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Evans R, Pick A, Lardner R, Masey V, Smith N, Greenhalgh T. Breathing difficulties after covid-19: a guide for primary care. BMJ 2023; 381:e074937. [PMID: 37315957 DOI: 10.1136/bmj-2023-074937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Rachael Evans
- National Institute for Health Research Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Anton Pick
- Long Covid Clinic, Churchill Hospital, Oxford OX3 7LE, UK
| | - Rachel Lardner
- Long Covid Clinic, Churchill Hospital, Oxford OX3 7LE, UK
| | - Vicki Masey
- Long Covid Clinic, Churchill Hospital, Oxford OX3 7LE, UK
| | - Nikki Smith
- Person with long covid, Windsor, Berkshire, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford
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2
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Larsen KSR, Lisby M, Kirkegaard H, Petersen AK. Functional decline in emergency department patients with dyspnea: a register-based cohort. Int J Qual Health Care 2021; 33:6174034. [PMID: 33724379 DOI: 10.1093/intqhc/mzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably, patients acutely admitted to hospital with dyspnea have a high risk of functional decline. OBJECTIVE The aim of this study was to describe patient characteristics, hospital trajectory and use of physiotherapy services by dyspneic patients in an emergency department. The study also wanted to compare readmission and death among patients with and without a functional decline and to identify predictors of functional decline. METHODS Data originated from a historic cohort of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients who were treated at the emergency department (ED) for dyspnea in 2015. The main outcome measures were readmission, death and functional decline. RESULTS In total, 2048 dyspneic emergency treatments were registered. Within 30 days after discharge, 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, P < 0.001) and mortality (9.3% vs. 3.6%, P = 0.009) as well as mortality within 1 year (36.1% vs. 13.4%, P < 0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. CONCLUSION Patients suffering from acute dyspnea are seen at the ED at all hours. In total, one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seem to be particularly vulnerable.
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Affiliation(s)
- Karoline Stentoft Rybjerg Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, Aarhus 8200, Central Denmark Region, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark
| | - Marianne Lisby
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark.,Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, Aarhus 8200, Central Denmark Region, Denmark
| | - Hans Kirkegaard
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark.,Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, Aarhus 8200, Central Denmark Region, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, Aarhus 8200, Central Denmark Region, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark
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3
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Hegendörfer E, Doukhopelnikoff A, Degryse JM. Validity and reliability of the Multidimensional Dyspnoea Profile in older adults. ERJ Open Res 2021; 7:00606-2020. [PMID: 33855062 PMCID: PMC8039901 DOI: 10.1183/23120541.00606-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Breathlessness is a common and distressing symptom in older adults and an independent predictor of adverse outcomes and yet its multidimensional assessment has not been validated in older adults. We apply and validate the Multidimensional Dyspnoea Profile (MDP) in a sample of adults 75 years and older in Belgium. Breathlessness was rated with the MDP, the modified Borg Dyspnoea Scale (mBDS), the Short Physical Performance Battery (SPPB, a numerical rating scale for intensity and unpleasantness both before and after exertion), as well as with the Medical Research Council (MRC) Dyspnoea Scale. The Hospital Anxiety and Depression Scale (HADS) assessed the affective status. Factor structure was analysed with exploratory principal components analysis, internal consistency with Cronbach's alpha and concurrent validity with Spearman's correlation coefficients with other breathlessness scales, HADS and SPPB scores. In 96 participants (mean age 85 years; 34% men) who rated breathlessness at both assessment points, exploratory principal components analysis identified two components: Immediate Perception (IP) and Emotional Reaction (ER), explaining most of the MDP item variance (65.37% before and 71.32% after exertion). Internal consistency was moderate to high for MDP-IP (Cronbach's alpha = 0.86 before and 0.89 after exertion) and MDP-ER (Cronbach's alpha = 0.89 before and 0.91 after exertion). The correlation patterns of MDP-IP and MDP-ER with other tests confirmed concurrent validity. The domain structure, reliability and concurrent validity of MDP for breathlessness before and after exertion were confirmed in a sample of adults 75 years and older, supporting its use and further research for the multidimensional profiling of breathlessness in older adults. Domain structure, reliability and concurrent validity of the MDP were confirmed in a sample of adults aged ≥75 years before and after exertion, supporting its use for the multidimensional assessment of breathlessness in this age grouphttps://bit.ly/3emiNRW
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Affiliation(s)
- Eralda Hegendörfer
- Dept of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Belgium.,Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Belgium
| | | | - Jean-Marie Degryse
- Dept of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Belgium.,Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Belgium
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4
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Dempsey JA, La Gerche A, Hull JH. Is the healthy respiratory system built just right, overbuilt, or underbuilt to meet the demands imposed by exercise? J Appl Physiol (1985) 2020; 129:1235-1256. [PMID: 32790594 DOI: 10.1152/japplphysiol.00444.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the healthy, untrained young adult, a case is made for a respiratory system (airways, pulmonary vasculature, lung parenchyma, respiratory muscles, and neural ventilatory control system) that is near ideally designed to ensure a highly efficient, homeostatic response to exercise of varying intensities and durations. Our aim was then to consider circumstances in which the intra/extrathoracic airways, pulmonary vasculature, respiratory muscles, and/or blood-gas distribution are underbuilt or inadequately regulated relative to the demands imposed by the cardiovascular system. In these instances, the respiratory system presents a significant limitation to O2 transport and contributes to the occurrence of locomotor muscle fatigue, inhibition of central locomotor output, and exercise performance. Most prominent in these examples of an "underbuilt" respiratory system are highly trained endurance athletes, with additional influences of sex, aging, hypoxic environments, and the highly inbred equine. We summarize by evaluating the relative influences of these respiratory system limitations on exercise performance and their impact on pathophysiology and provide recommendations for future investigation.
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Affiliation(s)
- Jerome A Dempsey
- John Robert Sutton Professor of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia.,National Center for Sports Cardiology, St. Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Institute of Sport, Exercise and Health (ISEH), University College London, United Kingdom
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5
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Molgat-Seon Y, Ramsook AH, Peters CM, Schaeffer MR, Dominelli PB, Romer LM, Road JD, Guenette JA, Sheel AW. Manipulation of mechanical ventilatory constraint during moderate intensity exercise does not influence dyspnoea in healthy older men and women. J Physiol 2019; 597:1383-1399. [PMID: 30578651 DOI: 10.1113/jp277476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/17/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The perceived intensity of exertional breathlessness (i.e. dyspnoea) is higher in older women than in older men, possibly as a result of sex-differences in respiratory system morphology. During exercise at a given absolute intensity or minute ventilation, older women have a greater degree of mechanical ventilatory constraint (i.e. work of breathing and expiratory flow limitation) than their male counterparts, which may lead to a greater perceived intensity of dyspnoea. Using a single-blind randomized study design, we experimentally manipulated the magnitude of mechanical ventilatory constraint during moderate-intensity exercise at ventilatory threshold in healthy older men and women. We found that changes in the magnitude of mechanical ventilatory constraint within the physiological range had no effect on dyspnoea in healthy older adults. When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. ABSTRACT We aimed to determine the effect of manipulating mechanical ventilatory constraint during submaximal exercise on dyspnoea in older men and women. Eighteen healthy subjects (aged 60-80 years; nine men and nine women) completed two days of testing. On day 1, subjects were assessed for pulmonary function and performed a maximal incremental cycle exercise test. On day 2, subjects performed three 6-min bouts of cycling at ventilatory threshold, in a single-blind randomized manner, while breathing: (i) normoxic helium-oxygen (HEL) to reduce the work of breathing (Wb ) and alleviate expiratory flow limitation (EFL); (ii) through an inspiratory resistance (RES) of ∼5 cmH2 O L-1 s-1 to increase Wb ; and (iii) ambient air as a control (CON). Oesophageal pressure, diaphragm electromyography, and sensory responses (category-ratio 10 Borg scale) were monitored throughout exercise. During the HEL condition, there was a significant decrease in Wb (men: -21 ± 6%, women: -17 ± 10%) relative to CON (both P < 0.01). Moreover, if EFL was present during CON (four men and five women), it was alleviated during HEL. Conversely, during the RES condition, Wb (men: 42 ± 19%, women: 50 ± 16%) significantly increased relative to CON (both P < 0.01). There was no main effect of sex on Wb (P = 0.59). Across conditions, women reported significantly higher dyspnoea intensity than men (2.9 ± 0.9 vs. 1.9 ± 0.8 Borg scale units, P < 0.05). Despite significant differences in the degree of mechanical ventilatory constraint between conditions, the intensity of dyspnoea was unaffected, independent of sex (P = 0.46). When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea.
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Affiliation(s)
- Yannick Molgat-Seon
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carli M Peters
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Paolo B Dominelli
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada.,Mayo Clinic, Rochester, MN, USA
| | - Lee M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, Uxbridge, UK.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
| | - Jeremy D Road
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jordan A Guenette
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - A William Sheel
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
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6
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Zhu Y, Chen X, Yang X, El-Hashash A. Stem cells in lung repair and regeneration: Current applications and future promise. J Cell Physiol 2018; 233:6414-6424. [PMID: 29271480 DOI: 10.1002/jcp.26414] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/19/2017] [Indexed: 12/18/2022]
Abstract
Lung diseases are major cause of morbidity and mortality worldwide. The progress in regenerative medicine and stem cell research in the lung are currently a fast-growing research topic that can provide solutions to these major health problems. Under normal conditions, the rate of cellular proliferation is relatively low in the lung in vivo, compared to other major organ systems. Lung injury leads to the activation of stem/progenitor cell populations that re-enter the cell cycle. Yet, little is known about stem cells in the lung, despite common thoughts that these cells could play a critical role in the repair of lung injuries. Nor do we fully understand the cellular and architectural complexity of the respiratory tract, and the diverse stem/progenitor cells that are involved in the lung repair and regeneration. In this review, we discuss the conceptual framework of lung stem/progenitor cell biology, and describe lung diseases, in which stem cell manipulations may be physiologically significant. In addition, we highlight the challenges of lung stem cell-based therapy.
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Affiliation(s)
- Yuqing Zhu
- Centre of Stem cell and Regenerative Medicine, Schools of Medicine and Basic Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao Chen
- Centre of Stem cell and Regenerative Medicine, Schools of Medicine and Basic Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xu Yang
- Section of Environmental Biomedicine, School of Life Science, Central China Normal University, Wuhan, Hubei, China
| | - Ahmed El-Hashash
- Centre of Stem cell and Regenerative Medicine, Schools of Medicine and Basic Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,University of Edinburgh-Zhejiang University Institute (UoE-ZJU Institute), Haining, Zhejiang, China.,Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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7
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Molgat-Seon Y, Dominelli PB, Ramsook AH, Schaeffer MR, Molgat Sereacki S, Foster GE, Romer LM, Road JD, Guenette JA, Sheel AW. The effects of age and sex on mechanical ventilatory constraint and dyspnea during exercise in healthy humans. J Appl Physiol (1985) 2017; 124:1092-1106. [PMID: 29357513 DOI: 10.1152/japplphysiol.00608.2017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We examined the effects of age, sex, and their interaction on mechanical ventilatory constraint and dyspnea during exercise in 22 older (age = 68 ± 1 yr; n = 12 women) and 22 younger (age = 25 ± 1 y, n = 11 women) subjects. During submaximal exercise, older subjects had higher end-inspiratory (EILV) and end-expiratory (EELV) lung volumes than younger subjects (both P < 0.05). During maximal exercise, older subjects had similar EILV ( P > 0.05) but higher EELV than younger subjects ( P < 0.05). No sex differences in EILV or EELV were observed. We noted that women had a higher work of breathing (Wb) for a given minute ventilation (V̇e) ≥65 l/min than men ( P < 0.05) and older subjects had a higher Wb for a given V̇e ≥60 l/min ( P < 0.05). No sex or age differences in Wb were present at any submaximal relative V̇e. At absolute exercise intensities, older women experienced expiratory flow limitation (EFL) more frequently than older men ( P < 0.05), and older subjects were more likely to experience EFL than younger subjects ( P < 0.05). At relative exercise intensities, women and older individuals experienced EFL more frequently than men and younger individuals, respectively (both P < 0.05). There were significant effects of age, sex, and their interaction on dyspnea intensity during exercise at absolute, but not relative, intensities (all P < 0.05). Across subjects, dyspnea at 80 W was significantly correlated with indexes of mechanical ventilatory constraint (all P < 0.05). Collectively, our findings suggest age and sex have significant impacts on Wb, operating lung volumes, EFL, and dyspnea during exercise. Moreover, it appears that mechanical ventilatory constraint may partially explain sex differences in exertional dyspnea in older individuals. NEW & NOTEWORTHY We found that age and sex have a significant effect on mechanical ventilatory constraint and the perception of dyspnea during exercise. We also observed that the perception of exertional dyspnea is associated with indexes of mechanical ventilatory constraint. Collectively, our results suggest that the combined influences of age and biological sex on mechanical ventilatory constraint during exercise contributes, in part, to the increased perception of dyspnea during exercise in older women.
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Affiliation(s)
- Yannick Molgat-Seon
- School of Kinesiology, University of British Columbia , Vancouver , Canada.,Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia , Vancouver , Canada
| | - Andrew H Ramsook
- Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - Michele R Schaeffer
- Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - Stéfan Molgat Sereacki
- Division of Family Medicine, Faculty of Medicine, University of British Columbia , Vancouver , Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada
| | - Lee M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Jeremy D Road
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia , Vancouver , Canada
| | - Jordan A Guenette
- Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver , Canada
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8
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Abstract
Dyspnea is due to an imbalance between the demand to breathe and the ability to breathe. The prevalence is ∼30% for those 65 years or older with walking on a level surface or up an incline. Dyspnea is a strong predictor of mortality in elderly individuals. Anemia, cardiovascular disease, deconditioning, psychological disorders, and respiratory diseases are common causes of dyspnea. Initial treatments to relieve breathing discomfort should be directed toward improving the pathophysiology of the underlying disease. Simple and inexpensive strategies to relieve dyspnea are available. This article provides an update on the evaluation of chronic dyspnea in elderly individuals.
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Affiliation(s)
- Donald A Mahler
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Department of Respiratory Services, Valley Regional Hospital, 243 Elm Street, Claremont, NH 03743, USA.
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9
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Geriatric dyspnea: doing worse, feeling better. Ageing Res Rev 2014; 15:94-9. [PMID: 24675044 DOI: 10.1016/j.arr.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/04/2014] [Accepted: 03/13/2014] [Indexed: 01/03/2023]
Abstract
Older age is associated with a decline in physical fitness and reduced efficiency of the respiratory system. Paradoxically, it is also related to reduced report of dyspnea, that is, the experience of difficult and uncomfortable breathing. Reduced symptom reporting contributes to misdiagnosis or late diagnosis of underlying disease, suboptimal treatment, faster disease progression, shorter life expectancy, lower quality of life for patients, and considerably increased costs for the health care system in an aging society. However, pathways in the complex relationship between dyspnea and age are not well explored yet. We propose a model on geriatric dyspnea that integrates physiological, neurological, psychological and social pathways which link older age with dyspnea perception and expression. We suggest that the seemingly paradox of reduction of dyspnea in older age, despite physiological decline, can be solved by taking age-related changes on these multiple levels into account. In identifying these variables, the Geriatric Dyspnea Model highlights risk factors for reduced dyspnea perception and report in older age and pathways for intervention.
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10
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Harver A, Schwartzstein RM, Kotses H, Humphries CT, Schmaling KB, Mullin ML. Descriptors of breathlessness in children with persistent asthma. Chest 2010; 139:832-838. [PMID: 21183610 DOI: 10.1378/chest.10-2388] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In adult patients, the consistent use of language to describe dyspnea enhances patient-provider communication and contributes to diagnostic and therapeutic decisions. The objective of this research was to determine whether pediatric patients similarly display consistency in the language used to describe "uncomfortable awareness of breathing." METHODS One hundred children between the ages of 8 and 15 years with moderate to severe persistent asthma enrolled in an asthma education research program completed questionnaires regarding descriptors of asthma on each of two occasions. In addition to the breathlessness questionnaires, demographic information, self-reported asthma severity, ED visits, missed school days, anthropometrics, and spirometry were obtained for each participant. RESULTS Children were reliable in their choice of the descriptors that they applied to their breathing discomfort across two occasions, and they selected the same descriptors that were used by adults with asthma in previous studies. Children with greater self-reported asthma severity endorsed more descriptors to characterize breathing discomfort than did children with less severe asthma, but no differences were found among children based on demographic or anthropometric variables. CONCLUSIONS Children with moderate to severe persistent asthma are reliable in their choice of descriptors of breathlessness. Knowledge of their experience of symptoms may be helpful clinically in the assessment and management of asthma.
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Affiliation(s)
- Andrew Harver
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, NC.
| | - Richard M Schwartzstein
- Harvard Medical School and Division of Pulmonary Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Harry Kotses
- Department of Psychology, Ohio University, Athens, OH
| | - C Thomas Humphries
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, NC; Asthma and Allergy Specialists, P.A., Charlotte, NC
| | - Karen B Schmaling
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, NC
| | - Melanie Lee Mullin
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, NC
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11
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Bom AT, Pinto AM. Allergic respiratory diseases in the elderly. Respir Med 2009; 103:1614-22. [PMID: 19570668 DOI: 10.1016/j.rmed.2009.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/28/2009] [Accepted: 06/01/2009] [Indexed: 11/18/2022]
Abstract
In industrialized countries there has been a significant increase in life expectancy, but chronic diseases are still important causes of death and disability in the elderly. Individuals over 65 years of age have a decrease in organic functions and lungs can lose more than 40% of their capacity. Although asthma and allergic rhinitis are more common in young people their prevalence in the elderly is increasing and the mortality reported in these patients is high. Asthmatic airways show an accumulation of activated eosinophils and lymphocytes determining structural changes of the bronchi. Local allergic inflammation, changes in T cell phenotypes and in apoptosis contribute to systemic inflammation. An increased risk of respiratory infections and neoplasic diseases has been recognized. These patients have increased susceptibility to atherosclerosis and cardiovascular diseases. Metabolic diseases are associated with an impairment of lung function and with systemic inflammation. Summing up older asthmatic patients have an increased risk to premature disability and death. A proper therapeutic approach to asthma can minimize this evolution. To identify the triggers is an important goal that allows reducing medication needs. Corticosteroids dampen allergic inflammation; therefore, they are the first choice in the treatment of patients with persistent asthma and rhinitis. Second-generation H1 receptor antagonists have reduced side effects and can be used if necessary. The elderly may have difficult access to health care. They should be educated about their disease and receive a written treatment plan. This information improves the quality of life, socialization and disease outcome in older people.
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Affiliation(s)
- A Todo Bom
- Immuno Allergology Department, Coimbra University Hospital, Portugal.
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12
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Jensen D, Ofir D, O’Donnell DE. Effects of pregnancy, obesity and aging on the intensity of perceived breathlessness during exercise in healthy humans. Respir Physiol Neurobiol 2009; 167:87-100. [DOI: 10.1016/j.resp.2009.01.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 01/26/2009] [Accepted: 01/30/2009] [Indexed: 11/29/2022]
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13
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Bonomo L, Larici AR, Maggi F, Schiavon F, Berletti R. Aging and the respiratory system. Radiol Clin North Am 2008; 46:685-702, v-vi. [PMID: 18922288 DOI: 10.1016/j.rcl.2008.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the elderly, the chest without evident pathology is characterized by findings that occupy a sort of "no man's land" between the normal and the pathologic. Aging results in physiologic modifications that must be recognized so as not to be interpreted erroneously as pathologies. On the other hand, the elderly tend to become ill more frequently and multipathologies are more frequent. Image diagnostics is a key element in the clarification of often blurry clinical pictures, which may make early diagnosis possible, a great advantage to timely treatment. In this sense, knowledge of heart/lung interactions makes it possible to obtain, from the onset, radiologic and clinical signs of the two physiopathologic models prevalent in the elderly, the "cardiac lung" and the "pulmonary heart."
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Affiliation(s)
- Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli, L.go F. Vito 8, 00168 Rome, Italy.
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14
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15
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Abstract
Dyspnea is among the most frequent complaints in the elderly. The prevalence of comorbid medical conditions and the physiologic changes of aging present significant challenges in determining the cause. The initial approach to the elderly dyspneic patient mandates consideration of a broad range of diagnoses. Failure to diagnose life-threatening medical conditions presenting with dyspnea such as pulmonary embolus, acute coronary syndromes, congestive heart failure, asthma, obstructive pulmonary disease, pneumothorax, and pneumonia can lead significant morbidity and mortality. This article focuses on the rapid assessment and approach to the acutely dyspneic elderly patient.
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Affiliation(s)
- Mercedes Torres
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA
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16
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Yates MW. How is the diagnosis of asthma in older people established in clinical practice? Med J Aust 2006; 183:S44-6. [PMID: 15992324 DOI: 10.5694/j.1326-5377.2005.tb06919.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 04/11/2005] [Indexed: 11/17/2022]
Abstract
WHAT WE NEED TO KNOW: How is breathlessness perceived and defined in older people? What impact does breathlessness have on quality of life? Can history taking and physical examination be tailored to efficiently cover all the organ systems associated with breathlessness? Can a self- or carer-rated questionnaire be used to identify asthma in patients with breathlessness? WHAT WE NEED TO DO: Develop self- and carer-rated questionnaires that measure change in function and quality of life before and after treatment. Validate objective measures of physical function and airflow that are sufficiently sensitive to measure change with treatment. Develop a diagnostic guideline in general practice that includes measures of mood and cognitive function and involves carers where necessary. Provide rehabilitation and restorative care services.
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Affiliation(s)
- Mark W Yates
- Subacute Medicine, Ballarat Health Services, 102 Acsot Street South, Ballarat, VIC 3350, Australia.
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Di Bari M, Pozzi C, Cavallini MC, Innocenti F, Baldereschi G, De Alfieri W, Antonini E, Pini R, Masotti G, Marchionni N. The diagnosis of heart failure in the community. J Am Coll Cardiol 2004; 44:1601-8. [PMID: 15489092 DOI: 10.1016/j.jacc.2004.07.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 06/24/2004] [Accepted: 07/05/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We sought to compare construct and predictive validity of four sets of heart failure (HF) diagnostic criteria in an epidemiologic setting. BACKGROUND The prevalence estimates of HF vary broadly depending on the diagnostic criteria. METHODS Data were collected in a survey of community dwellers who were > or =65 years of age living in Dicomano, Italy. At baseline, HF was diagnosed with the criteria of the Framingham, Boston, and Gothenburg studies and of the European Society of Cardiology (ESC). Left ventricular mass index and ejection fraction, left atrium systolic dimension, lower extremity mobility disability, summary physical performance score, and 6-min walk test were compared between HF and non-HF participants to test for construct validity of each set of criteria. Predictive validity was evaluated with follow-up assessment of cardiovascular mortality, incident disability, and HF-related hospitalizations. Comparisons were adjusted for demographics, comorbidity, and psychoaffective status. RESULTS Of 553 participants, 11.9%, 10.7%, 20.8%, and 9.0% had HF, according to Framingham, Boston, Gothenburg, and ESC criteria, respectively. In terms of construct validity, Framingham and Boston criteria discriminated HF from non-HF participants better than Gothenburg and ESC criteria across the measures of cardiac function and global performance. The Boston criteria showed a superior predictive validity because they indicated a significantly greater adjusted risk of cardiovascular death (hazard ratio3.9, 95% confidence interval 1.2 to 13.2), incident disability, and hospitalizations in participants with HF. CONCLUSIONS The Boston criteria are preferable to Framingham, Gothenburg, and ESC criteria for the diagnosis of HF in older community dwellers because they have good construct validity and more accurately predict cardiovascular death, incident disability, and hospitalizations.
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Affiliation(s)
- Mauro Di Bari
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, via delle Oblate 4, 50141 Florence, Italy.
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Neuringer IP, Randell SH. Stem cells and repair of lung injuries. Respir Res 2004; 5:6. [PMID: 15285789 PMCID: PMC499549 DOI: 10.1186/1465-9921-5-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Accepted: 07/20/2004] [Indexed: 11/28/2022] Open
Abstract
Fueled by the promise of regenerative medicine, currently there is unprecedented interest in stem cells. Furthermore, there have been revolutionary, but somewhat controversial, advances in our understanding of stem cell biology. Stem cells likely play key roles in the repair of diverse lung injuries. However, due to very low rates of cellular proliferation in vivo in the normal steady state, cellular and architectural complexity of the respiratory tract, and the lack of an intensive research effort, lung stem cells remain poorly understood compared to those in other major organ systems. In the present review, we concisely explore the conceptual framework of stem cell biology and recent advances pertinent to the lungs. We illustrate lung diseases in which manipulation of stem cells may be physiologically significant and highlight the challenges facing stem cell-related therapy in the lung.
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Affiliation(s)
- Isabel P Neuringer
- Assistant Professor, Division of Pulmonary and Critical Care Medicine and Cystic Fibrosis/Pulmonary Research and Treatment Center, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Scott H Randell
- Assistant Professor, Division of Pulmonary and Critical Care Medicine, Cystic Fibrosis/Pulmonary Research and Treatment Center and Department of Cellular and Molecular Physiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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