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Dyspnea is a common symptom and anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD). They affect individuals with COPD in a multifaceted way, causing many disabilities. Progressive relaxation exercises (PREs) are an important intervention in reducing symptoms and comorbidity. The aim of this study was to determine the effects of PREs on dyspnea and anxiety levels in individuals with COPD. A pretest-posttest randomized controlled trial was conducted at the chest diseases clinic of a university hospital in Turkey. Forty-four patients with COPD who met the inclusion criteria for participation in the study were assigned either to an intervention or a control group, with 22 patients in each group. In the intervention group, the patients performed PREs once a day for 4 weeks in addition to the standard treatment. The patients in the control group received the standard treatment. In the data collection stage of the study, questionnaire forms, namely, the Modified Borg Scale (MBS), Modified British Medical Research Council Dyspnea Scale, COPD Assessment Test (CAT), and Beck Anxiety Inventory (BAI), were used. Data were collected before (the first follow-up) and after the intervention (the second follow-up). In the second follow-up, the MBS, BAI, and CAT scores decreased significantly in the intervention group (P <.05) but showed no significant changes in the control group (P >.05). This study demonstrates that PREs can reduce dyspnea and anxiety levels in individuals with COPD. [ABSTRACT FROM AUTHOR]

Dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations, varies in intensity, and can only be known through the patient's report. Dyspnea is akin to suffocation and is one of the most distressing symptoms experienced by patients with advanced illness and at the end of life. Common approaches to dyspnea management, such as pulmonary rehabilitation, breathing strategies, or supplemental oxygen, have become accepted through pragmatic use or because studies do not include dyspnea as a measured outcome. Patients and clinicians urgently need evidence-based treatments to alleviate this frightening symptom. To fill this gap, a group of dyspnea researchers with expertise to conduct a literature review of evidence-based interventions for dyspnea in patients with serious illness produced these guidelines. We present the evidence from the strongest recommendations for practice to the weakest recommendations and include practical considerations for clinical nurses. [ABSTRACT FROM AUTHOR]

Patients often receive burdensome care at the end of life in the formof interventions that may need to be removed. Heated high-flow oxygen delivered through a nasal cannula (HHFNC) is one such intervention that can be delivered in the hospital yet is rarely available outside of this setting. During the COVID-19 (coronavirus disease 2019) pandemic, health care systems continue to face the possibility of rationing critical life-sustaining equipment that may include HHFNC. We present a clinical protocol designed for weaning HHFNC to allow a natural death and ensuring adequate symptom management throughout the process. This was a retrospective chart review of 8 patients seen by an inpatient palliative care service of an academic tertiary referral hospitalwho underwent terminal weaning of HHFNC using a structured protocol to manage dyspnea. Eight patients with diverse medical diagnoses, including COVID-19 pneumonia, underwent terminal weaning of HHFNC according to the clinical protocol with 4 down-titrations of approximately 25% for both fraction of inspired oxygen and liter flow with preemptive boluses of opioid and benzodiazepine. Clinical documentation supported good symptom control throughout the weaning process. This case series provides preliminary evidence that the clinical protocol proposed has the ability to ensure comfort through terminal weaning of HHFNC. [ABSTRACT FROM AUTHOR]

Northern New Jersey was inside one of the worst initial coronavirus disease 2019 pandemic epicenters in the United States. At the peak of the pandemic surge in mid-April 2020, New Jersey saw 8045 hospitalized patients with severe coronavirus disease 2019 symptoms, of which 2002 were in intensive care unit beds (86.3% of statewide capacity), including 1705 requiring mechanical ventilation. Because of the severity of pulmonary dysfunction/hypoxia, the unprecedented numbers of critically ill patients, the national opioid shortage, and transmission prevention measures for standard palliative care treatment protocols in place for refractory and/or end-of-life dyspnea were found to be ineffective in providing adequate symptom relief. The aim of the following Notes From the Field is to provide concise, pragmatic, and experiential reflection by 3 palliative care advanced practice nurses from 3 different hospital systems within the pandemic epicenter. The novel methods and opioid strategies implemented by their respective palliative care teams to ensure continued effective and appropriate treatment for end-of-life dyspnea are described. These accounts include Lessons Learned in order to assist others who may need to quickly implement changes in the future due to pandemic resurgence or second-wave events. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis is an unrelenting form of interstitial lung disease associated with a high symptom burden and reported low health-related quality of life. Clinicians have access to limited pharmacologic interventions to help slow the disease progression. Nonpharmacologic interventions are vital in managing dyspnea for these individuals, which is one of the most frequently reported factors that negatively impacts health-related quality of life. Common methods of symptom control include integration of pulmonary rehabilitation, supplemental oxygen, and interdisciplinary support, such as support groups, palliative care, and case conferences, into routine medical care. This literature review describes a multidisciplinary approach for managing dyspnea to improve health-related quality of life for those with idiopathic pulmonary fibrosis. Findings demonstrate that structured pulmonary rehabilitation programs, fast-track case conferences, and supplemental oxygen therapy are most effective. Further research is needed to demonstrate a clinically significant benefit of palliative care visits in the long term for these individuals. [ABSTRACT FROM AUTHOR]

This analysis extrapolates information from previous studies and experiences to bring physical medicine and rehabilitation perspective and intervention to the multidisciplinary treatment of COVID-19. The purpose of pulmonary rehabilitation in COVID-19 patients is to improve symptoms of dyspnea, relieve anxiety, reduce complications, minimize disability, preserve function, and improve quality of life. Pulmonary rehabilitation during the acute management of COVID-19 should be considered when possible and safe and may include nutrition, airway, posture, clearance technique, oxygen supplementation, breathing exercises, stretching, manual therapy, and physical activity. Given the possibility of long-term disability, outpatient posthospitalization pulmonary rehabilitation may be considered in all patients hospitalized with COVID-19. [ABSTRACT FROM AUTHOR]

Dyspnea is experienced by 15% to 70% of patients at end of life. Because of cognitive changes before death, patients may be unable to self-report dyspnea, which requires nurses to accurately assess and initiate symptom management. This study compared practicing nurses' experiential practice in the assessment and management of dyspnea in patients unable to self-report to practice using of the Respiratory Distress Observation Scale (RDOS). This pre-experimental pretest/posttest study evaluated nurse outcomes following a structured educational program aimed at preparing them to use the RDOS. Nurses (n = 39) who provide end-of-life care were recruited for the study. After receiving the educational program, there was not a significant difference in the nurse's ability to assess the patient's overall level of perceived comfort and determine a differential diagnosis. There was, however, improvement in the nurse's ability to correctly determine a patient's level of dyspnea (P = .021) and also in their ability to select appropriate treatment options. This study demonstrates applicability of the RDOS to the end-of-life population replacing experiential practice with an evidence-based tool for the assessment and treatment of dyspnea in patients who cannot self-report. [ABSTRACT FROM AUTHOR]

This randomized controlled study (pretest, posttest, test control group) was conducted with the aim of determining the effect ofmusic on the severity of dyspnea, anxiety, and hemodynamic parameters in patients with dyspnea. The research was conducted in the Chest Diseases Service of a public hospital in the western region of Turkey. The number of patients included in the sample was determined by power analysis, and as a result, 60 patients were accepted, 30 in the music group and 30 in the control group. Sixty percent of the patients who took part in the study were male, their mean age was 61.21 ± 1.13 years, and their mean dyspnea severity before the intervention was 62.68 ± 22.28. The difference between the mean dyspnea severity and anxiety scores of the music group patients before and after the application of music was found to be statistically significant (P G .05), but no statistically significant differencewas found in hemodynamic parameters (P > .05). In light of the research findings, it was concluded that music had an effect on anxiety and the severity of dyspnea in patients with dyspnea but that it had no effect on hemodynamic parameters. [ABSTRACT FROM AUTHOR]

Pulmonary rehabilitation, as a quality-of-life intervention, has a role to play in palliative care for lung cancer patients. Combining the art and skills of clinical care, physiological, and behavioral tools, pulmonary rehabilitation can serve to rebuild the functional capacity of patients limited by breathlessness and deconditioning. Exercise programs are the primary tool used to restore and rebuild the patient's endurance by challenging the entire pathway of oxygen transport and improving gas exchange. Other tools of pulmonary rehabilitation include breathing retraining, self-management skills, airway clearance techniques, bronchodilation, smoking cessation, and oxygen therapy. Pulmonary rehabilitation is now becoming a part of supportive care for patients undergoing chemotherapy and radiation therapy. The ability to be more active without suffering the consequences of dyspnea on exertion boosts the patient's self-efficacy and allows for an improved quality of life, so that lung cancer patients can participate in their family lives during this therapeutic challenge. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. [ABSTRACT FROM AUTHOR]

The article focuses on several aspects of establishing dyspnea clinics (DCs) for treating dyspnea. It mentions about the evaluation of dyspnea is concentrated on advanced cardiopulmonary imaging, objective assessment of functional capacity, cardiopulmonary exercise testing (CPET), and invasive hemodynamics. It also mentions that DCs at the University of Utah and Brigham and Women's Hospital are both multidisciplinary and include at least a cardiologist and a pulmonologist working together.

The article presents doctor's opinion on a case of a patient with a 2-year history of unexplained steroid-refractory polyneuropathy, monoclonal gammopathy and presented to hospital with dyspnea. Topics discussed includes his neurological evaluation at a community hospital, administration of intravenous immunoglobulin on patient and transthoracic echocardiography.

The article presents a case study of a 23-year-old man with a several-month history of progressively worsening episodes of palpitations associated with dyspnea, who was referred to the cardiology clinic. The patient was diagnosed with frequent and symptomatic episodes of nonsustained ventricular tachycardia (VT), related to a primary benign cardiac tumor, specifically hemangioma. Follow-up monitoring of the patient exhibited no supraventricular or ventricular arrhythmias.

The article discusses a study to evaluate and compare the efficacy of square wave (bilevel) cycle ergometry endurance exercise training (SWEET) as well as comprehensive dorected breathing as against walking on improving exertional dyspnea and exercise capacity. The study concluded that SWEET and comprehensive directed breathing was effective in improving the decline in exercise tolerance among men who smoked. Some smokers who continue to smoke can receive some benefits.

The article presents case studies of a 76=year-old man with hemicolectomy for colon cancer who was admitted due to syncope and shortness of breath and a 55-year-old woman who developed acute shortness of breath. They were diagnosed with acute pulmonary embolism (PE) and their conditions remain unstable despite being treated with oxygen. They were further treated with percutaneous catheter-based reperfusion and anticoagulants which improved their conditions.

The article discusses opioid responsiveness in an effort to find treatment for alleviating dyspnea in chronic pulmonary disease. It details a dyspnea target or the same conceptual models aimed to help clinicians predict more accurately how specific aspects of dyspnea respond to treatments. It highlights evidence that contributes to the sensation of dyspnea and builds on clinical observations to create a conceptual model of opioid responsiveness.

The article discusses the management of dyspnea in advanced lung cancer and its correlation with patient satisfaction with quality of life (QOL). Advances in the area and its assessment are discussed as it is one of the most common symptoms for lung cancer patients. Physicians and researchers are not only considering using conventional cancer treatment such as surgery, chemotherapy, and radiation therapy but also palliative care focused on relief of suffering and symptom control.

The article discusses the management of dyspnea in interstitial lung diseases (ILD) with focus on recent literature. Studies support that pulmonary rehabilitation is an effective treatment and should be considered in all dyspneic patients. It also recommends directing treatment toward each factor associated with dyspnea in ILD including ventilatory restriction, impaired gas exchange, and comorbid diseases that coexist with fibrotic ILD as these determinants may impact dyspnea severity.

The article presents a case study of a 75-year-old man with complaints of abrupt onset of dyspnea during sleep. A presumed diagnosis of acute heart failure was made and he was administered intravenously with supplemental oxygen via a facemask. The article discusses changes in the amplitude of the systolic click and diastolic extra sound over the clinical course, and the additional heart sound during early diastole.

The article focuses on the recent developments in the pulmonary rehabilitation for dyspnea in the palliative-care setting. It assesses which disease states other than chronic obstructive pulmonary disease (COPD) could benefit from the incorporation pulmonary rehabilitation and what further modifications of exercise protocols are feasible and effective in patients.

The article describes the role of lung volume reduction surgery (LVRS) for the management of refractory dyspnea as well as other debilitating conditions in patients with chronic obstructive pulmonary disease (COPD) secondary to emphysema. It offers a comparison of the cost effectiveness of LVRS with medical therapy. The improvement in a patient's quality of life following LVRS is also explored.

The article explores the advances in the pharmacological treatment of refractory breathlessness as well as the physical evidence for treatments for dyspnea. It discusses the efficacy of oral and parenteral opioids in reducing the subjective sensation of refractory breathlessness. It finds that nebulized frusemide in the management of dyspnea appears to be worthy of further investigation.

The article aims to summarize the nonpharmocological therapies that exist to treat the symptom of dyspnea, including counseling, relaxation, music therapy and psychotherapy. It discusses how case management and pulmonary rehabilitation may integrate many of the nonpharmacological therapies for dyspnea.

We describe two unusual cases of platypnea. The first patient had chronic obstructive pulmonary disease, but platypnea did not respond to chronic obstructive pulmonary disease therapy. He was found to have multiple pulmonary emboli, and symptoms rapidly improved on anticoagulation therapy. The second patient had Parkinson disease and developed severe platypnea, an association that has not been previously described. She had significant postural hypotension and responded to therapy with fludrocortisone. [ABSTRACT FROM AUTHOR]

HISTORY: A 19 year-old female division 1 NCAA cross country athlete presented for campus pre-participation physicals during the summer of her sophomore year 2020. She reported subjective chest tightness and exercise intolerance. Patient reported symptoms consistent with a COVID-19 viral infection in February 2020 including her initial symptoms were cough, congestion, fevers, and myalgias. She subsequently developed significant dyspnea on exertion, and was unable to tolerate even minimal exertion. Patient reported initial symptoms lasted for 2 weeks, and was seen by her PCP in March 2020. She was then tested for COVID-19 IgG antibodies, which were positive. She continued to have exertional dyspnea that progressed to night time cough. Patient has a medical history of anxiety and mild intermittent asthma, requiring her albuterol inhaler once a month. At onset of symptoms, she began using her albuterol more frequently, and progressed to daily inhaled corticosteroid. Due to her continued symptoms, further medical testing was ordered. PHYSICAL EXAMINATION: Patient was resting comfortably. Heart regular rate and rhythm without murmur. Lungs clear to auscultation bilaterally. Pulses 2/4 in upper and lower extremities. DIFFERENTIAL DIAGNOSIS: 1. Progression of mild intermittent asthma 2. Cardiomyopathy3. Deconditioning TEST AND RESULTS: EKG: - NSR at 64 BPM Chest XR: -No acute findings, mild hyperinflation Labs:-Troponin <0.01, Hgb 13.0 Pulmonary Function Testing:-Normal without signs of obstruction or restriction Transthoracic echocardiogram: - Normal atrium and ventricles. Normal left ventricular function Cardiopulmonary Exercise Testing: - Low VO2 max, depressed maximum heart rate, EKG with new inferior wall changes Cardiac MRI: - Normal cardiac anatomy, normal ventricular function, no evidence of scar of infiltration. FINAL WORKING DIAGNOSIS: - Post COVID-19 syndrome TREATMENT AND OUTCOMES: 1. Received clearance for return to athletic participation after full cardiac workup. 2. Symptoms due to cardiopulmonary deconditioning secondary to viral syndrome. 3. Gradual increase in exercise as tolerated. 4. Patient's symptoms slowly improving [ABSTRACT FROM AUTHOR]

Opinion. Focuses on chronic dyspnea and how to use non-drug measures to cope with the condition. What is accompanied by the condition; How to deal with attacks; Reference to the American Thoracic Society Grade of Breathlessness Scale; Detailed information on the condition. INSETS: What causes dyspnea?;How patients feel about dyspnea;Rating breathlessness.

The article presents questions and answers related to dyspnea which includes shortness of breath as a sign of a medical problem, causes of shortness of breath, and treatment for shortness of breath.

The article presents a case study of a 48-year-old who has been experiencing chest pain with dyspnea. Results of electrocardiogram (ECG) revealed prevalent ST elevation, sinus rhythm, and low voltage while chest x-ray showed signs of major cardiomegaly. It notes that histology supported the findings of a primary cardiac angiosarcoma which penetrates the pericardium. A series of chemotherapy had eliminated the suffering of the patient from hemoptysis and dyspnea, as well the pericardiac tumor.

Presents abstracts of two articles from the `Journal of Pain and Symptom Management,' which both deal with the clinical application of hospice and palliative nursing care. `An Assessment of the Safety, Efficacy, and Acceptability of Intranasal Fentanyl Citrate in the Management of Cancer-related Breakthrough Pain: A Pilot Study,' by Z. Giovambattista; `Management of Dyspnea in Severe Chronic Obstructive Pulmonary Disease,' by J. Janssens et al.

The article presents a case study of a 50-year-old woman who have Gorham-Stout syndrome with progressive dyspnea. She underwent urgent pericardiocentesis and 1.2 liters of milky fluid, known as chyle, was drained; however, pericardial fluid was reaccumulated. She underwent surgery for thoracic duct ligation, pericardial fluid drainage, and prophylactic surgery of the right pleura. Intravenous octreotide infusion was given followed by subcutaneous application of 100 micrograms of octreotide.

The article discusses the controversy concerning the use of nebulized morphine to relieve dyspnea in patients with advanced chronic obstructive pulmonary disease. Researchers speculate that nebulized morphine acts locally on opioid receptors in the respiratory tract to inhibit the release of chemicals involved in dyspnea. However, many terminally ill patients are too weak to use a nebulizer. The Global Initiative for Chronic Obstructive Lung Disease discourages the use of nebulized morphine because it can have serious adverse effects.

Assesses the case of a 79 year-old woman suffering from shellfish poisoning. Signs and symptoms of the patient; Prevalence of disease related to shellfish consumption; Administration of oxygen to relieve dyspnea and reduce respiratory rate.

Focuses on two techniques for overcoming shortness of breath. Abdominal breathing; Pursed-lip breathing.

Discusses basic cardiac life support standards adopted for cardiopulmonary resuscitation (CPR) training in the United States. Instruction of rescuers; Chest compression rate during CPR; Elimination of staircase breaths after establishing breathlessness; Use of abdominal thrust for choking victims over the age of one; Delivery of breaths during two-person CPR.