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Dyspnea is one of the most common and distressing symptoms in patients with cancer and noncancer advanced diseases. The Japanese Society for Palliative Medicine revised previous guidelines for the management of respiratory symptoms in patients with cancer and newly developed clinical guidelines for managing dyspnea in patients with advanced disease, based on the result of systematic reviews for each clinical question and consensus among experts. We describe the recommendations of the guidelines as well as provide insights into the reasoning behind the recommendations and their development process. There has been a paucity of evidence regarding the interventions for dyspnea in patients with advanced disease. Thus, more clinical research that includes not only randomized controlled trials but also real-world observational studies is warranted. [ABSTRACT FROM AUTHOR]

Background: Explanations provided by healthcare professionals contribute to patient beliefs. Little is known about how healthcare professionals explain chronic breathlessness to people living with this adverse sensation. Methods: A purpose-designed survey disseminated via newsletters of Australian professional associations (physiotherapy, respiratory medicine, palliative care). Respondents provided free-text responses for their usual explanation and concepts important to include, avoid, or perceived as difficult to understand by recipients. Content analysis coded free text into mutually exclusive categories with the proportion of respondents in each category reported. Results: Respondents (n = 61) were predominantly clinicians (93%) who frequently (80% daily/weekly) conversed with patients about breathlessness. Frequent phrases included within usual explanations reflected breathlessness resulting from medical conditions (70% of respondents) and physiological mechanisms (44%) with foci ranging from multifactorial to single-mechanism origins. Management principles were important to include and phrases encouraging maladaptive beliefs were important to avoid. The most frequent difficult concept identified concerned inconsistent relationships between oxygenation and breathlessness. Where explanations included the term 'oxygen', a form of cognitive shortcut (heuristic) may contribute to erroneous beliefs. Conclusions: This study presents examples of health professional explanations for chronic breathlessness as a starting point for considering whether and how explanations could contribute to adaptive or maladaptive breathlessness beliefs of recipients. [ABSTRACT FROM AUTHOR]

Background: Cancer is a leading cause of morbidity and mortality globally. Dyspnea, affecting up to 60% of cancer patients, exacerbates physical and psychological distress, reducing quality of life. This study aims to explore the relationship between dyspnea and factors such as age, sex, clinical diagnosis, and treatment lines in cancer patients, with the goal of improving understanding and management of this debilitating symptom to enhance patient care and quality of life. Methods: This study employed an observational, cross-sectional, and descriptive approach to investigate patients with oncological disease at the University Hospital of Salamanca between March 2021 and April 2024. A convenience sample was selected, including patients over 18 years old with a pathological diagnosis of cancer, experiencing any degree of dyspnea, and who consented to participate by signing the informed consent. Exclusion criteria included lack of consent and clinical conditions that prevented an interview. The studied variables encompass sociodemographic (age, gender, diagnosis, tumor stage, number of treatment lines) and clinical aspects (daily activities, degree of dyspnea, functional capacity, physical performance), evaluated using the Barthel Index, the mMRC Dyspnea Scale, the ECOG Scale, and the Short Physical Performance Battery (SPPB). Data were collected through semistructured interviews and medical records, and analyzed using specialized software. This research has ethical approval CEiM Code 2023 12 1472, Reference 2024/01. Results: The mean age was 66.82 years. Lung cancer was predominant (60.2%), with most patients in stage 3 (65.7%) and receiving three treatment lines (68.7%). Higher age, advanced disease stage, and more treatment lines correlated with lower Barthel and SPPB scores, and higher ECOG and mMRC scores, indicating worse functionality, physical performance, and greater dyspnea. No significant correlations were found between gender or pathological diagnosis and the studied variables. Conclusions: Advanced age, higher disease stage, and more treatment lines are associated with decreased functionality, poorer physical performance, and increased dyspnea in cancer patients. Gender and specific cancer diagnosis do not significantly affect these relationships. Addressing dyspnea is crucial to improving the quality of life and physical performance in this population. Future studies should explore additional factors like treatment types and nutritional status. [ABSTRACT FROM AUTHOR]

Context • In addition to pharmacological approaches, clinicians use nonpharmacological approaches in the management of dyspnea, one of which is fan therapy. It’s a simple, cost-effective intervention that patients can easily use independently, without requiring professional support. The field needs further research on the outcomes of fan use. Objective • The study intended to determine the effectiveness of fan therapy in relieving dyspnea for patients with dyspnea symptoms. Design • The research team conducted a single-group, pretest-posttest study. Setting • The study occurred at the Prof. Dr. Murat Dilmener Emergency Hospital, which is an additional service building of the Bakirkoy Dr. Sadi Konuk Training and Research Hospital in İstanbul, Turkey. Participants • Participants were 81 patients with respiratory distress who received inpatient treatment at the hospital between March 2022 and June 2023. Intervention • The research team used a hand fan for 5 minutes to cool participants’ faces. Outcome Measures • At 15 minutes post fan therapy, the research team: (1) measured patients’ dyspnea levels using with Modified Borg Scale (MBS), (2) oxygen saturation, (3) respiratory rate, (4) pulse rate, (5) body temperature, (6) blood pressure, and (7) respiratory-muscle-use status. Results • Between baseline and post intervention, participants’ oxygen saturation (P = .001) significantly increased and respiration rates (P = .014), systolic blood pressure (P = .003), diastolic blood pressure (P = .001), use of accessory respiratory muscles (P = .003), and MBS values (P = .001) significantly decreased. At baseline, a high dyspnea level was significantly negatively correlated with an age >67 (P = .019), BMI >25.0 (P = .044), an oxygen saturation of <95 (P = .005), and respiratory rate >20/pm (P = .001) and significantly positively correlated with a severe need for oxygen support (P = .035), a pulse rate >100/pm (P = .001), and hypertension (P = .005). Post intervention, a high dyspnea level was significantly positively correlated with smoking (P = .008), a need for oxygen support (P = .001), a severe need of oxygen support (P = .017), and hypertension (P = .001) and significantly negatively correlated with oxygen saturation <95 (P = .002). Conclusions • Fan therapy directed to the face can be effective in reducing the dyspnea level. With the therapy being a simple, reliable, and cost-effective method that nurses, patients, and their families can use, the current research team concludes that clinicians can use it together with pharmacological methods for patients experiencing dyspnea. [ABSTRACT FROM AUTHOR]

Background: Breathlessness is a prevalent symptom affecting the quality of life (QOL) of Amyotrophic Lateral Sclerosis (ALS) patients. This systematic review explored the interventions for controlling breathlessness in ALS patients, emphasizing palliative care (PALC), non-invasive ventilation (NIV), opioids, and non-pharmacological strategies. Methods: A comprehensive search of PubMed, Cochrane Library, and Web of Science databases was conducted. Eligibility criteria encompassed adults with ALS or motor neuron disease experiencing breathlessness. Outcomes included QOL and symptom control. Study designs comprised qualitative studies, cohort studies, and randomized controlled trials. Results: Eight studies were included, most exhibiting low bias risk, comprising one randomized controlled trial, three cohort studies, two comparative retrospective studies, and two qualitative studies (interviews). Most studies originated from Europe, with one from the United States of America. The participants totaled 3423, with ALS patients constituting 95.6%. PALC consultations significantly improved symptom assessment, advance care planning, and discussions about goals of care. NIV demonstrated efficacy in managing breathlessness, with considerations for device limitations. Opioids were effective, though predominantly studied in non-ALS patients. Non-pharmacological strategies varied in efficacy among patients. Conclusion: The findings underscore the need for individualized approaches in managing breathlessness in ALS. PALC, NIV, opioids, and non-pharmacological strategies each play a role, with unique considerations. Further research, especially ALS-specific self-management studies, is warranted. [ABSTRACT FROM AUTHOR]

Background: Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care. Methods: A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values. Results: We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values. Conclusion: Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide. [ABSTRACT FROM AUTHOR]

Patients at the end of life may experience dyspnea but be unable to report symptoms. The Respiratory Distress Observation Scale measures respiratory distress in patients who are unable to self-report and helps decrease any hesitation nurses may have about administering opioids to a patient who is dying. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: During pregnancy, the progesterone hormone causes the respiratory system to increase oxygen consumption. Maternal hyperventilation causes the partial pressure of oxygen to increase and partial pressure of carbon-dioxide to decrease. During the third trimester, the compression of the diaphragm in the lower base of the lungs, which causes dyspnoea. Purpose: The purpose of the study to find the prevalence and to evaluate the effect of threshold inspiratory muscle training device and incentive spirometry device for dyspnoea among third- trimester antenatal women using modified borg dyspnoea and dyspnea-12 questionnaire. Materials and Methods: The study analysed prevalence of dyspnoea in third-trimester antenatal women from December 2022 to April 2023 using the dyspnea-12 questionnaire. Out of 77 participants, 15 subjects were excluded due to improper follow-up, lack of participation, and withdrawal from the study. In phase 2, in May 2023, 62 participants were divided into two groups: 31 antenatal women underwent threshold inspiratory muscle training along with diaphragmatic breathing exercises, and 31 underwent incentive spirometry along with diaphragmatic breathing exercises. Result: Statistically significant differences between the two devices were evaluated by post-values of 13.80 ± 23.20; and the P value is < 0.0001. These values were considered to be extremely statistically significant. Conclusion: Threshold inspiratory muscle training device is more effective than Incentive Spirometry device for dyspnoea among third-trimester antenatal women. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' perceptions to alleviate dyspnoea in inpatients with advanced cancer while receiving palliative care. Design: A descriptive qualitative design. Method s : Seven focus groups were conducted with nurses (n = 27) from five specialized palliative care wards in four hospitals in south and southwest Finland. The focus groups were conducted between June and November 2019, and the transcripts were analysed using inductive analysis. Results: The findings revealed three categories: recognizing dyspnoea is a multi‐faceted problem, dealing with the complexity of assessment of dyspnoea and strategies for relieving dyspnoea. Nurses perceived the complexity of dyspnoea as a symptom and emphasized the importance of utilizing patients' subjective experiences and consistent assessment scales to determine its severity. Furthermore, nonpharmacological interventions are as pertinent as pharmacological and medical interventions. The findings can assist nurses in selecting appropriate interventions for dyspnoea care, ultimately enhancing the quality of patient care and patient safety. [ABSTRACT FROM AUTHOR]

Background: Dyspnea is an unpleasant subjective symptom and is associated with decreased physical activity level (PAL). Effect of blowing air toward the face has received a great deal of attention as a symptomatic therapy for dyspnea. However, little is known about the duration of its effect and its impact on PAL. Therefore, this study aimed to measure dyspnea severity and changes in dyspnea and PALs with air blasts to the face. Methods: The trial conducted was open-label, randomized, and controlled. This study included out-patients with dyspnea caused by chronic respiratory deficiency. Subjects were provided a small fan and instructed to blow air toward their faces either twice a day or when having trouble breathing. Subsequently, severity of dyspnea and PALs was measured using visual analog scale and physical activity scale for the elderly (PASE), respectively, before and after 3-week treatment. Amounts of changes in dyspnea and PALs before and after treatment were compared using analysis of covariance. Results: Overall, 36 subjects were randomized, and 34 were analyzed. Mean age was 75.4 y (26 males [76.5%] and 8 females [23.5%]). Visual analog scale score for dyspnea (SD) before treatment was 33 (13.9) mm and 42 (17.5) mm in the control and intervention groups, respectively. PASE score before treatment was 78.0 (45.1) and 57.7 (38.0) in the control and intervention groups, respectively. No significant difference in changes in dyspnea severity and PAL was observed between the 2 groups. Conclusions: No significant difference was observed for dyspnea and PALs in subjects after blowing air toward their own faces with a small fan for 3 weeks at home. Disease variability and impact of protocol violations were high due to small number of cases. Further studies with a design focused on subject protocol adherence and measurement methods are required to understand impact of air flow on dyspnea and PAL. [ABSTRACT FROM AUTHOR]

Objective: To identify the published review literature regarding movement, exercise, and breathing in the prevention and/ or treatment of the coronavirus 2019 disease (COVID-19) and long COVID, with the goal of describing the literature and identifying areas for further research and clinical application. Movement and exercise incorporate sedentary behaviours, various forms of exercise, breathing and respiratory therapies, and yoga-asanas (postures). Methods: This paper progresses from a live review and incorporates systematic reviews and narrative reviews. A literature search occurred monthly using PubMed and Google Scholar from May 2022 to May 2023. A measurement tool to assess systematic reviews (AMSTAR) scoring assessed systematic review quality, while the scale for the assessment of narrative review articles (SANRA) guidelines were used to evaluate narrative reviews. Only information and data focused on movement and exercise relevant to COVID-19 prevention and/or treatment were extracted from each review. Results: Three narrative reviews and five systematic reviews were included. Sedentary behaviours increased significantly during the pandemic. Decreased physical activity level was associated with risk of hospitalization from COVID-19. Physical activity and breathing exercises, whether conducted face-to-face (F-2-F) or via telerehabilitation were associated with improvement in dyspnea (shortness of breath), exercise capacity, lung function, fatigue, and quality of life (QoL). Extreme exercise is best avoided for at least 2 to 3 weeks after severe COVID-19 symptoms. Conclusion: Sedentary behaviour and lack of regular physical activity is correlated with an increased risk of COVID-19. Various forms of movement, exercise, and breathing may be beneficial in the treatment of COVID-19 and in long COVID. Further research and understanding of the importance of movement, exercise, and breathing as it relates to immune health is warranted. [ABSTRACT FROM AUTHOR]

Background & Objective: The safety of women during childbirth and personnel working in maternity care amidst the COVID-19 pandemic is a priority for the health system. Hence, good risk management practices need to be implemented to reduce the spread of infection between healthcare workers and pregnant women who have contracted COVID-19. Therefore, this study aimed to establish a risk map for managing dyspneic parturients suffering from COVID-19-related pneumopathy during delivery. Materials & Methods: This study focuses on examining potential risks beforehand in the context of the management of a dyspneic parturient suffering from COVID-19- related pneumopathy during delivery, executed using the method FMECA (Failure Mode, Effects and Criticality Analysis); this was conducted from September to December 2021 in the maternity service of the Hospital Center ElJadida, Morocco. Results: The risk analysis of a dyspneic parturient suffering from COVID-19-related pneumopathy during delivery revealed thirteen failure modes. Proposed are corrective measures aimed at addressing the failure modes of criticality class C3 whose vital risks are linked to the care of the dyspneic parturient suffering from COVID-19-related pneumopathy at the level of the reanimation service and the level of the neonatal intensive care unit. Conclusion: Employing risk mapping is a fundamental instrument for the ongoing enhancement of quality to maximize the safety of the parturient care process by changing the organizational culture from a reactive to a preventive approach. [ABSTRACT FROM AUTHOR]

Introduction: Among cancer centers, patients' interest in acupuncture is growing, in addition to clinical research in the intervention. Their National Cancer Institute-designated comprehensive cancer center piloted an acupuncture service. Their aim was to assess whether acupuncture impacted patient self-reported symptoms as delivered clinically and discuss their implementation strategy. Methods: Patients undergoing acupuncture at a comprehensive cancer center from June 2019 to March 2020 were asked to complete a modified Edmonton Symptom Assessment Scale (ESAS) before and after each session. The authors evaluated symptom changes after acupuncture in both outpatient and inpatient settings. A change of ≥1 U, on the 0–10 scale, was considered clinically significant. Results: Three hundred and nine outpatient and 394 inpatient acupuncture sessions were provided to patients at the comprehensive cancer center during this period, of which surveys from 186 outpatient (34 patients) and 124 inpatient (57 patients) sessions were available for analysis. The highest pretreatment symptoms reported by outpatients were neuropathy (5.78), pain (5.58), and tiredness (5.59). Outpatients receiving acupuncture reported clinically significant improvements in pain (ESAS score change of −2.97), neuropathy (−2.68), decreased lack of well-being (−2.60), tiredness (−1.85), nausea (−1.83), anxiety (−1.56), activities of daily living issues (−1.32), depression (−1.23), anorexia (−1.19), insomnia (−1.14), and shortness of breath (−1.14). The most severe pretreatment symptoms reported by inpatients were pain (6.90), insomnia (6.16), and constipation (5.44). Inpatients receiving acupuncture reported clinically significant improvements in anxiety (−3.69), nausea (−3.61), insomnia (−3.26), depression (−2.98), pain (−2.77), neuropathy (−2.68), anorexia (−2.20), constipation (−1.95), and diarrhea (−1.26). Conclusion: Both outpatient and inpatient participants in this pilot acupuncture program reported clinically significant improvements in symptoms after a single acupuncture treatment. Some differences between the outpatient and inpatient settings warrant further investigation. [ABSTRACT FROM AUTHOR]

Spiritual care specialists on the palliative care team are uniquely trained in performing spiritual assessments, a skillset necessary for identifying and treating spiritual distress (SD). While the importance of addressing SD as part of whole-person care has been explored in patients with diagnoses such as cancer and heart failure, the prevalence and treatment of SD in patients with dyspnea are not present in the literature. Using valid and reliable measurement tools to assess SD in severe dyspnea could improve patient-centered care at end-of-life, referring patients to spiritual care specialists and incorporating identified needs into the overall care plan. This paper reviews three tools designed to measure SD in patients with dyspnea. One tool, the Spiritual Distress Scale, has the greatest specificity and lowest patient burden. Recommendations for future research include creating and validating a shorter version of the tool to further reduce the burden on dyspneic patients. [ABSTRACT FROM AUTHOR]

Background: Mouthpiece ventilation (MPV) reduces hypoventilation, but its efficacy in relieving dyspnea in patients with acute chronic obstructive pulmonary disease exacerbation (AECOPD) is unclear. Objective: To assess the feasibility of MPV in relieving dyspnea among patients with AECOPD. Methods: In this prospective single-arm pilot study, the change in dyspnea on numeric rating scale (NRS) after using MPV and side effects of the treatment were studied in 18 patients with AECOPD. Results: The median decrease in dyspnea was 1.5 (95% confidence interval = 0.0–2.5, p = 0.006) on NRS after the intervention lasting a median of 16.9 minutes. Of the patients, 61% found MPV beneficial. The use of MPV did not increase the sense of anxiety or pain. Conclusions: MPV is feasible and may relieve dyspnea in patients with AECOPD, but the intervention needs further evaluation. clinicaltrials.gov study number: NCT03025425 [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, the main symptoms of which are dyspnoea and fatigue. Though exercise has been recommended for subjects with COPD, its benefits remain unclear. The aim of this study was to summarise, through a systematic review and meta-analysis, the available evidence on the effects of aerobic, resistance, stretching, and combined exercise on the main symptoms of COPD. Methods: Search was performed using the electronic databases PubMed and Web of Science. Randomised controlled trials (RCTs) with interventions based on aerobic, resistance and/or combined exercise published until July 2022 were identified. The effects were summarised based on standardised mean differences (95% confidence intervals) using random and fixed effect models. Results: Eight studies were selected, including a total of 375 subjects. The results obtained showed that resistance exercise, aerobic exercise and combined exercise seem to improve dyspnoea and fatigue symptoms in COPD subjects. Conclusions: In general, we can conclude that exercise-based interventions appear to improve the main COPD symptoms and may benefit quality of life in this population. [ABSTRACT FROM AUTHOR]

Purpose: Dysfunctional breathing behaviors are prevalent in chronic obstructive pulmonary disease (COPD). Although these behaviors contribute to dyspnea, abnormal carbon dioxide (CO2) levels, and COPD exacerbations, they are modifiable. Current dyspnea treatments for COPD are suboptimal, because they do not adequately address dysfunctional breathing behaviors and anxiety together. We developed a complementary mind–body breathlessness therapy, called capnography-assisted respiratory therapy (CART), that uses real-time CO2 biofeedback at the end of exhalation (end-tidal CO2 or ETCO2), to target dysfunctional breathing habits and improve dyspnea treatment and pulmonary rehabilitation (PR) adherence in COPD. The study aim was to test the feasibility of integrating CART with a traditional, clinic-based PR program in an urban setting. Methods: We used a feasibility pre- and post-test design, with 2:1 randomization to CART+PR or control (PR-alone) groups, to test and refine CART. Multi-component CART consisted of six, 1-h weekly sessions of slow breathing and mindfulness exercises, ETCO2 biofeedback, motivational counseling, and a home program. All participants were offered twice weekly, 1-h sessions of PR over 10 weeks (up to 20 sessions). Results: Thirty-one participants with COPD were enrolled in the study. Approximately a third of participants had symptoms of psychological distress. Results showed that CART was feasible and acceptable based on 74% session completion and 91.7% homework exercise completion (n = 22). Within-group effect sizes for CART+PR were moderate to large (Cohen's d = 0.51–1.22) for reduction in resting Borg dyspnea (anticipatory anxiety) and respiratory rate, St. George's Respiratory Questionnaire (SGRQ) respiratory symptoms; and increase in Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and physical activity; all p < 0.05. Conclusions: CART is a new mind–body breathing therapy that targets eucapnic breathing, interoceptive function, and self-regulated breathing to relieve dyspnea and anxiety symptoms in COPD. Study findings supported the feasibility of CART and showed preliminary signals that CART may improve exercise tolerance, reduce dyspnea, and enhance PR completion by targeting reduced dysfunctional breathing patterns (CTR No. NCT03457103). [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the effect of Positive Expiratory Pressure (PEP) Buddy on exertional dyspnea, exertional desaturation and quality of life in individuals with chronic obstructive pulmonary disease (COPD). The study performed baseline dyspnea and quality of life assessments using the Shortness of Breath Questionnaire and St. George respiratory Questionnaire. The research identified differences in the proportion of participants with improved exertional dyspnea.

Background & aim: Dyspnea and respiratory problems are the most common complications of the covid-19 disease. On the other hand, an effective solution to reduce respiratory complications and prevent weakness caused by hospitalization is respiratory rehabilitation. Therefore, this study was conducted in order to determine the effect of breathing exercises on the respiratory symptoms of patients with covid-19. Methods: The present study was a randomized clinical trial study that was conducted on 72 patients with covid-19 after being discharged from the hospital. Patients were randomly assigned into two intervention groups (36 individuals) and a control (36 individuals). The intervention group received a booklet of breathing exercises and training on how to perform diaphragmatic breathing and lip bud breathing through WhatsApp software. For a period of six weeks, telephone follow-up was done twice a week (in the first four weeks) and once a week (in the second two weeks) to perform breathing exercises and to receive a self-reporting checklist of breathing exercises. The control group received routine care and education after discharge. Demographic information questionnaires and the Borg Dyspnea Scale were used to collect data. Two groups completed the data before and after the end of the intervention. Results: Findings revealed that the mean and standard deviation of the severity of dyspnea before the intervention in the intervention group was 4.61 ± 0.9 and in the control group was 4.14 ± 0.83. After the intervention, it was 2.47 ± 0.56 in the intervention group and 3.67 ± 0.75 in the control group, which shows a decrease in shortness of breath with an average difference of 2.13 between the two groups. Therefore, the effect of breathing exercises on the improvement of respiratory symptoms was statistically significant (P<0.001). Conclusion: Breathing exercises play an important role in improving the rate of dyspnea in discharged patients with covid-19. Therefore, it is recommended to teach breathing exercises before discharge to patients with covid-19. [ABSTRACT FROM AUTHOR]

Aim: In order to make a definitive diagnosis of acute pulmonary embolism (APE), patients to undergo computed tomography angiography (CTA) are selected according to certain criteria. This study aimed to examine the partial oxygen pressure PaO2/inspired oxygen concentration ratio (P/F) as a new parameter to be used for this purpose in addition to the Wells score, which is one of the methods of determining clinical probability. Materials and Methods: This study was prospectively conducted between July 1, 2022, and October 1, 2022, and included 80 patients that presented to the emergency department with acute dyspnea and were diagnosed with APE using CTA. The Wells scores of the patients were recorded at the time of their presentation to the emergency department. IBM SPSS v. 20.0 was used for the statistical analysis of the data. Results: Of the cases included in the study, seven had a low probability, 57 had an intermediate probability, and 16 had a high probability of APE. The PaO2 values of the patients were 56.7±8.0, 56.1±11.2, and 51.8±9.9 mmHg for the low, intermediate, and high probability groups, respectively. According to the Wells scores, the P/F ratios of the patients with low, intermediate, and high probability were determined as 205.5±72.2, 198.5±62.5, and 183.5±43.6, respectively. Conclusion: There was a negative correlation between the P/F ratio and Wells score, but this was not statistically significant. Therefore, it may not be appropriate to evaluate the P/F ratio in making a decision to perform CTA in clinical practice. [ABSTRACT FROM AUTHOR]

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]

Objective: To evaluate the effect of acupuncture transcutaneous electrical nerve stimulation (acuTENS) on the reduction of dyspnoea during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A multicentric randomized control trial with masked patients and evaluators was carried out. During hospitalization, AECOPD patients received 45 min of acuTENS (experimental group) or sham acuTENS (controls) daily on 5 consecutive days. The trial was conducted at the Hospital del Mar, Barcelona, and Hospital Sant Joan de Déu, Manresa (both in Spain). Dyspnoea and peak expiratory flow were measured daily from the first to fifth days. Length of stay, readmissions at 3 months and adverse events were also analysed. Results: Finally, 19 patients with moderately to severely exacerbated COPD were included. Although some tendencies in dyspnoea during day 1 and length of hospital stay were found favouring acupuncture, no significant differences were shown between groups. Conclusions: The acuTENS intervention was feasible#well tolerated in AECOPD patients and no important side effects were reported. [ABSTRACT FROM AUTHOR]

Introduction: Post-COVID-19 syndrome is characterized by post-viral chronic fatigue syndrome and multi-organ complications. The typical clinical symptoms are exhaustion, dyspnea, and chest pain. This study examines the effect of laser acupuncture (LA), involving the use of laser treatment on acupuncture points, on boosting immunity and reducing the inflammatory symptoms in patients with post-COVID syndrome. Material and methods: A total of 80 patients of both sexes with post-COVID symptoms were enrolled. They were randomly divided into the LA group (n = 40), which received LA three times/week for 12 weeks, and a placebo group (n = 40) which received sham LA. The following measures were taken for both groups before and after the study: total lymphocyte count (TLC), Interleukin 6 (IL-6), dyspnea using the modified Medical Research Counseling Dyspnea Scale (mMRC), and fatigue using the Chalder Fatigue Scale (CFQ-11). Results: The LA group showed a significant elevation in TLC (p < 0.001) as well as a significant reduction in IL-6 levels, dyspnea, and fatigue (p < 0.001). The placebo group demonstrated a significant increase in TLC (p < 0.05). Conclusions: The use of lasers at particular acupuncture points related to lung and immunity showed promising results in ameliorating the typical main symptoms post-COVID, including chronic fatigue and dyspnea. [ABSTRACT FROM AUTHOR]

Aims: Vitamin D plays a role in controlling the function of vascular smooth muscle and endothelial cells, even in the pulmonary artery. We hypothesized that pulmonary artery elasticity were comprimised in individuals with relatively low vitamin D levels. Methods: Adult individuals with the complaint of shortness of breath were enrolled. They were divided into 2 groups according to vitamin D levels, with a cut-off of 20 ng/mL. Pulmonary artery stiffness (PAS) was calculated using the following formula: PAS (kHz/sec) = maximal frequency shift/pulmonary acceleration time. The six-minute walk distance (6MWD) was used to assess the functional exercise capability of subjects. Results: A total of 71 individuals (male: 31%) were enrolled. Subjects with low vitamin D levels had lower 6MWD than subjects with higher vitamin D levels (443.58±56.20 m vs. 483.20±58.43 m, p=0.007). The PAS was significantly higher in individuals with vitamin D level <20 ng/mL compared with subjects with vitamin D level > 20 ng/mL (11.65±3.76 vs. 9.46±2.53, respectively, p=0.011). Multiple regression showed that vitamin D level was inversely associated with PAS (ß=-0.280, p=0.009). Conclusions: We found that PAS was associated with lower vitamin D levels. Vitamin D deficiency might involved in the dynamics of the pulmonary artery vasculature, even in the absence of significant pulmonary artery pressure elevation. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient's characteristics, comparing severe patients with COPD to patients without CRF (COPD group).Methods: This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion.Results: CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD -1.5 ± 2.4 vs COPD -1.1 ± 1.2% baseline kJ-1, p = 0.5819), in the potentiated resting twitch force (CRF-COPD -2.8 ± 4.7 vs COPD -2.0 ± 3.3% baseline kJ-1, p = 0.7481) and in the maximal voluntary activation (CRF-COPD -0.1 ± 3.9 vs COPD -0.9 ± 1.2 -2.0 ± 3.3% baseline kJ-1, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found.Conclusion: Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction. [ABSTRACT FROM AUTHOR]

Demand for occupational therapy (OT) practitioners is increasing to help the growing population of adults with chronic conditions. Dyspnea, the feeling of shortness of breath or difficulty breathing, is the primary reason patients with chronic obstructive pulmonary disease (COPD) seek medical services. The case report focused on occupation-based OT interventions for an 84-year-old female suffering from COPD for the past 20 years. She was a homemaker, and her main symptoms were dyspnea and weakness that affected her sleep, leisure, and self-care task participation. The patient had consulted for ten OT sessions, including the follow-up. The interventions used were participation in leisure occupation, dyspnea management using controlled breathing and energy conservation techniques, aerobic training to promote overall well-being and activity tolerance, and sleep management. Significant improvement at discharge was noted in all areas mentioned above, evident from scores improvement in all four standardized tests, 15% improvement in Modified Barthel Index Shah Version, 14% improvement in Geriatric Depression Scale, 29% improvement in Pittsburgh Sleep Quality Index, and 40% improvement in Borg Rating for Perceived Exertion Scale. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a progressiveinflammatory disease characterized by chronic obstruction in the peripheral bronchus and pulmonary emphysema. The disease is disabling with symptoms such as chronic cough, phlegm, wheezing, shortness of breath and increased infections of the respiratory passage. Changes in the lungs result in mucus hyper secretion, dysfunction of the cilia, airflow limitation and hyper inflation of the lungs, gas exchange abnormalities, pulmonary hypertension and cor pulmonale. Persons with COPD are greatly under estimated because the disease is usually not diagnosed until it is moderately advanced .Patients usually seek medical help when they have an acute respiratory infection, with dyspnea being the main concern. Dyspnea is often progressive, and initially occurs with exertion, gradually interferes with daily activities and in late stages dyspnea may be present at rest also. The person becomes more of a chest breather, relying on the intercostals and accessory muscles rather than effective abdominal breathing. The objective of the study was, to assess the breathing pattern before and after pursed Lip breathing exercise among chronic obstructive pulmonary disease patients in control and experimental group. To evaluate the effectiveness of Pursed lip breathing exercise on the reduction of Dsypnea among chronic obstructive pulmonary disease patients in experimental group. To find out the association between the breathing pattern with selected demographic variables in thecontrol and experimental group. [ABSTRACT FROM AUTHOR]

Dyspnea is a common emergency requiring urgent care, and a variety of factors may mislead emergency medical technicians (EMTs). Typically, EMT education uses traditional lectures with paper books. The effect of interactive eBooks on EMT learning has not been explored. This study aims to develop an interactive eBook in dyspnea assessment and management and to evaluate its learning effect. A quasi-experimental design with three repeated measures was used. A total of 117 EMTs were recruited and assigned to the experimental group (eBook, n = 56) and the comparison group (paper book, n = 61). Questionnaires were administered to both groups at three time points. The results show that both materials can improve cognition and that the interactive eBook has better effects than the paper book. The interactive eBook motivated EMT to learn more than the paper book, but motivation did not last for five weeks. The long-term effect of the interactive eBook on confidence compared to the paper book is significant. The eBook can include real cases, concept maps, videos, quizzes, and instant feedback to meet learner needs. Health educators could integrate technology and cognitive strategies into EMTs' training curricula to improve their ability to provide better emergency medical services. [ABSTRACT FROM AUTHOR]

Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary healthcare provider's office, or directly to the closest emergency department [ED] via Emergency Medical Services [EMS]). This article specifically describes the initial assessment and management of shortness of breath in an adolescent athlete during a track event. [ABSTRACT FROM AUTHOR]

Background: Episodic dyspnea (ED) is a common problem in patients with advanced lung cancer (LC). However, the prevalence of ED and other related aspects in this patient population is not known. Objectives: To assess and describe the prevalence, clinical features, treatment, and risk factors for ED in outpatients with advanced LC. Design: Multicenter cross-sectional study. Subjects: Consecutive sample of adult outpatients with advanced LC. Measurements: We assessed background dyspnea (BD), the characteristics, triggers, and management of ED. Potential ED risk factors were assessed through multivariate logistic regression. Results: A total of 366 patients were surveyed. Overall, the prevalence of ED was 31.9% (90% in patients reporting BD). Patients reported a median of one episode per day (interquartile range [IQR]: 1–2), with a median intensity of 7/10 (IQR: 5–8.25). ED triggers were identified in 89.9% of patients. ED was significantly associated with chronic obstructive pulmonary disease (p = 0.011), pulmonary vascular disease (p = 0.003), cachexia (p = 0.002), and palliative care (p < 0.001). Continuous oxygen use was associated with higher risk of ED (odds ratio: 9.89; p < 0.001). Opioids were used by 44% patients with ED. Conclusions: ED is highly prevalent and severe in outpatients with advanced LC experiencing BD. The association between intrathoracic comorbidities and oxygen therapy points to alveolar oxygen exchange failure having a potential etiopathogenic role in ED in this population. Further studies are needed to better characterize ED in LC to better inform treatments and trial protocols. [ABSTRACT FROM AUTHOR]

Aims and objectives: The study aimed to describe how breathlessness is experienced by patients prior to prehospital care. Design: A qualitative phenomenological design. Methods: Lifeworld interviews were conducted with 14 participants. The analysis was carried out within the descriptive phenomenological framework. Results: The essential meaning of the breathlessness phenomenon is described as an existential fear in terms of losing control over one's body and dying, which involves a battle to try to regain control. This is further described by four constituents: being in an unknown body, striving to handle the situation, the ambiguity of having loved ones close and reaching the utmost border. Conclusions: Patients describe a battling for survival. It is at the extreme limit of endurance that patients finally choose to call the emergency number. It is a challenge for the ambulance clinician (AC) to support these patients in the most optimal fashion. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is characterised by symptomatic dyspnoea and reduced exercise tolerance, in part as a result muscle weakness, for which inspiratory muscle training (IMT) may be useful. Excess mucus hypersecretion commonly coexists in COPD and may lead to reduce ventilation, further impacting on breathlessness. Devices for sputum clearance may be employed to aid mucus expectoration. This trial aimed to explore the effectiveness of a combined IMT and high-frequency airway oscillating (HFAO) device in the management of dyspnoea.Methods: This was a double-blinded, randomised sham-controlled trial which recruited symptomatic patients with COPD. Patients were randomised to either a HFAO device (Aerosure) or sham device for 8 weeks, three times a day. The primary outcome was the Chronic Respiratory Questionnaire dyspnoea (CRQ-D) domain. Pre-specified subgroup analyses were performed including those with respiratory muscle weakness, excessive sputum and frequent exacerbators.Results: 104 participants (68% men, mean (SD) age 69.75 years (7.41), forced expiratory volume in 1 s per cent predicted 48.22% (18.75)) were recruited to this study with 96 participants completing. No difference in CRQ-D was seen between groups (0·28, 95% CI -0.19 to 0.75, p=0.24), though meaningful improvements were seen over time in both groups (mean (SD) HFAO 0.45 (0.78), p<0.01; sham 0.73 (1.09), p<0.01). Maximal inspiratory pressure significantly improved in the HFAO group over sham (5.26, 95% CI 0.34 to 10.19, p=0.05). Similar patterns were seen in the subgroup analysis.Conclusion: There were no statistical differences between the HFAO and the sham group in improving dyspnoea measured by the CRQ-D.Trial Registration Number: ISRCTN45695543. [ABSTRACT FROM AUTHOR]

BACKGROUND: Interstitial lung disease is characterized by exertion dyspnea, exercise limitation and reduced quality of life. The role of exercise training in this diverse patient group is unclear. The growth differentiation factor 15 (GDF15) is a stress-sensitive circulating factor that regulates systemic energy balance and could be a possible biomarker in interstitial lung disease. OBJECTIVE: To evaluate the effect of supervised exercise (endurance and resistance) training (SET) on exercise capacity, pulmonary function parameters and GDF15 levels in patients with interstitial lung disease (PwILD). METHODS: In this non-randomized case-control trial, the experimental group comprised of 10 PwILD (7 women and 3 men) while the control group consisted of of 18 apparently healthy participants s 11 women and 7 men). All subjects completed an 8-week supervised exercise training program, at a rate of twice a week. Dyspnea was evaluated using the Shortness of Breath Respiratory Questionnaire. Exercise capacity was measured using the 6-min walk test while the heart rate (HR) was monitored before and after the exercise training. GDF15 levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS: PwILD had significantly shorter 6-min walk distance than the control subjects at both the 1 st and the 15 th visit. However, both groups improved significantly in this test. The change (pre to post-exercise) in HR value was smaller in PwILD compared to the controls. Moreover, PwILD had higher Shortness of Breath Respiratory Questionnaire score than controls. The mean pre and post GDF15 values in both groups remained statistically unchanged. However the GDF15 values of the PwILD patients were significantly higher compared to the controls with respect to pre and post exercise training respectively. CONCLUSION: Supervised exercise training did not affect GDF15 levels in both patient and control groups but its values in PwILD were significantly higher compared to those of controls (p ⩽ 0.05). The exercise capacity and dyspnea in these patients improved after exercise training program. [ABSTRACT FROM AUTHOR]

Introduction: The battery-operated hand-held fan ('fan') is an inexpensive and portable non-pharmacological intervention for chronic breathlessness. Evidence from randomised controlled trials suggests the fan reduces breathlessness intensity and improves physical activity in patients with a range of advanced chronic conditions. Qualitative data from these trials suggests the fan may also reduce anxiety and improve daily functioning for many patients. This study aimed to explore barriers and facilitators to the fan's implementation in specialist respiratory care as a non-pharmacological intervention for chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD).Methods: A qualitative approach was taken, using focus groups. Participants were clinicians from any discipline working in specialist respiratory care at two hospitals. Questions asked about current fan-related practice and perceptions regarding benefits, harms and mechanisms, and factors influencing its implementation. Analysis used a mixed inductive/deductive approach.Results: Forty-nine participants from nursing (n = 30), medical (n = 13) and allied health (n = 6) disciplines participated across 9 focus groups. The most influential facilitator was a belief that the fan's benefits outweighed disadvantages. Clinicians' beliefs about the fan's mechanisms determined which patient sub-groups they targeted, for example anxious or palliative/end-stage patients. Barriers to implementation included a lack of clarity about whose role it was to implement the fan, what advice to provide patients, and limited access to fans in hospitals. Few clinicians implemented the fan for acute-on-chronic breathlessness or in combination with other interventions.Conclusion: Implementation of the fan in specialist respiratory care may require service- and clinician-level interventions to ensure it is routinely recommended as a first-line intervention for chronic breathlessness in patients for whom this symptom is of concern, regardless of COPD stage. [ABSTRACT FROM AUTHOR]

Context: Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care.Objectives: Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer.Methods: Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses.Results: Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point.Conclusion: SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness. [ABSTRACT FROM AUTHOR]

Context: For patients with cancer, uncontrolled pain and other symptoms are the leading cause of unplanned hospitalizations. Early access to specialty palliative care (PC) is effective to reduce symptom burden, but more efficient approaches are needed for rapid identification and referral. Information on symptom burden largely exists in free-text notes, limiting its utility as a trigger for best practice alerts or automated referrals.Objectives: To evaluate whether natural language processing (NLP) can be used to identify uncontrolled symptoms (pain, dyspnea, or nausea/vomiting) in the electronic health record (EHR) among hospitalized cancer patients with advanced disease.Methods: The dataset included 1,644 hospitalization encounters for cancer patients admitted from 1/2017 -6/2019. We randomly sampled 296 encounters, which included 15,580 clinical notes. We manually reviewed the notes and recorded symptom severity. The primary endpoint was an indicator for whether a symptom was labeled as "controlled" (none, mild, not reported) or as "uncontrolled" (moderate or severe). We randomly split the data into training and test sets and used the Random Forest algorithm to evaluate final model performance.Results: Our models predicted presence of an uncontrolled symptom with the following performance: pain with 61% accuracy, 69% sensitivity, and 46% specificity (F1: 69.5); nausea/vomiting with 68% accuracy, 21% sensitivity, and 90% specificity (F1: 29.4); and dyspnea with 80% accuracy, 22% sensitivity, and 88% specificity (F1: 21.1).Conclusion: This study demonstrated initial feasibility of using NLP to identify hospitalized cancer patients with uncontrolled symptoms. Further model development is needed before these algorithms could be implemented to trigger early access to PC. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic or refractory breathlessness adversely affects quality of life. Current treatment strategies for managing breathlessness are often inadequate in providing complete relief. Kinesiology taping is generally used in musculoskeletal practice for preventive and rehabilitative purposes. Recently, our attention was drawn to the plausible mechanism(s) and indication for use of kinesiology taping for managing chronic breathlessness. We present a brief review of the scientific rationale and efficacy of kinesiology taping for respiratory function-related outcomes. Through this publication, we hope to catalyse discussions amongst palliative care professionals and researchers on the potential use of kinesiology taping in the management of chronic breathlessness. [ABSTRACT FROM AUTHOR]

Patients with chronic obstructive pulmonary disease (COPD) commonly experience dyspnea, which may limit activities of daily living. Pursed-lip breathing improves dyspnea for COPD patients; however, access to pursed-lip breathing training is limited. The proposed MELodica Orchestra for DYspnea (MELODY) study will be a single-site pilot study to assess the safety, feasibility, and efficacy of a music-based approach to teach pursed-lip breathing. Patients with COPD and moderate-severe dyspnea are randomized to intervention, education-control, or usual care control groups. Intervention patients meet twice weekly for eight weeks for melodica instruction, group music-making, and COPD education. Safety, feasibility, and efficacy is assessed qualitatively and quantitatively. This manuscript describes the rationale and methods of the MELODY pilot project. If pilot data demonstrate efficacy, then a multi-site randomized control trial will be conducted to evaluate program effectiveness and implementation. [ABSTRACT FROM AUTHOR]

Background: Respiratory medicine (RM) and palliative care (PC) physicians' management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey.Methods: A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists.Results: 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018).Conclusions: These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled. [ABSTRACT FROM AUTHOR]

Rationale: Patients with chronic obstructive pulmonary disease (COPD) may remain breathless despite optimal medical treatment. Hand-held fans (HHFs) are recommended to relieve breathlessness, but little is known about physical properties of different fans and the impact HHF properties may have on patient perceptions of fans.Objective: To describe the physical properties of HHFs and investigate the relationship of these properties to patient fan preference.Methods: We recruited 33 participants with COPD who were attending a pulmonary rehabilitation program. Participants trialled 5 HHFs in random order. Participants rated perceived airflow, pleasantness of airflow, noisiness, and ease of use of each fan using a 1-10 numerical rating scale (NRS). After trialling all 5 fans, participants ranked each HHF from best (5 arbitrary units; a.u.) to worst (1 a.u.). Rankings for each fan were tallied to produce total HHF scores (T-HHF; maximum=165 a.u.). Objective measurements were made of sound intensity (dB; sound level meter), airflow between 5cm and 30cm from the middle of the fan (anemometer), blade rotation speed, blade size and total fan weight. We assessed the strength of association of T-HHF scores against mean NRS values using Spearman correlation coefficients and used linear regression to compare measured to perceived airflow, and noisiness to sound intensity.Results: Participants were 68.5 ± 8.9 years (mean ± SD), 63% male, with a median FEV1 of 0.99L(IQR 0.76-1.31L). There was considerable variability between the 5 fans tested in terms of participant perceptions and physical properties with an almost 5-fold difference in air velocity at 30cm and a 3-fold difference in blade rotation speed. The most preferred fan had a T-HHF score of 140 and had the highest airflow (1.9 m/s) measured at 30cm. T-HHF score positively correlated with pleasantness of airflow (r = 0.46; P < 0.001), perceived airflow (r=0.58; P<0.001) and airflow velocity at 30cm from fan blades (r=1.0; P = 0.02). There were positive linear relationships between fan airflow velocity and perceived air amount, and between measured sound intensity and perceived noisiness(both P<0.001). Women reported significantly higher perceived airflow than men (P < 0.001).Conclusions: The physical properties of the five included HHFs are quite distinct. Patient preference was related to pleasantness of airflow, perceived airflow, and measured airflow at 30cm. Gender differences in perceived airflow were noted. Future research should explore the relationship between HHF characteristics and relief of breathlessness. [ABSTRACT FROM AUTHOR]

Background: COPD, called Chronic Obstructive Non-transmitted Pulmonary Disease, is a disease that causes severe sequelae in the respiratory system, which in combination with other types of viruses such as covid-19 aggravates the disease, with major effects on the locomotor system due to saturation instabilities. The main victims of the disease are elderly smokers and ex-smokers of both sexes. In more severe cases, there is a need for continuous treatment with oxygen therapy, limiting the quality of life and physical activity of the elderly. Objective: Physical activity is an alternative non-pharmacological treatment to help the recovery of the individual with severe COPD, minimizing the complications of the disease. Method: The study aims to describe the case of a 77-year-old elderly man, ex-smoker for 17 years, with severe sequelae post COPD-19 in the respiratory system, dependent on oxygen therapy for great instability of mean saturation below 70%, with reflexes on the locomotor system, having difficulties in locomotion. In this case, to keep him active, active static stretching exercises were proposed forfive consecutive days. Results: Afterfive consecutive days of active stretching, the results were positive, increasing saturation by an average of 1.75%, reaching 89.79% without the help of oxygen therapy, which was enough to reduce dyspnea, wean him off oxygen therapy, and improve his mobility and quality of life. Conclusion: that active static stretching is beneficial for severe cases of COPD, minimizing complications and reducing the use of oxygen therapy. [ABSTRACT FROM AUTHOR]