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Vranić L, Biloglav Z, Medaković P, Talapko J, Škrlec I. The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome. Zdr Varst 2024; 63:123-131. [PMID: 38881631 PMCID: PMC11178033 DOI: 10.2478/sjph-2024-0017] [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: 09/28/2023] [Accepted: 04/23/2024] [Indexed: 06/18/2024] Open
Abstract
Aim The aim of this study was to estimate the effects of a pulmonary rehabilitation programme (PR) on the functional capacity and respiratory muscle strength of patients with post-COVID syndrome. Methods A cross-sectional study was conducted using hospital data on patients who participated in a pulmonary rehabilitation programme at the Clinic for Lung Diseases, University Hospital Centre Zagreb, Croatia, between January 2021 and December 2022. Data on the spirometry, respiratory muscle strength, and functional exercise capacity of patients were collected at baseline and three weeks after the start of rehabilitation. The study included 80 patients (43 females, 37 males) with a mean age of 51±10 years. Results A significant increase in respiratory muscle strength (P<0.001) was observed after pulmonary rehabilitation, with effect sizes ranging from small to large (Cohen's d from 0.39 to 1.07), whereas the effect for PImax expressed as a percentage was large (Cohen's d=0.99). In addition, the pulmonary rehabilitation programme significantly improved the parameters of the six-minute walk test in patients, and the parameters of lung function, FVC, FEV1, and DLCO also improved significantly after PR (P<0.05). Conclusion The results showed that the pulmonary rehabilitation programme has clinically significant effects on functional capacity and respiratory muscle strength in patients with post-COVID syndrome.
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Affiliation(s)
- Lana Vranić
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zrinka Biloglav
- Department of Medical Statistics, Epidemiology and Medical Informatics, School of Public Health Andrija Štampar, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Petar Medaković
- Department of Radiology, Polyclinic Croatia, 10000 Zagreb, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
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Torres-Castro R, Pascual H, Alonso A, Gimeno-Santos E, Palomo M, Barberà JA, Bigorra J, Batlle J, Masip-Bruin X, Blanco I. Use of automatic 6-minute walking test recording system in patients with chronic respiratory diseases. Pulmonology 2024; 30:390-392. [PMID: 37783641 DOI: 10.1016/j.pulmoe.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- R Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - H Pascual
- CRAAX Lab, Universitat Politècnica de Catalunya, Vilanova i la Geltru, Spain
| | - A Alonso
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E Gimeno-Santos
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Instituto de Salud Global (ISGlobal), Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES); Madrid, Spain
| | - M Palomo
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - J A Barberà
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES); Madrid, Spain
| | - J Bigorra
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Instituto de Salud Global (ISGlobal), Barcelona, Spain
| | - J Batlle
- Innovation Consultant-Techno & Innovative Solutions, SLU; Vilanova i la Geltrú, Spain
| | - X Masip-Bruin
- CRAAX Lab, Universitat Politècnica de Catalunya, Vilanova i la Geltru, Spain
| | - I Blanco
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES); Madrid, Spain.
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Lang JE, Carrion VM, Bhammar DM, Howard JB, Armstrong SC. A Randomized Trial of Inspiratory Training in Children and Adolescents With Obesity. Child Obes 2024. [PMID: 38696657 DOI: 10.1089/chi.2023.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Introduction: Children with obesity suffer excess dyspnea that contributes to sedentariness. Developing innovative strategies to increase exercise tolerance and participation in children with obesity is a high priority. Because inspiratory training (IT) has reduced dyspnea, we sought to assess IT in children with obesity. Methods: We conducted a 6-week randomized IT trial involving 8- to 17-year-olds with obesity. Participants were randomized 1:1 to either high [75% of maximal inspiratory pressure (MIP)] or low resistance control (15% of MIP) three times weekly. Assessments included adherence, patient satisfaction, and changes in inspiratory strength and endurance, dyspnea scores and total activity level. Results: Among 27 randomized, 24 (89%) completed the intervention. Total session adherence was 72% which did not differ between treatment groups. IT was safe, and more than 90% felt IT benefitted breathing and general health. IT led to a mean improvement (95% CI) in inspiratory strength measured by MIP of 10.0 cm H2O (-3.5, 23.6; paired t-test, p = 0.139) and inspiratory endurance of 8.9 (1.0, 16.8; paired t-test, p = 0.028); however, there was no significant difference between high- and low-treatment groups. IT led to significant reductions in dyspnea with daily activity (p < 0.001) and in prospectively reported dyspnea during exercise (p = 0.024). Among the high- versus low-treatment group, we noted a trend for reduced dyspnea with daily activity (p = 0.071) and increased daily steps (865 vs. -51, p = 0.079). Discussion: IT is safe and feasible for children with obesity and holds promise for reducing dyspnea and improving healthy activity in children with obesity. Breathe-Fit trial NCT05412134.
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Affiliation(s)
- Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Veronica M Carrion
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Dharini M Bhammar
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Janna B Howard
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Sarah C Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Zhao L, Wang C, Song J, Jiang P. Examining the potential risk factors for variable airflow limitation in patients recovering from SARS-CoV-2 Omicron variant infection: A case-control study. Am J Infect Control 2024; 52:541-545. [PMID: 38036179 DOI: 10.1016/j.ajic.2023.11.015] [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: 09/14/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The Omicron strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally. However, it remains uncertain whether variable airflow limitation (VAL) occurs during the recovery phase after contracting the Omicron variant. To address this question, we conducted a study to examine the occurrence of VAL in patients infected with the Omicron variant (BA.1) of SARS-CoV-2, and we also investigated the potential risk factors associated with this phenomenon. METHODS We summarized and analyzed data taken from the electronic health records of recovering patients who had contracted the Omicron variant. The information was obtained from the Shuixi Branch of our Hospital during the period from January 22 to February 24, 2022. We focused on examining the occurrence of VAL and identifying the associated risk factors among these patients. RESULTS In this case-control study, a total of 176 patients were enrolled. The occurrence of VAL was observed in 9.66% (17 individuals). Patients with VAL showed significantly elevated levels of the modified Borg dyspnea score, daytime cough score, night-time cough score, chest computed tomography severity score, and Treg ratio compared to those without VAL. Additionally, patients with VAL had a lower 6MWD value compared to those without it. Logistic regression analysis demonstrated that the modified Borg dyspnea score independently increased the risk of Omicron infection with VAL, with an odds ratio of 3.375, and a 95% confidence interval ranging from 1.537 to 7.408, with a P-value of .002. CONCLUSIONS There is a possibility of experiencing VAL in certain patients recovering from the SARS-CoV-2 Omicron variant infection. The modified Borg dyspnea score has been identified as a standalone risk factor for the occurrence of VAL in SARS-CoV-2 Omicron infection.
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Affiliation(s)
- Lihong Zhao
- Department of Respiratory and Critical Care Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Chunfang Wang
- Department of Respiratory and Critical Care Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Jinxin Song
- Department of Respiratory and Critical Care Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Ping Jiang
- Department of Respiratory and Critical Care Medicine, Tianjin First Central Hospital, Tianjin, China.
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Tramonti C, Graziani F, Pasqualone E, Ricci E, Moncini C, Lombardi B. Outpatient rehabilitation in post-acute COVID-19 patients: a combined progressive treatment protocol. Disabil Rehabil 2024:1-11. [PMID: 38407196 DOI: 10.1080/09638288.2024.2316797] [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: 04/20/2023] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE to investigate the effectiveness of a 4-week combined progressive program on functional abilities, disability status and quality of life (QoL) in COVID-19 recovered patients. MATERIALS & METHODS 18 COVID-19 recovered patients performed a combined rehabilitation treatment accounting for 12 sessions, including both respiratory and motor training sessions. A careful monitoring of exercise intensity, duration and progression to tailor complexity evolution on patients' competencies was carried out. Patients were monitored with different functional scales and self-reported questionnaires before (T0) and after (T1) rehabilitation. RESULTS 6-Minutes Walk Test, Timed Up and Go Test and Short Physical Performance Battery significantly improved, while Physiological Cost Index presented a significant reduction after rehabilitation. Moreover, Barthel Index significantly improved and patients presented significantly increased upper and lower limbs strength at T1. Furthermore, mMRC Dyspnoea Scale presented a significant reduction after training. Finally, physical and psychological well-being scales improved according to Short-Form 36; while, self-reported questionnaires related to mood and depression showed no significant modification after rehabilitation. CONCLUSIONS results evidenced the efficacy of the combined progressive intervention in COVID-19 recovered patients. The specific customization on patients' needs and the careful exercise monitoring promoted improvements on functional abilities and disability status, with positive impact on QoL.
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Affiliation(s)
- Caterina Tramonti
- Department of Physical and Rehabilitation Medicine, Firenze, Italy
- Levante Ligure Rehabilitation Center, Fondazione Don C. Gnocchi Onlus, La Spezia, Italy
| | | | | | - Eleonora Ricci
- Department of Physical and Rehabilitation Medicine, Firenze, Italy
| | - Cristina Moncini
- Department of Physical and Rehabilitation Medicine, Firenze, Italy
| | - Bruna Lombardi
- Department of Physical and Rehabilitation Medicine, Firenze, Italy
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Peroy-Badal R, Sevillano-Castaño A, Torres-Castro R, García-Fernández P, Maté-Muñoz JL, Dumitrana C, Sánchez Rodriguez E, de Frutos Lobo MJ, Vilaró J. Comparison of different field tests to assess the physical capacity of post-COVID-19 patients. Pulmonology 2024; 30:17-23. [PMID: 36117103 PMCID: PMC9339971 DOI: 10.1016/j.pulmoe.2022.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/01/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In coronavirus disease (COVID-19), physical capacity is one of the most impaired sequelae. Due to their simplicity and low cost, field tests such as the six-minute walk test (6MWT) are widely used However, in many places it is difficult to perform them and alternatives can be used such as the 1 min sit-to-stand test (1min-STST) or the Chester step test (CST). Therefore, our objective was to compare the 6MWT, 1min-STST and the CST in post-COVID-19 patients. METHODS We conducted a cross-sectional analysis in post-COVID-19 patients, compared with matched controls (CG). Demographic characteristics and comorbidities were collected. We analysed oxygen saturation (SpO2), heart rate (HR), and the modified Borg scale in the 6MWT, 1min-STST, and CST. Additionally, the correlations between tests were analysed. RESULTS We recruited 27 post-COVID-19 patients and 27 matched controls. The median age was 48 (IQR 43-59) years old (44% female). The median distance walked in 6MWT was 461 (IQR 415-506) m in post-COVID-patients and 517 (IQR 461-560) m in CG (p = 0.001). In 1min-STST, the repetitions were 21.9 ± 6.7 and 28.3 ± 7.1 in the post-COVID-19 group and CG, respectively (p = 0.001). In the CST, the post-COVID-19 group performed 150 (86-204) steps vs the CG with 250 (250-250) steps (p < 0.001). We found correlations between the 6MWT with the 1min-STST in COVID-19 patients (r = 0.681, p < 0.001) and CG (r = 0.668, p < 0.001), and between the 6MWT and the CST in COVID-19 patients (r = 0.692, p < 0.001). CONCLUSION The 1min-STST and the CST correlated significantly with the 6MWT in patients post-COVID-19 being alternatives if the 6MWT cannot be performed.
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Affiliation(s)
- R Peroy-Badal
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain; Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - A Sevillano-Castaño
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain; Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - R Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain.
| | - P García-Fernández
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - J L Maté-Muñoz
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - C Dumitrana
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain
| | - E Sánchez Rodriguez
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M J de Frutos Lobo
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J Vilaró
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain; Facultad de Ciencias de la Salud Blanquerna, Global Research on Wellbeing (GRoW), Universidad Ramon Llull, Barcelona, Spain
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7
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Mavronasou A, Asimakos A, Vasilopoulos A, Katsaounou P, Kortianou EA. Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment. Disabil Rehabil 2023:1-11. [PMID: 38156771 DOI: 10.1080/09638288.2023.2297928] [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: 01/23/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To assess the inter-reliability of the Short Physical Performance Battery (SPPB), the 1-min Sit to Stand test (1-MSTS), and the Chester Step Test (CST) via remote assessment in post-COVID-19 patients after hospitalization. METHODS Twenty-five post-COVID-19 patients randomly performed the functional tests via remote assessment using a software platform at home and via face-to-face assessment at the rehabilitation center 24-72 h apart. One day before the remote assessment, all participants had a 1-h guidance session regarding the platform use, safety instructions, and home equipment preparation. RESULTS Participants completed all tests for both assessment procedures without experience of adverse events. The mean age was 53 (SD = 10) years old, and the median days of hospitalization were 23 (IQR = 10-33). The inter-reliability was moderate for the total score in the SPPB: Cohen's kappa = 0.545 (95% CI: 0.234 to 0.838), excellent for the number of repetitions in the 1-MSTS: ICC = 0.977 (95% CI: 0.948 to 0.990) and good for the total number of steps in the CST: ICC = 0.871 (95% CI: 0.698 to 0.944). CONCLUSION Remote functional assessments for SPPB, 1-MSTS, and CST indicated moderate to excellent inter-reliability in post-COVID-19 patients after hospitalization.
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Affiliation(s)
- Aspasia Mavronasou
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Andreas Asimakos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, Athens, Greece
| | - Aristeidis Vasilopoulos
- Health Assessment and Quality of Life Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Paraskevi Katsaounou
- Pulmonary & Respiratory Failure Department, First ICU, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni A Kortianou
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
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Huang CT, Ruan SY, Lai F, Chien JY, Yu CJ. Prognostic Value of Pace Variability, a Novel 6MWT-Derived Feature, in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1555-1564. [PMID: 37497382 PMCID: PMC10368117 DOI: 10.2147/copd.s407708] [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] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose The 6-minute walk test (6MWT) is often used to evaluate chronic obstructive pulmonary disease (COPD) patients' functional capacity, with 6-minute walk distance (6MWD) and related measures being linked to mortality and hospitalizations. This study investigates the prognostic value of pace variability, a significant indicator in sports medicine, during the 6MWT for COPD patients. Patients and Methods We retrospectively screened consecutive COPD patients who had been prospectively enrolled in a pay-for-performance program from January 2019 to May 2020 to determine their eligibility. Patient characteristics, including demographics, exacerbation history, and 6MWT data, were analyzed to investigate their potential associations with prognosis. The primary outcome was a composite of adverse events, including overall mortality or hospitalizations due to exacerbations during a 1-year follow-up period. To analyze the 6MWT data, we divided it into three 2-minute epochs and calculated the average walk speed for each epoch. We defined pace variability as the difference between the maximum and minimum average speed in a single 2-minute epoch, divided by the average speed for the entire 6-minute walk test. Results A total of 163 patients with COPD were included in the study, and 19 of them (12%) experienced the composite adverse outcome. Multivariable logistic regression analyses revealed that two predictors were independently associated with the composite outcome: % predicted 6MWD <72 (adjusted odds ratio [aOR] 7.080; 95% confidence interval [CI] 1.481-33.847) and pace variability ≥0.39 (aOR 9.444; 95% CI 2.689-33.170). Patients with either of these adverse prognostic features had significantly worse composite outcome-free survival, with both log-rank P values less than 0.005. Notably, COPD patients with both adverse features experienced an especially poor outcome after 1 year. Conclusion Patients with COPD who exhibited greater pace variability during the 6MWT had a significantly higher risk of overall mortality and COPD-related hospitalizations, indicating a worse prognosis.
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Affiliation(s)
- Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Slobod D, Spinelli E, Crotti S, Lissoni A, Galazzi A, Grasselli G, Mauri T. Effects of an asymmetrical high flow nasal cannula interface in hypoxemic patients. Crit Care 2023; 27:145. [PMID: 37072854 PMCID: PMC10111067 DOI: 10.1186/s13054-023-04441-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Optimal noninvasive respiratory support for patients with hypoxemic respiratory failure should minimize work of breathing without increasing the transpulmonary pressure. Recently, an asymmetrical high flow nasal cannula (HFNC) interface (Duet, Fisher & Paykel Healthcare Ltd), in which the caliber of each nasal prong is different, was approved for clinical use. This system might reduce work of breathing by lowering minute ventilation and improving respiratory mechanics. METHODS We enrolled 10 patients ≥ 18 years of age who were admitted to the Ospedale Maggiore Policlinico ICU in Milan, Italy, and had a PaO2/FiO2 < 300 mmHg during HFNC support with a conventional cannula. We investigated whether the asymmetrical interface, compared to a conventional high flow nasal cannula, reduces minute ventilation and work of breathing. Each patient underwent support with the asymmetrical interface and the conventional interface, applied in a randomized sequence. Each interface was provided at a flow rate of 40 l/min followed by 60 l/min. Patients were continuously monitored with esophageal manometry and electrical impedance tomography. RESULTS Application of the asymmetrical interface resulted in a -13.5 [-19.4 to (-4.5)] % change in minute ventilation at a flow rate of 40 l/min, p = 0.006 and a -19.6 [-28.0 to (-7.5)] % change at 60 l/min, p = 0.002, that occurred despite no change in PaCO2 (35 [33-42] versus 35 [33-43] mmHg at 40 l/min and 35 [32-41] versus 36 [32-43] mmHg at 60 l/min). Correspondingly, the asymmetrical interface lowered the inspiratory esophageal pressure-time product from 163 [118-210] to 140 [84-159] (cmH2O*s)/min at a flow rate of 40 l/min, p = 0.02 and from 142 [123-178] to 117 [90-137] (cmH2O*s)/min at a flow rate of 60 l/min, p = 0.04. The asymmetrical cannula did not have any impact on oxygenation, the dorsal fraction of ventilation, dynamic lung compliance, or end-expiratory lung impedance, suggesting no major effect on PEEP, lung mechanics, or alveolar recruitment. CONCLUSIONS An asymmetrical HFNC interface reduces minute ventilation and work of breathing in patients with mild-to-moderate hypoxemic respiratory failure supported with a conventional interface. This appears to be primarily driven by increased ventilatory efficiency due to enhanced CO2 clearance from the upper airway.
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Affiliation(s)
- Douglas Slobod
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Critical Care Medicine, McGill University, Montreal, Canada
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Stefania Crotti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alfredo Lissoni
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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10
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Eman G, Synn S, Galen B, Shah R, Nauka P, Hope AA, Congdon S, Islam M. Thoracic Ultrasound in COVID-19: Use of Lung and Diaphragm Ultrasound in Evaluating Dyspnea in Survivors of Acute Respiratory Distress Syndrome from COVID-19 Pneumonia in a Post-ICU Clinic. Lung 2023; 201:149-157. [PMID: 37036522 PMCID: PMC10088741 DOI: 10.1007/s00408-023-00614-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Dyspnea is a common symptom in survivors of severe COVID-19 pneumonia. While frequently employed in hospital settings, the use of point-of-care ultrasound in ambulatory clinics for dyspnea evaluation has rarely been explored. We aimed to determine how lung ultrasound score (LUS) and inspiratory diaphragm excursion (DE) correlate with patient-reported dyspnea during a 6-min walk test (6MWT) in survivors of COVID-19 acute respiratory distress syndrome (ARDS). We hypothesize higher LUS and lower DE will correlate with dyspnea severity. STUDY DESIGN AND METHODS Single-center cross-sectional study of survivors of critically ill COVID-19 pneumonia (requiring high-flow nasal cannula, invasive, or non-invasive mechanical ventilation) seen in our Post-ICU clinic. All patients underwent standardized scanning protocols to compute LUS and DE. Pearson correlations were performed to detect an association between LUS and DE with dyspnea at rest and exertion during 6MWT. RESULTS We enrolled 45 patients. Average age was 61.5 years (57.7% male), with average BMI of 32.3 Higher LUS correlated significantly with dyspnea, at rest (r = + 0.41, p = < 0.01) and at exertion (r = + 0.40, p = < 0.01). Higher LUS correlated significantly with lower oxygen saturation during 6MWT (r = -0.55, p = < 0.01) and lower 6MWT distance (r = -0.44, p = < 0.01). DE correlated significantly with 6MWT distance but did not correlate with dyspnea at rest or exertion. CONCLUSION Higher LUS correlated significantly with patient-reported dyspnea at rest and exertion. Higher LUS significantly correlated with more exertional oxygen desaturation during 6MWT and lower 6MWT distance. DE did not correlate with dyspnea.
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Affiliation(s)
- Gerardo Eman
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
- Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
| | - Shwe Synn
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Benjamin Galen
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Roshni Shah
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Peter Nauka
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Aluko A Hope
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Seth Congdon
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Marjan Islam
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
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11
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The Chester Step Test Is a Reproducible Tool to Assess Exercise Capacity and Exertional Desaturation in Post-COVID-19 Patients. Healthcare (Basel) 2022; 11:healthcare11010051. [PMID: 36611511 PMCID: PMC9819391 DOI: 10.3390/healthcare11010051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Many people recovering from an acute episode of coronavirus disease (COVID-19) experience prolonged symptoms. Exercise testing is a feasible and cost-effective option for assessing exercise tolerance, fatigue, and dyspnea related to effort. Being that the Chester step test (CST) is a progressive, submaximal test for predicting aerobic capacity, it could be a good option to explore. This study aimed to determine the reproducibility of CST for assessing exertional desaturation and exercise capacity in patients post-COVID-19 disease. A cross-sectional study was conducted on post-COVID-19 patients. Two attempts of the CST were performed. The intraclass correlation coefficient (ICC) was used to assess agreement between the two tests. Forty-two symptomatic post-COVID-19 patients were included, the mean age was 53.8 ± 10.3 years, and 52% were female. There was no significant difference between both tests (p = 0.896). Twenty-four percent of participants (10 cases) had a clinically significant decrease in SpO2 at the first assessment, compared to 30.1% (13 cases) at the second, with no significant difference. An ICC of 0.993 (95% CI: 0.987 to 0.996) was obtained for the total number of steps in the CST.
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12
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Correa EM, Vallespín GT. COVID persistente. Elementos básicos para el médico de atención primaria. FMC : FORMACION MEDICA CONTINUADA EN ATENCION PRIMARIA 2022; 29:481-489. [PMID: 36338437 PMCID: PMC9619169 DOI: 10.1016/j.fmc.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
•La COVID persistente es una presentación clínica prevalente entre las personas contagiadas por SARS-CoV-2 que provoca multitud de síntomas que pueden afectar a prácticamente todos los sistemas del cuerpo y que impactan en la funcionalidad de las personas afectadas. •La dificultad inicial en su reconocimiento y diagnóstico han provocado un infradiagnóstico y un déficit en la atención sanitaria a las personas afectadas. •Hasta el momento no se han aclarado cuáles son las causas que producen la persistencia de síntomas invalidantes en personas infectadas por SARS-CoV-2 transcurridos 3 meses de la infección aguda. •No existe ningún tratamiento que haya demostrado ser efectivo en la curación de la COVID persistente. •El abordaje de las personas afectadas por COVID persistente debe recaer en la atención primaria priorizando la atención integral, el acompañamiento y la investigación.
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Polastri M, Carbonara P, Prediletto I, Gardini A, Venturoli F, Tagariello F, Neri L, Carpano M, Pacilli AMG, Nava S. Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background/Aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic. Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March–12 June 2020 and 2 November 2020–9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge. Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 ± 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH2O, and the maximal expiratory pressure was 59.1 cmH2O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH2O; and maximal expiratory pressure by 9.5 cmH2O. Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Carbonara
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Gardini
- Department of Statistical Sciences ‘P. Fortunati’, University of Bologna, Bologna, Italy
| | - Francesca Venturoli
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Tagariello
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lucia Neri
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Carpano
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Maria Grazia Pacilli
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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14
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Sevillano-Castaño A, Peroy-Badal R, Torres-Castro R, Gimeno-Santos E, García Fernández P, Garcia Vila C, Ariza Alfaro A, De Dios Álvarez R, Vilaró J, Blanco I. Is there a learning effect on 1-minute sit-to-stand test on post-COVID-19 patients? ERJ Open Res 2022; 8:00189-2022. [PMID: 36171984 PMCID: PMC9511157 DOI: 10.1183/23120541.00189-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Due to the sequelae of the coronavirus disease 19 (COVID-19), clinical guidelines have had to develop follow-up programmes focused on imaging, lung function, symptoms and physical capacity [1, 2]. To assess functional capacity, field tests are recommended, such as the 6-min walking test (6MWT) or the 1-min sit-to-stand test (STST) [3, 4]. The advantage of these tests is that they have been widely demonstrated to be useful in assessing functional capacity in respiratory chronic diseases and can be performed in low-resource settings [5]. The 1-min sit-to-stand test is a repeatable field test without differences between the first and second tests. Hence, conducting one attempt of the 1-min STST would be enough to evaluate functional capacity in patients recovered from #COVID19.https://bit.ly/3y3ycAP
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15
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Lyu YR, Lee SW, Kim SY, Han HB, Yang WK, Kim SH, Jung IC, Kwon OJ, Kim AR, Kim J, Lee MY, Park YC. Herbal Medicines for the Treatment of Chronic Obstructive Airway Diseases (Asthma or Chronic Obstructive Pulmonary Disease): A Prospective Observational Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:3485757. [PMID: 35677382 PMCID: PMC9168097 DOI: 10.1155/2022/3485757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022]
Abstract
Background Obstructive airway disease is a major health problem and has a great impact on global socioeconomic burden. Despite therapeutic advances in recent decades, there is still a need for effective and safe therapeutic agents for patients with asthma or chronic obstructive pulmonary disease (COPD). Methods This prospective observational study explored the effects of herbal medicines in patients with asthma and COPD. All participants visited the hospital at least every 4 weeks for 12 weeks to receive their herbal medicines based on their pattern identification and to evaluate safety and efficacy endpoints. We followed the diagnostic criteria used by Korean medicine doctors to prescribe herbal medicines, explored variations in prescribed herbal medicines, and explored a number of clinical features in patients with asthma or COPD. Results A total of 24 patients were enrolled: 14 were diagnosed with asthma and 10 with COPD and 19 completed the study. After 12 weeks of herbal medicine treatment, herbal medicines significantly improved the modified Clinical Asthma Measurement Scale in Oriental Medicine-V in asthma patients and the modified Medical Research Council Dyspnoea Scale and St. George's Respiratory Questionnaire in COPD patients. For all patients, modified Medical Research Council Dyspnoea Scale score and interleukin-13 were found to be significantly different after treatment. Additionally, the majority of patients were satisfied with our herbal medicine treatments, and no severe adverse events were reported during the study. Conclusions Our study provides preliminary clinical data on the safety and efficacy of herbal medicines in patients with asthma and COPD.
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Affiliation(s)
- Yee Ran Lyu
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Su-Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Si-Yeon Kim
- Clinical Trial Center, Daejeon Korean Medicine Hospital, Daejeon University, Daejeon, Republic of Korea
| | - Hye-Bin Han
- Clinical Trial Center, Daejeon Korean Medicine Hospital, Daejeon University, Daejeon, Republic of Korea
| | - Won-Kyung Yang
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Seung-Hyung Kim
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - In Chul Jung
- Department of Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - O-jin Kwon
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Medicine Division, R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jinhee Kim
- Korean Medicine Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Mi Young Lee
- Korean Medicine Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Yang-Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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16
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Williams MT, Lewthwaite H, Paquet C, Johnston K, Olsson M, Belo LF, Pitta F, Morelot-Panzini C, Ekström M. Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties. J Pain Symptom Manage 2022; 63:e75-e87. [PMID: 34273524 DOI: 10.1016/j.jpainsymman.2021.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT The Dyspnoea-12 (D-12) and Multidimensional Dyspnea Profile (MDP) were specifically developed for assessment of multiple sensations of breathlessness. OBJECTIVES This systematic review aimed to identify the use and measurement properties of the D-12 and MDP across populations, settings and languages. METHODS Electronic databases were searched for primary studies (2008-2020) reporting use of the D-12 or MDP in adults. Two independent reviewers completed screening and data extraction. Study and participant characteristics, instrument use, reported scores and minimal clinical important differences (MCID) were evaluated. Data on internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient, ICC) were pooled using random effects models between settings and languages. RESULTS A total 75 publications reported use of D-12 (n = 35), MDP (n = 37) or both (n = 3), reflecting 16 chronic conditions. Synthesis confirmed two factor structure, internal consistency (Cronbach's α mean, 95% CI: D-12 Total = 0.93, 0.91-0.94; MDP Immediate Perception [IP] = 0.88, 0.85-0.90; MDP Emotional Response [ER] = 0.86, 0.82-0.89) and 14 day test-rest reliability (ICC: D-12 Total = 0.91, 0.88-0.94; MDP IP = 0.85, 0.70-0.93; MDP ER = 0.84, 0.73-0.90) across settings and languages. MCID estimates for clinical interventions ranged between -3 and -6 points (D-12 Total) with small variability in scores over 2 weeks (D-12 Total 2.8 (95% CI: 2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1) and six months (D-12 Total 2.9 (2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1)). CONCLUSION D-12 and MDP are widely used, reliable, valid and responsive across various chronic conditions, settings and languages, and could be considered standard instruments for measuring dimensions of breathlessness in international trials.
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Affiliation(s)
- Marie T Williams
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Hayley Lewthwaite
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada; College of Engineering, Science and Environment, School of Environmental & Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Catherine Paquet
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Faculté des Sciences de l'Administration, Université Laval, Québec (Québec) , Canada
| | - Kylie Johnston
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Max Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
| | - Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Groupe Hospitalo-Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
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17
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Carpagnano GE, Pierucci P, Migliore G, Minicucci AM, Aricò M, Marra M, Carpagnano LF. Tailored Post-Acute Care Coordination for Survivors of Moderate to Severe COVID-19 Infection. J Am Med Dir Assoc 2021; 23:447-449. [PMID: 34995511 PMCID: PMC8677462 DOI: 10.1016/j.jamda.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari, Italy
| | | | | | | | - Maurizio Marra
- Hospital Health Direction Office, Bari Policlinic University Hospital, Bari, Italy
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18
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Aitken CR, Sharma P, Louis M, Walsh J, Stewart GM, Sabapathy S, Adams L, Morris NR. Examining the repeatability of a novel test to measure exertional dyspnoea in chronic obstructive pulmonary disease. Respir Physiol Neurobiol 2021; 296:103826. [PMID: 34864520 DOI: 10.1016/j.resp.2021.103826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Exertional dyspnoea(ED) is a hallmark of chronic obstructive pulmonary disease(COPD). We examined the repeatability and face validity of the end-exercise ED(EDend) response during the Dyspnoea Challenge and compared those to the six-minute walk test (6MWT) in COPD. METHODS Twenty-six individuals with COPD(13 Females, age:69 ± 5.5yrs, FEV1:63.4 ± 11.9 %) completed 2 × 6MWTs and 4 x Dyspnoea Challenges on three occasions. The challenge consisted of a two-minute treadmill walk at 80 % of 6MWT speed(3.9 ± 0.5 km·hr-1) at either a low(LIDC:5.3 ± 2%) or high angle of incline(HIDC:9.5 ± 3%). Dyspnoea(0-10 scale), heart rate(HR) and oxygen saturation(SpO2) were monitored continuously. RESULTS Mean 6MWT distance was 488 ± 58 m. End-exercise ED and HR were higher in the HIDC(EDend 6.2 ± 2.0; HR: 123 ± 17beats·min-1) compared to the LIDC(EDend 4.2 ± 2.0; HR: 119 ± 15beats·min-1) and the 6MWT(EDend 4.3 ± 2.0; HR: 115 ± 16beats·min-1)(P < 0.01). SpO2 was not different between 6MWT, LIDC or HIDC(P = 0.34). The intraclass correlation coefficient(ICC) for each intensity was excellent (HIDC, ICC = 0.88, LIDC, ICC = 0.93, P < 0.001) with neither reporting bias(HIDC, P = 0.63; LIDC, P = 0.94). CONCLUSIONS The Dyspnoea Challenge is a simple measure of ED that appears to have both repeatability and face validity. With further optimisation, this test may enhance the field-based clinical assessment of ED.
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Affiliation(s)
- Craig R Aitken
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia.
| | - Pramod Sharma
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - Menaka Louis
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - James Walsh
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia
| | - Glenn M Stewart
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Surendran Sabapathy
- School of Health Sciences and Social Work, Southport, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Lewis Adams
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
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19
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Kocatepe V, Can G, Oruç Ö. Lung Cancer-Related Dyspnea: The Effects of a Handheld Fan on Management of Symptoms. Clin J Oncol Nurs 2021; 25:655-661. [PMID: 34800099 DOI: 10.1188/21.cjon.655-661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The application of a handheld fan may reduce patients' shortness of breath and increase their activity tolerance by enabling cooling and air flow into the second and third branches of the trigeminal nerve. OBJECTIVES The aim of the study was to assess the effects of directing a handheld fan toward the face in the management of lung cancer-related dyspnea. METHODS Using a randomized controlled experimental design, 96 inpatients with lung cancer were evaluated, with the experimental group (n = 49) using a handheld fan to manage dyspnea for 14 days. Dyspnea, respiration rate, oxygen saturation, heart rate, and quality of life were assessed for both groups. FINDINGS A statistically significant difference was found in dyspnea scores between groups on the first, seventh, and fourteenth days of fan application, and statistically significant differences were found between groups in dyspnea scores, respiration rates, oxygen saturation, heart rate, and quality of life on the fourteenth day of application.
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Affiliation(s)
| | | | - Özlem Oruç
- Ministry of Health of Turkey Health Sciences University
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20
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Bhandoria G, Solanki SL, Bhavsar M, Balakrishnan K, Bapuji C, Bhorkar N, Bhandarkar P, Bhosale S, Divatia JV, Ghosh A, Mahajan V, Peedicayil A, Nath P, Sinukumar S, Thambudorai R, Seshadri RA, Bhatt A. Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey. Pleura Peritoneum 2021; 6:99-111. [PMID: 34676283 PMCID: PMC8482448 DOI: 10.1515/pp-2021-0117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Enhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians' practice about ERAS in patients undergoing CRS-HIPEC. METHODS An online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists. RESULTS The response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76-95%), preoperative (50-94%), and intraoperative (55-90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated. CONCLUSIONS Most respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.
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Affiliation(s)
- Geetu Bhandoria
- Department of Obstetrics & Gynecology, Command Hospital, Pune, India
| | - Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mrugank Bhavsar
- Department of Critical Care Medicine, Zydus Hospital, Ahmedabad, India
| | | | | | - Nitin Bhorkar
- Department of Anaesthesiology, Saifee Hospital, Mumbai, India
| | | | - Sameer Bhosale
- Department of Anaesthesiology, Jehangir Hospital, Pune, India
| | - Jigeeshu V. Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anik Ghosh
- Department of Gynecologic Oncology, Tata Medical Centre, Kolkata, India
| | - Vikas Mahajan
- Department of Surgical Oncology, Apollo Hospital, Chennai, India
| | - Abraham Peedicayil
- Department of Gynecologic Oncology, Christian Medical College, Vellore, India
| | - Praveen Nath
- Department of Anaesthesiology, Kumaran Hospital, Chennai, India
| | - Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Pune, India
| | - Robin Thambudorai
- Department of Surgical Oncology, Tata Medical Centre, Kolkata, India
| | | | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
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21
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Hentsch L, Cocetta S, Allali G, Santana I, Eason R, Adam E, Janssens JP. Breathlessness and COVID-19: A Call for Research. Respiration 2021; 100:1016-1026. [PMID: 34333497 PMCID: PMC8450822 DOI: 10.1159/000517400] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
Breathlessness, also known as dyspnoea, is a debilitating and frequent symptom. Several reports have highlighted the lack of dyspnoea in a subgroup of patients suffering from COVID-19, sometimes referred to as “silent” or “happy hypoxaemia.” Reports have also mentioned the absence of a clear relationship between the clinical severity of the disease and levels of breathlessness reported by patients. The cerebral complications of COVID-19 have been largely demonstrated with a high prevalence of an acute encephalopathy that could possibly affect the processing of afferent signals or top-down modulation of breathlessness signals. In this review, we aim to highlight the mechanisms involved in breathlessness and summarize the pathophysiology of COVID-19 and its known effects on the brain-lung interaction. We then offer hypotheses for the alteration of breathlessness perception in COVID-19 patients and suggest ways of further researching this phenomenon.
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Affiliation(s)
- Lisa Hentsch
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Gilles Allali
- Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
| | | | - Rowena Eason
- Phyllis Tuckwell Hospice Care, Surrey, United Kingdom
| | - Emily Adam
- Independent Researcher, London, United Kingdom
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland
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22
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Delgado-Enciso I, Paz-Garcia J, Barajas-Saucedo CE, Mokay-Ramírez KA, Meza-Robles C, Lopez-Flores R, Delgado-Machuca M, Murillo-Zamora E, Toscano-Velazquez JA, Delgado-Enciso J, Melnikov V, Walle-Guillen M, Galvan-Salazar HR, Delgado-Enciso OG, Cabrera-Licona A, Danielewicz-Mata EJ, Mandujano-Diaz PJ, Guzman-Esquivel J, Montes-Galindo DA, Perez-Martinez H, Jimenez-Villegaz JM, Hernandez-Rangel AE, Montes-Diaz P, Rodriguez-Sanchez IP, Martinez-Fierro ML, Garza-Veloz I, Tiburcio-Jimenez D, Zaizar-Fregoso SA, Gonzalez-Alcaraz F, Gutierrez-Gutierrez L, Diaz-Lopez L, Ramirez-Flores M, Guzman-Solorzano HP, Gaytan-Sandoval G, Martinez-Perez CR, Espinoza-Gómez F, Rojas-Larios F, Hirsch-Meillon MJ, Baltazar-Rodriguez LM, Barrios-Navarro E, Oviedo-Rodriguez V, Mendoza-Hernandez MA, Prieto-Diaz-Chavez E, Paz-Michel BA. Safety and efficacy of a COVID-19 treatment with nebulized and/or intravenous neutral electrolyzed saline combined with usual medical care vs. usual medical care alone: A randomized, open-label, controlled trial. Exp Ther Med 2021; 22:915. [PMID: 34306189 PMCID: PMC8281484 DOI: 10.3892/etm.2021.10347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is currently the major public health problem worldwide. Neutral electrolyzed saline solution that contains reactive chlorine and oxygen species may be an effective therapeutic. In the present study, the treatment efficacy of intravenous and/or nebulized neutral electrolyzed saline combined with usual medical care vs. usual medical care alone was evaluated in ambulatory patients with COVID-19. A prospective, 2-arm, parallel-group, randomized, open-label, multi-center, phase I-II clinical trial including 214 patients was performed. The following two outcomes were evaluated during the 20-day follow-up: i) The number of patients with disease progression; and ii) the patient acceptable symptom state. Serial severe acute respiratory syndrome coronavirus 2 naso/oro-pharyngeal detection by reverse transcription-quantitative (RT-q) PCR was performed in certain patients of the experimental group. Biochemical and hematologic parameters, as well as adverse effects, were also evaluated in the experimental group. The experimental treatment decreased the risk of hospitalization by 89% [adjusted relative risk (RR)=0.11, 95% confidence interval (CI): 0.03-0.37, P<0.001] and the risk of death by 96% (adjusted RR=0.04, 95% CI: 0.01-0.42, P=0.007) and also resulted in an 18-fold higher probability of achieving an acceptable symptom state on day 5 (adjusted RR=18.14, 95% CI: 7.29-45.09, P<0.001), compared with usual medical care alone. Overall, neutral electrolyzed saline solution was better than usual medical care alone. Of the patients analyzed, >50% were negative for the virus as detected by RT-qPCR in naso/oro-pharyngeal samples on day 4, with only a small number of positive patients on day 6. Clinical improvement correlated with a decrease in C-reactive protein, aberrant monocytes and increased lymphocytes and platelets. Cortisol and testosterone levels were also evaluated and a decrease in cortisol levels and an increase in the testosterone-cortisol ratio were observed on days 2 and 4. The experimental treatment produced no serious adverse effects. In conclusion, neutral electrolyzed saline solution markedly reduced the symptomatology and risk of progression in ambulatory patients with COVID-19. The present clinical trial was registered in the Cuban public registry of clinical trials (RPCEC) database (May 5, 2020; no. TX-COVID19: RPCEC00000309).
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Affiliation(s)
- Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Juan Paz-Garcia
- Department of Internal Medicine and Surgery, Union Hospital Center, Villa de Álvarez, Colima 28970, México
| | - Carlos E Barajas-Saucedo
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Karen A Mokay-Ramírez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Carmen Meza-Robles
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Rodrigo Lopez-Flores
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Marina Delgado-Machuca
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Efren Murillo-Zamora
- Department of Research, General Hospital of Zone No. 1 and Family Medicine Unit No. 19 IMSS, Villa de Alvarez, Colima 28984, México
| | - Jose A Toscano-Velazquez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Josuel Delgado-Enciso
- Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima 28085, México
| | - Valery Melnikov
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Mireya Walle-Guillen
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Hector R Galvan-Salazar
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Osiris G Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima 28085, México
| | | | | | - Pablo J Mandujano-Diaz
- COVID-19 Respiratory Care Clinic INSABI Poliforum, Tuxtla Gutierrez, Chiapas 29040, México
| | - José Guzman-Esquivel
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima 28085, México
| | - Daniel A Montes-Galindo
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Henry Perez-Martinez
- COVID-19 Respiratory Care Clinic INSABI Poliforum, Tuxtla Gutierrez, Chiapas 29040, México
| | | | | | | | - Iram P Rodriguez-Sanchez
- Laboratory of Molecular and Structural Physiology, School of Biological Sciences, Universidad Autónoma de Nuevo León, San Nicolas de los Garza, Nuevo León 66455, México
| | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, México
| | - Idalia Garza-Veloz
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, México
| | - Daniel Tiburcio-Jimenez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Sergio A Zaizar-Fregoso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | | | | | - Luciano Diaz-Lopez
- COVID-19 Respiratory Care Clinic INSABI Poliforum, Tuxtla Gutierrez, Chiapas 29040, México
| | - Mario Ramirez-Flores
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | | | - Gustavo Gaytan-Sandoval
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Carlos R Martinez-Perez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Francisco Espinoza-Gómez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Fabián Rojas-Larios
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Michael J Hirsch-Meillon
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | - Luz M Baltazar-Rodriguez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Enrique Barrios-Navarro
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México
| | - Vladimir Oviedo-Rodriguez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, México
| | | | | | - Brenda A Paz-Michel
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, México.,Department of Research, Esteripharma S.A. de C.V., Ciudad de México 03100, México
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23
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Lewthwaite H, Jensen D, Ekström M. How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:1581-1598. [PMID: 34113091 PMCID: PMC8184148 DOI: 10.2147/copd.s277523] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assessment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multidimensional instruments are available. Borg's 0-10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field-based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assessment in daily life and in relation to exertion in people with COPD.
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Affiliation(s)
- Hayley Lewthwaite
- School of Environmental & Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, Australia
- UniSA: Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, Australia
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada
- Research Institute of the McGill University Health Centre, Faculty of Medicine, McGill University, Montréal, Québec, Canada
- Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Canada
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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24
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Effects of Respiratory Muscle Training on Baroreflex Sensitivity, Respiratory Function, and Serum Oxidative Stress in Acute Cervical Spinal Cord Injury. J Pers Med 2021; 11:jpm11050377. [PMID: 34062971 PMCID: PMC8147917 DOI: 10.3390/jpm11050377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: respiratory complications are a leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). We examined the effects of respiratory muscle training (RMT) in patients with acute cervical SCI. Methods: this prospective trial enrolled 44 adults with acute cervical SCI, of which twenty received RMT and twenty-four did not receive RMT. Respiratory function, cardiovascular autonomic function, and reactive oxidative species (ROS) were compared. The experimental group received 40-min high-intensity home-based RMT 7 days per week for 10 weeks. The control group received a sham intervention for a similar period. The primary outcomes were the effects of RMT on pulmonary and cardiovascular autonomic function, and ROS production in individuals with acute cervical SCI. Results: significant differences between the two groups in cardiovascular autonomic function and the heart rate response to deep breathing (p = 0.017) were found at the 6-month follow-up. After RMT, the maximal inspiratory pressure (p = 0.042) and thiobarbituric acid-reactive substances (TBARS) (p = 0.006) improved significantly, while there was no significant difference in the maximal expiratory pressure. Significant differences between the two groups in tidal volume (p = 0.005) and the rapid shallow breathing index (p = 0.031) were found at 6 months. Notably, the SF-36 (both the physical (PCS) and mental (MCS) component summaries) in the RMT group had decreased significantly at the 6-month follow-up, whereas the clinical scores did not differ significantly (p = 0.333) after RMT therapy. Conclusions: High-intensity home-based RMT can improve pulmonary function and endurance and reduce breathing difficulties in patients with respiratory muscle weakness after injury. It is recommended for rehabilitation after spinal cord injury.
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25
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Alsina-Restoy X, Burgos F, Torres-Castro R, Torralba-García Y, Arismendi E, Barberà JA, Agustí À, Blanco I. A New and More Sensitive Method to Integrate the Desaturation Distance Ratio During a 6-Minute Walking Test in Chronic Respiratory Diseases: Physiological Correlates. Arch Bronconeumol 2021; 58:188-190. [PMID: 34001352 DOI: 10.1016/j.arbres.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Xavier Alsina-Restoy
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Felip Burgos
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Rodrigo Torres-Castro
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Yolanda Torralba-García
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Ebymar Arismendi
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Joan Albert Barberà
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Àlvar Agustí
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Isabel Blanco
- Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain.
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26
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Hui D, Bohlke K, Bao T, Campbell TC, Coyne PJ, Currow DC, Gupta A, Leiser AL, Mori M, Nava S, Reinke LF, Roeland EJ, Seigel C, Walsh D, Campbell ML. Management of Dyspnea in Advanced Cancer: ASCO Guideline. J Clin Oncol 2021; 39:1389-1411. [DOI: 10.1200/jco.20.03465] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- David Hui
- MD Anderson Cancer Center, Houston, TX
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Arjun Gupta
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Aliza L. Leiser
- Rutgers RWJ Cancer Institute of New Jersey, New Brunswick, NJ
| | - Masanori Mori
- Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Stefano Nava
- IRCCS Azienda Ospedaliera University of Bologna, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
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27
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Ahmed I, Inam AB, Belli S, Ahmad J, Khalil W, Jafar MM. Effectiveness of aerobic exercise training program on cardio-respiratory fitness and quality of life in patients recovered from COVID-19. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1909649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ishtiaq Ahmed
- College of Physical Therapy, Government College University, Faisalabad, Pakistan
| | - Awais Bin Inam
- College of Physical Therapy, Government College University, Faisalabad, Pakistan
| | - Stefano Belli
- Istituti Clinici Scientifici Maugeri IRCCS, Neurologic Rehabilitation Unit of Veruno Institute, Veruno, Italy
| | - Junaid Ahmad
- Prime Institute of Public Health (PIPH), Peshawar Medical College (PMC), Peshawar, Pakistan
| | - Wajid Khalil
- College of Physical Therapy, Government College University, Faisalabad, Pakistan
| | - M. Muneeb Jafar
- College of Physical Therapy, Government College University, Faisalabad, Pakistan
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28
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Abstract
PURPOSE OF REVIEW Exertional breathlessness is common and pervasive across various chronic disease populations. To accurately assess response to intervention and optimize clinical (symptom) management, detailed assessment of exertional breathlessness is imperative. This review provides an update on current approaches to assess exertional breathlessness and presents the need for individualized assessment of breathlessness standardized for the level of exertion. RECENT FINDINGS Breathlessness assessment tools commonly invite people to recall their breathlessness while at rest with reference to activities of daily living. To directly quantify breathlessness, however, requires assessment of the dimensions of breathlessness (e.g., sensory intensity, quality, and unpleasantness) in response to a standardized exercise stimulus. Different exercise stimuli (e.g., self-paced, incremental, and constant work rate exercise tests) have been used to elicit a breathlessness response. Self-paced (e.g., 6-min walk test) and incremental exercise tests assess exercise tolerance or endurance, and are not recommended for assessment of exertional breathlessness. Constant work rate tests, however, including recently validated 3-min constant-rate stair stepping and walking tests, standardize the exercise stimulus to enable the breathlessness response to be directly quantified and monitored over time. SUMMARY To adequately guide symptom management and assess intervention efficacy, clinicians and researchers should assess breathlessness with multidimensional assessment tools in response to a standardized and individualized exercise stimulus.
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29
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Hübner M, Kusamura S, Villeneuve L, Al-Niaimi A, Alyami M, Balonov K, Bell J, Bristow R, Guiral DC, Fagotti A, Falcão LFR, Glehen O, Lambert L, Mack L, Muenster T, Piso P, Pocard M, Rau B, Sgarbura O, Somashekhar SP, Wadhwa A, Altman A, Fawcett W, Veerapong J, Nelson G. Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations - Part I: Preoperative and intraoperative management. Eur J Surg Oncol 2020; 46:2292-2310. [PMID: 32873454 DOI: 10.1016/j.ejso.2020.07.041] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. METHODS The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. RESULTS Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. CONCLUSION The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.
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Affiliation(s)
- Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Switzerland.
| | - Shigeki Kusamura
- Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laurent Villeneuve
- Clinical Research and Epidemiological Unit, Department of Public Health, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France
| | - Ahmed Al-Niaimi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Konstantin Balonov
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, USA
| | - John Bell
- Department of Anesthesiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Robert Bristow
- Department of Obstetrics and Gynecologic Oncology, University of California, Irvine School of Medicine, Orange, USA
| | - Delia Cortés Guiral
- Department of General Surgery (Peritoneal Surface Surgical Oncology). University Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Anna Fagotti
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Luiz Fernando R Falcão
- Discipline of Anesthesiology, Pain and Critical Care Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Olivier Glehen
- Department of Digestive Surgery, Lyon University Hospital, EA 3738, University of Lyon, Lyon, France
| | - Laura Lambert
- Peritoneal Surface Malignancy Program, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lloyd Mack
- Department of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tino Muenster
- Department of Anaesthesiology and Intensive Care Medicine. Hospital Barmherzige Brüder, Regensburg, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Marc Pocard
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - Beate Rau
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute Montpellier (ICM), University of Montpellier, Montpellier, France
| | - S P Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India
| | - Anupama Wadhwa
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Alon Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
| | - William Fawcett
- Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Jula Veerapong
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA, USA
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Polastri M, Loforte A. Heart failure syndrome and left ventricular assist devices: considering physiotherapeutic evaluation tools. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2020.0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Massimiliano Polastri
- Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St. Orsola University Hospital, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac-Thoracic-Vascular Diseases, Cardiac Surgery and Transplantation, St. Orsola University Hospital, Bologna, Italy
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[Pulmonary rehabilitation in the in-hospital and outpatient phases]. Rehabilitacion (Madr) 2020; 54:191-199. [PMID: 32441270 DOI: 10.1016/j.rh.2020.02.008] [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: 12/13/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022]
Abstract
Pulmonary rehabilitation programmes aim to improve aerobic capacity and enhance quality of life in patients with chronic pulmonary disease, facilitating their participation and integration in different areas and activities of daily living, through the prescription and performance of physical exercise, as well as education on risk factors and healthy living. In multidisciplinary processes, various health professionals work together to support patients through the rehabilitation process, guiding lifestyle changes to improve their level of physical activity, nutritional factors, smoking cessation, diabetes management, medication adherence and weight loss, based on theories of behavioural change. The main objective of pulmonary rehabilitation programmes is to empower users in self-care and facilitate long-term management of chronic lung disease.
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Cortés-Guiral D, Mohamed F, Glehen O, Passot G. Prehabilitation of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Eur J Surg Oncol 2020; 47:60-64. [PMID: 32063398 DOI: 10.1016/j.ejso.2020.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Treatment of peritoneal malignancy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is often undertaken in patients who have nutritional, physical and psychological challenges as a result of advanced disease. Prehabilitation is a multimodal approach that helps optimize postoperative recovery and reduce morbidity and may be of benefit in this group of patients. It begins once the decision to operate is made and continues until recovery to baseline health. Here we present recommendations on Prehabilitation for patients undergoing cytoreductive surgery and HIPEC following discussion at the 10th Peritoneal Malignancy Workshop in Paris September 2018.
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Affiliation(s)
- Delia Cortés-Guiral
- Department of Surgical Oncology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, GECOP Grupo Español de Cirugía Oncológica Peritoneal, Madrid, Spain.
| | - Faheez Mohamed
- Peritoneal Malignancy Department, Basingstoke and North Hampshire Hospitals, Basingstoke, UK
| | - Olivier Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, France
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, France
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Currow DC, Hunt T, Louw S, Eckert D, Allcroft P, To THM, Greene A, Krajnik M, Mahler D, Ekström M. Isolating peripheral effects of endogenous opioids in modulating exertional breathlessness in people with moderate or severe COPD: a randomised controlled trial. ERJ Open Res 2019; 5:00153-2019. [PMID: 31886161 PMCID: PMC6926367 DOI: 10.1183/23120541.00153-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/17/2019] [Indexed: 11/05/2022] Open
Abstract
Question addressed by the study Endogenous opioids (endorphins) have been reported to modulate exercise-induced breathlessness, but the relative contribution of peripheral opioid receptors has not been tested. Materials, participants and methods This was a double-blind, randomised, three-arm, cross-over trial in outpatients with spirometry-verified moderate to severe chronic obstructive pulmonary disease. Participants undertook an incremental symptom-limited treadmill test followed by five endurance treadmill tests at 75% of their maximal work rate; two tests for familiarisation and three tests 30 min after intravenous injection of either methylnaltrexone 0.3 mg·kg−1 (blocking peripheral opioid receptors only) or naloxone 0.1 mg·kg−1 (blocking both central and peripheral opioid receptors) or normal saline, in randomised order. The primary end-point was the regression slope between breathlessness intensity (0–10 numerical rating scale) and oxygen consumption (V′O2) during the walk tests, comparing methylnaltrexone and placebo using a paired t-test. Results 17 participants completed the trial: median (range) 66 (55–82) years; 15 males; mean±sd forced expiratory volume (FEV1) 53.8±17.6% predicted; FEV1/forced vital capacity ratio 0.55±15.9. There was no statistically or clinically significant difference in the primary end-point (regression slope of breathlessness intensity and V′O2) for methylnaltrexone (p=0.498) or naloxone (p=0.804), compared to placebo. Secondary outcomes were similar between the three treatment groups, including peak and mean breathlessness intensity and unpleasantness, exercise capacity, endurance time and leg fatigue. Answer to the question Blocking peripheral opioid receptors (methylnaltrexone) or peripheral and central opioid receptors (naloxone) did not appear to modulate breathlessness intensity nor exercise capacity when compared with placebo (no blockade). A double-blind, placebo controlled, randomised, cross-over study using methylnaltrexone found no evidence for a contribution of peripheral opioid receptors to the modulation of breathlessness by endogenous endorphins.http://bit.ly/32DZv3I
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Affiliation(s)
- David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Discipline Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Toby Hunt
- Dept of Respiratory Medicine, Flinders University, Adelaide, Australia
| | - Sandra Louw
- McCloud Consulting Group, Belrose, Australia
| | - Danny Eckert
- Neuroscience Research Australia, Margarete Ainsworth Building, Sydney, Australia
| | - Peter Allcroft
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, Australia.,Southern Adelaide Palliative Services (SAPS), Flinders Medical Centre, Bedford Park, Australia
| | - Tim H M To
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, Australia.,Southern Adelaide Palliative Services (SAPS), Flinders Medical Centre, Bedford Park, Australia
| | - Aine Greene
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Malgorzata Krajnik
- Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Don Mahler
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Magnus Ekström
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Ruangsomboon O, Dorongthom T, Chakorn T, Monsomboon A, Praphruetkit N, Limsuwat C, Surabenjawong U, Riyapan S, Nakornchai T, Chaisirin W. High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study. Ann Emerg Med 2019; 75:615-626. [PMID: 31864728 DOI: 10.1016/j.annemergmed.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/25/2019] [Accepted: 09/13/2019] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED. METHODS This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs. RESULTS Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose. CONCLUSION High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure.
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Affiliation(s)
- Onlak Ruangsomboon
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thawonrat Dorongthom
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tipa Chakorn
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Apichaya Monsomboon
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattakarn Praphruetkit
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chok Limsuwat
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Usapan Surabenjawong
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sattha Riyapan
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Nakornchai
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wansiri Chaisirin
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ozberk S, Karadibak D, Polat M. Predictors of exercise capacity in chronic venous disease patients. Phlebology 2019; 35:190-198. [DOI: 10.1177/0268355519870895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives The aim of this study was to determine predictors of exercise capacity and explore the relationship between exercise capacity, lower extremity performance level, pain, fatigue, physical activity, sleep quality, and quality of life in patients with chronic venous disease. Methods A total of 170 chronic venous disease patients who were referred to the Cardiovascular Surgery department were included. Assessment tools included the six-minute walk test for exercise capacity, repeated sit-to-stand test for lower limb performance level, Visual Analog Scale for pain, Fatigue Severity Scale for fatigue, Pittsburgh Sleep Quality Index for sleep quality, International Physical Activity Questionnaire for physical activity, and Venous Insufficiency Epidemiological and Economic Study’s Quality of Life questionnaire for quality of life. Results Exercise capacity was weakly and negatively correlated with body mass index (r = –0.391, p < 0.001), pain level (r = –0.268, p < 0.001), age (r = –0.355, p < 0.001), and fatigue severity (r = –0.141, p < 0.05). There was a weak positive correlation in walking distance with quality of life (r = –0.129, p < 0.05) and education level (r = 0.166, p < 0.05), whereas moderate positive correlation was observed between walking distance and lower limb performance level (r = 0.518, p < 0.001). Lower limb performance level was a significant predictor of exercise capacity, accounting for 50% of the variance. Conclusions Exercise capacity is an important determinant of morbidity. Therefore, there is a need to improve lower extremity performance and functional mobility in patients suffering from chronic venous disease.
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Affiliation(s)
- Sema Ozberk
- Institute of Health Science, Dokuz Eylul University, Izmir, Turkey
| | - Didem Karadibak
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Muslum Polat
- Department of Cardiovasculary Surgery, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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Pain during exacerbation of chronic obstructive pulmonary disease: A prospective cohort study. PLoS One 2019; 14:e0217370. [PMID: 31125359 PMCID: PMC6534306 DOI: 10.1371/journal.pone.0217370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background and objective Pain, a symptom often present in patients with Chronic Obstructive Pulmonary Disease (COPD), alters quality of life. COPD exacerbation augments several mechanisms that may cause pain (dyspnea, hyperinflation and inflammation) and therefore we hypothesized that pain might be increased during exacerbation. Methods A prospective cohort study was conducted in patients admitted for acute exacerbations of COPD (AECOPD) in two emergency departments in France and Canada. Patients with cancer-related pain or recent trauma were not included. The Short Form McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI) scale were used to evaluate pain intensity and location. Patients also completed the Borg Dyspnea Scale and Hospital Anxiety and Depression Scale. The questionnaires were completed again during an outpatient assessment in the stable phase. The primary outcome was difference in pain intensity (SF-MPQ) between the exacerbation and stable phases. Results Fifty patients were included. During exacerbation, 46 patients (92%) reported pain compared to 29 (58%) in the stable phase (p<0.001). Pain intensity was higher during exacerbation (SF-MPQ 29.7 [13.6–38.2] vs. 1.4 [0.0–11.2]; p<0.001). Pain was predominantly located in the chest during exacerbation and in the limbs during the stable phase. Pain intensity during exacerbation correlated with anxiety score. Conclusion The frequency and intensity of pain were higher during AECOPD, with a specific distribution. Pain should therefore be routinely assessed and treated in patients with AECOPD.
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Kozina Z, Sobko I, Kozin S, Garmash I. Вплив застосування нетрадиційних засобів відновлення працездатності на функціональний стан юних гребців 11-12 років. HEALTH, SPORT, REHABILITATION 2018. [DOI: 10.34142/hsr.2018.04.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Мета роботи – експериментально обґрунтувати ефективність застосування нетрадиційних педагогічних, психологічних та медико-біологічних засобів відновлення для підвищення функціонального стану юних гребців 11-12 років. Матеріал і методи. Усього в даному дослідженні взяли участь 43 юних гребця 11-12 років (дівчата), середній ріст яких склав 152,3±5,2 см середня вага – 39,01±6,5 кг. Обстежувані були поділені на 4 групи, приблизно рівні (р>0,05) по показникам фізичної та функціональної підготовленості. Три групи були експериментальними, в яких застосовувались різні засоби відновлення працездатності. У першій експериментальній групі застосовувався педагогічної метод контролю інтенсивності навантаження і часу відновлення по суб'єктивних відчуттях по шкалі Борга у сполученні з застосуванням масажу з утиранням мазі на травах і мумійо, у другій експериментальній групі застосовувався педагогічний метод контролю інтенсивності навантаження і часу відновлення по суб'єктивних відчуттях у сполученні з прийомом бальзаму з лікарських трав і мумійо, у третій експериментальній групі застосовувався педагогічної метод контролю інтенсивності навантаження і часу відновлення по суб'єктивних відчуттях у сполученні з аутогенним тренуванням (психотренінгом). Психотренінг проводився після тренування, аутотренінг - самостійно, індивідуально, за бажанням. Аутогенне тренування (психотренінг) за бажанням супроводжувались музичним оформленням. Контрольна група тренувалася без використання засобів відновлення. Для перевірки ефективності застосування нетрадиційних засобів відновлення працездатності застосовували тест Новаккі на велоергометрі. Випробувані виконували роботу двічи – до і після основного експерименту, який тривав 8 тижнів. Частота педалування складала 60 об·хв -1. Відчуваєму напругу (ВН) оцінювали по шкалі Борга наприкінці кожної ступіні і безпосередньо перед закінченням роботи. Одночасно реєстрували ЧСС. Результати. Показано, що прийом бальзаму на лікарських травах і мумійо робить дію на організм, що стимулює та тонізує. Про це свідчить підвищення показників працездатності в тесті Новаккі. Застосування даних компонентів у мазях при масажі робить релаксируючу та відновлювальну дію, про що свідчить підвищення показників ефективності відновлення. Психо- і аутотренінг робить хоча і достовірне, але менш виражене як стимулюючу, так і відбудовну дію, причому його відбудовна дія виявлена сильніше. Застосування психотренінгу приводить до зменшення взаємозв'язку між ЧСС і суб’єктивного сприйняття навантаження у зв'язку зі зниженням чутливості нервової системи до відчуттів дискомфорту при м'язовій діяльності. Висновки. В навчально-тренувальному процесі гребців доцільно застосовувати всі досліджувані в даній роботі засоби, тому що вони істотно доповнюють і підсилюють один одного.
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Herzog M, Sucec J, Van Diest I, Van den Bergh O, Chenivesse C, Davenport P, Similowski T, von Leupoldt A. Observing dyspnoea in others elicits dyspnoea, negative affect and brain responses. Eur Respir J 2018; 51:13993003.02682-2017. [DOI: 10.1183/13993003.02682-2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/29/2018] [Indexed: 11/05/2022]
Abstract
Dyspnoea is usually caused by diagnosable cardiorespiratory mechanisms. However, frequently dyspnoea relates only weakly or not at all to cardiorespiratory functioning, suggesting that additional neuropsychosocial processes contribute to its experience. We tested whether the mere observation of dyspnoea in others constitutes such a process and would elicit dyspnoea, negative affect and increased brain responses in the observer.In three studies, series of pictures and videos were presented, which either depicted persons suffering from dyspnoea or nondyspnoeic control stimuli. Self-reports of dyspnoea and affective state were obtained in all studies. Additionally, respiratory variables and brain responses during picture viewing (late positive potentials in electroencephalograms) were measured in one study.In all studies, dyspnoea-related pictures and videos elicited mild-to-moderate dyspnoea and increased negative affect compared to control stimuli. This was paralleled by increased late positive potentials for dyspnoea-related pictures while respiratory variables did not change. Moreover, increased dyspnoea correlated modestly with higher levels of empathy in observers.The present results demonstrate that observing dyspnoea in others elicits mild-to-moderate dyspnoea, negative affect, and increased brain responses in the absence of respiratory changes. This vicarious dyspnoea has clinical relevance, as it might increase suffering in the family and medical caregivers of dyspnoeic patients.
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Wade J, Mendonca S, Booth S, Ewing G, Gardener AC, Farquhar M. Are within-person Numerical Rating Scale (NRS) ratings of breathlessness 'on average' valid in advanced disease for patients and for patients' informal carers? BMJ Open Respir Res 2017; 4:e000235. [PMID: 29071084 PMCID: PMC5652535 DOI: 10.1136/bmjresp-2017-000235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Numerical Rating Scale (NRS) is frequently used to assess patient-reported breathlessness in both a research and clinical context. A subgroup of patients report average breathlessness as worse than their worst breathlessness in the last 24 hours (paradoxical average). The Peak/End rule describes how the most extreme and current breathlessness influence reported average. This study seeks to highlight the existence of a subpopulation who give 'paradoxical averages using the NRS, to characterise this group and to investigate the explanatory relevance of the 'Peak/End' rule. METHODS Data were collected within mixed method face-to-face interviews for three studies: the Living with Breathlessness Study and the two subprotocols of the Breathlessness Intervention Service phase III randomised controlled trial. Key variables from the three datasets were pooled (n=561), and cases where participants reported a paradoxical average (n=45) were identified. These were compared with non-cases and interview transcripts interrogated. NRS ratings of average breathlessness were assessed for fit to Peak/End rule. RESULTS Patients in the paradoxical average group had higher Chronic Respiratory Questionnaire physical domain scores on average p=0.042). Peak/End rule analysis showed high positive correlation (Spearman's rho=0.756, p<0.001). CONCLUSIONS The NRS requires further standardisation with reporting of question order and construction of scale used to enable informed interpretation. The application of the Peak/End rule demonstrates fallibility of NRS-Average as a construct as it is affected by current breathlessness. Measurement of breathlessness is important for both clinical management and research, but standardisation and transparency are required for meaningful results.
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Affiliation(s)
- Joshua Wade
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Silvia Mendonca
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Sara Booth
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - A Carole Gardener
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- University of East Anglia, School of Health Sciences, Norwich, UK
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Currow D, Watts GJ, Johnson M, McDonald CF, Miners JO, Somogyi AA, Denehy L, McCaffrey N, Eckert DJ, McCloud P, Louw S, Lam L, Greene A, Fazekas B, Clark KC, Fong K, Agar MR, Joshi R, Kilbreath S, Ferreira D, Ekström M. A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol. BMJ Open 2017; 7:e018100. [PMID: 28716797 PMCID: PMC5726102 DOI: 10.1136/bmjopen-2017-018100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD. METHODS AND ANALYSIS The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0-10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used. ETHICS AND DISSEMINATION Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness. TRIAL REGISTRATION NUMBER NCT02720822; Pre-results.
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Affiliation(s)
- David Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Gareth John Watts
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Christine F McDonald
- Department of Austin Health, Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Australia
| | - John O Miners
- Clinical Pharmacology School of Medicine, Flinders University, Adelaide, Australia
| | - Andrew A Somogyi
- Department of Clinical Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Linda Denehy
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nicola McCaffrey
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeRA) Randwick, New South Wales, Australia
| | - Philip McCloud
- MCloud Consulting Group, Belrose, New South Wales, Australia
| | - Sandra Louw
- MCloud Consulting Group, Belrose, New South Wales, Australia
| | - Lawrence Lam
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Aine Greene
- Southern Adelaide Palliative Services, Adelaide, South Australia, Australia
| | - Belinda Fazekas
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Katherine C Clark
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
- School of Medicine and Public Health, The University if Newcastle, Newcastle, New South Wales, Australia
| | - Kwun Fong
- Thoracic Research Centre, The Prince Charles Hospital School of Medicine, University of Queensland, Australia
| | - Meera R Agar
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
- Clinical Trials, Ingham Institute of Applied Medical Research, Sydney, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Rohit Joshi
- Department of Medical Oncology, University of Adelaide Lyell MEwin Hospital, Adelaide, Australia
| | - Sharon Kilbreath
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Diana Ferreira
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Magnus Ekström
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Sweden
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Tan JY, Yorke J, Harle A, Smith J, Blackhall F, Pilling M, Molassiotis A. Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire. J Pain Symptom Manage 2017; 53:208-215. [PMID: 27720789 DOI: 10.1016/j.jpainsymman.2016.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 12/26/2022]
Abstract
CONTEXT The Dyspnea-12 (D-12) Questionnaire is a well-validated instrument in respiratory illnesses for breathlessness assessment, but its psychometric properties have not been tested in lung cancer. OBJECTIVE To demonstrate the psychometric properties of the D-12 in lung cancer patients. METHODS Baseline data from a lung cancer feasibility trial were adopted for this analysis. D-12 and a series of patient-reported tools, including five Numeric Rating Scales (NRS), the Hospital Anxiety and Depression Scale (HADS), and the Lung Cancer Symptom Scale (LCSS), were used for the psychometric assessment. Spearman's correlation coefficients (rs) were used to estimate the convergent validity of the D-12 with the NRS, HADS, and LCSS. Exploratory factor analysis was performed to examine construct validity. Reliability was tested by Cronbach's alpha and item-to-total correlations. D-12 score difference between patients with or without anxiety, depression, and chronic obstructive pulmonary disease (COPD) was explored to identify its discriminate performance. RESULTS One hundred and one lung cancer patients were included. There were significantly positive correlations between the D-12 and the HADS, LCSS, and NRS measuring breathlessness severity and its associated affective distress. Factor analysis clearly identified two components (physical and emotional) of the D-12. Cronbach's alpha for D-12 total, physical, and emotional subscales was 0.95, 0.92, and 0.94, respectively. Patients with anxiety or depression demonstrated significantly higher D-12 scores than those without it, and patients with COPD reported significantly more severe breathlessness than those without COPD. CONCLUSION The D-12 is a valid and reliable self-reported questionnaire for use in breathlessness assessment in lung cancer patients.
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Affiliation(s)
- Jing-Yu Tan
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Amelie Harle
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jacky Smith
- Centre for Respiratory and Allergy, University Hospital South Manchester, Manchester, United Kingdom; Faculty of Medicine and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Faculty of Medicine and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark Pilling
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Watts GJ, Clark K, Agar M, Davidson PM, McDonald C, Lam LT, Sajkov D, McCaffrey N, Doogue M, Abernethy AP, Currow DC. Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinical effect and cost-effectiveness of sertraline for the palliative relief of breathlessness in people with chronic breathlessness. BMJ Open 2016; 6:e013177. [PMID: 27899400 PMCID: PMC5168508 DOI: 10.1136/bmjopen-2016-013177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Breathlessness remains a highly prevalent and distressing symptom for many patients with progressive life-limiting illnesses. Evidence-based interventions for chronic breathlessness are limited, and there is an ongoing need for high-quality research into developing management strategies for optimal palliation of this complex symptom. Previous studies have suggested that selective serotonin reuptake inhibitors such as sertraline may have a role in reducing breathlessness. This paper presents the protocol for a large, adequately powered randomised study evaluating the use of sertraline for chronic breathlessness in people with progressive life-limiting illnesses. METHODS AND ANALYSIS A total of 240 participants with modified Medical Research Council Dyspnoea Scale breathlessness of level 2 or higher will be randomised to receive either sertraline or placebo for 28 days in this multisite, double-blind study. The dose will be titrated up every 3 days to a maximum of 100 mg daily. The primary outcome will be to compare the efficacy of sertraline with placebo in relieving the intensity of worst breathlessness as assessed by a 0-100 mm Visual Analogue Scale. A number of other outcome measures and descriptors of breathlessness as well as caregiver assessments will also be recorded to ensure adequate analysis of participant breathlessness and to allow an economic analysis to be performed. Participants will also be given the option of continuing blinded treatment until either study data collection is complete or net benefit ceases. Appropriate statistical analysis of primary and secondary outcomes will be used to describe the wealth of data obtained. ETHICS AND DISSEMINATION Ethics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12610000464066.
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Affiliation(s)
- Gareth J Watts
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Katherine Clark
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Meera Agar
- Faculty of Health and Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Clinical Trials, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
- Department of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- Faculty of Health and Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine McDonald
- Austin Health, Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Lawrence T Lam
- Faculty of Health and Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicola McCaffrey
- Department of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Doogue
- Department of Clinical Pharmacology, University of Otago, Christchurch, New Zealand
| | - Amy P Abernethy
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Currow
- Department of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
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