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Vermeer CJC, Groenewegen A, Hollander M, Schuring J, Looijmans-van den Akker I, Oostindjer A, van Duijn H, Nederend I, Rutten FH. Comparing the diagnostic considerations between general practitioners with a special interest in cardiovascular disease and those without in patients with symptoms suggestive of heart failure: a vignette study. BMC PRIMARY CARE 2024; 25:216. [PMID: 38877394 PMCID: PMC11177529 DOI: 10.1186/s12875-024-02466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND General practitioners (GPs) specialized in cardiovascular disease (GPSI-CVD) may suspect heart failure (HF) more easily than GPs not specialized in CVD. We assessed whether GPSI-CVD consider investigations aimed at detecting HF more often than other GPs in two clinical scenarios of an older male person with respiratory and suggestive HF symptoms. METHODS In this vignette study, Dutch GPs evaluated two vignettes. The first involved a 72-year-old man with hypertension and a 30 pack-year smoking history who presented himself with symptoms of a common cold, but also shortness of breath, reduced exercise tolerance, and signs of fluid overload. The second vignette was similar but now the 72-year-old man was known with chronic obstructive pulmonary disease (COPD). GPs could select diagnostic tests from a multiple-choice list with answer options targeted at HF, COPD or exacerbation of COPD, or lower respiratory tract infection. With Pearson Chi-square or Fisher's exact test differences between the two GP groups were assessed regarding the chosen diagnostic tests. RESULTS Of the 148 participating GPs, 25 were GPSI-CVD and 123 were other GPs. In the first vignette, GPSI-CVD more often considered performing electrocardiography (ECG) than other GPs (64.0% vs. 32.5%, p = 0.003). In the second vignette, GPSI-CVD were more inclined to perform both ECG (36.0% vs. 12.2%, p = 0.003) and natriuretic peptide testing (56.0% vs. 32.5%, p = 0.006). CONCLUSIONS Most GPs seemed to consider multiple diagnoses, including HF, with GPSI-CVD more likely performing ECG and natriuretic peptide testing in an older male person with both respiratory and suggestive HF symptoms.
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Affiliation(s)
- Cornelia J C Vermeer
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Amy Groenewegen
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monika Hollander
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Leidsche Rijn Julius Healthcare Centers, Utrecht, The Netherlands
| | - Janneke Schuring
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ingrid Looijmans-van den Akker
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Leidsche Rijn Julius Healthcare Centers, Utrecht, The Netherlands
| | | | | | | | - Frans H Rutten
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Petrie K, Abramson MJ, George J. Smoking, respiratory symptoms, lung function and life expectancy: A longitudinal study of ageing. Respirology 2024; 29:471-478. [PMID: 38403987 DOI: 10.1111/resp.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Prognostic indices have been developed to predict various outcomes, including mortality. These indices and hazard ratios may be difficult for patients to understand. We investigated the association between smoking, respiratory symptoms and lung function with remaining life expectancy (LE) in older adults. METHODS Data were from the 2004/05 English Longitudinal Study of Ageing (ELSA) (n = 8930), participants aged ≥50-years, with mortality data until 2012. Respiratory symptoms included were chronic phlegm and shortness of breath (SOB). The association between smoking, respiratory symptoms and FEV1/FVC, and remaining LE was estimated using a parametric survival function and adjusted for covariates including age at baseline and sex. RESULTS The extent to which symptoms and FEV1/FVC predicted differences in remaining LE varied by smoking. Compared to asymptomatic never smokers with normal lung function (the reference group), in never smokers, only those with SOB had a significant reduction in remaining LE. In former and current smokers, those with respiratory symptoms had significantly lower remaining LE compared to the reference group if they had FEV1/FVC <0.70 compared to those with FEV1/FVC ≥0.70. Males aged 50-years, current smokers with SOB and FEV1/FVC <0.70, had a remaining LE of 19.2 (95%CI: 16.5-22.2) years, a decrease of 8.1 (5.3-10.8) years, compared to the reference group. CONCLUSION Smoking, respiratory symptoms and FEV1/FVC are strongly associated with remaining LE in older people. The use of remaining LE to communicate mortality risk to patients needs further investigation.
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Affiliation(s)
- Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Goh JT, Balmain BN, Wilhite DP, Granados J, Sandy LL, Liu YL, Pawelczyk JA, Babb TG. Elevated risk of dyspnea in adults with obesity. Respir Physiol Neurobiol 2023; 318:104151. [PMID: 37673304 PMCID: PMC11087888 DOI: 10.1016/j.resp.2023.104151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/08/2023]
Abstract
We investigated whether older adults (OA) with obesity are more likely to have dyspnea compared with OA without obesity, and whether OA with obesity are at a greater risk of having dyspnea compared with middle-aged (MA) and younger adults (YA) with obesity. We obtained de-identified data from the TriNetX UT Southwestern Medical Center database. We identified obesity and dyspnea using ICD-10-CM codes E66 and R06.0, respectively. Patients were separated into three age groups: OA, (65-75 y.o.), MA (45-55 y.o.), and YA (25-35 y.o). Within these groups, those with and without obesity or dyspnea were identified for analysis. The risk of dyspnea was greater in OA (risk ratio: 3.64), MA (risk ratio: 3.52), and YA (risk ratio: 2.76) with obesity compared with age-matched patients without obesity (all p < 0.01). The risk of dyspnea was greater in OA and MA with obesity compared with YA with obesity (both p < 0.001 vs. YA). These findings suggest that clinicians should consider obesity as an independent risk factor for dyspnea.
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Affiliation(s)
- Josh T Goh
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel P Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jorge Granados
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lydia L Sandy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yu-Lun Liu
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A Pawelczyk
- Noll Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Müller A, Mraz T, Wouters EF, van Kuijk SM, Amaral AF, Breyer-Kohansal R, Breyer MK, Hartl S, Janssen DJ. Prevalence of dyspnea in general adult populations: A systematic review and meta-analysis. Respir Med 2023; 218:107379. [PMID: 37595674 DOI: 10.1016/j.rmed.2023.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Dyspnea is a commonly described symptom in various chronic and acute conditions. Despite its frequency, relatively little is known about the prevalence and assessment of dyspnea in general populations. The aims of this review were: 1) to estimate the prevalence of dyspnea in general adult populations; 2) to identify associated factors; and 3) to identify used methods for dyspnea assessment. METHODS A systematic literature search was conducted using MEDLINE/PubMed, Embase, CINAHL and JAMA network. Records were screened by two independent reviewers and quality was assessed by using the Joanna Briggs Institute checklist for risk of bias in prevalence studies. Multi-level meta-analysis was performed to estimate pooled prevalence. The protocol was registered on PROSPERO (CRD42021275499). RESULTS Twenty original articles, all from studies in high-income countries, met the criteria for inclusion. Overall, their quality was good. Pooled prevalence of dyspnea in general adult populations based on 11 studies was 10% (95% CI 7, 15), but heterogeneity across studies was high. The most frequently reported risk factors were increasing age, female sex, higher BMI and respiratory or cardiac disease. The MRC or the modified MRC scale was the most used tool to assess dyspnea in general populations. CONCLUSIONS Dyspnea is a common symptom in adults in high-income countries. However, the high heterogeneity across studies and the lack of data from low- and middle-income countries limit the generalizability of our findings. Therefore, more research is needed to unveil the prevalence of dyspnea and its main risk factors in general populations around the world.
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Affiliation(s)
- Alexander Müller
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
| | - Tobias Mraz
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna Healthcare Group, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Emiel Fm Wouters
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Peter Debyeplein 1, 6229 HA, Maastricht, the Netherlands
| | - André Fs Amaral
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK; NIHR Imperial Biomedical Research Centre, The Bays, Entrance 2, South Wharf Road, St. Mary's Hospital, London, W2 1NY, UK
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Wolkersbergenstrasse 1, 1130, Vienna, Austria
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna Healthcare Group, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Daisy Ja Janssen
- Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands; Department of Research & Development, Ciro, Hornerheide 1, 6085 NM, Horn, the Netherlands
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Annaka H, Nomura T, Moriyama H. Association between cognitive decline and activities of daily living decline in patients undergoing long-term oxygen therapy: a prospective observational pilot study. Disabil Rehabil 2023; 45:3493-3499. [PMID: 36171683 DOI: 10.1080/09638288.2022.2127934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Patients undergoing long-term oxygen therapy (LTOT) are predisposed to progressive cognitive decline; however, the association between cognitive decline progression and activities of daily living (ADL) decline has not been described. We aimed to describe the association between cognitive decline progression and ADL decline in patients undergoing LTOT. MATERIALS AND METHODS In this prospective observational pilot study, data were collected at baseline and 1-year following the ambulatory recruitment of patients in the Department of Respiratory Medicine at the National Hospital Organization Nishiniigata Chuo Hospital. We recruited 96 patients with chronic respiratory disease undergoing LTOT, and 55 patients who completed a 1-year follow-up were finally included. RESULTS Multivariate logistic regression analysis revealed that Montreal Cognitive Assessment score reduction (a measure of cognitive decline) was associated with Barthel index score reduction (a measure of ADL) at 1-year follow-up (odds ratio: 3.98; 95% confidence interval: 1.16 - 13.69; p = 0.02). CONCLUSION A progression of cognitive decline in patients undergoing LTOT may affect ADL decline. An early detection of cognitive decline in patients undergoing LTOT is essential for ADL maintenance in rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPatients undergoing long-term oxygen therapy (LTOT) present with progressive cognitive decline.Cognitive decline progression is associated with a decline in activities of daily living in patients undergoing LTOT.A periodic cognitive assessment is important in rehabilitation practice for the early detection of progressive cognitive decline in patients undergoing LTOT.
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Affiliation(s)
- Hiroki Annaka
- Department of Occupational Therapy, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Niigata, Japan
- Graduate School, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Tomonori Nomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Hiroshi Moriyama
- Respiratory Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Niigata, Japan
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Aucoin R, Lewthwaite H, Ekström M, von Leupoldt A, Jensen D. Impact of trigeminal nerve and/or olfactory nerve stimulation on activity of human brain regions involved in the perception of breathlessness. Respir Physiol Neurobiol 2023; 311:104036. [PMID: 36804472 DOI: 10.1016/j.resp.2023.104036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
Breathlessness is a centrally processed symptom, as evidenced by activation of distinct brain regions such as the insular cortex and amygdala, during the anticipation and/or perception of breathlessness. Inhaled L-menthol or blowing cool air to the face/nose, both selective trigeminal nerve (TGN) stimulants, relieve breathlessness without concurrent improvements in physiological outcomes (e.g., breathing pattern), suggesting a possible but hitherto unexplored central mechanism of action. Four databases were searched to identify published reports supporting a link between TGN stimulation and activation of brain regions involved in the anticipation and/or perception of breathlessness. The collective results of the 29 studies demonstrated that TGN stimulation activated 12 brain regions widely implicated in the anticipation and/or perception of breathlessness, including the insular cortex and amygdala. Inhaled L-menthol or cool air to the face activated 75% and 33% of these 12 brain regions, respectively. Our findings support the hypothesis that TGN stimulation contributes to breathlessness relief by altering the activity of brain regions involved in its central neural processing.
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Affiliation(s)
- Rachelle Aucoin
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montréal, Quebec H2W 1S4, Canada.
| | - Hayley Lewthwaite
- College of Engineering, Science and Environment, School of Environment & Life Sciences, The University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258, Australia
| | - Magnus Ekström
- Department of Respiratory Medicine, Allergology and Palliative Medicine, Institution for Clinical Sciences in Lund, Lund University, SE-221 00 Lund, Sweden
| | - Andreas von Leupoldt
- Health Psychology, University of Leuven, Tiensestraat 102 Box 3726, 3000 Leuven, Belgium
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montréal, Quebec H2W 1S4, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, 2155 Guy Street Suite 500, Montréal, Quebec H3H 2R9, Canada
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Hegendörfer E, Degryse JM. Breathlessness in older adults: What we know and what we still need to know. J Am Geriatr Soc 2023. [PMID: 36929105 DOI: 10.1111/jgs.18326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/18/2023]
Abstract
Breathlessness is common among older adults, but it is often hidden as "normal aging "or considered narrowly as a symptom of cardio-respiratory diseases. Studies on breathlessness in older adults are mostly focused on specific diseases, whereas older adults are characterized by multimorbidity and multi-system age-related impairments. This article aims to provide an overview of what is known so far on breathlessness in the general population of older adults and identify areas for further research. Research shows that breathlessness in older adults is a multifactorial geriatric condition, crossing the borders of system-based impairments and diseases, and a valuable independent prognostic indicator for adverse outcomes. Further research needs to investigate (1) the multi-factorial mechanisms of breathlessness in community-dwelling older adults including the role of respiratory sarcopenia; (2) the influence of affective and cognitive changes of older age on the perception and report of breathlessness; (3) the best way to assess and use breathlessness for risk prediction of adverse outcomes in general geriatric assessments; and (4) the most appropriate multi-modal rehabilitation interventions and their outcomes. Clinicians need to shift their approach to dyspnea from a disease symptom to a multifactorial geriatric condition that should be proactively searched for, as it identifies higher risk for adverse outcomes, and can be addressed with evidence-based interventions that can improve the quality of life and may reduce the risk of adverse outcomes in older adults.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Leuven, Belgium.,Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Leuven, Belgium
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study. Chron Respir Dis 2023; 20:14799731231221820. [PMID: 38126966 DOI: 10.1177/14799731231221820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults. METHOD The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2). RESULTS Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively). CONCLUSIONS Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
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A systematic review on the effectiveness and impact of clinical decision support systems for breathlessness. NPJ Prim Care Respir Med 2022; 32:29. [PMID: 35987745 PMCID: PMC9392800 DOI: 10.1038/s41533-022-00291-x] [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: 03/14/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractBreathlessness is a common presenting symptom in practice. This systematic review aimed to evaluate the impact of CDSS on breathlessness and associated diseases in real-world clinical settings. Studies published between 1 January 2000 to 10 September 2021 were systematically obtained from 14 electronic research databases including CENTRAL, Embase, Pubmed, and clinical trial registries. Main outcomes of interest were patient health outcomes, provider use, diagnostic concordance, economic evaluation, and unintended consequences. The review protocol was prospectively registered in PROSPERO (CRD42020163141). A total of 4294 records were screened and 37 studies included of which 30 were RCTs. Twenty studies were in primary care, 13 in hospital outpatient/emergency department (ED), and the remainder mixed. Study duration ranged from 2 weeks to 5 years. Most were adults (58%). Five CDSS were focused on assessment, one on assessment and management, and the rest on disease-specific management. Most studies were disease-specific, predominantly focused on asthma (17 studies), COPD (2 studies), or asthma and COPD (3 studies). CDSS for COPD, heart failure, and asthma in adults reported clinical benefits such as reduced exacerbations, improved quality of life, improved patient-reported outcomes or reduced mortality. Studies identified low usage as the main barrier to effectiveness. Clinicians identified dissonance between CDSS recommendations and real-world practice as a major barrier. This review identified potential benefits of CDSS implementation in primary care and outpatient services for adults with heart failure, COPD, and asthma in improving diagnosis, compliance with guideline recommendations, promotion of non-pharmacological interventions, and improved clinical outcomes including mortality.
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Respiratory Symptoms among US Adults: a Cross-Sectional Health Survey Study. Pulm Ther 2022; 8:255-268. [PMID: 35794458 PMCID: PMC9458821 DOI: 10.1007/s41030-022-00194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/23/2022] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Data collected through ongoing, state-based, cross-sectional health surveys could be used to better understand the contribution of respiratory symptoms to impaired health among the US adult population. METHODS We used the 2015 Behavioral Risk Factor Surveillance System telephone health survey in four states (Kentucky, Florida, South Carolina, Texas) to describe the relationship between symptoms, associated factors such as tobacco smoking, and health impairments. Self-reported productive cough, shortness of breath (SOB), and dyspnea on exertion (DOE) were categorized as minimal, moderate, or severe. Data were analyzed using multiple logistic regression models with age as a covariate to assess relationships of symptoms with other factors. RESULTS Among adults ≥ 18 years, respiratory impairment [current asthma, chronic obstructive pulmonary disease (COPD), or a current moderate or severe symptom] occurred in 39.1% of the population. More than half of adults reporting moderate or severe symptoms had not been diagnosed with asthma or COPD, particularly with DOE and productive cough. Subjects were at greater risk of moderate and severe SOB or productive cough with increasing age, prolonged smoking duration (≥ 20 years), being an ever-smoker, or if reporting COPD, current asthma, or any other comorbidity except cancer. Morbid obesity [body mass index (BMI) > 35 kg/m2] was associated with severe DOE at a rate similar to current asthma or COPD (25.6%, 95% CI 20.9-30.3%; 20.8%, 95% CI 16.4-25.1%; 21.3%, 95% CI 17.5-25.1%, respectively); it was the most common cause of DOE. SOB was associated with worse general health impairment and limited ambulation compared with other symptoms. Tobacco smoking prevalence and race varied among states, affecting symptom prevalence. CONCLUSION In the largest US survey in decades, we provide a current perspective of respiratory symptoms among adults of all ages. While known risk factors were apparent, low-risk persons also frequently reported symptoms and impairments.
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Buarque GLA, Borim FSA, Neri AL, Yassuda MS, de Melo RC. Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study. SAO PAULO MED J 2022; 140:356-365. [PMID: 35508002 PMCID: PMC9671253 DOI: 10.1590/1516-3180.2021.0237.r2.27072021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Dyspnea is a symptom present in several chronic diseases commonly seen among older adults. Since individuals with dyspnea tend to stay at rest, with consequently reduced levels of physical activity, they are likely to be at greater risk of developing frailty, especially at older ages. DESIGN AND SETTING Cross-sectional study at community level, Brazil. OBJECTIVE To analyze the relationships between self-reported dyspnea, health conditions and frailty status in a sample of community-dwelling older adults. METHOD Secondary data from the follow-up of the Frailty in Brazilian Elderly (FIBRA) study, involving 415 community-dwelling older adults (mean age: 80.3 ± 4.68 years), were used. The variables analyzed were sociodemographic characteristics, reported dyspnea, clinical data and frailty phenotype. Associations between dyspnea and other variables (age, sex, education and body mass index) were verified through the crude (c) and adjusted (a) odds ratios. RESULTS The prevalence of dyspnea in the entire sample was 21.0%. Dyspnea was more present in individuals with pulmonary diseases, heart disease, cancer and depression. Older adults with multimorbidities (adjusted odds ratio, ORa = 2.91; 95% confidence interval, CI = 1.41-5.99) and polypharmacy (ORa = 2.02; 95% CI = 1.15-3.54) were more likely to have dyspnea. Those who reported dyspnea were 2.54 times more likely to be frail (ORa = 2.54; 95% CI = 1.08-5.97), and fatigue was their most prevalent phenotype component. CONCLUSION Dyspnea was associated with different diseases, multimorbidities, polypharmacy and frailty. Recognizing the factors associated with dyspnea may contribute to its early identification and prevention of its negative outcomes among older adults.
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Affiliation(s)
- Giselle Layse Andrade Buarque
- PT, MSc. Physiotherapist and Doctoral Student, Postgraduate Program on Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Flávia Silva Arbex Borim
- PT, PhD. Physiotherapist, Assistant Professor, Department of Collective Health, School of Health Sciences, Universidade de Brasília (UnB), Brasília (DF), Brazil; and Advisor, Postgraduate Program on Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Anita Liberalesso Neri
- PhD. Psychologist and Collaborating Professor, Department of Medical Psychology and Psychiatry and Advisor, Postgraduate Program on Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Mônica Sanches Yassuda
- PhD. Psychologist, Full Professor, School of Arts, Sciences and Humanities, and Advisor, Postgraduate Program on Gerontology, School of Arts, Sciences and Humanities, Universidade de São Paulo (USP), São Paulo (SP), Brazil; and Advisor, Postgraduate Program on Gerontology, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Ruth Caldeira de Melo
- PT, PhD. Physiotherapist and Assistant Professor, School of Arts, Sciences and Humanities, and Advisor, Postgraduate Program on Gerontology, School of Arts, Sciences and Humanities, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
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12
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Simões F, Bouveyron C, Piga D, Borel D, Descombes S, Paquis-Flucklinger V, Levraut J, Gibelin P, Bottini S. Cardiac dyspnea risk zones in the South of France identified by geo-pollution trends study. Sci Rep 2022; 12:1900. [PMID: 35115629 PMCID: PMC8813995 DOI: 10.1038/s41598-022-05827-2] [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: 02/23/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
The incidence of cardiac dyspnea (CD) and the distribution of pollution in the south of France suggests that environmental pollution may have a role in disease triggering. CD is a hallmark symptom of heart failure leading to reduced ability to function and engage in activities of daily living. To show the impact of short-term pollution exposure on the increment of CD emergency room visits, we collected pollutants and climate measurements on a daily basis and 43,400 events of CD in the Région Sud from 2013 to 2018. We used a distributed lag non-linear model (DLNM) to assess the association between air pollution and CD events. We divided the region in 357 zones to reconciliate environmental and emergency room visits data. We applied the DLNM on the entire region, on zones grouped by pollution trends and on singular zones. Each pollutant has a significant effect on triggering CD. Depending on the pollutant, we identified four shapes of exposure curves to describe the impact of pollution on CD events: early and late effect for NO2; U-shape and rainbow-shape (or inverted U) for O3; all the four shapes for PM10. In the biggest cities, O3 has the most significant association along with the PM10. In the west side, a delayed effect triggered by PM10 was found. Zones along the main highway are mostly affected by NO2 pollution with an increase of the association for a period up to 9 days after the pollution peak. Our results can be used by local authorities to set up specific prevention policies, public alerts that adapt to the different zones and support public health prediction-making. We developed a user-friendly web application called Health, Environment in PACA Region Tool (HEART) to collect our results. HEART will allow citizens, researchers and local authorities to monitor the impact of pollution trends on local public health.
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Affiliation(s)
- Fanny Simões
- Center of Modeling, Simulation and Interactions, Université Côte d'Azur, 151 Route de Saint Antoine de Ginestiere, 06200, Nice, France
| | - Charles Bouveyron
- Inria, CNRS, Laboratoire JA Dieudonné, Maasai Research Team, Université Côté d'Azur, Nice, France
| | | | | | - Stéphane Descombes
- Inria, CNRS, Laboratoire JA Dieudonné, Université Côté d'Azur, Nice, France
| | | | - Jaques Levraut
- Département Hospitalo-Universitaire de Médecine d'Urgence, Nice, France
| | - Pierre Gibelin
- Faculté de Médicine, Université Côte d'Azur, Nice, France
| | - Silvia Bottini
- Center of Modeling, Simulation and Interactions, Université Côte d'Azur, 151 Route de Saint Antoine de Ginestiere, 06200, Nice, France.
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13
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Doe G, Clanchy J, Wathall S, Chantrell S, Edwards S, Baxter N, Jackson D, Armstrong N, Steiner M, Evans RA. Feasibility study of a multicentre cluster randomised control trial to investigate the clinical and cost-effectiveness of a structured diagnostic pathway in primary care for chronic breathlessness: protocol paper. BMJ Open 2021; 11:e057362. [PMID: 34815293 PMCID: PMC8611440 DOI: 10.1136/bmjopen-2021-057362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Chronic breathlessness is a common and debilitating symptom, associated with high healthcare use and reduced quality of life. Challenges and delays in diagnosis for people with chronic breathlessness frequently occur, leading to delayed access to therapies. The overarching hypothesis is a symptom-based approach to diagnosis in primary care would lead to earlier diagnosis, and therefore earlier treatment and improved longer-term outcomes including health-related quality of life. This study aims to establish the feasibility of a multicentre cluster randomised controlled trial to assess the clinical and cost-effectiveness of a structured diagnostic pathway for breathlessness in primary care. METHODS AND ANALYSIS Ten general practitioner (GP) practices across Leicester and Leicestershire will be cluster randomised to either a structured diagnostic pathway (intervention) or usual care. The structured diagnostic pathway includes a panel of investigations within 1 month. Usual care will proceed with patient care as per normal practice. Eligibility criteria include patients presenting with chronic breathlessness for the first time, who are over 40 years old and without a pre-existing diagnosis for their symptoms. An electronic template triggered at the point of consultation with the GP will aid opportunistic recruitment in primary care. The primary outcome for this feasibility study is recruitment rate. Secondary outcome measures, including time to diagnosis, will be collected to help inform outcomes for the future trial and to assess the impact of an earlier diagnosis. These will include symptoms, health-related quality of life, exercise capacity, measures of frailty, physical activity and healthcare utilisation. The study will include nested qualitative interviews with patients and healthcare staff to understand the feasibility outcomes, explore what is 'usual care' and the study experience. ETHICS AND DISSEMINATION The Research Ethics Committee Nottingham 1 has provided ethical approval for this research study (REC Reference: 19/EM/0201). Results from the study will be disseminated by presentations at relevant meetings and conferences including British Thoracic Society and Primary Care Respiratory Society, as well as by peer-reviewed publications and through patient presentations and newsletters to patients, where available. TRIAL REGISTRATION NUMBER ISRCTN14483247.
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Affiliation(s)
- Gillian Doe
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Jill Clanchy
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Simon Wathall
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Stacey Chantrell
- NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah Edwards
- NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Noel Baxter
- International Primary Care Respiratory Group, London, UK
| | | | | | - Michael Steiner
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachael A Evans
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
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14
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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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15
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Karamercan MA, Dündar ZD, Ergin M, VAN Meer O, Body R, Harjola VP, Verschuren F, Christ M, Golea A, Capsec J, Barletta C, Garcia-Castrillo L, Altuncı YA, Katırcı Y, Kelly AM, Laribi S. Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study. Turk J Med Sci 2020; 50:1879-1886. [PMID: 32562519 PMCID: PMC7775711 DOI: 10.3906/sag-2002-221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background/aim To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods An observational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results The study included 2524 patients with a median age of 69 (53–80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.
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Affiliation(s)
| | - Zerrin Defne Dündar
- Department of Emergency Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Oene VAN Meer
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Richard Body
- Department of Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK,Department of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Veli-Pekka Harjola
- Department of Emergency Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Franck Verschuren
- Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Micheal Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Adela Golea
- Department of Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jean Capsec
- Department of Public Health, Tours University Hospital, Tours, France
| | - Cinzia Barletta
- Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy
| | | | - Yusuf Ali Altuncı
- Department of Emergency Medicine, Faculty of Medicine Hospital, Ege University, İzmir, Turkey
| | - Yavuz Katırcı
- Department of Emergency Medicine, Ankara Education and Research Hospital, Ankara, Turkey
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Australia,Department of Medicine, Melbourne Medical School – Western Precinct, The University of Melbourne, Melbourne, Australia
| | - Said Laribi
- Department of Emergency Medicine, Faculty of Medicine, Tours University, Tours, France
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16
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Breathlessness Isn't Cool, But Its Treatment Can Be. Chest 2020; 157:1401-1402. [PMID: 32505299 DOI: 10.1016/j.chest.2020.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 11/20/2022] Open
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17
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Trevisan C, Vianello A, Zanforlini BM, Curreri C, Maggi S, Noale M, De Rui M, Corti MC, Perissinotto E, Manzato E, Sergi G. The mutual association between dyspnea and depressive symptoms in older adults: a 4-year prospective study. Aging Ment Health 2020; 24:993-1000. [PMID: 30835502 DOI: 10.1080/13607863.2019.1582005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: dyspnea in daily living (DDL), night-time dyspnea (NTD) and depression are common symptoms in older people. However, how changes in dyspnea may influence and be influenced by modifications in depressive symptoms, so far has not been fully evaluated. We aimed to estimate the extent to which both DDL and NTD could be mutually associated to depressive symptoms in older adults with chronic conditions.Methods: this prospective study includes 2322 community-dwelling individuals aged ≥65 years enrolled in the Progetto Veneto Anziani (Pro.V.A.). At baseline and after 4.4 years, we evaluated the following parameters: DDL, assessed by the Medical Research Council dyspnea scale (MRC); self-reported NTD, assessed by personal interview; depressive symptoms, assessed using the Geriatric Depression Scale (GDS). The strength of the association between dyspnea and depression over the follow-up was evaluated through logistic regression and estimated by odds ratios and 95%Confidence Intervals (95%CI). Corrected risk ratios (RR) were then approximated from odds ratios.Results: GDS changes over the follow-up positively correlated with MRC changes (β = 0.938). Individuals with baseline DDL or NTD and those with incident/worsening DDL showed higher risk of developing or worsening depressive symptoms compared with their counterparts (RR = 3.36 [95%CI 2.11-5.06] for incident depression in people with worsening DDL). Incident or persistent depression increased more than twice the risk of developing DDL and NTD (for incident depression RR = 2.33 [95%CI 1.85-2.83] for DDL, and RR = 2.01 [95%CI 1.27-3.11] for NTD).Conclusions: older people may benefit from a comprehensive evaluation of respiratory and psychological symptoms, which seem to be related to each other in advanced age.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padova, Padova, Italy
| | - Bruno M Zanforlini
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Chiara Curreri
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Marina De Rui
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | | | - Egle Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.,National Research Council, Neuroscience Institute, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
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18
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Li XF, Mao YM. Beta-blockers in COPD: A systematic review based on recent research. Life Sci 2020; 252:117649. [PMID: 32275936 DOI: 10.1016/j.lfs.2020.117649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 01/14/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) with cardiovascular complications is very common. Due to fear of exacerbating airway spasm, β-blockers are rarely used in such patients. Many observational studies suggest that β-blockers can reduce the disease progression and the risk of mortality in patients with COPD, but lack of confirmation from randomized controlled trials. This article reviews the application of β-blockers in patients with COPD based on the results of the latest published randomized controlled trials.
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Affiliation(s)
- Xiao-Fang Li
- Department of Respiratory Medicine, The First Affiliated Hospital/College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, China
| | - Yi-Min Mao
- Department of Respiratory Medicine, The First Affiliated Hospital/College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, China.
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19
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Silva CDFR, Pegorari MS, Matos AP, Ohara DG. Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study. SAO PAULO MED J 2020; 138:112-117. [PMID: 32294715 PMCID: PMC9662837 DOI: 10.1590/1516-3180.2019.0428.r1.09122019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/09/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Dyspnea and poorer physical performance are conditions that may be related and be present among the elderly. However, few studies have evaluated associations between these variables. OBJECTIVE To determine whether there is an association between dyspnea and physical performance among community-dwelling older adults of both sexes (age 60 years and over). DESIGN AND SETTING Cross-sectional study conducted in the city of Macapá, state of Amapá, Brazil. METHODS Socioeconomic and health data were collected using a structured form. Frailty syndrome was assessed based on the frailty phenotype proposed by Fried et al. Dyspnea was measured using the modified Medical Research Council (mMRC) scale and physical performance was measured using the Short Physical Performance Battery (SPPB). Data were analyzed using a linear regression model. RESULTS A total of 411 subjects (70.15 ± 7.25 years) were evaluated, most of them females (66.4%). It was observed from the mMRC scale that 30.9% (n = 127) of the subjects had some dyspnea symptoms: grade 1 was most frequent. The physical performance score from the SPPB was 9.22 ± 2.01. Higher dyspnea scores were associated with poor physical performance, both in the crude analysis (β = -0.233; P = 0.028) and after adjustment for frailty condition (β = -0.148; P = 0.002) and for the socioeconomic and health variables (age, sex, number of diseases, smoking habit and frailty status) (β = -0.111; P = 0.025). CONCLUSION Higher dyspnea score was independently associated with poor physical performance among community-dwelling older adults.
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Affiliation(s)
- Caroline de Fátima Ribeiro Silva
- PT. Physiotherapist and Student, Postgraduate Program on Health Science, Universidade Federal do Amapá (UNIFAP), Macapá (AP), Brazil.
| | - Maycon Sousa Pegorari
- PhD. Physiotherapist and Adjunct Professor, Physiotherapy Course, Universidade Federal do Amapá (UNIFAP), Macapá (AP), Brazil.
| | - Areolino Pena Matos
- PhD. Physiotherapist and Adjunct Professor, Physiotherapy Course, Universidade Federal do Amapá (UNIFAP), Macapá (AP), Brazil.
| | - Daniela Gonçalves Ohara
- PhD. Physiotherapist and Adjunct Professor, Physiotherapy Course, Universidade Federal do Amapá (UNIFAP), Macapá (AP), Brazil.
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20
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van Mourik Y, Rutten FH, Bertens LC, Cramer MJ, Lammers JWJ, Gohar A, Reitsma JB, Moons KG, Hoes AW. Clinical research study implementation of case-finding strategies for heart failure and chronic obstructive pulmonary disease in the elderly with reduced exercise tolerance or dyspnea: A cluster randomized trial. Am Heart J 2020; 220:73-81. [PMID: 31790904 DOI: 10.1016/j.ahj.2019.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF) and chronic obstructive pulmonary disease (COPD) often remain undiagnosed in older individuals, although both disorders inhibit functionality and impair health. The aim of the study was to assess the effectiveness of a case-finding strategy of these disorders. METHODS This is a clustered randomized trial; 18 general practices from the vicinity of Utrecht, the Netherlands, were randomly allocated to a case-finding strategy or usual care. Multimorbid community subjects (≥65 years) with dyspnea or reduced exercise tolerance were eligible for inclusion. The case-finding strategy consisted of history taking, physical examination, blood tests, electrocardiography, spirometry, and echocardiography. Subsequent treatment decisions were at the discretion of the general practitioner. Questionnaires regarding health status and functionality were filled out at baseline and after 6 months of follow-up. Information regarding changes in medication and health care use during the 6 months follow-up was extracted. RESULTS A total of 829 participants were randomized: 389 in the case-finding strategy group and 440 in the usual care group. More patients in the case-finding group received a new diagnosis of HF or COPD than the usual care group (cumulative incidence 34% vs 2% and 17% vs. 2%, respectively). Scores for health status, functionality, and health care use were similar between the 2 strategies after 6 months of follow-up. CONCLUSIONS A case-finding strategy applied in primary care to multimorbid older people with dyspnea or reduced exercise tolerance resulted in a number of new diagnoses of HF and COPD but did not result in short-term improvement of health status compared to usual care.
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21
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van Maanen R, Rutten FH, Klok FA, Huisman MV, Blom JW, Moons KGM, Geersing GJ. Validation and impact of a simplified clinical decision rule for diagnosing pulmonary embolism in primary care: design of the PECAN prospective diagnostic cohort management study. BMJ Open 2019; 9:e031639. [PMID: 31601598 PMCID: PMC6797359 DOI: 10.1136/bmjopen-2019-031639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Combined with patient history and physical examination, a negative D-dimer can safely rule-out pulmonary embolism (PE). However, the D-dimer test is frequently false positive, leading to many (with hindsight) 'unneeded' referrals to secondary care. Recently, the novel YEARS algorithm, incorporating flexible D-dimer thresholds depending on pretest risk, was developed and validated, showing its ability to safely exclude PE in the hospital environment. Importantly, this was accompanied with 14% fewer computed tomographic pulmonary angiography than the standard, fixed D-dimer threshold. Although promising, in primary care this algorithm has not been validated yet. METHODS AND ANALYSIS The PECAN (Diagnosing Pulmonary Embolism in the context of Common Alternative diagNoses in primary care) study is a prospective diagnostic study performed in Dutch primary care. Included patients with suspected acute PE will be managed by their general practitioner according to the YEARS diagnostic algorithm and followed up in primary care for 3 months to establish the final diagnosis. To study the impact of the use of the YEARS algorithm, the primary endpoints are the safety and efficiency of the YEARS algorithm in primary care. Safety is defined as the proportion of false-negative test results in those not referred. Efficiency denotes the proportion of patients classified in this non-referred category. Additionally, we quantify whether C reactive protein measurement has added diagnostic value to the YEARS algorithm, using multivariable logistic and polytomous regression modelling. Furthermore, we will investigate which factors contribute to the subjective YEARS item 'PE most likely diagnosis'. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Ethical Committee Utrecht, the Netherlands. Patients eligible for inclusion will be asked for their consent. Results will be disseminated by publication in peer-reviewed journals and presented at (inter)national meetings and congresses. TRIAL REGISTRATION NTR 7431.
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Affiliation(s)
- Rosanne van Maanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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22
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Elbehairy AF, Quint JK, Rogers J, Laffan M, Polkey MI, Hopkinson NS. Patterns of breathlessness and associated consulting behaviour: results of an online survey. Thorax 2019; 74:814-817. [DOI: 10.1136/thoraxjnl-2018-212950] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 11/04/2022]
Abstract
The online British Lung Foundation Breath Test provides an opportunity to study the relationship between breathlessness, common sociobehavioural risk factors and interaction with healthcare. We analysed data from 356 799 responders: 71% were ≥50 years old and 18% were smokers. 20% reported limiting breathlessness (Medical Research Council breathlessness score ≥3), and the majority of these (85%) worried about their breathing; of these, 29% had not sought medical advice. Of those who had, 58% reported that the advice received had not helped their breathlessness. Limiting breathlessness was associated with being older, physically inactive, smoking and a higher body mass index. These data suggest a considerable unmet need associated with breathlessness as well as possibilities for intervention.
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Sparks JA, Doyle TJ, He X, Pan B, Iannaccone C, Frits ML, Dellaripa P, Rosas IO, Lu B, Weinblatt ME, Shadick NA, Karlson EW. Incidence and predictors of dyspnea on exertion in a prospective cohort of patients with rheumatoid arthritis. ACR Open Rheumatol 2019; 1:4-15. [PMID: 30923795 PMCID: PMC6433160 DOI: 10.1002/acr2.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the incidence and predictors of dyspnea on exertion among subjects with rheumatoid arthritis (RA). METHODS We investigated dyspnea on exertion using a prospective cohort, the Brigham RA Sequential Study (BRASS). Clinically significant dyspnea on exertion was defined as a score of ≥3 (unable to ambulate without breathlessness or worse) on the validated Medical Research Council (MRC) scale (range 0-5). We analyzed subjects with MRC score <3 at BRASS baseline and ≥1 year of follow-up. The MRC scale was administered annually. We determined the incidence rate (IR) of dyspnea on exertion. We used Cox regression to estimate the HR for dyspnea on exertion occurring one year after potential predictors were assessed. RESULTS We analyzed 829 subjects with RA and no clinically significant dyspnea on exertion during mean follow-up of 3.0 years (SD 1.9). At baseline, mean age was 55.7 years (SD 13.6), 82.4% were female, and median RA duration was 8 years. During follow-up, 112 subjects (13.5%) developed incident dyspnea on exertion during 2,476 person-years of follow-up (IR 45.2 per 1000 person-years). Independent predictors of incident dyspnea on exertion were: older age (HR 1.03 per year, 95%CI 1.01-1.04), female sex (HR 2.22, 95%CI 1.14-4.29), mild dyspnea (HR 2.62, 95%CI 1.60-4.28), and worsened MDHAQ (HR 2.36 per unit, 95%CI 1.54-3.60). Methotrexate use, RA disease activity, and seropositivity were not associated with incident dyspnea on exertion. CONCLUSION Dyspnea on exertion occurred commonly in patients with RA. Older women with impaired physical function were especially vulnerable to developing dyspnea on exertion.
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Affiliation(s)
- Jeffrey A. Sparks
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Tracy J. Doyle
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Xintong He
- Brigham and Women’s HospitalBostonMassachusetts
| | | | | | | | - Paul F. Dellaripa
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Ivan O. Rosas
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Bing Lu
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Michael E. Weinblatt
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Nancy A. Shadick
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Elizabeth W. Karlson
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
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The Integrated Dyspnea Clinic: An Evaluation of Efficiency. Int J Integr Care 2018; 18:15. [PMID: 30622450 PMCID: PMC6319311 DOI: 10.5334/ijic.3983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Dyspnea is a common complaint and in 70 to 90% the origin is pulmonary or cardiovascular. However, referral to the “wrong” specialism could result in diagnostic- and treatment delay. Integrated care by a cardiologist and a pulmonologist could improve this. The aim of the present study was to evaluate whether integrated care for patients with dyspnea is more efficient and effective than regular care. Methods: Consecutive patients (n = 235) seen at our dyspnea clinic after June 2014 were included. Two patient groups were compared: 1) patients with an integrated consultation and 2) patients with a non-integrated consultation, who were seen by the cardiologist and the pulmonologist on separate occasions. Results: The median time until first diagnosis, final diagnosis and time needed for diagnostic workup was shorter for patients evaluated by a integrated consultation compared with patients with a non-integrated consultation for dyspnea (16 days vs. 37 days, p < 0.001; 51 days vs. 78 days, p < 0.001; 35 days vs. 67 days, p < 0.001). There were no significant differences in the majority of diagnostic tests used and final medical conclusions. Conclusions: Patients with dyspnea evaluated using integrated care were diagnosed almost one month faster than patients in regular care without affecting the type of medical conclusions made. This study supports the start of a dyspnea clinic as an efficient way to provide integrated care to patients with dyspnea. Take home message: Patients with dyspnea evaluated using integrated care where diagnosed one month faster than patients in regular care.
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25
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Hale ZE, Singhal A, Hsia RY. Causes of Shortness of Breath in the Acute Patient: A National Study. Acad Emerg Med 2018; 25:1227-1234. [PMID: 29738108 DOI: 10.1111/acem.13448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dyspnea is a common and ambiguous complaint that results in 3.4 million emergency department (ED) visits annually. While learners may encounter lists of differential diagnoses to consider while in training, often these lists are not empirically based. We sought to establish an evidence-based differential diagnosis for dyspnea and to determine whether normal vital signs can rule out a life-threatening diagnosis. METHODS We analyzed data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2014 for ED visits with a chief complaint of dyspnea and tallied the principal discharge diagnosis. We included 10,170 sampled ED visits by adults with a chief complaint of dyspnea, representing nearly 42 million visits nationally. We then calculated the most common principal discharge diagnoses by age group and the frequency of abnormal respiratory vital signs in cases with life-threatening diagnoses. RESULTS The most represented age group was 45 to 64 years (31.6%). Most visits were discharged directly from the ED (57.5%), while 8.1% required admission to an intensive care unit (ICU). The most common diagnosis in patients aged 18 to 44 was acute asthma exacerbation (14.8%). Obstructive chronic bronchitis was the most common specified diagnosis in both patients ages 45 to 64 (11.1%) and patients ages 65 to 79 (12.4%), while congestive heart failure was the most common for patients ages 80 and over (15.9%). Respiratory vital signs were frequently normal in the 44.6% of visits that resulted in a potentially life-threatening diagnosis but corresponded to increased ICU utilization when abnormal. CONCLUSIONS For patients with dyspnea, the high utilization of ICUs highlights the importance of an accurate differential. The frequencies established here can be used as pretest probabilities in Bayesian analysis to improve the accuracy of differential diagnosis lists.
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Affiliation(s)
- Zachariah E. Hale
- School of Medicine University of California at San Francisco San Francisco CA
| | - Astha Singhal
- Department of Health Policy and Health Services Research Boston University Henry M. Goldman School of Dental Medicine Boston MA
| | - Renee Y. Hsia
- Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies University of California at San Francisco San Francisco CA
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26
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Duncan D, Ashby A. Managing chronic breathlessness in the community. Br J Community Nurs 2018; 23:318-321. [PMID: 29972663 DOI: 10.12968/bjcn.2018.23.7.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Breathlessness or dyspnoea is a subjective experience that can be described as an unpleasant or uncomfortable awareness of breathing. It is a subjective experience for patients and often they learn to adapt to the limitations caused by their condition, which makes their breathlessness less apparent to others. Breathlessness can be subdivided in the context of chronic refractory breathlessness, such as acute breathlessness, which is either an episodic breathlessness or breathlessness crisis. Chronic refractory breathlessness is defined as breathlessness at rest or on minimal exertion that will persist chronically despite optimal treatment of the underlying causative factors. The role of the community nurse in managing the breathless patient should involve differentiating between different types of breathlessness and knowing how to effectively manage it in a holistic manner.
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Affiliation(s)
| | - Abigail Ashby
- Senior lecturer in Nursing, Bucks New University, Buckinghamshire
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27
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Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence. Prim Health Care Res Dev 2018; 19:570-574. [PMID: 29463343 DOI: 10.1017/s1463423618000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AimTo investigate if cardiac/pulmonary functional tests and variables obtained from clinical practice (body mass index, dyspnea, functional class, clinical judgment of disability to perform an exercise test and previous hospitalization rate) are related to mortality in patients with overlap chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). BACKGROUND: Although the coexistence of COPD and CHF has been growingly reported, description of survival predictors considering the presence of both conditions is still scarce. METHODS: Using a cohort design, outpatients with the previous diagnosis of COPD and/or CHF that performed both spirometry and echocardiography in the same year were followed-up during a mean of 20.9±8.5 months.FindingsOf the 550 patients initially evaluated, 301 had both spirometry and echocardiography: 160 (53%) with COPD on isolation; 100 (33%) with CHF on isolation; and 41 (14%) with overlap. All groups presented similar mortality: COPD 17/160 (11%); CHF 12/100 (12%); and overlap 7/41 (17%) (P=0.73). In the overlap group (n=41), inability to exercise and hospitalization rate were the unique parameters associated with higher mortality (seven events) in univariate analyses. In conclusion, inability to exercise and hospitalization rate emerged as the unique parameters associated with mortality in our sample.
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28
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Hegendörfer E, Vaes B, Matheï C, Van Pottelbergh G, Degryse JM. Correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. Age Ageing 2017. [PMID: 28633384 DOI: 10.1093/ageing/afx095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background adults aged 80 and over, a fast growing age-group, with increased co-morbidity and frailty have not been the focus of previous research on dyspnoea. We investigate the correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. Methods about 565 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had assessment of Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEV1), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data. Kaplan-Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analysis assessed association of dyspnoea (MRC 3-5) with time-to-cardiovascular and all-cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates. Results participants with dyspnoea MRC 3-5 (29.9%) had increased hazard ratios for cardiovascular mortality 2.85 (95% confidence interval 1.93-4.20), all-cause mortality 2.04 (1.58-2.64), first hospitalisation 1.72 (1.35-2.19); and increased odds ratio for new/worsened disability 2.49 (1.54-4.04), independent of age, sex and smoking status. Only FEV1, physical performance, BMI and NT-proBNP (in order of importance) were selected in the tree-based classification model for dyspnoea. Conclusions in a cohort of adults aged 80 and over, dyspnoea was common and an independent predictor of adverse outcomes, with cardio-respiratory and physical performance impairments as key independent correlates. Its routine and comprehensive evaluation in primary care could be very valuable in caring for this age-group.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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29
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Magnussen H, Canepa M, Zambito PE, Brusasco V, Meinertz T, Rosenkranz S. What can we learn from pulmonary function testing in heart failure? Eur J Heart Fail 2017; 19:1222-1229. [DOI: 10.1002/ejhf.946] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/06/2017] [Accepted: 06/26/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Helgo Magnussen
- Pulmonary Research Institute at Lung Clinic Grosshansdorf and Airway Research Center North; Member of the German Center for Lung Research; Grosshansdorf Germany
| | - Marco Canepa
- Department of Internal Medicine and Medical Specialties; University of Genoa, San Martino Hospital; Genoa Italy
| | | | - Vito Brusasco
- Department of Internal Medicine and Medical Specialties; University of Genoa, San Martino Hospital; Genoa Italy
| | | | - Stephan Rosenkranz
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, and Cologne Cardiovascular Research Center (CCRC); Heart Center at the University of Cologne; Cologne Germany
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30
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Rutten FH, Gallagher J. What the General Practitioner Needs to Know About Their Chronic Heart Failure Patient. Card Fail Rev 2017; 2:79-84. [PMID: 28785457 DOI: 10.15420/cfr.2016:18:1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In this article we highlight what general practitioners (GPs) need to know about heart failure (HF). We pay attention to its definition, diagnosis - with risks of under- and over-diagnosis - and the role natriuretic peptides, electrocardiography, echocardiography, but also spirometry. We stress the role of the GP in case finding and risk stratification with optimisation of cardiovascular drug use in high-risk groups. Epidemiological data are provided, followed by discussion of the management aspects and possibilities of cooperative care of patients with chronic HF, focussing on pharmacological treatment, comorbidities and end-of-life care. This article highlights the experience and clinical practice of the authors: specifics of local heart failure management, and the role of the GP, will naturally vary.
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Affiliation(s)
- Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Joe Gallagher
- Department of General Practice, Health Research Group, University College Dublin, Dublin, Ireland
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31
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Özbay PS, Duerst Y, Wilm BJ, Pruessmann KP, Nanz D. Enhanced quantitative susceptibility mapping (QSM) using real-time field control. Magn Reson Med 2017; 79:770-778. [DOI: 10.1002/mrm.26735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Pinar Senay Özbay
- University Hospital Zurich and University of Zurich, Institute of Diagnostic and Interventional Radiology; Zurich Switzerland
- ETH Zurich and University of Zurich, Institute for Biomedical Engineering; Zurich Switzerland
| | - Yolanda Duerst
- ETH Zurich and University of Zurich, Institute for Biomedical Engineering; Zurich Switzerland
| | - Bertram Jakob Wilm
- ETH Zurich and University of Zurich, Institute for Biomedical Engineering; Zurich Switzerland
| | - Klaas Paul Pruessmann
- ETH Zurich and University of Zurich, Institute for Biomedical Engineering; Zurich Switzerland
| | - Daniel Nanz
- University Hospital Zurich and University of Zurich, Institute of Diagnostic and Interventional Radiology; Zurich Switzerland
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32
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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.
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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
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33
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Santos M, Kitzman DW, Matsushita K, Loehr L, Sueta CA, Shah AM. Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study. PLoS One 2016; 11:e0165111. [PMID: 27780208 PMCID: PMC5079579 DOI: 10.1371/journal.pone.0165111] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background The relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease. Methods and Results We studied 10 881 community-dwelling participants (mean age 57±6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-to-severe (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19±5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16–1.46), MI (adjusted HR 1.34; 95%CI: 1.20–1.50), and death (adjusted HR 1.16; 95%CI: 1.06–1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59–2.89; 1.93, 95%CI: 1.41–2.56; 1.96, 95%CI: 1.55–2.48, respectively). Conclusion In community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.
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Affiliation(s)
- Mario Santos
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dalane W. Kitzman
- Wake Forest Baptist Medical Center, Winston Salem, NC, United States of America
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Laura Loehr
- University of North Carolina, Chapel Hill, NC, United States of America
| | - Carla A. Sueta
- University of North Carolina, Chapel Hill, NC, United States of America
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- * E-mail:
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34
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Physiological and functional failure in chronic obstructive pulmonary disease, congestive heart failure and cancer: a debilitating intersection of sarcopenia, cachexia and breathlessness. Curr Opin Support Palliat Care 2016; 10:236-41. [DOI: 10.1097/spc.0000000000000222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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35
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Miner B, Tinetti ME, Van Ness PH, Han L, Leo-Summers L, Newman AB, Lee PJ, Vaz Fragoso CA. Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition. J Am Geriatr Soc 2016; 64:2042-2050. [PMID: 27549914 DOI: 10.1111/jgs.14290] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons. DESIGN Cross-sectional. SETTING Cardiovascular Health Study. PARTICIPANTS Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% <high school education, 54.7% ever-smokers). MEASUREMENTS Dyspnea severity (moderate to severe defined as American Thoracic Society Grade ≥2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV1 )), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, medication use, and body mass index (BMI). RESULTS In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 2.37-3.49), left ventricular ejection fraction less than 45% (aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95% CI = 1.61-2.73), depressive symptoms (CES-D score ≥16; aOR = 2.02, 95% CI = 1.26-3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31-1.71). CONCLUSION In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.
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Affiliation(s)
- Brienne Miner
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
| | - Mary E Tinetti
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - Peter H Van Ness
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Ling Han
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Linda Leo-Summers
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Anne B Newman
- Department of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patty J Lee
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Carlos A Vaz Fragoso
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
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36
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Lee L, Patel T, Hillier LM, Milligan J. Office-Based Case Finding for Chronic Obstructive Pulmonary Disease in Older Adults in Primary Care. Can Respir J 2016; 2016:1083270. [PMID: 27445513 PMCID: PMC4933849 DOI: 10.1155/2016/1083270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/30/2016] [Indexed: 11/25/2022] Open
Abstract
Background. Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed in primary care. Aim. To explore the utility of proactive identification of COPD in patients 75 years of age and older in a Canadian primary care setting. Methods. Canadian Thoracic Society (CTS) screening questions were administered to patients with a smoking history of 20 pack-years or more; those with a positive screen were referred for postbronchodilator spirometry. Results. A total of 107 patients (21%), of 499 screened, had a 20-pack-year smoking history; 105 patients completed the CTS screening. Forty-four (42%) patients were positive on one or more questions on the screening; significantly more patients with a previous diagnosis of COPD (64%) were positive on the CTS compared to those without a previous diagnosis of COPD (30%). Of those who were not previously diagnosed with COPD (N = 11), four (36%) were newly diagnosed with COPD. Conclusion. A systematic two-stage method of screening for COPD, using CTS screening questions followed by spirometric confirmation, is feasible in the context of a busy primary care setting. More research is needed to assess the value of restricting screening to patients with a smoking history of 20 pack-years and on the sensitivity and specificity of these measures.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON, Canada N2G 1C5
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
| | - Tejal Patel
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON, Canada N2G 1C5
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- University of Waterloo School of Pharmacy, Waterloo, ON, Canada
| | - Loretta M. Hillier
- St. Joseph's Health Care, London, ON, Canada
- Aging, Rehabilitation and Geriatric Care Research Centre of the Lawson Health Research Institute, London, ON, Canada
| | - James Milligan
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, ON, Canada N2G 1C5
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
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Kupper N, Bonhof C, Westerhuis B, Widdershoven J, Denollet J. Determinants of Dyspnea in Chronic Heart Failure. J Card Fail 2016; 22:201-9. [DOI: 10.1016/j.cardfail.2015.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/25/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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van Riet EES, Hoes AW, Limburg A, Landman MAJ, Kemperman H, Rutten FH. Extended prediction rule to optimise early detection of heart failure in older persons with non-acute shortness of breath: a cross-sectional study. BMJ Open 2016; 6:e008225. [PMID: 26880668 PMCID: PMC4762114 DOI: 10.1136/bmjopen-2015-008225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES There is a need for a practical tool to aid general practitioners in early detection of heart failure in the elderly with shortness of breath. In this study, such a screening rule was developed based on an existing rule for detecting heart failure in older persons with a diagnosis of chronic obstructive pulmonary disease. The original rule included a history of ischaemic heart disease, body mass index, laterally displaced apex beat, heart rate, elevated N-terminal pro B-type natriuretic peptide and an abnormal ECG. DESIGN Cross-sectional data were used to validate, update and extend the original prediction rule according to a standardised state-of-the-art stepwise approach. SETTING Primary care with 30 participating general practices. PARTICIPANTS Community-dwelling people aged ≥ 65 years with shortness of breath on exertion. METHODS AND RESULTS Validation of the existing screening rule in our population showed satisfying discrimination with a concordance statistic of 0.84 (range 0.80-0.85), but poor calibration. Performance measures were most improved by adding the predictors age >75 years, peripheral oedema and systolic murmur, resulting in a concordance statistic of 0.88 (range 0.85-0.90) and a net reclassification improvement of 31%. A risk score was computed, which showed high accuracy with a negative predictive value of 87% and a positive predictive value of 73%. Evaluating the improved rule in the derivation set and an independent set of patients with type 2 diabetes aged 60 years or older showed satisfying generalisability of the rule. CONCLUSIONS Our rule resulted in excellent prediction of heart failure in the large domain of the elderly with shortness of breath, and would help general practitioners to select those needing echocardiography. TRIAL REGISTRATION NUMBER NCT01202006.
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Affiliation(s)
- Evelien E S van Riet
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marcel A J Landman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans Kemperman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Kardos P, Schütt T, Mück T, Schumacher H, Michel MC. Pathophysiological Factors in the Relationship between Chronological Age and Calculated Lung Age as Detected in a Screening Setting in Community-Dwelling Subjects. Front Med (Lausanne) 2016; 3:2. [PMID: 26870734 PMCID: PMC4737876 DOI: 10.3389/fmed.2016.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/12/2016] [Indexed: 11/20/2022] Open
Abstract
Aim To explore the relationship between pathophysiological factors and premature lung aging in a cohort of community-dwelling subjects in a health-screening setting. Methods 16,107 pharmacy customers in Germany (5954 males, 10,153 females; mean age 59.7 years) participated in a lung function screening project by providing demographic data, including smoking status and known airway conditions and performing spirometry with a Vitalograph, a spirometry screening device. Lung age was calculated from the spirometric findings, and the difference between chronological age and calculated lung age was analyzed in its relationship to the demographic data in general linear models. Results In the overall cohort, calculated lung age exceeded chronological age by 10.0 years. Based on the subset of non-smokers not reporting any airway conditions, Vitalograph data in this setting may underestimate FEV1 to some degree, but this apparently had little impact on the detection of association of lung age with pathophysiological factors or the corresponding effect sizes. The most important factors associated with greater lung age based on strength of association were presence of dyspnea, being a smoker, and reporting a history of COPD or asthma. Corresponding effect sizes for the difference between age and lung age were 6.5, 5.7, 13.9, and 8.3 years over the chronological age. Discussion and Conclusion These data confirm the usefulness of screening devices of lung function testing for epidemiological but potentially also for pharmaco-epidemiological studies.
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Affiliation(s)
- Peter Kardos
- Group Practice, Center for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital , Frankfurt am Main , Germany
| | - Tanja Schütt
- Department of Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG , Ingelheim , Germany
| | - Tobias Mück
- Department of Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG , Ingelheim , Germany
| | | | - Martin C Michel
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany; Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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Fisher AJ, Yadegarfar ME, Collerton J, Small T, Kirkwood TBL, Davies K, Jagger C, Corris PA. Respiratory health and disease in a U.K. population-based cohort of 85 year olds: The Newcastle 85+ Study. Thorax 2016; 71:255-66. [PMID: 26732736 PMCID: PMC4789822 DOI: 10.1136/thoraxjnl-2015-207249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/18/2015] [Indexed: 12/01/2022]
Abstract
Background People aged 85 years and older are the fastest growing age group worldwide. This study assessed respiratory health, prevalence of respiratory disease and use of spirometry in respiratory diagnosis in a population-based cohort of 85 year olds to better understand respiratory health and disease in this sector of society. Methods A single year birth-cohort of 85 year olds participated in a respiratory assessment at their home or residential institution including self-reporting of symptoms and measurement of spirometry. General practice medical records were reviewed for respiratory diagnoses and treatments. Findings In the 845 participants, a substantial burden of respiratory disease was seen with a prevalence of COPD in medical records of 16.6% (n=140). A large proportion of the cohort had environmental exposures through past or current smoking (64.2%, n=539) and occupational risk factors (33.6%, n=269). Spirometry meeting reliability criteria was performed in 87% (n=737) of participants. In the subgroup with a diagnosis of COPD (n=123), only 75.6% (n=93) satisfied Global Initiative in Obstructive Lung Disease (GOLD) criteria for airflow obstruction, and in a healthy subgroup without respiratory symptoms or diagnoses (n=151), 44.4% (n=67) reached GOLD criteria for airflow obstruction and 43.3% (n=29) National Institute of Health and Care Excellence criteria for at least moderate COPD. Interpretation Spirometry can be successfully performed in the very old, aged 85 years, and may help identify respiratory diseases such as COPD. However interpretation in this age group using current definitions of COPD based on spirometry indices may be difficult and lead to overdiagnosis in a healthy group with transient symptoms.
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Affiliation(s)
- Andrew J Fisher
- Department of Respiratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK
| | - Mohammad E Yadegarfar
- Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK Faculty of Medical Sciences, Institute of Health and Society, Newcastle Upon Tyne, UK
| | - Joanna Collerton
- Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK Faculty of Medical Sciences, Institute of Health and Society, Newcastle Upon Tyne, UK
| | - Therese Small
- Department of Respiratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Karen Davies
- Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK
| | - Carol Jagger
- Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK Faculty of Medical Sciences, Institute of Health and Society, Newcastle Upon Tyne, UK
| | - Paul A Corris
- Department of Respiratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK Institute for Ageing, Newcastle University, Newcastle Upon Tyne, UK
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Bandera F, Generati G, Pellegrino M, Tufaro V, Secchi F, Sugimoto T, Lombardi M, Sardanelli F, Guazzi M. Paradoxical low flow/low gradient aortic stenosis: Can cardiopulmonary exercise test help in identifying it? Int J Cardiol 2016; 203:37-9. [DOI: 10.1016/j.ijcard.2015.10.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
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Winchester DE, Zhang P, Jadhav MP, Beyth RJ. A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms: Contributing Factors and Results of Testing. Medicine (Baltimore) 2015; 94:e1154. [PMID: 26266347 PMCID: PMC4616717 DOI: 10.1097/md.0000000000001154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Myocardial perfusion imaging (MPI) is commonly used to detect ischemia. Concerns about silent ischemia may encourage orders for MPI in asymptomatic patients. Factors contributing to this practice are poorly described and the clinical utility is questionable.We conducted a single center retrospective cohort investigation on Veterans who underwent MPI between December 2010 and July 2011. We gathered data on symptoms, baseline characteristics, results of MPI, and cardiovascular events within 1 year. MPI were categorized using 2009 appropriate use criteria (AUC).Of 592 patients, 127 (21.5%) had no symptoms at the time of MPI. Comparing symptomatic and asymptomatic patients, no differences were observed in baseline characteristics except abnormal ECG, more common in asymptomatic patients (n = 86, 67.7% vs. n = 232, 49.9% for symptomatic patients, P < 0.0001). Asymptomatic MPI were more commonly inappropriate (n = 26, 21.5% vs. n = 31, 6.7% for appropriate/uncertain, P < 0.0001). Detection of ischemia between patients with and without symptoms was not different (P = 0.86); however, among asymptomatic MPI that also demonstrated ischemia, none were inappropriate (n = 10 appropriate, n = 7 uncertain). In multivariate regression, 2 factors were associated with asymptomatic status, abnormal ECG (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.5-3.49) and age over the median (OR 0.63, 95% CI: 0.41-0.95).A substantial portion of MPI tests are ordered for patients without symptoms. When compared to symptomatic patients, MPI for asymptomatic patient were more commonly inappropriate; however, the prevalence of ischemia was similar. MPI may be clinically relevant in some asymptomatic patients and decisions to test should be based on the AUC.
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Affiliation(s)
- David E Winchester
- From the Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA (DEW, RJB); Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA (DEW, MPJ); College of Medicine, University of Florida, Gainesville, Florida, USA (PZ); and Division of General Internal Medicine, Department of Medicine (RB), College of Medicine, University of Florida, Gainesville, Florida, USA (RJB)
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Clini E, Beghe B, Fabbri LM. Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management. Eur Respir J 2014; 44:1397-400. [DOI: 10.1183/09031936.00150814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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