centre & University of Bristol, Southmead Hospital, Bristol, UK
| |
Collapse
|
21
|
Teixeira CA, Rodrigues Júnior AL, Straccia LC, Vianna EDSO, Silva GAD, Martinez JAB. Dyspnea descriptors translated from English to Portuguese: application in obese patients and in patients with cardiorespiratory diseases. J Bras Pneumol 2012; 37:455-63. [PMID: 21881735 DOI: 10.1590/s1806-37132011000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/09/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the usefulness of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) that were developed in English and translated to Brazilian Portuguese in patients with four distinct clinical conditions that can be accompanied by dyspnea. METHODS We translated, from English to Brazilian Portuguese, a list of 15 dyspnea descriptors reported in a study conducted in the USA. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. RESULTS The use of this set of descriptors led to a solution with nine clusters, designated expiração (exhalation), fome de ar (air hunger), sufoco (suffocating), superficial (shallow), rápido (rapid), aperto (tight), falta de ar (shortness of breath), trabalho (work), and inspiração (inhalation). Overlapping of the descriptors was quite common among the patients, regardless of their clinical condition. Asthma, COPD, and heart failure were significantly associated with the inspiração cluster. Heart failure was also associated with the trabalho cluster, whereas obesity was not associated with any of the clusters. CONCLUSIONS In our study sample, the application of dyspnea descriptors translated from English to Portuguese led to the identification of distinct clusters, some of which were similar to those identified in a study conducted in the USA. The translated descriptors were less useful than were those developed in Brazil regarding their ability to generate significant associations among the clinical conditions investigated here.
Collapse
Affiliation(s)
- Christiane Aires Teixeira
- Department of Clinical Medicine, University of São Paulo at Ribeirão Preto School of Medicine – Ribeirão Preto, Brazil
| | | | | | | | | | | |
Collapse
|
22
|
Teixeira CA, Rodrigues Júnior AL, Straccia LC, Vianna EDSO, Silva GAD, Martinez JAB. Dyspnea descriptors developed in Brazil: application in obese patients and in patients with cardiorespiratory diseases. J Bras Pneumol 2012; 37:446-54. [PMID: 21881734 DOI: 10.1590/s1806-37132011000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/09/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. METHODS We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. RESULTS The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. CONCLUSIONS In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.
Collapse
Affiliation(s)
- Christiane Aires Teixeira
- Department of Clinical Medicine, University of São Paulo at Ribeirão Preto School of Medicine – Ribeirão Preto, Brazil
| | | | | | | | | | | |
Collapse
|
23
|
Relationship between inspiratory muscle capacity and peak exercise tolerance in patients post-myocardial infarction. Heart Lung 2012; 41:137-45. [DOI: 10.1016/j.hrtlng.2011.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 07/20/2011] [Accepted: 07/27/2011] [Indexed: 11/21/2022]
|
24
|
Valadares YD, Corrêa KDS, Silva BO, Araujo CLPD, Karloh M, Mayer AF. Aplicabilidade de testes de atividades de vida diária em indivíduos com insuficiência cardíaca. REV BRAS MED ESPORTE 2011. [DOI: 10.1590/s1517-86922011000500003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A limitação nas atividades de vida diária (AVD) por dispneia é um achado comum nos pacientes com insuficiência cardíaca (IC), classe funcional III e IV. A avaliação específica da limitação nas AVD poderia ser utilizada como parâmetro de evolução da doença e de resposta terapêutica. Entretanto, há uma escassez de instrumentos de avaliação das AVD nessa população. Dessa forma, o objetivo do estudo foi verificar a aplicabilidade da escala London Chest Activity of Daily Living (LCADL) e do teste de AVD-Glittre (T Glittre), na avaliação da limitação funcional de indivíduos com IC classe funcional III e IV. Participaram do estudo 10 pacientes (57 ± 9 anos; 27,5 ± 4,5kg/m²) de ambos os sexos com diagnóstico clínico de IC classe funcional III e IV e fração de ejeção do ventrículo esquerdo (FEVE) 34 ± 7%, foram avaliados: espirometria, índice de massa corpórea (IMC), escala LCADL, teste de caminhada de seis minutos (TC6min), T Glittre, escala Medical Research Council (MRC) e questionário SF-36. Os pacientes apresentaram, em média, escore da escala LCADLtotal de 27,7 ± 12,1 (LCADL%total: 41,5 ± 16,9) e tempo do T Glittre de 6,3 ± 4,8 minutos, encontrando-se correlação positiva entre eles (r = 0,88; p < 0,05). O LCADL%total correlacionou-se com o TC6min (r = -0,83), FEVE (r = -0,64), MRC (r = 0,68) e domínio capacidade funcional (CF) do SF-36 (r = -0,63), com p < 0,05. O T Glittre correlacionou-se com o TC6min (r = -0,90), FEVE (r = -0,66) e CF do SF-36 (r = -0,69), com p < 0,05. Conclui-se com o estudo que a escala LCADL e o T Glittre têm aplicabilidade em pacientes com IC classe III e IV, apresentando associação com a FEVE, com a distância percorrida no TC6min, grau de dispneia e qualidade de vida.
Collapse
Affiliation(s)
| | | | | | | | | | - Anamaria Fleig Mayer
- Centro Universitário do Triângulo, Brasil; Universidade do Estado de Santa Catarina, Brasil; Universidade do Estado de Santa Catarina, Brasil
| |
Collapse
|
25
|
Kamal AH, Maguire JM, Wheeler JL, Currow DC, Abernethy AP. Dyspnea review for the palliative care professional: assessment, burdens, and etiologies. J Palliat Med 2011; 14:1167-72. [PMID: 21895451 PMCID: PMC3189385 DOI: 10.1089/jpm.2011.0109] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common symptom experienced by many patients with chronic, life-threatening, and/or life-limiting illnesses. Although it can be defined and measured in several ways, dyspnea is best described directly by patients through regular assessment, as its burdens exert a strong influence on the patient's experience throughout the trajectory of serious illness. Its significance is amplified due to its impact on family and caregivers. DISCUSSION Anatomic and physiologic changes associated with dyspnea, and cognitive perceptions related to patients and the underlying disease, provide insights into how to shape interventions targeting this oppressive symptom. Additionally, as described in the concept of "total dyspnea," the complex etiology and manifestation of this symptom require multidisciplinary treatment plans that focus on psychological, social, and spiritual distress as well as physical components. Several validated assessment tools are available for clinical and research use, and choice of method should be tailored to the individual patient, disease, and care setting in the context of patient-centered care. CONCLUSION This article, the first in a two-part series, reviews the identification and assessment of dyspnea, the burden it entails, and the underlying respiratory and nonrespiratory etiologies that may cause or exacerbate it.
Collapse
Affiliation(s)
- Arif H. Kamal
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer M. Maguire
- Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jane L. Wheeler
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - David C. Currow
- Department of Palliative and Supportive Services, Division of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Amy P. Abernethy
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
- Department of Palliative and Supportive Services, Division of Medicine, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
26
|
Parshall MB, Carle AC, Ice U, Taylor R, Powers J. Validation of a three-factor measurement model of dyspnea in hospitalized adults with heart failure. Heart Lung 2011; 41:44-56. [PMID: 21794918 DOI: 10.1016/j.hrtlng.2011.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 04/28/2011] [Accepted: 05/06/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to validate a 3-factor measurement model of dyspnea sensory quality (WORK-EFFORT, TIGHTNESS, SMOTHERING-AIR HUNGER) originally derived in patients with exacerbated chronic obstructive pulmonary disease. METHODS In this validation study, adult patients with heart failure were enrolled after hospital admission (median hospital day 1) and asked to rate the intensity of dyspnea sensory quality descriptors on the day of enrollment (study day 1; N = 119) and in a recall version for the day of admission (study day 0; n = 97). RESULTS Confirmatory factor analysis demonstrated good model fit for both days. Cronbach's α for each factor was greater than .87 for both study days. CONCLUSION This is the first study to validate a previously specified measurement model of dyspnea sensory quality in an independent sample. Results indicate that measurement of dyspnea sensory quality in exacerbated cardiopulmonary disease does not necessarily require disease-specific questionnaires.
Collapse
Affiliation(s)
- Mark B Parshall
- College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
| | | | | | | | | |
Collapse
|
27
|
Exercise and its impact on dyspnea. Curr Opin Pharmacol 2011; 11:195-203. [PMID: 21530401 DOI: 10.1016/j.coph.2011.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 03/09/2011] [Accepted: 04/07/2011] [Indexed: 11/23/2022]
Abstract
Dyspnea is a subjective experience of breathing discomfort that can limit the ability and motivation to perform exercise or exertion. It is a common problem that affects specific groups of patients, such as, those suffering from chronic obstructive pulmonary disease, congestive heart failure, and interstitial lung disease, and in healthy humans during aging, pregnancy, and obesity. In this review, the current mechanistic model of exertional dyspnea is summarized and new research demonstrating how treatment strategies improve dyspnea by reducing central ventilatory drive, improving dynamic ventilatory mechanics, and improving respiratory muscle function is highlighted. Lastly, we review the effects of healthy aging and recent evidence for a male-female difference with respect to exertional-related dyspnea.
Collapse
|
28
|
Huang TY, Moser DK, Hwang SL, Lennie TA, Chung M, Heo S. Comparison of health-related quality of life between American and Taiwanese heart failure patients. J Transcult Nurs 2011; 21:212-9. [PMID: 20371738 DOI: 10.1177/1043659609358779] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Few investigators have compared health-related quality of life (HRQOL) in heart failure (HF) patients from different countries.The purposes of this study were to compare HRQOL between American (n = 87) and Taiwanese (n = 88) HF patients and to determine factors associated with HRQOL in both groups. In this cross-sectional survey, HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire. American patients rated their HRQOL worse than Taiwanese patients did. Sociodemographics, disease severity, and symptom severity were associated with HRQOL, accounting for 42.4% of the variance in HRQOL in Americans and 57.3% in Taiwanese. Symptom severity was the most important predictor of HRQOL in both groups. Interventions targeting symptom severity could improve HF patients' HRQOL.
Collapse
Affiliation(s)
- Tsuey-Yuan Huang
- Chang Gung Institute of Technology, No. 133 4F Chang Gung Medical Village, Taoyuan 333, Taiwan.
| | | | | | | | | | | |
Collapse
|
29
|
Williams M, Cafarella P, Olds T, Petkov J, Frith P. Affective Descriptors of the Sensation of Breathlessness Are More Highly Associated With Severity of Impairment Than Physical Descriptors in People With COPD. Chest 2010; 138:315-22. [DOI: 10.1378/chest.09-2498] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
30
|
Lange P, Mogelvang R, Marott JL, Vestbo J, Jensen JS. Cardiovascular morbidity in COPD: A study of the general population. COPD 2010; 7:5-10. [PMID: 20214458 DOI: 10.3109/15412550903499506] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although there are a number of studies on the coexistence of heart disease and COPD among patients acutely admitted to hospital, this relationship has not been accurately described in the general population. Especially data on the prevalence of both reduced lung function and impaired left ventricular ejection fraction (LVEF) are sparse. We used data from the 4th examination of The Copenhagen City Heart Study, which comprises 5,890 individuals with data on pulmonary and cardiac symptoms, risk factors for cardiovascular diseases, pulmonary function tests, ECG and relevant medical history. Among the participants a randomly selected subgroup of 3,469 individuals underwent both spirometry and echocardiography. The participants were classified according to COPD stage using the international GOLD staging according to FEV(1) in % of predicted. The prevalence of COPD was 5.7% for mild COPD (GOLD stage 1), 9.4% for moderate COPD (GOLD stage 2) and 2.5% for severe and very severe COPD (GOLD stages 3+4). Individuals with COPD were older and had a higher prevalence of cardiovascular risk factors and a higher prevalence of cardiovascular diseases. Among the echocardiographical findings, only the presence of left ventricular hyperthrophy was significantly more frequent among individuals with COPD (17.7%) than among participants without COPD (12.1%.), yet this relationship was no longer significant after statistical adjustment for age and gender. In the general population, subjects with COPD have a higher prevalence of cardiovascular diseases and an unfavourable cardiovascular risk profile compared with individuals without COPD, but this was mainly related to higher age among the participants with COPD.
Collapse
|
31
|
Hawkins NM, Wang D, Petrie MC, Pfeffer MA, Swedberg K, Granger CB, Yusuf S, Solomon SD, Östergren J, Michelson EL, Pocock SJ, Maggioni AP, McMurray JJ. Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme. Eur J Heart Fail 2010; 12:557-65. [DOI: 10.1093/eurjhf/hfq040] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Duolao Wang
- Medical Statistics Unit; London School of Hygiene and Tropical Medicine; London UK
| | | | | | - Karl Swedberg
- Sahlgrenska University Hospital/Östra; Göteborg Sweden
| | | | - Salim Yusuf
- Hamilton Health Sciences and McMaster University; Hamilton ON Canada
| | | | | | | | - Stuart J. Pocock
- Medical Statistics Unit; London School of Hygiene and Tropical Medicine; London UK
| | - Aldo P. Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center; Florence Italy
| | | | | |
Collapse
|
32
|
Casarett D, Pickard A, Fishman JM, Alexander SC, Arnold RM, Pollak KI, Tulsky JA. Can metaphors and analogies improve communication with seriously ill patients? J Palliat Med 2010; 13:255-60. [PMID: 19922170 DOI: 10.1089/jpm.2009.0221] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. DESIGN Cross-sectional observational study of audio-recorded conversations between patients and physicians. SETTING Three outpatient oncology practices. PATIENTS Ninety-four patients with advanced cancer and 52 physicians. INTERVENTION None. MAIN OUTCOME MEASURES Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. RESULTS In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001). CONCLUSIONS The use of metaphors and analogies may enhance physicians' ability to communicate.
Collapse
Affiliation(s)
- David Casarett
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Sundin K, Bruce E, Barremo AS. Elderly women's experiences of support when living with congestive heart failure. Int J Qual Stud Health Well-being 2010; 5:10.3402/qhw.v5i2.5064. [PMID: 20640021 PMCID: PMC2875970 DOI: 10.3402/qhw.v5i2.5064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2010] [Indexed: 11/22/2022] Open
Abstract
Heart failure is a chronic syndrome that has physiological, psychological and social effects. The aim of the study was to illuminate the meanings of support as experienced by elderly women with chronic heart failure. Narrative interviews were conducted with five elderly women with chronic heart failure. A phenomenological hermeneutic method of interpretation was used. The meanings of support were experienced by the women out of two perspectives, that is, when support is present and when there is a lack of support. The findings were revealed in two themes: "Feeling confident means support" and "Feeling abandoned". The women do not wish to be a burden. They want to be independent as much as possible to defend their dignity. An important support to the women is that they are understood and confirmed in their illness. Supportive relations are most valuable, that is, a relationship that supports the women's independence. If there is no supportive relationship, they feel like a burden to others and they feel lonely; this loneliness creates suffering and counteracts wellbeing and health.
Collapse
Affiliation(s)
- Karin Sundin
- Department of Nursing, Campus Örnsköldsvik, Umeå University, Örnsköldsvik, Sweden
| | - Elisabeth Bruce
- Department of Nursing, Campus Örnsköldsvik, Umeå University, Örnsköldsvik, Sweden
| | | |
Collapse
|
34
|
Briscoe WP, Woodgate RL. Sustaining self: the lived experience of transition to long-term ventilation. QUALITATIVE HEALTH RESEARCH 2010; 20:57-67. [PMID: 20019349 DOI: 10.1177/1049732309356096] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Long-term mechanical ventilation (LTMV) is used to support growing numbers of children and adults who develop chronic respiratory failure. The purpose of this hermeneutic phenomenological study was to explore the subjective meaning of the experience of transition from spontaneous breathing to reliance on LTMV. In-depth, audiorecorded interviews of 11 ventilated individuals living in a western Canadian province were transcribed and analyzed. The transition journey was revealed to be a time of psychological, physical, and spiritual challenge. "Sustaining self " was revealed as the essence of ventilator users' transition experience. Findings underscore the complex nature of transition to technological reliance, illuminating the need for increased health professional knowledge and understanding of the symptom experience and management options for individuals living with chronic respiratory failure. Strategies to support individuals' sense of self as they journey to a life reliant on LTMV are required.
Collapse
Affiliation(s)
- Winnifred P Briscoe
- Red River College of Applied Arts, Science and Technology, Winnipeg, Manitoba, Canada.
| | | |
Collapse
|
35
|
Yorke J, Moosavi SH, Shuldham C, Jones PW. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax 2009; 65:21-6. [PMID: 19996336 PMCID: PMC2795166 DOI: 10.1136/thx.2009.118521] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
RATIONALE Dyspnoea is a debilitating and distressing symptom that is reflected in different verbal descriptors. Evidence suggests that dyspnoea, like pain perception, consists of sensory quality and affective components. The objective of this study was to develop an instrument that measures overall dyspnoea severity using descriptors that reflect its different aspects. METHODS 81 dyspnoea descriptors were administered to 123 patients with chronic obstructive pulmonary disease (COPD), 129 with interstitial lung disease and 106 with chronic heart failure. These were reduced to 34 items using hierarchical methods. Rasch analysis informed decisions regarding further item removal and fit to the unidimensional model. Principal component analysis (PCA) explored the underlying structure of the final item set. Validity and reliability of the new instrument were further assessed in a separate group of 53 patients with COPD. RESULTS After removal of items with hierarchical methods (n = 47) and items that failed to fit the Rasch model (n = 22), 12 were retained. The "Dyspnoea-12" had good internal reliability (Cronbach's alpha = 0.9) and fit to the Rasch model (chi(2) p = 0.08). Items patterned into two groups called "physical"(n = 7) and "affective"(n = 5). In the separate validation study, Dyspnoea-12 correlated with the Hospital Anxiety and Depression Scale (anxiety r = 0.51; depression r = 0.44, p<0.001, respectively), 6-minute walk distance (r = -0.38, p<0.01) and MRC (Medical Research Council) grade (r = 0.48, p<0.01), and had good stability over time (intraclass correlation coefficient = 0.9, p<0.001). CONCLUSION Dyspnoea-12 fulfills modern psychometric requirements for measurement. It provides a global score of breathlessness severity that incorporates both "physical" and "affective" aspects, and can measure dyspnoea in a variety of diseases.
Collapse
Affiliation(s)
- J Yorke
- School of Nursing, Faculty of Health and Social Care, University of Salford, Greater Manchester, UK.
| | | | | | | |
Collapse
|
36
|
Williams M, Garrard A, Cafarella P, Petkov J, Frith P. Quality of recalled dyspnoea is different from exercise-induced dyspnoea: an experimental study. ACTA ACUST UNITED AC 2009; 55:177-83. [PMID: 19681739 DOI: 10.1016/s0004-9514(09)70078-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
QUESTIONS Are volunteered and endorsed descriptors of recalled breathlessness consistent with descriptors of exercise-induced breathlessness? Are volunteered and endorsed descriptors of exercise-induced breathlessness consistent? DESIGN Within-participant, repeated measures, experimental study. PARTICIPANTS 57 people with symptomatic chronic respiratory disease aged 71 years. INTERVENTION There were three conditions. The first was recalled breathlessness. Two conditions of exercise-induced breathlessness were created by getting the participants to undertake the 6-min Walk Test twice (breathlessness 1 and 2). OUTCOME MEASURES Descriptors of breathlessness were volunteered (where participants' used their own words) or endorsed (from a pre-existing list of 15 breathlessness statements). RESULTS Emotive descriptors made up 65% of recalled descriptors compared with 11% of exercise-induced descriptors, whereas physical descriptors made up 35% of recalled descriptors compared with 89% of exercise-induced descriptors. Of the 237 potential language pairs volunteered to describe recalled and exercise-induced breathlessness 1, only 27 (11%) were identical whereas of the 171 potential language pairs endorsed as describing recalled and exercise-induced breathlessness 1, 66 (39%) were identical. Of the 175 potential language pairs of descriptors volunteered to describe exercise-induced breathlessness 1 and 2, 72 (41%) were identical whereas of the 153 potential language pairs endorsed as describing exercise-induced breathlessness 1 and 2, 71 (46%) were identical. CONCLUSION The language used to describe exercise-induced breathlessness immediately after two walking challenges was similar. However, descriptions of recalled breathlessness did not consistently match descriptions of exercise-induced breathlessness, which may reflect the different contexts under which breathlessness was recalled and induced.
Collapse
Affiliation(s)
- Marie Williams
- School of Health Sciences, University of South Australia, Adelaide 5000, South Australia, Australia.
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Williams MT, Olds T, Petkov J, Cafarella P, Frith P. Response. Chest 2009; 135:1112-1113. [DOI: 10.1378/chest.08-2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
39
|
Padula CA, Yeaw E, Mistry S. A home-based nurse-coached inspiratory muscle training intervention in heart failure. Appl Nurs Res 2009; 22:18-25. [PMID: 19171291 DOI: 10.1016/j.apnr.2007.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Revised: 02/20/2007] [Accepted: 02/22/2007] [Indexed: 11/24/2022]
Abstract
People with heart failure (HF) are living longer but with disabling dyspnea that erodes quality of life (QOL). Decreased strength of inspiratory muscles (IMs) may contribute to dyspnea in HF, and inspiratory muscle training (IMT) has been shown to improve the strength of IMs. The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program. Bandura's Self-Efficacy Theory directed nursing interventions. This randomized controlled trial employed an experimental group (IMT) and a control group (education). Data were collected during six home visits. Outcome measures included maximal inspiratory pressure, perceived dyspnea, self-efficacy, and health-related QOL. Significant differences in PI(max), dyspnea, and respiratory rate were found. Implications for further research and practice are discussed.
Collapse
Affiliation(s)
- Cynthia A Padula
- College of Nursing, University of Rhode Island, Kingston, RI 02881, USA.
| | | | | |
Collapse
|
40
|
Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009; 11:130-9. [PMID: 19168510 PMCID: PMC2639415 DOI: 10.1093/eurjhf/hfn013] [Citation(s) in RCA: 378] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/31/2008] [Accepted: 11/03/2008] [Indexed: 11/12/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are global epidemics incurring significant morbidity and mortality. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. Evaluation of cardiac and pulmonary function is often problematic and occasionally misleading. Echocardiography and pulmonary function tests should be performed in every patient. Careful interpretation is required to avoid misdiagnosis and inappropriate treatment. Airflow obstruction, in particular, must be demonstrated when clinically euvolaemic. Very high and very low concentrations of natriuretic peptides have high positive and negative predictive values for diagnosing HF in those with both conditions. Intermediate values are less informative. Both conditions are systemic disorders with overlapping pathophysiological processes. In patients with HF, COPD is consistently an independent predictor of death and hospitalization. However, the impact on ischaemic and arrhythmic events is unknown. Greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.
Collapse
Affiliation(s)
- Nathaniel Mark Hawkins
- Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
| | | | | | | | | | | |
Collapse
|
41
|
Michaels C, Meek PM, Dedkhard S. Breathing intensity and word use in individuals with COPD. Chron Respir Dis 2008; 5:197-204. [DOI: 10.1177/1479972308096710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Shifts in natural or spontaneous language have been reported with psychological and physical changes, as well as shifts in predetermined words selected to describe dyspnea. Less evidence exists for natural language shifts and breathing intensity, particularly for everyday life and for negative emotion. Therefore, this study purpose was to describe the relationship between levels of everyday breathing intensity and the natural language word categories used in describing breathing, including a negative emotion category. A longitudinal descriptive research design and a convenience sample of 45 individuals were used. Natural language was analyzed as rates of word used based on three levels of breathing intensity. Non-parametric statistics were used to test differences between rates of word use and non-use on low, moderate, and high breathing intensity days, as well as correlations to subscales that measured negative emotion on the Bronchitis–Emphysema Symptom Checklist (BESC) and the Breathing Standard Index. Statistically significant associations were reported between level of breathing intensity and negative emotion, anger, cause, insight, time, and body words. Several significant correlations were reported with the psychosocial measures, including negative emotion and anxiety words with the BESC hopelessness/helplessness, time subscale, and negative emotion words with the inverse of typical breathing (i.e., atypical breathing). By showing significant associations between key word categories, in particular negative emotion and anger word use, levels of breathing intensity, and selected psychosocial measures, this study contributes to the body of knowledge about the influence of levels of breathing intensity on natural word use in everyday life.
Collapse
Affiliation(s)
- C Michaels
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - PM Meek
- College of Nursing, University of Colorado, Denver, Aurora, Colorado, USA
| | - S Dedkhard
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| |
Collapse
|
42
|
Huang TY, Moser DK, Hsieh YS, Lareau SC, Durkin AC, Hwang SL. Validation of Chinese Version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire With Heart Failure Patients in Taiwan. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.5.436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Dyspnea is a distressing and functionally limiting symptom that patients with heart failure commonly experience. A valid instrument to quantify dyspnea for comparison of groups and for illness management is important.
Objective To validate the Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire.
Methods The Chinese version was developed by using translation and back translation and was tested in Taiwan in 88 patients who had heart failure but no pulmonary disease or comorbid conditions limiting physical function. Data on a Taiwanese subsample (n=30) were compared with data on 30 patients in the United States matched by sex, age, and severity of disease to determine the equivalence of the Chinese and English versions. Construct validity was assessed by testing the hypothesis that health-related quality of life measured by using the Minnesota Living With Heart Failure Questionnaire is associated with the score on the dyspnea questionnaire. Reliability was assessed by using the Cronbach α and item-total correlations.
Results Equivalence between the US and Taiwanese samples was high, from 0.67 to 0.91 for each item of the questionnaire and for the total score. Satisfactory correlations between the Chinese dyspnea and the Minnesota questionnaires, especially in the physical dimension (r=0.71, P<.001), provided support for the construct validity of the Chinese questionnaire. Reliability of the Chinese questionnaire was adequate (α=0.94).
Conclusions The Chinese Modified Pulmonary Functional Status and Dyspnea Questionnaire is a reliable and valid measure for dyspnea that can be used in Taiwanese patients with heart failure.
Collapse
Affiliation(s)
- Tsuey-Yuan Huang
- Tsuey-Yuan Huang is a senior lecturer at the Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Debra K. Moser
- Debra K. Moser is a professor and holds the Gill Endowed Chair of Nursing at the College of Nursing, University of Kentucky in Lexington. She is also the editor of the Journal of Cardiovascular Nursing
| | - Yeu-Sheng Hsieh
- Yeu-Sheng Hsieh is a professor in the Department of Agriculture Extension, National Taiwan University
| | - Suzanne C. Lareau
- Suzanne C. Lareau is a senior instructor, College of Nursing, University of Colorado, Denver
| | - Adelaide Caroci Durkin
- Adelaide Caroci Durkin is an assistant professor at Kettering College of Medical Arts, Dayton, Ohio
| | - Shiow-Li Hwang
- Shiow-Li Hwang is a professor at and the president of Chang Gung Institute of Technology, Taoyuan, Taiwan
| |
Collapse
|
43
|
Williams M, Cafarella P, Olds T, Petkov J, Frith P. The language of breathlessness differentiates between patients with COPD and age-matched adults. Chest 2008; 134:489-496. [PMID: 18490404 DOI: 10.1378/chest.07-2916] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND If descriptors of the sensation of breathlessness are able to differentiate between medical conditions, the language of breathlessness could potentially have a role in differential diagnosis. This study investigated whether the language used to describe the sensation of breathlessness accurately categorized older individuals with and without a prior diagnosis of COPD. METHODS Using a parallel-group design, participants with and without a prior diagnosis of COPD volunteered words and phrases and endorsed up to three statements to describe their sensation of breathlessness. Cluster analysis (v-fold cross-validation) was applied, and subjects were clustered by their choice of words. Cluster membership was then compared to original group membership (COPD vs non-COPD), and predictive power was assessed. RESULTS Groups were similar for age and gender (COPD, n = 94; 48 men; mean age, 70 +/- 10 years [+/- SD]; vs non-COPD, n = 55; 21 men; mean age, 69 +/- 13 years) but differed significantly in breathlessness-related impairment, intensity, and quality of life (p < 0.0001). Cluster membership corresponded accurately with original group classifications (volunteered, 85%; and up to three statements, 68% agreement). Classification based on a single best descriptor (volunteered [62%] or endorsed [55%]) was less accurate for group membership. CONCLUSIONS Language used to describe the sensation of breathlessness differentiated people with and without a prior diagnosis of COPD when descriptors were not limited to a single best word or statement.
Collapse
Affiliation(s)
- Marie Williams
- School of Health Sciences, University of South Australia, City East Campus, Adelaide.
| | - Paul Cafarella
- Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, Adelaide
| | - Timothy Olds
- School of Health Sciences, University of South Australia, City East Campus, Adelaide
| | - John Petkov
- Applied Statistics Unit, University of South Australia, Whyalla Campus, Whyalla
| | - Peter Frith
- Respiratory Services, Repatriation General Hospital and Flinders Medical Centre, Repatriation General Hospital, Daw Park, Adelaide, SA, Australia
| |
Collapse
|
44
|
Effect of dyspnea and clinical variables on the quality of life and functional capacity in patients with chronic obstructive pulmonary disease and congestive heart failure. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200804010-00004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
45
|
Wingårdh A, Engström CP, Claesson L. Test-retest of a Swedish version of the Pulmonary Functional Status & Dyspnea Questionnaire-modified. Scand J Occup Ther 2008; 14:183-91. [PMID: 17763200 DOI: 10.1080/11038120601058422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The number of people suffering from chronic obstructive pulmonary disease (COPD) is increasing. From an occupational therapy perspective, it is important to estimate dyspnea, fatigue and activity performance in daily activities to be able to use the most effective interventions. In Sweden, there are several assessments for evaluating activities in daily living, but none of them are diagnosis specific for this group. The Pulmonary Functional Status & Dyspnea Questionnaire-Modified (PFSDQ-M) is a self-completion assessment, which takes a short time to complete. The aim of this study was to translate the PFSDQ-M into Swedish and test it twice on 30 people to make a test-retest assessment. The aim was also to evaluate the interviewees' experience of filling in the form. Agreement between the assessments was examined by percentage agreement (PA) and unweighted kappa value (k). The test-retest shows the complexity of evaluating the influence of dyspnea and fatigue in performing activities. It was easier to reach agreement in a five-point scale compared to an eleven-point scale. When it comes to screening people with COPD, the PFSDQ-M can be a valuable instrument for detecting individuals who require occupational therapy.
Collapse
Affiliation(s)
- Ann Wingårdh
- Department of Occupational Therapy, The Sahlgrenska Academy at Goteborg University, Goteborg, Sweden.
| | | | | |
Collapse
|
46
|
|
47
|
Heinzer MMV, Bish C, Detwiler R. The moved to evidenced-based practice from a clinical nursing question. JOURNAL FOR NURSES IN STAFF DEVELOPMENT : JNSD : OFFICIAL JOURNAL OF THE NATIONAL NURSING STAFF DEVELOPMENT ORGANIZATION 2007; 23:293-297. [PMID: 18043339 DOI: 10.1097/01.nnd.0000300837.84653.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Registered nurses on a medical unit questioned whether current practice adequately met the emotional needs of patients with chronic obstructive pulmonary disease hospitalized for acute dyspnea. The unit's education committee surveyed nursing staff regarding priority nursing activities during dyspneic episodes. After discussion with staff development educators, several registered nurses met with the center's nurse researcher, formed a research team, and designed a descriptive study. Findings of the study gave evidence for clinical practice change and revision of care guidelines.
Collapse
Affiliation(s)
- Marjorie M V Heinzer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA.
| | | | | |
Collapse
|
48
|
Patel H, Shafazand M, Schaufelberger M, Ekman I. Reasons for seeking acute care in chronic heart failure. Eur J Heart Fail 2007; 9:702-8. [DOI: 10.1016/j.ejheart.2006.11.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 09/13/2006] [Accepted: 11/09/2006] [Indexed: 11/27/2022] Open
Affiliation(s)
- Harshida Patel
- Institute of Health and Care Sciences; Sahlgrenska Academy at Göteborg University; Sweden
- The Vårdal Institute; Göteborg University; Göteborg Sweden
| | - Masoud Shafazand
- Institute of Medicine; Sahlgrenska UniversitetssjukhusetÖstra; Göteborg Sweden
| | | | - Inger Ekman
- Institute of Health and Care Sciences; Sahlgrenska Academy at Göteborg University; Sweden
| |
Collapse
|
49
|
Michaels C. Content validity and the language of breathing. Heart Lung 2006; 35:405-11. [PMID: 17137942 DOI: 10.1016/j.hrtlng.2006.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study objective was to validate the content validity of natural language words and phrases selected from participant logs as breathing-intensity descriptors. DESIGN AND SETTING A descriptive design was implemented using data collected in a prior study in which the breathing-intensity descriptors had been identified. METHODS Content validity was used to rate natural language breathing-intensity descriptors. Six seasoned nurses with a minimum of master's preparation served as the expert panel. On the basis of a 4-point (0-3) scale, mean scores were calculated for natural language breathing-intensity descriptors. Content validity was established for mean scores greater than 1.0. RESULTS A total of 66 (89%) natural language breathing-intensity descriptors were validated. The experts did not validate eight descriptors that described the lower end of breathing intensity. CONCLUSIONS Natural language breathing-intensity descriptors were validated. The highest validation scores were achieved with breathing-intensity descriptors at the upper end of the breathing-intensity spectrum. However, words and phrases that aligned with the lower end of the spectrum generated lower content validity scores. This was an unexpected finding on the full spectrum of breathing intensity that raised questions about differences in language, meaning, and significance between participants and experts.
Collapse
|
50
|
Abstract
Dyspnea, defined as uncomfortable or labored breathing, is a common and often devastating cause of distress for patients and their caregivers with advanced cancer and other life-threatening illnesses. The mechanism by which dyspnea develops is not fully understood, but it involves integration of the central respiratory complex with the sensory (perceptual) cortex. The gold standard of diagnosis is patient self-report. Careful assessment should be undertaken to identify reversible existing causes. Systemic opioids are the first-line therapy for symptomatic management, along with other general comfort measures (positioning, cool air, calming environment). Medical or surgical management can be directed toward underlying causes. Advanced care planning should include discussions concerning the burdens and benefits of medical/surgical management of underlying causes of dyspnea to more effectively direct goals of care. This article reviews current literature on dyspnea, with a focus on items published since 2000.
Collapse
|