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Sample records for dyspnea

  1. [Dyspnea and behavioral control].

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    Chonan, T

    1992-04-01

    Respiration is automatically regulated via chemo- and mechanoreceptors existing in and outside the lungs, but it is also controlled voluntarily by behavioral factors. Voluntary increase in ventilation accentuates dyspnea and the sensory intensity at a given ventilation does not differ from that of exercise-induced hyperventilation, but it is significantly smaller than that during hypercapnia or hypoxia. Voluntary constraint of ventilation augments dyspnea in proportion to the degree of constraint even under isocapnic hyperoxia, and the respiratory sensation during constrained breathing is qualitatively more discomfortable than that during hyperventilation. Changes in the level and pattern of breathing under constant levels of chemical stimuli increase respiratory sensations and the intensity of dyspnea is minimal near the spontaneous levels, which supports the hypothesis that breathing is behaviorally regulated in part to minimize dyspnea. The system of behavioral control of breathing appears to be involved in the maintenance of body homeostasis by modifying the respiratory output through respiratory sensations.

  2. Multiple dimensions of cardiopulmonary dyspnea

    Institute of Scientific and Technical Information of China (English)

    HAN Jiang-na; XIONG Chang-ming; YAO Wei; FANG Qiu-hong; ZHU Yuan-jue; CHENG Xian-sheng; Karel P Van de Woestijne

    2011-01-01

    Background The current theory of dyspnea perception presumes a multidimensional conception of dyspnea.However,its validity in patients with cardiopulmonary dyspnea has not been investigated.Methods A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort,affective aspects,and behavioral items was administered to 396 patients with asthma,chronic obstructive pulmonary disease (COPD),diffuse parenchymal lung disease,pulmonary vascular disease,chronic heart failure,and medically unexplained dyspnea.Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis.The separation of patient groups was achieved by a variance analysis on symptom factors.Results Seven factors appeared to measure three dimensions of dyspnea:sensory (difficulty breathing and phase of respiration,depth and frequency of breathing,urge to breathe,wheeze),affective (chest tightness,anxiety),and behavioral (refraining from physical activity) dimensions.Difficulty breathing and phase of respiration occurred more often in COPD,followed by asthma (R2=0.12).Urge to breathe was unique for patients with medically unexplained dyspnea (R2=0.12).Wheeze occurred most frequently in asthma,followed by COPD and heart failure (R2=0.17).Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R2=0.04).Anxiety characterized medically unexplained dyspnea (R2=0.08).Refraining from physical activity appeared more often in heart failure,pulmonary vascular disease,and COPD (R2=0.15).Conclusions Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups.These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

  3. Fearful imagery induces hyperventilation and dyspnea in medically unexplained dyspnea

    Institute of Scientific and Technical Information of China (English)

    HAN Jiang-na; ZHU Yuan-jue; LUO Dong-mei; LI Shun-wei; Ilse Van Diest; Omer Van den Bergh; Karel P Van de Woestijne

    2008-01-01

    Background Medically unexplained dyspnea refers to a condition characterized by a Sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective Symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting Symptoms, specifically dyspnea.Methods Forty patients with medically unexplained dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO2 (PetCO2) and breathing frequency were recorded and subjective Symptoms evaluated. The subject who had PetCO2 falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder.Results In patients with medically unexplained dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO2 (P<0.05). Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects (P<0.01). The patients reported Symptoms of dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO2 fall was significantly correlated with the intensity of dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety Symptoms on the other.Conclusions Fearful imagery provokes hyperventilation and induces subjective Symptoms of dyspnea and palpitation in patients with medically unexplained dyspnea.

  4. Hiatal hernia: An unusual presentation of dyspnea

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    Seied Ahmad Mirdamadi

    2010-01-01

    Full Text Available Context : Hiatal hernia is an infrequent but serious cause of dyspnea. We report a case of acute dyspnea and paroxysmal nocturnal dyspnea secondary to hiatal hernia and epicardial fat pad. Case Report : A 78-year-old woman presented with dyspnea and paroxysmal nocturnal dyspnea. Lab data and physical examination were normal. Computed tomography scan demonstrated a large hiatal hernia and epicardial fat pad. Conclusion : Although rare, hiatal hernia should be suspected in patients who develop unexplained dyspnea.

  5. Mechanisms of dyspnea in healthy subjects

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    Gigliotti Francesco

    2010-06-01

    Full Text Available Abstract Dyspnea is a general term used to characterize a range of different descriptors; it varies in intensity, and is influenced by a wide variety of factors such as cultural expectations and the patient's experiences. Healthy subjects can experience dyspnea in different situations, e.g. at high altitude, after breath-holding, during stressful situations that cause anxiety or panic, and more commonly during strenuous exercise. Discussing the mechanisms of dyspnea we need to briefly take into account the physiological mechanisms underlying the sensation of dyspnea: the functional status of the respiratory muscles, the role of chemoreceptors and mechanoreceptors, and how the sense of respiratory motor output reaches a level of conscious awareness. We also need to take into account theories on the pathophysiological mechanisms of the sensation of dyspnea and the possibility that each pathophysiological mechanism produces a distinct quality of breathing discomfort. The terms used by subjects to identify different characteristics of breathing discomfort - dyspnea descriptors - may contribute to understanding the mechanisms of dyspnea and providing the rationale for a specific diagnosis.

  6. Mechanisms of dyspnea in healthy subjects

    Science.gov (United States)

    2010-01-01

    Dyspnea is a general term used to characterize a range of different descriptors; it varies in intensity, and is influenced by a wide variety of factors such as cultural expectations and the patient's experiences. Healthy subjects can experience dyspnea in different situations, e.g. at high altitude, after breath-holding, during stressful situations that cause anxiety or panic, and more commonly during strenuous exercise. Discussing the mechanisms of dyspnea we need to briefly take into account the physiological mechanisms underlying the sensation of dyspnea: the functional status of the respiratory muscles, the role of chemoreceptors and mechanoreceptors, and how the sense of respiratory motor output reaches a level of conscious awareness. We also need to take into account theories on the pathophysiological mechanisms of the sensation of dyspnea and the possibility that each pathophysiological mechanism produces a distinct quality of breathing discomfort. The terms used by subjects to identify different characteristics of breathing discomfort - dyspnea descriptors - may contribute to understanding the mechanisms of dyspnea and providing the rationale for a specific diagnosis. PMID:22958405

  7. [Confusion about MRC dyspnea scales in Japan--which MRC dyspnea scale should we employ?].

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    Miyamoto, Kenji

    2008-08-01

    Though the Hugh-Jones dyspnea scale has been widely used in Japan, the British Medical Research Council (MRC) dyspnea scale and/or modified MRC dyspnea scales have been used in many other countries. One of these modified MRC dyspnea scales was translated into Japanese and appeared in both the "Japanese Manual of Respiratory Rehabilitation (2003)" and the "Japanese Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease (2004)" which were published by the Japanese Respiratory Society. Subsequently, the MRC dyspnea scale appeared in a textbook and in review articles published in Japan. However, this dyspnea scale, which was translated into Japanese, is not used by the British Thoracic Society, American Thoracic Society, European Respiratory Society, Canadian Respiratory Society, or Global Initiative for Chronic Obstructive Lung Disease (GOLD). The Japanese version of the MRC dyspnea scale has two serious problems: 1) normal healthy subjects have to be classified into dyspnea grade 0 or grade 1, and 2) incorrect Japanese translation of the scale. The Japanese Respiratory Society has to decide which MRC dyspnea scale should be employed, with a well-thought-out translation.

  8. Predicting Dyspnea Inducers by Molecular Topology

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    María Gálvez-Llompart

    2013-01-01

    Full Text Available QSAR based on molecular topology (MT is an excellent methodology used in predicting physicochemical and biological properties of compounds. This approach is applied here for the development of a mathematical model capable to recognize drugs showing dyspnea as a side effect. Using linear discriminant analysis, it was found a four-variable regression equations enabling a predictive rate of about 81% and 73% in the training and test sets of compounds, respectively. These results demonstrate that QSAR-MT is an efficient tool to predict the appearance of dyspnea associated with drug consumption.

  9. Giant Hiatal Hernia Which Causes Dyspnea

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    Muhammet Sayan

    2014-03-01

    Full Text Available Hiatal hernia refers to circumstance in which content of abdomen, especially stomach, herniate to through the esophageal hiatus into the mediastinum. Variable symptoms occur such as epigastric pain, dyspnea, dyspepsia. The indications for surgery, symptomatic patients which refractory to medical therapy, obstruction and bleeding.

  10. Nature and evaluation of dyspnea in speaking and swallowing.

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    Hoit, Jeannette D; Lansing, Robert W; Dean, Kristen; Yarkosky, Molly; Lederle, Amy

    2011-02-01

    Dyspnea (breathing discomfort) is a serious and pervasive problem that can have a profound impact on quality of life. It can manifest in different qualities (air hunger, physical exertion, chest/lung tightness, and mental concentration, among others) and intensities (barely noticeable to intolerable) and can influence a person's emotional state (causing anxiety, fear, and frustration, among others). Dyspnea can make it difficult to perform daily activities, including speaking and swallowing. In fact, dyspnea can cause people to change the way they speak and swallow in their attempts to relieve their breathing discomfort; in extreme cases, it can even cause people to avoid speaking and eating/drinking. This article provides an overview of dyspnea in general, describes the effects of dyspnea on speaking and swallowing, includes data from two survey studies of speaking-related dyspnea and swallowing-related dyspnea, and outlines suggested protocols for evaluating dyspnea during speaking and swallowing.

  11. Progressive dyspnea due to pulmonary carcinoid tumorlets

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    Anastasios Kallianos

    2017-01-01

    Full Text Available This is a case description of a female patient, 77 years-old, who presented with progressive dyspnea and cough. She had a mild hypoxemia in the arterial blood gases (PaO2 72 mmHg and normal spirometry. The chest computer tomography revealed diffuse “ground glass” opacities, segmental alveolitis, bronchiectasis, fibrotic lesions and numerous micronodules. A thoracoscopy was performed and the obtained biopsy showed carcinoid tumorlets, with positive CK8/18, CD56, TTF-1 and synaptophysin immunohistochemical markers. Pulmonary carcinoid tumorlets are rare, benign lesions and individuals with tumorlets are typically asymptomatic. Our report presents a symptomatic clinical case of carcinoid tumorlet.

  12. Dyspnea: when the preliminary imaging is unconvincing

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    Angelica Moretti

    2015-05-01

    Full Text Available A 73-year-old man was admitted to the Emergency Room (ER for dyspnea and cough from several months. In ER were performed blood sampling, chest X-ray, electrocardiogram, echocardiogram and arterial blood gas. A thoracic ultrasound (US revealed in the left side an abundant pleural effusion and a lung consolidation area of about 5 cm without air bronchogram. A thoracentesis showed the presence of hemorrhagic effusion. Chest computed tomography (CT revealed micro-pulmonary embolism, abundant left pleural effusion with atelectasis of the lower ipsilateral lobe. Meanwhile the chest CT revised by the pulmonologist appeared suspicious for the presence of cancer, the cytological examination of pleural fluid revealed the presence of an adenocarcinoma. While the patient was waiting for the bronchoscopy he had a stroke and died in a few days. In conclusion, we believe that thoracic US has to be considered an extension of the physical examination, it is a bedside tool and it represents a valid diagnostic and therapeutic method. Therefore thoracic US, if closely linked to the physician’s activity, can directly affect the decision-making process and management of the patient with dyspnea.

  13. Intrathoracic Caecal Perforation Presenting as Dyspnea

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    Vincent Granier

    2010-01-01

    Full Text Available Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  14. Intrathoracic caecal perforation presenting as dyspnea.

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    Granier, Vincent; Coche, Emmanuel; Hantson, Philippe; Thoma, Maximilien

    2010-01-01

    Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  15. The Interpretation of Dyspnea in the Patient with Asthma

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    Marc H. Lavietes

    2015-01-01

    Full Text Available Physicians have noted dyspnea in severely ill asthmatic patients to be associated with fright or panic; in more stable patients dyspnea may reflect characteristics including lung function, personality and behavioral traits. This study evaluates the symptom of dyspnea in 32 asthmatic patients twice: first when acutely ill and again after an initial response to therapy. Spirometry was performed, dyspnea quantified (Borg scale, and panic assessed with a specialized measure of acute panic (the acute panic inventory (API in the 32 patients before and again after treatment. After treatment, questionnaires to evaluate somatization and panic disorder were also administered. When acutely ill, both the API and all spirometric measures (PEFR; FEV1; IC correlated with dyspnea. Multiple linear regression showed that measures of the API, the peak expiratory flow rate, and female sex taken together accounted for 41% of dyspnea in acute asthma. After treatment, the API again predicted dyspnea while spirometric data did not. Those subjects who described themselves as having chronic panic disorder reported high grades of dyspnea after treatment also. We conclude that interpretations of the self-report of asthma differ between acutely ill and stable asthmatic patients.

  16. How does negative affectivity contribute to medically unexplained dyspnea?

    Institute of Scientific and Technical Information of China (English)

    Karel P. Van de Woestijne

    2004-01-01

    @@ Typical for medically unexplained dyspnea is the combination of respiratory complaints, specifically dyspnea, the absence of any disability that might explain these complaints, and, in addition, a high level of anxiety. When the latter is quantified by the STAI-state and trait anxiety inventory,1 the resulting scores are significantly higher than those observed in organic pulmonary disorders.

  17. Late-onset Bochdalek's Hernia Associated with Severe Dyspnea

    OpenAIRE

    早川, 峰司; 丸藤, 哲; 森本, 裕二; 武山, 佳洋; 中村, 宏治; 古根, 高; 松原, 泉

    2001-01-01

    Late-onset Bochdalek's hernia is rare enough to be frequently diagnosed incorrectly. We present a case of lateonset Bochdalek's hernia associated with severe dyspnea and cyanosis. A 14-month-old female infant was admitted to our emergency clinic due to severe dyspnea and cyanosis. A chest radiogram and computed tomographic (CT) scan revealed a gastrointestinal shadow in the left thorax, necessitating emergency surgery that confirmed Bochdalek's hernia. Although left lung dysplasia was observe...

  18. Dyspnea assessment and adverse events during sputum induction in COPD

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    Moschandreas Joanna

    2006-06-01

    Full Text Available Abstract Background The inhalation of normal or hypertonic saline during sputum induction (SI may act as an indirect bronchoconstrictive stimulus leading to dyspnea and lung function deterioration. Our aim was to assess dyspnea and adverse events in COPD patients who undergo SI following a safety protocol. Methods Sputum was induced by normal and hypertonic (4.5% saline solution in 65 patients with COPD of varying severity. In order to minimize saline-induced bronchoconstriction a protocol based on the European Respiratory Society sputum induction Task group report was followed. Dyspnea change was scored using the Borg scale and lung function was assessed by spirometry and oximetry. Results Borg score changes [median(IQR 1.5(0–2] were observed during SI in 40 subjects; 16 patients required temporary discontinuation of the procedure due to dyspnea-general discomfort and 2 did not complete the session due to dyspnea-wheezing. The change in Borg dyspnea score was significantly correlated with oxygen saturation and heart rate changes and with discontinuation of the procedure due to undesired symptoms. 19 subjects presented an hyperresponsive reaction (decline>20% from baseline FEV1. No significant correlation between Borg changes and FEV1decline was found. Patients with advanced COPD presented significantly greater Borg and oxygen saturation changes than patients with less severe disease (p = 0.02 and p = 0.001, respectively. Baseline FEV1, oxygen saturation and 6MWT demonstrated significant diagnostic values in distinguishing subjects who develop an adverse physiologic reaction during the procedure. Conclusion COPD patients undergoing SI following a safety protocol do not experience major adverse events. Dyspnea and oxygen desaturation is more likely to occur in patients with disease in advanced stages, leading to short discontinuation or less frequently to termination of the procedure. Baseline FEV1, oxygen saturation and 6MWT may have a

  19. Influence of sustained hypoxia on the sensation of dyspnea.

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    Chonan, T; Okabe, S; Hida, W; Satoh, M; Kikuchi, Y; Takishima, T; Shirato, K

    1998-08-01

    We assessed the effect of sustained isocapnic hypoxia (PCO2 = 40 Torr, SaO2 = 80%) on the sensation of dyspnea in 16 normal healthy males. Subjects rated the sensation of dyspnea (c) on 15 cm visual analog scales during 20 min of sustained hypoxia. Following this hypoxic period, 8 subjects undertook mild exercise (10-50 W on a bicycle ergometer for 3 min) under the continuation of hypoxia. During sustained hypoxia, psi increased initially with ventilation from 0.6 +/- 0.2 (n = 16, mean +/- SE) to 2.9 +/- 0.6 at peak ventilation, but it decreased with ventilatory depression to 1.6 +/- 0.4. Dyspnea intensity during hypoxic exercise was significantly smaller than that at peak ventilation in the resting hypoxic period (2.3 +/- 0.7 vs. 3.9 +/- 1.0), although the ventilation was greater during exercise (24.0 +/- 3.0 vs. 19.7 +/- 1.4 l/min). These results indicate that sustained hypoxia has a biphasic, i.e., initial stimulatory and delayed depressant, effect on dyspnea and on ventilation. It is suggested that the dyspnea sensing mechanism is suppressed during mild exercise under sustained hypoxia.

  20. Severe dyspnea due to a giant antrochoanal polyp

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    Coloma-Milano M

    2012-07-01

    Full Text Available SummaryIntroduction: The antrochoanal polyp is a prevalent pathology in teenagers and young adults. It usually presents with nasal obstruction.Patient and method: Case report: An 80-year-old male with alcoholic encephalopathy, chronic bronchial disease of unknown etiology and polypoid chronic rhinosinusitis came to the emergency service with severe dyspnea without laryngeal features.Anterior rhinoscopy showed a polypoid mass in left nostril that prevented the visualization with nasal endoscopy.Examination of the mouth revealed a large polypoid mass involving nasopharynx and extends to hypopharynx until the laryngeal side of epiglottis.CT was requested urgently. ResultsCT demonstrated an almost complete opacification of the left maxillary sinus, left complex ethmoid cells and the presence of a soft-tissue mass, passing through the maxilary ostium into the posterior nasal cavity and choana. Mass caudal extention was located close to the laryngeal surface of the epiglottis and partially occupying the laryngeal vestibule conditioning the air way.Functional endoscopic sinus surgery was performed urgently with clinical remission.ConclusionsIn case we are treating a patient with severe dyspnea, we must determinate the etiology and localization of it, in order to decide the best treatment option.Dyspnea´s features dismissed the laryngeal site.Complementary image studies give us information about the extension.Antrochoanal polyp cases causing dyspnea are unsual, but we must think of it, or in pharyngeal formations, every time dyspnea improves with a cervical extention.

  1. Giant cell myocarditis : a fatal cause of dyspnea in pregnancy

    NARCIS (Netherlands)

    van Haelst, PL; van Rossem, M; Valentijn, RM; Beijer, GJP

    2001-01-01

    The clinical course of a pregnant patient, who presented with progressive dyspnea and heart failure is described. Despite intensive care and resuscitative efforts to mother and child, both expired. The autopsy revealed giant cell myocarditis in the mother. Giant cell myocarditis can affect pregnant

  2. Dyspnea and pain share emotion-related brain network.

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    von Leupoldt, Andreas; Sommer, Tobias; Kegat, Sarah; Baumann, Hans Jörg; Klose, Hans; Dahme, Bernhard; Büchel, Christian

    2009-10-15

    The early detection of stimuli signalling threat to an organism is a crucial evolutionary advantage. For example, the perception of aversive bodily sensations such as dyspnea and pain strongly motivates fast adaptive behaviour to ensure survival. Their similarly threatening and motivating characters led to the speculation that both sensations are mediated by common brain areas, which has also been suggested by neuroimaging studies on either dyspnea or pain. By using functional magnetic resonance imaging (fMRI), we formally tested this hypothesis and compared the cortical processing of perceived heat pain and resistive load induced dyspnea in the same group of participants. Here we show that the perception of both aversive sensations is processed in similar brain areas including the insula, dorsal anterior cingulate cortex, amygdala and medial thalamus. These areas have a documented role in the processing of emotions such as fear and anxiety. Thus, the current study highlights the role of a common emotion-related human brain network which underlies the perception of aversive bodily sensations such as dyspnea and pain. This network seems crucial for translating the threatening character of different bodily signals into behavioural consequences that promote survival.

  3. Effects of expiratory resistive loading on the sensation of dyspnea.

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    Chonan, T; Altose, M D; Cherniack, N S

    1990-07-01

    To determine whether an increase in expiratory motor output accentuates the sensation of dyspnea (difficulty in breathing), the following experiments were undertaken. Ten normal subjects, in a series of 2-min trials, breathed freely (level I) or maintained a target tidal volume equal to (level II) or twice the control (level III) at a breathing frequency of 15/min (similar to the control frequency) with an inspiratory load, an expiratory load, and without loads under hyperoxic normocapnia. In tests at levels II and III, end-expiratory lung volume was maintained at functional residual capacity. A linear resistance of 25 cmH2O.1(-1).s was used for both inspiratory and expiratory loading; peak mouth pressure (Pm) was measured, and the intensity of dyspnea (psi) was assessed with a visual analog scale. The sensation of dyspnea increased significantly with the magnitude of expiratory Pm during expiratory loading (level II: Pm = 9.4 +/- 1.5 (SE) cmH2O, psi = 1.26 +/- 0.35; level III: Pm = 20.3 +/- 2.8 cmH2O, psi = 2.22 +/- 0.48) and with inspiratory Pm during inspiratory loading (level II: Pm = 9.7 +/- 1.2 cmH2O, psi = 1.35 +/- 0.38; level III: Pm = 23.9 +/- 3.0 cmH2O, psi = 2.69 +/- 0.60). However, at each level of breathing, neither the intensity of dyspnea nor the magnitude of peak Pm during loading was different between inspiratory and expiratory loading. The augmentation of dyspnea during expiratory loading was not explained simply by increases in inspiratory activity. The results indicate that heightened expiratory as well as inspiratory motor output causes comparable increases in the sensation of difficulty in breathing.

  4. Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea.

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    Pang, Peter S; Lane, Kathleen A; Tavares, Miguel; Storrow, Alan B; Shen, Changyu; Peacock, W Frank; Nowak, Richard; Mebazaa, Alexandre; Laribi, Said; Hollander, Judd E; Gheorghiade, Mihai; Collins, Sean P

    Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established. We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard ('minimally improved or worse'). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale ('minimally worse', 'no change', or 'minimally better'). Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale. A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Platypnea-orthodeoxia and blockpnea as two unrecognized or underdiagnosed causes of medically unexplained dyspnea

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ To the Editor: I read with interest the recent article on medically unexplained dyspnea by Han et al.1 There are two frequently missed causes of 'medically unexplained dyspnea' both of which are cardiac in origin.

  6. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.

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    Parshall, Mark B; Schwartzstein, Richard M; Adams, Lewis; Banzett, Robert B; Manning, Harold L; Bourbeau, Jean; Calverley, Peter M; Gift, Audrey G; Harver, Andrew; Lareau, Suzanne C; Mahler, Donald A; Meek, Paula M; O'Donnell, Denis E

    2012-02-15

    Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.

  7. Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Perez T

    2015-08-01

    Full Text Available Thierry Perez,1 Pierre Régis Burgel,2 Jean-Louis Paillasseur,3 Denis Caillaud,4 Gaetan Deslée,5 Pascal Chanez,6 Nicolas Roche2 For the INITIATIVES BPCO Scientific Committee 1Clinique des Maladies Respiratoires, CHRU de Lille, Université Lille Nord de France, Lille, 2Service de Pneumologie, Groupe Hospitalier Cochin Broca Hotel Dieu, AP HP et Université René Descartes, 3EFFI-STAT, Paris, 4Service de Pneumologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, 5Service de Pneumologie, Hôpital Maison Blanche, CHU de Reims, Reims, 6Département des Maladies respiratoires, AP-HM, Université de Méditerranée, Marseille, France Background: Assessment of dyspnea in COPD patients relies in clinical practice on the modified Medical Research Council (mMRC scale, whereas the Baseline Dyspnea Index (BDI is mainly used in clinical trials. Little is known on the correspondence between the two methods.Methods: Cross-sectional analysis was carried out on data from the French COPD cohort Initiatives BPCO. Dyspnea was assessed by the mMRC scale and the BDI. Spirometry, plethysmography, Hospital Anxiety-Depression Scale, St George’s Respiratory Questionnaire, exacerbation rates, and physician-diagnosed comorbidities were obtained. Correlations between mMRC and BDI scores were assessed using Spearman’s correlation coefficient. An ordinal response model was used to examine the contribution of clinical data and lung function parameters to mMRC and BDI scores.Results: Data are given as median (interquartile ranges, [IQR]. Two-hundred thirty-nine COPD subjects were analyzed (men 78%, age 65.0 years [57.0; 73.0], forced expiratory volume in 1 second [FEV1] 48% predicted [34; 67]. The mMRC grade and BDI score were, respectively, 1 [1–3] and 6 [4–8]. Both BDI and mMRC scores were significantly correlated at the group level (rho =-0.67; P<0.0001, but analysis of individual data revealed a large scatter of BDI scores for any given m

  8. Dysphagia and dyspnea by lingual thyroid mass: An appropriate approach

    Directory of Open Access Journals (Sweden)

    Samad Ghiasi

    2015-03-01

    Full Text Available Lingual thyroid is a rare embryological anomaly originated from the thyroid gland failure that descends from the foramen cecum to its normal eutopic pre-laryngeal site. The case in this study was a 39 year old female, presenting with the sensation of a foreign body, progressive dysphagia and dyspnea. Indirect laryngoscopy revealed a large well-defined mass in the tongue base. Imaging studies confirmed the diagnosis of large ectopic lingual thyroid. The surgery was performed via an external cervical approach due to the mass size. The decision on the best treatment looks into the mass position, size, symptoms, airway emergency and medical facilities.

  9. Relationship between exercise induced dyspnea and functional capacity with doppler-derived diastolic function’

    OpenAIRE

    Nasim, Sumera; Nadeem, Najaf; Zahidie, Aysha; Sharif, Tabbasum

    2013-01-01

    Background Dyspnea is the frequent cause of exercise intolerance and physical inactivity among patients referred for exercise tolerance test. Diastolic dysfunction has shown significant correlation with exercise capacity and exercise induced dyspnea. To find out the frequency of diastolic dysfunction (DD) and the relationships between impaired exercise capacity and exercise induced dyspnea with DD by Doppler-derived indices among patients referred for stress test in a tertiary care hospital o...

  10. A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea

    Directory of Open Access Journals (Sweden)

    Cem Sahin

    2015-01-01

    Full Text Available Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

  11. The Assessment of Dyspnea during the Vigorous Intensity Exercise by Three Dyspnea Rating Scales in Inactive Medical Personnel

    Science.gov (United States)

    Intarakamhang, Patrawut; Wangjongmeechaikul, Piyathida

    2013-01-01

    It is well recognized that exercise is good for health especially as it’s known to prevent metabolic syndromes such as diabetes, hypertension and heart disease. To reap the benefits from exercise the most appropriate level of intensity must be determined, the level of intensity ranging from low, low to moderate to hard (vigorous). This study is aimed to 1. To investigate and evaluate 3 subjective rating scales. The Borg scale, the Combined Numerical Rating Scale (NRS) + FACES Dyspnea Rating Scale (FACES) and the Likert scale, during hard (vigorous) exercise. 2. To compare the effectiveness of the Borg scale and Combined Numerical Rating Scale (NRS) + FACES Dyspnea Rating Scale during the hard (vigorous) intensity exercise. This study uses a descriptive methodology. The sample group was 73 medical personnel that were leading an inactive life style, volunteers from Phramongkutklao Hospital. Participants were randomly divided into 3 groups. Group 1, those to report using the Borg Scale, group 2 using NRS + FACES, and group 3 to subjectively assess the intensity of the exercise using the Likert scale during a treadmill Exercise Stress Test (EST) using the Bruce protocol. The upper limit of the intensity in the study was equal to 85% of the maximal heart rate of all participants. The subjective reporting of the experienced level of dyspnea was undertaken immediately after the completion of exercise. The average age of participants was 23.37 years old. The 26 participants reporting using the Borg scale had mean Borg scale score of 13.46+1.77, a mode score of 15. The 24 participants reporting intensity levels through NRS +FACES had a mean NRS + FACES score of 6.83+1.09 and mode on the NRS + FACES scale equal to 7. The Likert scale group evaluated 23 participants with a mean Likert scale score of 2.74. That is those choosing Levels 2 and 3 were 6 (26.9%) and 17 participants (73.95%), respectively. Comparing the two groups with the Borg scale at equal to or greater than

  12. The assessment of dyspnea during the vigorous intensity exercise by three Dyspnea Rating Scales in inactive medical personnel.

    Science.gov (United States)

    Intarakamhang, Patrawut; Wangjongmeechaikul, Piyathida

    2013-07-24

    It is well recognized that exercise is good for health especially as it's known to prevent metabolic syndromes such as diabetes, hypertension and heart disease. To reap the benefits from exercise the most appropriate level of intensity must be determined, the level of intensity ranging from low, low to moderate to hard (vigorous). This study is aimed to 1. To investigate and evaluate 3 subjective rating scales. The Borg scale, the Combined Numerical Rating Scale (NRS) + FACES Dyspnea Rating Scale (FACES) and the Likert scale, during hard (vigorous) exercise. 2. To compare the effectiveness of the Borg scale and Combined Numerical Rating Scale (NRS) + FACES Dyspnea Rating Scale during the hard (vigorous) intensity exercise. This study uses a descriptive methodology. The sample group was 73 medical personnel that were leading an inactive life style, volunteers from Phramongkutklao Hospital. Participants were randomly divided into 3 groups. Group 1, those to report using the Borg Scale, group 2 using NRS + FACES, and group 3 to subjectively assess the intensity of the exercise using the Likert scale during a treadmill Exercise Stress Test (EST) using the Bruce protocol. The upper limit of the intensity in the study was equal to 85% of the maximal heart rate of all participants. The subjective reporting of the experienced level of dyspnea was undertaken immediately after the completion of exercise. The average age of participants was 23.37 years old. The 26 participants reporting using the Borg scale had mean Borg scale score of 13.46+1.77, a mode score of 15. The 24 participants reporting intensity levels through NRS +FACES had a mean NRS + FACES score of 6.83+1.09 and mode on the NRS + FACES scale equal to 7. The Likert scale group evaluated 23 participants with a mean Likert scale score of 2.74. That is those choosing Levels 2 and 3 were 6 (26.9%) and 17 participants (73.95%), respectively. Comparing the two groups with the Borg scale at equal to or greater than 15

  13. Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    de Voogd, J.N.; Sanderman, R.; Postema, K.; van Sonderen, E.; Wempe, J.B.

    2011-01-01

    Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine th

  14. Nebulized furosemide for the management of dyspnea: does the evidence support its use?

    Science.gov (United States)

    Newton, Phillip J; Davidson, Patricia M; Macdonald, Peter; Ollerton, Richard; Krum, Henry

    2008-10-01

    Dyspnea is a common and distressing symptom associated with multiple chronic illnesses and high levels of burden for individuals, their families and health care systems. The subjective nature dyspnea and a poor understanding of pathophysiological mechanisms challenge the clinician in developing management plans. Nebulized furosemide has been identified as a novel approach to dyspnea management. This review summarizes published studies, both clinical and experimental, reporting the use of nebulized furosemide. The search criteria yielded 42 articles published in the period 1988 to 2004. Although nebulized furosemide appeared to have a positive influence on dyspnea and physiological measurements, caution must be taken with the results primarily coming from small-scale clinical trials or observation trials. Despite the limitations of the studies reported, given the range of conditions reporting effectiveness of nebulized furosemide, further investigation of this potential novel treatment of dyspnea is warranted.

  15. Patient-Reported Dyspnea Correlates Poorly with Aerobic Exercise Capacity Measured During Cardiopulmonary Exercise Testing.

    Science.gov (United States)

    Gaspard, Dany; Kass, Jonathan; Akers, Stephen; Hunter, Krystal; Pratter, Melvin

    2017-08-08

    Patient-reported dyspnea plays a central role in assessing cardiopulmonary disease. There is little evidence, however, that dyspnea correlates with objective exercise capacity measurements. If the correlation is poor, dyspnea as a proxy for objective assessment may be misleading. To compare patient's perception of dyspnea with maximum oxygen uptake (MaxVO2) during cardiopulmonary exercise testing (CPET). Fifty patients undergoing CPET for dyspnea evaluation were studied prospectively. Dyspnea assessment was measured by a metabolic equivalent of task (METs) table, Mahler Dyspnea Index, Borg Index, number of blocks walked, and flights of stairs climbed before stopping due to dyspnea. These descriptors were compared to MaxVO2. MaxVO2 showed low correlation with METs table (r = 0.388, p = 0.005) and no correlation with Mahler Index (r = 0.24, p = 0.093), Borg Index (r = -0.017, p = 0.905), number of blocks walked (r = 0.266, p = 0.077) or flights of stairs climbed (r = 0.188, p = 0.217). When adjusted for weight (maxVO2/kg), there was significant correlation between MaxVO2 and METs table (r = 0.711, p Max VO2 and the assessment methods, while patients with BMI > 30 had moderate correlation between MaxVO2 and METs table (r = 0.568, p = 0.002). Patient-reported dyspnea correlates poorly with MaxVO2 and fails to predict exercise capacity. Reliance on reported dyspnea may result in suboptimal categorization of cardiopulmonary disease severity.

  16. Relationship between Dyspnea Descriptors and Underlying Causes of the Symptom; a Cross-sectional Study.

    Science.gov (United States)

    Sajadi, Seyyed Mohammad Ali; Majidi, Alireza; Abdollahimajd, Fahimeh; Jalali, Fatemeh

    2017-01-01

    History taking and physical examination help clinicians identify the patient's problem and effectively treat it. This study aimed to evaluate the descriptors of dyspnea in patients presenting to emergency department (ED) with asthma, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). This cross-sectional study was conducted on all patients presenting to ED with chief complaint of dyspnea, during 2 years. The patients were asked to describe their dyspnea by choosing three items from the valid and reliable questionnaire or articulating their sensation. The relationship between dyspnea descriptors and underlying cause of symptom was evaluated using SPSS version 16. 312 patients with the mean age of 60.96±17.01 years were evaluated (53.2% male). Most of the patients were > 65 years old (48.7%) and had basic level of education (76.9%). "My breath doesn't go out all the way" with 83.1%, "My chest feels tight " with 45.8%, and "I feel that my airway is obstructed" with 40.7%, were the most frequent dyspnea descriptors in asthma patients. "My breathing requires work" with 46.3%, "I feel that I am suffocating" with 31.5%, and "My breath doesn't go out all the way" with 29.6%, were the most frequent dyspnea descriptors in COPD patients. "My breathing is heavy" with 74.4%, "A hunger for more air" with 24.4%, and "I cannot get enough air" with 23.2%, were the most frequent dyspnea descriptors in CHF patients. Except for "My breath does not go in all the way", there was significant correlation between studied dyspnea descriptors and underlying disease (p = 0.001 for all analyses). It seems that dyspnea descriptors along with other findings from history and physical examination could be helpful in differentiating the causes of the symptom in patients presenting to ED suffering from dyspnea.

  17. Estimation of the severity of breathlessness in the emergency department: a dyspnea score.

    Science.gov (United States)

    Gondos, Tibor; Szabó, Viktor; Sárkány, Ágnes; Sárkány, Adrienn; Halász, Gábor

    2017-04-26

    Dyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients' rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters. We performed a double center, prospective, observational study including 350 patients who were admitted in EDs with dyspnea. We evaluated the patients' subjective feeling about dyspnea and applied our Dyspnea Severity Score (DSS), rating the dyspnea in 7 Dimensions from 0 to 3 points. The DSS was validated using the deterioration of pH, base-excess and lactate levels in the blood gas samples (Objective Classification Scale (OCS) 9 points and 13 points groups). All of the Dimensions correlated closely with the OCS values and with the subjective feeling of the dyspnea. Using multiple linear regression analysis we were able to decrease the numbers of Dimensions from seven to four without causing a significant change in the determination coefficient in any OCS groups. This reduced DSS values (exercise tolerance, cooperation, cyanosis, SpO2 value) showed high sensitivity and specificity to predict the values of OCS groups (the ranges: AUC 0.77-0.99, sensitivity 65-100%, specificity 64-99%). There was a close correlation between the subjective dyspnea scores and the OCS point values (p < 0.001), though the scatter was very large. A new DSS was validated which score is suitable to compare the severity of dyspnea among different patients and different illnesses. The simplified version of the score (its value ≥7 points without correction factors) can be useful at the triage or in pre-hospital care.

  18. Evaluation of a Provocative Dyspnea Severity Score in Acute Heart Failure

    Science.gov (United States)

    AbouEzzeddine, Omar F.; Lala, Anuradha; Khazanie, Prateeti P.; Shah, Ravi; Ho, Jennifer E.; Chen, Horng H.; Pang, Peter S.; McNulty, Steven E.; Anstrom, Kevin J.; Hernandez, Adrian F.; Redfield, Margaret M.

    2015-01-01

    Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analogue scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with five-point Likert dyspnea scales administered during four stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥ 1 Likert point) in 24% and 42% of eligible patients respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the three feasible assessment conditions (A–C). Relative to DVAS, the distribution of the pDS was more skewed with a high “ceiling effect” at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions While oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF. Clinical Trial Registration RED-ROSE; ClinicalTrials.gov identifier: NCT01132846 PMID:26856213

  19. Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit.

    Science.gov (United States)

    Madeira, Sérgio; Raposo, Luís; David, Raquel; Marques, Alexandre; Andrade Gomes, José; Cardim, Nuno; Anjos, Rui

    2015-09-01

    Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery.

  20. Radiological findings, pulmonary function and dyspnea in underground coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, T.T.; Heyer, C.M.; Duchna, H.W.; Andreas, K.; Weber, A.; Schmidt, E.W.; Ammenwerth, W.; Schultze-Werninghaus, G. [University Hospital Bergmannsheil, Bochum (Germany)

    2007-07-01

    Respiratory disability induced by dust exposure in coal workers is assessed by pulmonary function tests and radiological evidence of pneumoconiosis. High-resolution computed tomography (HR-CT) improves the visibility of tissue changes, but the value of the findings for the clinical evaluation is controversial. It was the aim of this study to evaluate the correlation between the International Labour Office (ILO) classification and the degree of emphysema in HR-CT with self-reported dyspnea and pulmonary function tests including diffusion capacity for CO (D-L, CO). We investigated 87 coal miners (aged 67 +/- 6 years), having worked underground for 26 +/- 9 years, with pulmonary function tests and HR-CT. Univariate associations were tested with correlation coefficients, and multivariable analyses used a stepwise forward regression model. It was concluded that the clinical grade of breathlessness was best approximated by D-L,D-CO. HR-CT showed a good association with expiratory flow limitation. ILO classification of the chest radiograph may be a marker of exposure but conveys little information about the degree of respiratory impairment.

  1. Gastroesophagial reflux disease and asthma in pregnant women with dyspnea.

    Directory of Open Access Journals (Sweden)

    Katayoon Bidad

    2014-04-01

    Full Text Available Asthma and gastroesophageal reflux disease (GERD are two common problems in pregnancy and they affect pregnancy in several ways. In this study, we aimed to evaluate GERD and asthma in pregnant women who referred for prenatal care visits. One-hundred and seventy three pregnant women with a complaint of dyspnea were included in the study. A questionnaire was filled and lung function tests were performed. All patients were visited by a respiratory specialist and questionnaires were evaluated by a gastroenterologist. Out of the total number of women studied, 37% were diagnosed to have asthma and 36.4% were non-asthmatics. Twenty six percent of the pregnant women who had symptoms and signs of asthma with normal spirometry were classified as probable to have asthma. GERD was diagnosed in 80.9% of the pregnant women, but it was not significantly higher in asthmatic or probable asthmatic women compared to non-asthmatic ones. However, severity of GERD was significantly higher in asthmatic pregnant women compared to the others. In conclusion, the prevalence of GERD was quite high in pregnant women, irrespective of the fact that they were asthmatic or non-asthmatic. Further studies evaluating women throughout pregnancy will inform us more about this relationship.

  2. An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.

    Science.gov (United States)

    Mularski, Richard A; Reinke, Lynn F; Carrieri-Kohlman, Virginia; Fischer, Mark D; Campbell, Margaret L; Rocker, Graeme; Schneidman, Ann; Jacobs, Susan S; Arnold, Robert; Benditt, Joshua O; Booth, Sara; Byock, Ira; Chan, Garrett K; Curtis, J Randall; Donesky, Doranne; Hansen-Flaschen, John; Heffner, John; Klein, Russell; Limberg, Trina M; Manning, Harold L; Morrison, R Sean; Ries, Andrew L; Schmidt, Gregory A; Selecky, Paul A; Truog, Robert D; Wang, Angela C C; White, Douglas B

    2013-10-01

    In 2009, the American Thoracic Society (ATS) funded an assembly project, Palliative Management of Dyspnea Crisis, to focus on identification, management, and optimal resource utilization for effective palliation of acute episodes of dyspnea. We conducted a comprehensive search of the medical literature and evaluated available evidence from systematic evidence-based reviews (SEBRs) using a modified AMSTAR approach and then summarized the palliative management knowledge base for participants to use in discourse at a 2009 ATS workshop. We used an informal consensus process to develop a working definition of this novel entity and established an Ad Hoc Committee on Palliative Management of Dyspnea Crisis to further develop an official ATS document on the topic. The Ad Hoc Committee members defined dyspnea crisis as "sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers' ability to achieve symptom relief." Dyspnea crisis can occur suddenly and is characteristically without a reversible etiology. The workshop participants focused on dyspnea crisis management for patients in whom the goals of care are focused on palliation and for whom endotracheal intubation and mechanical ventilation are not consistent with articulated preferences. However, approaches to dyspnea crisis may also be appropriate for patients electing life-sustaining treatment. The Ad Hoc Committee developed a Workshop Report concerning assessment of dyspnea crisis; ethical and professional considerations; efficient utilization, communication, and care coordination; clinical management of dyspnea crisis; development of patient education and provider aid products; and enhancing implementation with audit and quality improvement.

  3. Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity.

    Science.gov (United States)

    Wysham, Nicholas G; Miriovsky, Benjamin J; Currow, David C; Herndon, James E; Samsa, Gregory P; Wilcock, Andrew; Abernethy, Amy P

    2015-10-01

    Measurement of dyspnea is important for clinical care and research. To characterize the relationship between the 0-10 Numerical Rating Scale (NRS) and four-level categorical Verbal Descriptor Scale (VDS) for dyspnea assessment. This was a substudy of a double-blind randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness. Dyspnea was assessed with both a 0-10 NRS and a four-level categorical VDS over the one-week trial. NRS and VDS responses were analyzed in cross section and longitudinally. Relationships between NRS and VDS responses were portrayed using descriptive statistics and visual representations. Two hundred twenty-six participants contributed responses. At baseline, mild and moderate levels of breathlessness were reported by 41.9% and 44.6% of participants, respectively. NRS scores demonstrated increasing mean and median levels for increasing VDS intensity, from a mean (SD) of 0.6 (±1.04) for VDS none category to 8.2 (1.4) for VDS severe category. The Spearman correlation coefficient was strong at 0.78 (P < 0.0001). Based on the distribution of NRS scores within VDS categories, we calculated test characteristics of two different cutpoint models. Both models yielded 75% correct translations from NRS to VDS; however, Model A was more sensitive for moderate or greater dyspnea, with fewer misses downcoded. There is strong correlation between VDS and NRS measures for dyspnea. Proposed practical cutpoints for the relationship between the dyspnea VDS and NRS are 0 for none, 1-4 for mild, 5-8 for moderate, and 9-10 for severe. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. A sigh of relief or a sigh of expected relief: Sigh rate in response to dyspnea relief.

    Science.gov (United States)

    Vlemincx, Elke; Meulders, Michel; Luminet, Olivier

    2017-08-09

    Research has suggested that sighs may serve a regulatory function during stress and emotions by facilitating relief. Evidence supports the hypotheses that sighs both express and induce relief from stress. To explore the potential role of sighs in the regulation of symptoms, the present study aimed to investigate the relationship between sighs and relief of symptoms, and relief of dyspnea, specifically. Healthy volunteers participated in two studies (N = 44, N = 47) in which dyspnea was induced by mild (10 cmH2 O/l/s) or high (20 cmH2 0/l/s) inspiratory resistances. Dyspnea relief was induced by the offset of the inspiratory resistances (transitions from high and mild inspiratory resistance to no resistance). Control comparisons included dyspnea increases (transitions from no or mild inspiratory resistance to high inspiratory resistance) and dyspnea continuations (continuations of either no resistance or a high resistance). In Experiment 1, dyspnea levels were cued. In Experiment 2, no cues were provided. Sigh rate during dyspnea relief was significantly higher compared to control conditions, and sigh rate increased as self-reported dyspnea decreased. Additionally, sigh rate was higher during cued dyspnea relief compared to noncued dyspnea relief. These results suggest that sighs are important markers of dyspnea relief. Moreover, sighs may importantly express dyspnea relief, as they are related to experiential dyspnea decreases and occur more frequently during expected dyspnea relief. These findings suggest that sighs may not only be important in the regulation of stress and emotions, but also may be functional in the regulation of dyspnea. © 2017 Society for Psychophysiological Research.

  5. Dyspnea is a dangerous symptom in the pre-hospital setting

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Kirkegaard, Hans; Christensen, Erika Frischknecht

    ABSTRACT: Background Electrocardiogram (ECG) based telemedicine is a cornerstone in pre-hospital triage of patients with suspected ST-elevation myocardial infarction (STEMI). An ECG transmitted from the ambulance is reviewed by a cardiologist on-call in case of ongoing or recent chest pain......, resuscitation from cardiac arrest, acute dyspnea of unknown origin and other suspicion of STEMI. We hypothesize that unresolved dyspnea is an independent predictor of mortality in this prehospital setting and that the mortality is higher in patients with acute dyspnea of unknown origin than in patients......,204 (70%) of the patients, acute dyspnea of unknown origin in 1,461 (8 %), resuscitated from cardiac arrest in 163 (1%) and other suspicion of STEMI in 3,533 (20%). When adjusting for age, sex, systolic blood pressure and Charlson Comorbidity Index (p

  6. Evidence for cognitive–behavioral strategies improving dyspnea and related distress in COPD

    Directory of Open Access Journals (Sweden)

    Norweg A

    2013-09-01

    Full Text Available Anna Norweg,1 Eileen G Collins2,3 1Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC, Chicago, IL, USA; 2Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago (UIC, Chicago, IL, USA; 3Rehabilitation Research and Development (RR&D, Edward Hines Jr. VA Hospital, Hines, IL, USA Background: Dyspnea is a complex, prevalent, and distressing symptom of chronic obstructive pulmonary disease (COPD associated with decreased quality of life, significant disability, and increased mortality. It is a major reason for referral to pulmonary rehabilitation. Methods: We reviewed 23 COPD studies to examine the evidence for the effectiveness of cognitive–behavioral strategies for relieving dyspnea in COPD. Results: Preliminary evidence from randomized controlled trials exists to support cognitive–behavioral strategies, used with or without exercise, for relieving sensory and affective components of dyspnea in COPD. Small to moderate treatment effects for relieving dyspnea were noted for psychotherapy (effect size [ES] = 0.08–0.25 for intensity; 0.26–0.65 for mastery and distractive auditory stimuli (ES = 0.08–0.33 for intensity; 0.09 to -0.61 for functional burden. Small to large dyspnea improvements resulted from yoga (ES = 0.2–1.21 for intensity; 0.67 for distress; 0.07 for mastery; and −8.37 for functional burden; dyspnea self-management education with exercise (ES = −0.14 to −1.15 for intensity; −0.62 to −0.69 for distress; 1.04 for mastery; 0.14–0.35 for self-efficacy; and slow-breathing exercises (ES = 4390.34 to −0.83 for intensity; -0.61 to -0.80 for distress; and 0.62 for self-efficacy. Cognitive–behavioral interventions may relieve dyspnea in COPD by (1 decreasing sympathetic nerve activity, dynamic hyperinflation, and comorbid anxiety, and (2 promoting arterial oxygen saturation, myelinated vagus nerve activity, a greater

  7. Use of post-exercise laryngoscopy to evaluate exercise induced dyspnea.

    LENUS (Irish Health Repository)

    McNally, P

    2010-10-01

    We present the case of a child with asthma who continued to have marked exercise induced dyspnea despite appropriate treatment, and in the face of adequate control of all other asthma symptoms. Spirometry showed a marked truncation of inspiratory flow, and laryngoscopy performed immediately after exercise showed laryngomalacia with dynamic, partial inspiratory obstruction. Exercise induced laryngomalacia (EIL) is a rare cause of exercise induced dyspnea which is diagnosed by post exercise flexible laryngoscopy and may require supraglottoplasty.

  8. Value of arterial blood gas analysis in patients with acute dyspnea: an observational study

    OpenAIRE

    2011-01-01

    Introduction The diagnostic and prognostic value of arterial blood gas analysis (ABGA) parameters in unselected patients presenting with acute dyspnea to the Emergency Department (ED) is largely unknown. Methods We performed a post-hoc analysis of two different prospective studies to investigate the diagnostic and prognostic value of ABGA parameters in patients presenting to the ED with acute dyspnea. Results We enrolled 530 patients (median age 74 years). ABGA parameters were neither useful ...

  9. Medically unexplained dyspnea:psychophysiological characteristics and role of breathing therapy

    Institute of Scientific and Technical Information of China (English)

    HAN Jiang-na 韩江娜; ZHU Yuan-jue 朱元珏; LI Shun-wei 李舜伟; LUO Dong-mei 雒冬梅; HU Zheng 胡征; Van Diest I; De Peuter S; Van de Woestijne KP; Van den Bergh O

    2004-01-01

    Background Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients.Methods A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. In another group of patients, the influence of breathing therapy on complaints, anxiety, and breath-holding was evaluated for an average of 1.5 years. Results Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally, they were anxious and presented a broad range of symptoms in daily life and under challenge, for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest, less increase in breath-holding time and higher chances of showing a "paradoxical" decrease of breath-holding time after hyperventilation. A combination of PaO2, forced expiratory volume in one second (FEV1), and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover, they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased. Conclusions Patients with medically unexplained dyspnea appear to have the feature of a "psychosomatic" patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those "difficult to

  10. Airway Management & Assessment of Dyspnea in Emergency Department Patients with Acute Heart Failure

    Science.gov (United States)

    Pang, Peter S.; Zaman, Masood

    2013-01-01

    Shortness of breath is the most common symptom in patients with acute heart failure (AHF). Ensuring adequate oxygenation and ventilation as well as symptomatic relief are key goals of early emergency department management. In this focused review, we describe how to assess dyspnea in clinical practice and how to treat AHF patients to relieve dyspnea, with initial discussion on Airway and Breathing management for patients who present in extremis. PMID:23795334

  11. Effect of induced leg muscle fatigue on exertional dyspnea in healthy subjects.

    Science.gov (United States)

    Sharma, Pramod; Morris, Norman R; Adams, Lewis

    2015-01-01

    The genesis of dyspnea is complex. It appears to be related to central respiratory drive although prevailing leg fatigue could independently potentiate dyspnea. We hypothesized that experimentally induced leg fatigue generates more intense exertional dyspnea for a given level of ventilatory drive. Following familiarization, 19 healthy subjects (32.2 ± 7.6 yr; 11 men) performed a 5-min treadmill test (speed: ∼4 km/h; grade: ∼25%) on two separate days randomized between control (C) and experimentally induced leg fatigue (E) achieved by repeated knee extension against 40% body weight until task failure. Oxygen uptake (V̇o2, l/min), carbon dioxide output (V̇co2, l/min), ventilation (V̇e, l/min), and respiratory rate (fR) were measured breath by breath. Heart rate (HR) and perceived dyspnea intensity (0-10 numerical scale) were recorded continuously. Data were averaged over 30-s intervals. Exertional dyspnea during E was statistically significantly higher (E vs. C: 4.2 ± 0.2 vs. 3.4 ± 0.2, P leg fatigue. These findings support the hypothesis that the intensity of exertional dyspnea is exacerbated by peripheral afferent information from fatigued leg muscles.

  12. Multimarker Strategy for Short-Term Risk Assessment in Patients With Dyspnea in the Emergency Department The MARKED (Multi mARKer Emergency Dyspnea)-Risk Score

    NARCIS (Netherlands)

    Eurlings, Luc W.; Sanders-van Wijk, Sandra; van Kimmenade, Roland; Osinski, Aart; van Helmond, Lidwien; Vallinga, Maud; Crijns, Harry J.; van Dieijen-Visser, Marja P.; Brunner-La Rocca, Hans-Peter; Pinto, Yigal M.

    2012-01-01

    Objectives The study aim was to determine the prognostic value of a multimarker strategy for risk-assessment in patients presenting to the emergency department (ED) with dyspnea. Background Combining biomarkers with different pathophysiological backgrounds may improve risk stratification in dyspneic

  13. Relationship between Dyspnea Descriptors and Underlying Causes of the Symptom; a Cross-sectional Study

    Directory of Open Access Journals (Sweden)

    Seyyed Mohammad Ali Sajadi

    2017-03-01

    Full Text Available Introduction: History taking and physical examination help clinicians identify the patient’s problem and effectively treat it. This study aimed to evaluate the descriptors of dyspnea in patients presenting to emergency department (ED with asthma, congestive heart failure (CHF, and chronic obstructive pulmonary disease (COPD. Method: This cross-sectional study was conducted on all patients presenting to ED with chief complaint of dyspnea, during 2 years. The patients were asked to describe their dyspnea by choosing three items from the valid and reliable questionnaire or articulating their sensation. The relationship between dyspnea descriptors and underlying cause of symptom was evaluated using SPSS version 16. Results: 312 patients with the mean age of 60.96±17.01 years were evaluated (53.2% male. Most of the patients were > 65 years old (48.7% and had basic level of education (76.9%.  "My breath doesn’t go out all the way" with 83.1%, “My chest feels tight " with 45.8%, and "I feel that my airway is obstructed" with 40.7%, were the most frequent dyspnea descriptors in asthma patients. "My breathing requires work" with 46.3%, "I feel that I am suffocating" with 31.5%, and "My breath doesn’t go out all the way" with 29.6%, were the most frequent dyspnea descriptors in COPD patients. "My breathing is heavy" with 74.4%, "A hunger for more air” with 24.4%, and "I cannot get enough air" with 23.2%, were the most frequent dyspnea descriptors in CHF patients. Except for “My breath does not go in all the way”, there was significant correlation between studied dyspnea descriptors and underlying disease (p = 0.001 for all analyses. Conclusion: It seems that dyspnea descriptors along with other findings from history and physical examination could be helpful in differentiating the causes of the symptom in patients presenting to ED suffering from dyspnea.  

  14. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men.

    Science.gov (United States)

    Ramsook, Andrew H; Molgat-Seon, Yannick; Schaeffer, Michele R; Wilkie, Sabrina S; Camp, Pat G; Reid, W Darlene; Romer, Lee M; Guenette, Jordan A

    2017-03-02

    Inspiratory muscle training (IMT) has consistently been shown to reduce exertional dyspnea in health and disease; however, the physiological mechanisms remain poorly understood. A growing body of literature suggests that dyspnea intensity can largely be explained by an awareness of increased neural respiratory drive, as indirectly measured using diaphragmatic electromyography (EMGdi). Accordingly, we sought to determine if improvements in dyspnea following IMT can be explained by decreases in inspiratory muscle EMG activity. Twenty-five healthy recreationally-active men completed a detailed familiarization visit followed by two maximal incremental cycle exercise tests separated by 5 weeks of randomly assigned pressure threshold IMT or sham control training (SC). The IMT group (n=12) performed 30 inspiratory efforts twice daily against a 30 repetition maximum intensity. The SC group (n=13) performed a daily bout of 60 inspiratory efforts against 10% maximal inspiratory pressure (MIP), with no weekly adjustments. Dyspnea intensity was measured throughout exercise using the modified 0-10 Borg scale. Sternocleidomastoid and scalene EMG were measured using surface electrodes whereas EMGdi was measured using a multi-pair esophageal electrode catheter. IMT significantly improved MIP (pre:-138±45 vs. post:-160±43cmH2O, pmuscle EMG during exercise in either group. Improvements in dyspnea intensity ratings following IMT in healthy humans cannot be explained by changes in the electrical activity of the inspiratory muscles.

  15. Assessment of dyspnea early in acute heart failure: patient characteristics and response differences between likert and visual analog scales.

    Science.gov (United States)

    Pang, Peter S; Collins, Sean P; Sauser, Kori; Andrei, Adin-Cristian; Storrow, Alan B; Hollander, Judd E; Tavares, Miguel; Spinar, Jindrich; Macarie, Cezar; Raev, Dimitar; Nowak, Richard; Gheorghiade, Mihai; Mebazaa, Alexandre

    2014-06-01

    Dyspnea is the most common symptom in acute heart failure (AHF), yet how to best measure it has not been well defined. Prior studies demonstrate differences in dyspnea improvement across various measurement scales, yet these studies typically enroll patients well after the emergency department (ED) phase of management. The aim of this study was to determine predictors of early dyspnea improvement for three different, commonly used dyspnea scales (i.e., five-point absolute Likert scale, 10-cm visual analog scale [VAS], or seven-point relative Likert scale). This was a post hoc analysis of URGENT Dyspnea, an observational study of 776 patients in 17 countries enrolled within 1 hour of first physician encounter. Inclusion criteria were broad to reflect real-world clinical practice. Prior literature informed the a priori definition of clinically significant dyspnea improvement. Resampling-based multivariable models were created to determine patient characteristics significantly associated with dyspnea improvement. Of the 524 AHF patients, approximately 40% of patients did not report substantial dyspnea improvement within the first 6 hours. Baseline characteristics were similar between those who did or did not improve, although there were differences in history of heart failure, coronary artery disease, and initial systolic blood pressure. For those who did improve, patient characteristics differed across all three scales, with the exception of baseline dyspnea severity for the VAS and five-point Likert scale (c-index ranged from 0.708 to 0.831 for each scale). Predictors of early dyspnea improvement differ from scale to scale, with the exception of baseline dyspnea. Attempts to use one scale to capture the entirety of the dyspnea symptom may be insufficient. © 2014 by the Society for Academic Emergency Medicine.

  16. Assessment of Dyspnea Early in Acute Heart Failure: Patient Characteristics and Response Differences Between Likert and Visual Analog Scales

    Science.gov (United States)

    Pang, Peter S.; Collins, Sean P.; Sauser, Kori; Andrei, Adin-Cristian; Storrow, Alan B.; Hollander, Judd E.; Tavares, Miguel; Spinar, Jindrich; Macarie, Cezar; Raev, Dimitar; Nowak, Richard; Gheorghiade, Mihai; Mebazaa, Alexandre

    2014-01-01

    Background Dyspnea is the most common symptom in acute heart failure (AHF), yet how to best measure it has not been well defined. Prior studies demonstrate differences in dyspnea improvement across various measurement scales, yet these studies typically enroll patients well after the ED phase of management. Objectives The aim of this study was to determine predictors of early dyspnea improvement for three different, commonly used dyspnea scales (i.e. five point absolute Likert scale, 10 cm visual analogue scale [VAS], or seven point relative Likert scale). Methods This was a post-hoc analysis of URGENT Dyspnea, an observational study of 776 patients in 17 countries enrolled within one hour of first physician encounter. Inclusion criteria were broad to reflect real-world clinical practice. Prior literature informed the a priori definition of clinically significant dyspnea improvement. Resampling-based multivariable models were created to determine patient characteristics significantly associated with dyspnea improvement. Results Of the 524 AHF patients, approximately 40% of patients did not report substantial dyspnea improvement within the first 6 hours. Baseline characteristics were similar between those who did or did not improve, though there were differences in history of heart failure, coronary artery disease, and initial systolic blood pressure. For those who did improve, patient characteristics differed across all three scales, with the exception of baseline dyspnea severity for the VAS and five point Likert scale (c-index ranged from 0.708 to 0.831 for each scale). Conclusions Predictors of early dyspnea improvement differ from scale to scale, with the exception of baseline dyspnea. Attempts to use one scale to capture the entirety of the dyspnea symptom may be insufficient. PMID:25039550

  17. Lung volume reduction surgery for the management of refractory dyspnea in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Shah, Asad A; D'Amico, Thomas A

    2009-06-01

    This review describes the role of lung volume reduction surgery (LVRS) for the management of refractory dyspnea and other debilitating conditions in patients with chronic obstructive pulmonary disease. Recent studies, including a randomized trial comparing LVRS to medical therapy, are analyzed. LVRS plus optimal medical therapy is superior to medical therapy alone in treating certain subsets of patients with severe emphysema. In patients with predominantly upper lobe emphysema and low-exercise capacity, LVRS not only improves symptoms of dyspnea and exercise intolerance, but also is associated with improved survival. Furthermore, LVRS has recently been shown to be superior to medical therapy in improving other quality of life parameters, such as nutritional status, sleep quality, and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe emphysema. LVRS is an effective strategy in the treatment of properly selected patients with COPD, improving survival and quality of life, including exercise tolerance, dyspnea, oxygen requirement and functional status.

  18. Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition.

    Science.gov (United States)

    Miner, Brienne; Tinetti, Mary E; Van Ness, Peter H; Han, Ling; Leo-Summers, Linda; Newman, Anne B; Lee, Patty J; Vaz Fragoso, Carlos A

    2016-10-01

    To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons. Cross-sectional. Cardiovascular Health Study. Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% score ≥16; aOR = 2.02, 95% CI = 1.26-3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31-1.71). In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  19. The prospective association of perceived criticism with dyspnea in chronic lung disease.

    Science.gov (United States)

    Holm, Kristen E; Wamboldt, Frederick S; Ford, Dee W; Sandhaus, Robert A; Strand, Matthew; Strange, Charlie; Hoth, Karin F

    2013-05-01

    Perceived criticism from family members influences mental health. The link between perceived criticism and physical health has not been thoroughly investigated. The objective of this study was to examine the association of perceived criticism with dyspnea in chronic obstructive pulmonary disease (COPD). 401 individuals with alpha-1 antitrypsin deficiency-associated COPD completed questionnaires at baseline, 1- and 2-year follow-up. Perceived criticism at baseline was examined as a predictor of dyspnea at all three time points using a linear mixed model that adjusted for demographic and health characteristics. There was an interaction between perceived criticism and psychological distress (p=0.038). Perceived criticism was associated with dyspnea only among individuals with elevated psychological distress (b=0.32, SE=0.13, p=0.018). Further research is needed to replicate these findings and determine the extent to which they apply to other common subjective physical symptoms such as pain. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. McArdle's Disease Presenting as Unexplained Dyspnea in a Young Woman

    Directory of Open Access Journals (Sweden)

    Nha Voduc

    2004-01-01

    Full Text Available McArdle's disease is a rare, inherited deficiency of myophosphorylase, an enzyme required for the utilization of glycogen. Patients with myophosphorylase deficiency classically present with exercise intolerance, leg pain and muscle fatigue. The case of a young woman with exertional dyspnea and leg cramps is described. Exercise testing confirmed the presence of exercise intolerance and demonstrated an accelerated heart rate response, despite the absence of an anaerobic threshold and a respiratory exchange ratio of less than 1.0. Subsequent ischemic forearm testing and muscle biopsy confirmed the diagnosis of myophosphorylase deficiency. Evaluation of lung mechanics with esophageal pressure measurements demonstrated the presence of respiratory muscle weakness and early fatiguability, suggesting that the patient's dyspnea might have been attributable to an increased respiratory effort. Dyspnea is not a classic symptom associated with myophosphorylase deficiency, although subclinical respiratory muscle impairment may be present. No previous studies have evaluated respiratory muscle function during exercise in patients with myophosphorylase deficiency.

  1. The German CPU Registry: Dyspnea independently predicts negative short-term outcome in patients admitted to German Chest Pain Units.

    Science.gov (United States)

    Hellenkamp, Kristian; Darius, Harald; Giannitsis, Evangelos; Erbel, Raimund; Haude, Michael; Hamm, Christian; Hasenfuss, Gerd; Heusch, Gerd; Mudra, Harald; Münzel, Thomas; Schmitt, Claus; Schumacher, Burghard; Senges, Jochen; Voigtländer, Thomas; Maier, Lars S

    2015-02-15

    While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients. We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea. Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular were more common in patients with dyspnea (21.0% vs. 5.3%, pCPU patients. Our data show that dyspnea is associated with a fourfold higher 3month mortality which is underestimated by the established ACS risk scores. To improve their predictive value we therefore propose to add dyspnea as an item to common risk scores. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Qualitative aspects of exertional dyspnea in patients with restrictive lung disease

    Directory of Open Access Journals (Sweden)

    Laveneziana Pierantonio

    2010-06-01

    Full Text Available Abstract Restrictive lung disease is a broad term encompassing a number of conditions in which lung volumes are reduced. Dyspnea is a common clinical manifestation of restrictive lung disease and frequently becomes a prominent and disabling symptom that undermines patients' ability to function and engage in activities of daily living (especially in those with more advanced restriction. Effective management of this disabling symptom awaits a better understanding of its underlying physiology. In recent decades, our understanding of the mechanisms of dyspnea in restrictive lung disease has been improved by a small, but significant, body of research. One approach to the study of dyspnea is to identify the major qualitative dimensions of the symptom in an attempt to uncover different underlying neurophysiologic mechanisms. This article will review the existing literature on the intensity and qualitative dimensions of dyspnea during exercise in patients with restrictive lung disease. The main focus will be on interstitial lung disease (ILD, since it is the prototypical restrictive disease.

  3. Right sided arcus aorta as a cause of dyspnea and chronic cough

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    Ozkaya Sevket

    2012-10-01

    Full Text Available Abstract Background Right sided arcus aorta (RSAA is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital. Methods The characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated. Results A total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54% were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients. Conclusions The RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

  4. Respiratory muscle activity and dyspnea during exercise in chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Duiverman, M. L.; de Boer, E. W. J.; van Eykern, L. A.; de Greef, M. H. G.; Jansen, D. F.; Wempe, J. B.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2009-01-01

    We aimed to determine by non-invasive EMG, whether during exercise: (1)COPD patients increase scalene and intercostal EMG activity, (2) increased EMG activity is associated with increased dyspnea, and (3) the ratio between EMG activity and volume displacement is increased in COPD compared to healthy

  5. Exercise tolerance and dyspnea in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Čekerevac Ivan

    2010-01-01

    Full Text Available Background/Aim. Peripheral muscle weakness and nutritional disorders, firstly loss of body weight, are common findings in patients with chronic obstructive pulmonary disease (COPD. The aim of this study was to analyse the impact of pulmonary function parameters, nutritional status and state of peripheral skeletal muscles on exercise tolerance and development of dyspnea in COPD patients. Methods. Thirty COPD patients in stable state of disease were analyzed. Standard pulmonary function tests, including spirometry, body pletysmography, and measurements of diffusion capacity were performed. The 6-minute walking distance test (6MWD was done in order to assess exercise tolerance. Level of dyspnea was measured with Borg scale. In all patients midthigh muscle cross-sectional area (MTCSA was measured by computerized tomography scan. Nutritional status of patients was estimated according to body mass index (BMI. Results. Statistically significant correlations were found between parameters of pulmonary function and exercise tolerance. Level of airflow limitation and lung hyperinflation had significant impact on development of dyspnea at rest and especially after exercise. Significant positive correlation was found between MTCSA and exercise tolerance. Patients with more severe airflow limitation, lung hyperinflation and reduced diffusion capacity had significantly lower MTCSA. Conclusion. Exercise tolerance in COPD patients depends on severity of bronchoobstruction, lung hyperinflation and MTCSA. Severity of bronchoobstruction and lung hyperinflation have significant impact on dyspnea level.

  6. Anthropometric Indicators Associated with Dyspnea and Spirometric Parameters in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Emami Ardestani, Mohammad; Sajadi, Ghazaleh; Jazayeri, Nasrin

    2016-01-01

    This study aimed to determine anthropometric indicators associated with dyspnea and spirometric parameters in patients with chronic obstructive pulmonary disease (COPD). A cross-sectional and observational study was carried out on 88 patients with COPD, who were visited in an outpatient respiratory clinic of a university hospital during two months. Patient height, weight, body mass index (BMI), waist circumference (WC), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and subscapular skinfold thickness (SST) were recorded. Also, data on lung function and dyspnea were collected. The association between anthropometric indices and other parameters was studied. Pearson's correlation coefficient showed that forced expiratory volume in one second (FEV1)% predicted was positively correlated with BMI (R=0.239, P<0.05) and MUAC (R=0.431, P<0.01). By applying ANOVA, we found that the relationship between FEV1% predicted and BMI (P=0.007), WC (P=0.019) and MUAC (P<0.001) was statistically significant. Chi-square test showed that there was an association between MUAC and dyspnea (P<0.05). There was a relationship between FEV1% predicted and some anthropometric indices such as BMI, MUAC and WC; also, we found an association between MUAC and dyspnea.

  7. Prevalence of diastolic dysfunction as a possible cause of dyspnea in the elderly

    DEFF Research Database (Denmark)

    Pedersen, Frants; Raymond, Ilan; Mehlsen, Jesper;

    2005-01-01

    Symptoms in patients with heart failure and preserved left ventricular ejection fraction may be caused by isolated diastolic dysfunction. The purpose of this study was to assess the prevalence of diastolic dysfunction as a potential cause of dyspnea in a sample of elderly subjects, as well...

  8. [A 35-year-old woman with fever, dyspnea, and pain in the left thigh].

    Science.gov (United States)

    Picardi, A; Navajas, F; De Iorio, F; Amicarelli, M; Spoto, S; De Galasso, L; Vespaciani Gentilucci, U; Scarlata, S; Zardi, E; Di Cuonzo, G

    2001-01-01

    A thirty-five years old woman during her twelfth pregnancy presented fever and pain at the left thigh. After cesarean delivery dyspnea added to the first two symptoms and pulmonary embolism was suspected. A clinical history revaluation suggested a diagnosis of infectious endocarditis and femoural osteomielitis due to a septic embolus.

  9. Respiratory muscle activity and dyspnea during exercise in chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Duiverman, M. L.; de Boer, E. W. J.; van Eykern, L. A.; de Greef, M. H. G.; Jansen, D. F.; Wempe, J. B.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2009-01-01

    We aimed to determine by non-invasive EMG, whether during exercise: (1)COPD patients increase scalene and intercostal EMG activity, (2) increased EMG activity is associated with increased dyspnea, and (3) the ratio between EMG activity and volume displacement is increased in COPD compared to healthy

  10. Exertional dyspnea as initial manifestation of Takayasu's arteritis – A case report and literature review

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    Bachmann Lucas M

    2001-12-01

    Full Text Available Abstract Background Takayasu's arteritis is a chronic systemic inflammatory disease that usually affects the aorta, its primary branches and occasionally the pulmonary and coronary arteries. Female gender in reproductive age and Asian origin are known factors associated with higher disease prevalence. The clinical manifestations vary considerably and are typically caused by limb or organ ischemia illness and fever. The estimated incidence rate in the western world is 2.6 cases per million persons per year. Occasionally, exertional dyspnea can be the sole primary clinical manifestation of Takayasu's arteritis. Case presentation We report the case of a 57-year-old woman who was referred to our institution with increasing exertional dyspnea caused by pulmonary artery involvement in Takayasu's arteritis. In a review of the literature we discuss demographic data, clinical and radiographic findings and available therapeutic options. Conclusions Dyspnea due to pulmonary artery involvement can be the initial symptom of Takayasu's arteritis. Simple clinical tests, including a complete pulse-status and blood pressure measuring at both arms can lead to the right diagnosis and should always be done beyond the auscultation of the heart and lungs in patients with dyspnea.

  11. Effects of changes in level and pattern of breathing on the sensation of dyspnea.

    Science.gov (United States)

    Chonan, T; Mulholland, M B; Altose, M D; Cherniack, N S

    1990-10-01

    Breathing during hypercapnia is determined by reflex mechanisms but may also be influenced by respiratory sensations. The present study examined the effects of voluntary changes in level and pattern of breathing on the sensation of dyspnea at a constant level of chemical drive. Studies were carried out in 15 normal male subjects during steady-state hypercapnia at an end-tidal PCO2 of 50 Torr. The intensity of dyspnea was rated on a Borg category scale. In one experiment (n = 8), the level of ventilation was increased or decreased from the spontaneously adopted level (Vspont). In another experiment (n = 9), the minute ventilation was maintained at the level spontaneously adopted at PCO2 of 50 Torr and breathing frequency was increased or decreased from the spontaneously adopted level (fspont) with reciprocal changes in tidal volume. The intensity of dyspnea (expressed as percentage of the spontaneous breathing level) correlated with ventilation (% Vspont) negatively at levels below Vspont (r = -0.70, P less than 0.001) and positively above Vspont (r = 0.80, P less than 0.001). At a constant level of ventilation, the intensity of dyspnea correlated with breathing frequency (% fspont) negatively at levels below fspont (r = -0.69, P less than 0.001) and positively at levels above fspont (r = 0.75, P less than 0.001). These results indicate that dyspnea intensifies when the level or pattern of breathing is voluntarily changed from the spontaneously adopted level. This is consistent with the possibility that ventilatory responses to changes in chemical drive may be regulated in part to minimize the sensations of respiratory effort and discomfort.

  12. Physical activity, fitness, and dyspnea perception in children with congenital diaphragmatic hernia.

    Science.gov (United States)

    Turchetta, Attilio; Fintini, Danilo; Cafiero, Giulia; Calzolari, Armando; Giordano, Ugo; Cutrera, Renato; Morini, Francesco; Braguglia, Annabella; Bagolan, Pietro

    2011-10-01

    We assessed whether physical activity could influence the performance and perception of dyspnea in children who were operated on for high risk congenital diaphragmatic hernia (CDH). We hypothesized that CDH children with normal activity would have better lung function and exercise performance level when compared to sedentary CDH subjects. We studied 18 children (11 males and 7 females, mean age 6.6 ± 2.6 years) who were surgically corrected. All children underwent physical examination, ECG at rest, and a maximal exercise stress test on a treadmill to measure the duration of exercise, maximal heart rate and blood pressure, maximal oxygen uptake (VO(2)  max and VO(2)  ml/kg/min). Lung function testing to measure forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV(1) ), and peak expiratory flow (PEF) was also performed. Following the stress test, the Dalhousie dyspnea and effort scale was shown to children as a pictorial panel with three groups of increasing (from 1 to 7) levels of effort perception, throat discomfort, and chest dyspnea. Children were divided into group A (sedentary) and group B (regular physical participation). There was no difference in CDH severity between the two groups. Group A had a statistically significant lower duration of exercise (P < 0.01), maximal oxygen consumption (VO(2)  max P < 0.0001), VO(2)  ml/kg/min (P < 0.001), higher throat closing feeling (P < 0.004), chest dyspnea (P < 0.001), and effort perception (P < 0.04) compared to group B. No differences were found in lung function tests. In conclusion, our data may suggest that children with a history of CDH who are active maintain a higher level of performance with less perception of dyspnea and effort.

  13. Effects of beclomethasone/formoterol fixed combination on lung hyperinflation and dyspnea in COPD patients

    Directory of Open Access Journals (Sweden)

    Tzani P

    2011-10-01

    Full Text Available Panagiota Tzani1, Ernesto Crisafulli2, Gabriele Nicolini3, Marina Aiello1, Alfredo Chetta1, Enrico Maria Clini2, Dario Olivieri1 1Department of Clinical Sciences, University of Parma, Parma, Italy; 2Department of Oncology Haematology and Pulmonary Diseases, University of Modena and Ospedale Villa Pineta, Pavullo, Modena, Italy; 3Medical Affairs Department, Chiesi Farmaceutici SpA, Parma, Italy Background: Chronic obstructive pulmonary disease (COPD is a common disease characterized by airflow obstruction and lung hyperinflation leading to dyspnea and exercise capacity limitation. Objectives: The present study was designed to evaluate whether an extra-fine combination of beclomethasone and formoterol (BDP/F was effective in reducing air trapping in COPD patients with hyperinflation. Fluticasone salmeterol (FP/S combination treatment was the active control. Methods: COPD patients with forced expiratory volume in one second <65% and plethysmographic functional residual capacity ≥120% of predicted were randomized to a double-blind, double-dummy, 12-week, parallel group, treatment with either BDP/F 400/24 µg/day or FP/S 500/100 µg/day. Lung volumes were measured with full body plethysmography, and dyspnea was measured with transition dyspnea index. Results: Eighteen patients were evaluable for intention to treat. A significant reduction in air trapping and clinically meaningful improvement in transition dyspnea index total score was detected in the BDP/F group but not in the FP/S group. Functional residual capacity, residual volume (RV and total lung capacity significantly improved from baseline in the BDP/F group only. With regard to group comparison, a significantly greater reduction in RV was observed with BDP/F versus FP/S. Conclusion: BDP/F extra-fine combination is effective in reducing air trapping and dyspnea in COPD patients with lung hyperinflation. Keywords: small airways, chronic obstructive pulmonary disease, airflow obstruction 

  14. Value of arterial blood gas analysis in patients with acute dyspnea: an observational study

    Science.gov (United States)

    2011-01-01

    Introduction The diagnostic and prognostic value of arterial blood gas analysis (ABGA) parameters in unselected patients presenting with acute dyspnea to the Emergency Department (ED) is largely unknown. Methods We performed a post-hoc analysis of two different prospective studies to investigate the diagnostic and prognostic value of ABGA parameters in patients presenting to the ED with acute dyspnea. Results We enrolled 530 patients (median age 74 years). ABGA parameters were neither useful to distinguish between patients with pulmonary disorders and other causes of dyspnea nor to identify specific disorders responsible for dyspnea. Only in patients with hyperventilation from anxiety disorder, the diagnostic accuracy of pH and hypoxemia rendered valuable with an area under the receiver operating characteristics curve (AUC) of 0.86. Patients in the lowest pH tertile more often required admission to intensive care unit (28% vs 12% in the first tertile, P < 0.001) and had higher in-hospital (14% vs 5%, P = 0.003) and 30-day mortality (17% vs 7%, P = 0.002). Cumulative mortality rate was higher in the first (37%), than in the second (28%), and the third tertile (23%, P = 0.005) during 12 months follow-up. pH at presentation was an independent predictor of 12-month mortality in multivariable Cox proportional hazard analysis both for patients with pulmonary (P = 0.043) and non-pulmonary disorders (P = 0.038). Conclusions ABGA parameters provide limited diagnostic value in patients with acute dyspnea, but pH is an independent predictor of 12 months mortality. PMID:21663600

  15. Impact of Blunted Perception of Dyspnea on Medical Care Use and Expenditure, and Mortality in Elderly People

    Directory of Open Access Journals (Sweden)

    Satoru eEbihara

    2012-07-01

    Full Text Available Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment (CGA in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20 and 30 cmH2O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs and death through computerized linkage with National Health Insurance (NHI beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all cause mortality were 0.65 (95%CI 0.23-1.89 for intermediate perception group and 0.31(0.10-0.97 for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p=0.04. The blunted perception of dyspnea is related to hospitalization, large medical costs and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.

  16. Development of a Barthel Index based on dyspnea for patients with respiratory diseases

    Directory of Open Access Journals (Sweden)

    Vitacca M

    2016-06-01

    Full Text Available Michele Vitacca,1 Mara Paneroni,1 Paola Baiardi,2 Vito De Carolis,3 Elisabetta Zampogna,4 Stefano Belli,5 Mauro Carone,3 Antonio Spanevello,4,6 Bruno Balbi,5 Giorgio Bertolotti7 1Respiratory Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Institute of Lumezzane, Brescia, 2Scientific Direction, Salvatore Maugeri Foundation, IRCCS, Institute of Pavia, Pavia, 3Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Cassano delle Murge, Bari, 4Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Tradate, Varese, 5Respiratory Division, Salvatore Maugeri Foundation, IRCCS, Institute of Veruno, Novara, 6Respiratory Diseases Unit, University of Insubria, Varese, 7Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Institute of Tradate, Varese, Italy Background: As Barthel Index (BI quantifies motor impairment but not breathlessness, the use of only this index could underestimate disability in chronic respiratory disease (CRD. To our knowledge, no study evaluates both motor and respiratory disability in CRD during activities of daily living (ADLs simultaneously and with a unique tool. The objective of this study was to propose for patients with CRD an additional tool for dyspnea assessment during ADLs based on BI items named Barthel Index dyspnea.Methods: Comprehensibility, reliability, internal consistency, validity, responsiveness, and ability to differentiate between disease groups were assessed on 219 subjects through an observational study performed in an in-hospital rehabilitation setting.Results: Good comprehensibility, high reliability (interrater intraclass correlation coefficient was 0.93 [95% confidence interval 0.892–0.964] and test–retest intraclass correlation coefficient was 0.99 [95% confidence interval 0.983–0.994], good internal consistency (Cronbach’s alpha 0.89, strong concurrent validity with 6 minute walking distance (Pearson r=–0.538, P<0.001 and Medical Research Council

  17. Dyspnea during panic attacks. An Internet survey of incidences of changes in breathing.

    Science.gov (United States)

    Anderson, B; Ley, R

    2001-09-01

    This article presents the results of a survey that investigated breathing-related symptoms of panic attacks together with the frequency of other symptoms reported by active panickers. All the participants of this study experienced naturally occurring panic attacks and sought treatment guidance by visiting a Web site devoted to the treatment of panic. The results of a symptom questionnaire showed that 195 respondents (95.1%) reported breathing changes during panic attacks, and remarkable dyspnea was reported by more than two thirds (68%) of respondents. These findings are consistent with earlier studies but are contrary to conclusions that only a small number of panickers report shortness of breath as a symptom. This study concludes that outside of the laboratory, a large majority of people who suffer from panic attacks experience symptoms of dyspnea.

  18. 29-year-old man presenting with progressive dyspnea, oculocutaneous albinism, and epistaxis.

    Science.gov (United States)

    Asefi, Golriz; Lahiji, Arta; Kamangar, Nader

    2015-06-01

    A 29-year-old man with a history of oculocutaneous albinism presented to the ED complaining of progressive dyspnea on exertion. One month prior to admission, the patient had begun to experience worsening dyspnea provoked by routine household activities. Additionally, he had developed a nonproductive cough, exacerbated by cold weather. He denied associated chest pain, hemoptysis, fever, chills, or night sweats. He denied any new exposures or sick contacts in the recent past. A review of systems was significant for a history of epistaxis and frequent bruising. Born in Honduras, he had immigrated to the United States approximately 10 years prior to his presentation to our facility. Furthermore, there was no family history of albinism, bleeding disorders, or pulmonary disease.

  19. A 34-Year-Old Woman With Recurrent Right-Sided Chest Pain and Dyspnea.

    Science.gov (United States)

    Albores, Jeffrey; Fishbein, Gregory; Bando, Joanne

    2015-11-01

    A 34-year-old woman presented with her third episode of acute-onset right-sided chest pain and dyspnea. She had two prior similar occurrences of right-sided sharp, pleuritic chest pain with radiation to the back and dyspnea. Chest radiographs during these presentations revealed a small apical right-sided pneumothorax that was managed conservatively with high-flow oxygen. All three presentations were associated with vigorous exercise and the first day of her menses. She denied cough, hemoptysis, fever, smoking history, airplane travel, scuba diving, or trauma during these presentations. The patient has been trying to conceive for the past year but has been unsuccessful because of uterine fibroids but no history of endometriosis.

  20. A Case of Dyspnea in Pancreatic cancer Treated through Herbal Acupunture Treatment

    OpenAIRE

    2006-01-01

    Objective : This study planed to evaluate effect of oriental medicine therapy treatment method of dyspnea that happen from cancer of the pancreas patient who accompany Multiple metasis Methods : Patient complained dyspnoea during admission into dept . Of internal medicine, college of oriental medicine, Dong-eui Univ ,was appealed patient treated by Oriental medicine therapy that is of use Herb Medication and Herbal -acupuncture Treatment being diagnosed in lung asthenia including deficienc...

  1. [Chronic cough and worsening dyspnea: a case of idiopathic tracheal stenosis].

    Science.gov (United States)

    Conti, Valentina; Calia, Nunzio; Pasquini, Claudio; Zardi, Silvia; Finetti, Cinzia; Stomeo, Francesco; Ravenna, Franco

    2013-04-01

    We report a case of idiopathic tracheal stenosis in a 75-year-old woman, who presented to our observation with a diagnosis of asthmatic bronchitis characterized by cough and exertional dyspnea, later complicated by the appearance of tirage. Biopsy of the lesion showed focal squamous metaplasia of the epithelium lining, multiple sclerosis and chronic inflammatory infiltration of the corium. The patient was treated with endoscopic destruction via rigid bronchoscopy, through the combined action of YAG laser and mechanical debulking.

  2. An 84-Year-Old Man With Progressive Dyspnea and an Abnormal Chest CT Scan.

    Science.gov (United States)

    Fakih, Hafiz Abdul Moiz; Samra, Yasser; Ataya, Ali; Prasad, Ashish; Papierniak, Eric; Wakefield, Dara; Urbine, Daniel

    2017-08-01

    An 84-year-old man without a history of smoking presented with progressive dyspnea of 6 months' duration accompanied by fatigue and unintentional weight loss. He denied fever, chills, chest pain, hemoptysis, rash, joint pains, or muscle aches. He had multiple hospitalizations for similar presentations that were diagnosed as pneumonia. History was significant for diastolic heart failure, hypertension, and type 2 diabetes mellitus. Published by Elsevier Inc.

  3. Relationship Among Pulmonary Hypertension, Autoimmunity, Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism.

    Science.gov (United States)

    Zuhur, Sayid Shafi; Baykiz, Derya; Kara, Sonat Pinar; Sahin, Ertan; Kuzu, Idris; Elbuken, Gulsah

    2017-04-01

    Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism. A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT. Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves׳ disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels. Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHT; however, severe dyspnea requires further evaluation. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  4. Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide

    DEFF Research Database (Denmark)

    Mogelvang, R; Goetze, JP; Schnohr, P

    2007-01-01

    OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac...... with dyspnea, left ventricular hypertrophy and/or systolic dysfunction was associated with a 2.6-fold increase in plasma proBNP concentration (p ...% to 17%). CONCLUSIONS: In the general population with dyspnea, plasma proBNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction, but are unaffected by pulmonary dysfunction....

  5. A new method for rating dyspnea during exercise in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    WANG Hao-yan; XU Qiu-fen; YUAN Wei; NIE Shan; HE Xin; ZHANG Jian; KONG Yuan-yuan

    2013-01-01

    Background The Borg scale is most commonly used to measure dyspnea in China.However,many patients that find it is difficult to distinguish the labeled numbers corresponding to different dyspnea scores.We developed a new method to rate dyspnea,which we call the count scale (CS).It includes the count scale number (CSN) and count scale time (CST).The aims of the present study were to determine the reproducibility and sensitivity of the CS during exercise in patients with chronic obstructive pulmonary disease (COPD).Methods Fourteen male patients with COPD (aged 58.00±7.72 years) participated in this study.A progressive incremental exercise and a 6-minute constant work exercise test were performed every 2 to 3 days for a total of 3 times.The CS results were evaluated at rest and at 30% and 70% of maximal workload (Wmax) and Wmax.The Borg scales were obtained during exercise.Results No significant differences occurred across the three trials during exercise for the CS and Borg scores.The CSN and CST were more varied at Wmax (coefficient of variation (CV)=(22.28±16.96)% for CSN,CV=(23.08±19.11)% for CST) compared to 30% of Wmax (CV=(11.92±8.78)% for CSN,CV=(11.16±9.96)% for CST) and 70% of Wmax (CV=(9.08±7.09)% for CSN,CV=(12.19±12.32)% for CST).Dyspnea ratings with either CSN or CST tended to decrease at the higher workload compared to the lower workload.CSN and CST scores were highly correlated (r=0.861,P <0.001).CSN was negatively correlated with Borg scores (r=0.363,P=0.001).Similar results were obtained for the relationship between CST and Borg scores (r=0.345,P=0.003).Conclusion We concluded that the CS is simple and reproducible when measuring dyspnea during exercise in patients with COPD.

  6. Benefits of short inspiratory muscle training on exercise capacity, dyspnea, and inspiratory fraction in COPD patients

    Directory of Open Access Journals (Sweden)

    Barakat Shahin

    2008-10-01

    Full Text Available Barakat Shahin1, Michele Germain2, Alzahouri Kazem3, Guy Annat41Department of Physiology, University of Claude Bernard Lyon I, Lyon, France; 2Chef of the Service of EFR, Hospital of the Croix-Rousse at Lyon, France; 3Department of Medical Informatics, Hospital of St. Julien, Nancy, France; 4Department of Physiology, UFR Médecine Lyon Grange-Blanche Université Claude Bernard Lyon I, INSERM ESPRI ERI 22, Lyon, FranceAbstract: Static lung hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD. Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT. The present study is designed to investigate the benefits of a short outpatient program of IMT on inspiratory muscle performance, exercise capacity, perception of dyspnea, and the inspiratory fraction (IF. Thirty patients (24 males, 6 females with significant COPD (forced expiratory volume in one second [FEV1] = 46.21% ± 6.7% predicted, FEV1 = 33.6% ± 8.04% predicted were recruited for this study and had 3 months of IMT (30 minutes/day for 6 days/week in an outpatient clinic. Following IMT, there was a statistically significant increase in inspiratory muscle performance (an increase of the maximal inspiratory pressure from 59% ± 19.1% to 79% ± 21.85% predicted; p = 0.0342, a decrease in dyspnea (from 5.8 ± 0.78 to 1.9 ± 0.57; p = 0.0001, an increase in the distance walked during the 6 minute walk test, from 245 ± 52.37 m to 302 ± 41.30 m, and finally an increase in the IF (the new prognostic factor in COPD from 27.6 ± 9.7% to 31.4% ± 9.8%. The present study concludes that in patients with significant COPD, IMT results in improvement in performance, exercise capacity, sensation of dyspnea, and moreover an improvement in the IF prognostic factor.Keywords: inspiratory muscle training, dyspnea, inspiratory

  7. Three-minute constant rate step test for detecting exertional dyspnea relief after bronchodilation in COPD

    Directory of Open Access Journals (Sweden)

    Borel B

    2016-11-01

    Full Text Available Benoit Borel,1,2 Courtney A Wilkinson-Maitland,3 Alan Hamilton,4 Jean Bourbeau,5 Hélène Perrault,6 Dennis Jensen,3,5,7 François Maltais2 1Laboratoire HAVAE, Université de Limoges, Limoges, France; 2Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, 3Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, 4Boehringer Ingelheim (Canada Limited, Burlington, ON, 5Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Center, Montreal, QC, 6Faculty of Health Sciences, University of Ottawa, Ottawa, ON, 7Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada Background: The aim of this study was to evaluate the responsiveness of the 3-minute constant rate step test (3-MST to detect the relief of exertional dyspnea (respiratory discomfort after acute bronchodilation in COPD patients. Patients and methods: A total of 40 patients with moderate-to-severe COPD (mean forced expiratory volume in 1 second: 45.7 (±14.7, % predicted performed four 3-MSTs at randomly assigned stepping rates of 14, 16, 20 and 24 steps/min after inhalation of nebulized ipratropium bromide (500 µg/salbutamol (2.5 mg and saline placebo, which were randomized to order. Patients rated their intensity of perceived dyspnea at the end of each 3-MST using Borg 0–10 category ratio scale. Results: A total of 37 (92.5%, 36 (90%, 34 (85% and 27 (67.5% patients completed all 3 minutes of exercise at 14, 16, 20 and 24 steps/min under both treatment conditions, respectively. Compared with placebo, ipratropium bromide/salbutamol significantly decreased dyspnea at the end of the third minute of exercise at 14 steps/min (by 0.6±1.0 Borg 0–10 scale units, P<0.01 and 16 steps/min (by 0.7±1.3 Borg 0–10 scale

  8. Treatment of Cough and Dyspnea due to Acute Bronchitis by Plaster for Cough and Dyspnea-A Report of 735 Cases

    Institute of Scientific and Technical Information of China (English)

    陈振甫; 周文秀; 高举先; 孙江桥

    2002-01-01

    @@ In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang 咳喘一贴康) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P<0.01); and that in the treatment group, the cure rate for the wind-cold type of acute bronchitis was significantly higher than that for the wind-heat type of acute bronchitis (P<0.01).

  9. Impact of exercise capacity on dyspnea and health-related quality of life in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Frølich, Anne; Godtfredsen, Nina S

    2012-01-01

    To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD).......To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD)....

  10. Effect of intraoral and subcutaneous morphine on dyspnea at rest in terminal patients with primary lung cancer or lung metastases

    DEFF Research Database (Denmark)

    Gamborg, Helle; Riis, Jette; Christrup, Lona Louring;

    2013-01-01

    Dyspnea is considered as one of the most frequent and distressing symptoms in patients with advanced cancer, and systemic administration of morphine has been reported to have beneficial effect on this complaint.......Dyspnea is considered as one of the most frequent and distressing symptoms in patients with advanced cancer, and systemic administration of morphine has been reported to have beneficial effect on this complaint....

  11. Buspirone for management of dyspnea in cancer patients receiving chemotherapy: a randomized placebo-controlled URCC CCOP study.

    Science.gov (United States)

    Peoples, Anita R; Bushunow, Peter W; Garland, Sheila N; Heckler, Charles E; Roscoe, Joseph A; Peppone, Luke L; Dudgeon, Deborah J; Kirshner, Jeffrey J; Banerjee, Tarit K; Hopkins, Judith O; Dakhil, Shaker R; Flannery, Marie A; Morrow, Gary R

    2016-03-01

    Cancer-related dyspnea is a common, distressing, and difficult-to-manage symptom in cancer patients, resulting in diminished quality of life and poor prognosis. Buspirone, a non-benzodiazepine anxiolytic which does not suppress respiration and has proven efficacy in the treatment of generalized anxiety disorder, has been suggested to relieve the sensation of dyspnea in patients with COPD. The main objective of our study was to evaluate whether buspirone alleviates dyspnea in cancer patients. We report on a randomized, placebo-controlled trial of 432 patients (mean age 64, female 51%, lung cancer 62%) from 16 participating Community Clinical Oncology Program (CCOP) sites with grade 2 or higher dyspnea, as assessed by the Modified Medical Research Council Dyspnea Scale. Dyspnea was assessed by the Oxygen Cost Diagram (OCD; higher scores are better) and anxiety by the state subscale of the State-Trait Anxiety Inventory (STAI-S; lower scores are better) at baseline and after the 4-week intervention (post-intervention). Mean scores from baseline to post-intervention for buspirone were OCD 8.7 to 9.0 and STAI-S 40.5 to 40.1 and for placebo were OCD 8.4 to 9.3 and STAI-S 40.9 to 38.6 with raw improvements over time on both measures being greater in the placebo group. Analysis of covariance (ANCOVA) controlling for baseline scores showed no statistically significant difference between groups for OCD (P = 0.052) or STAI-S (P = 0.062). Buspirone did not result in significant improvement in dyspnea or anxiety in cancer patients. Thus, buspirone should not be recommended as a pharmacological option for dyspnea in cancer patients.

  12. Study of the relationship of dyspnea with depression and functional status in patients with interstitial lung disease

    Directory of Open Access Journals (Sweden)

    Hoda A. Abu Youssef

    2015-01-01

    Conclusion: Dyspnea is common in ILD and is strongly correlated with functional status and psychiatric disorders. Dyspnea score, functional status and psychiatric disorders are more affected in ILD with PHTN than in ILD without PHTN. Accordingly, routine screening for mental disorders is recommended for patients with ILD, and should be accompanied by accurate assessment of patient’s symptoms, particularly in patients with high levels of functional impairment.

  13. The origin of dyspnea and its role in the reduction of exercise endurance in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Mikhail Vasil'evich Sheyanov

    2010-01-01

    Results. Dyspnea during exercise was reported by 54 (52% patients with RA and 9 (9% control patients (p < 0.001. Dyspnea was more frequently detected and more significant in RA patients with other symptoms of respiratory organ lesions (cough, sputum discharge, chest pain on breathing and coughing, anemia, and emotional disorders of the anxious-depressive type. The degree of dyspnea correlated with DAS 28 scores (r = 0.33; p < 0.01. No correlation was found between lung function parameters and blood gas composition. Pulmonary MSCT in RA patients with dyspnea more frequently revealed signs of bronchiolitis and lesion of the lung as its interstitial fibrotic type. Conclusion. Dyspnea is a common symptom and an important factor in reducing EE and QL in patients with RA. Dyspnea in these patients has a multifactorial origin. Of importance in its occurrence are the involvement of the lung and bronchi in the pathological process irrespective of the lung function, as well as RA-associated factors (including anemia, and nosogenic emotional disorders (anxiety and/or depression.

  14. Nasal flaring as a clinical sign of respiratory acidosis in patients with dyspnea.

    Science.gov (United States)

    Zorrilla-Riveiro, José Gregorio; Arnau-Bartés, Anna; Rafat-Sellarés, Ramón; García-Pérez, Dolors; Mas-Serra, Arantxa; Fernández-Fernández, Rafael

    2017-04-01

    To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models. The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis. Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second

    Directory of Open Access Journals (Sweden)

    Carlos A. Nigro

    2010-08-01

    Full Text Available During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1 to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2 to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095, females (OR 2.90, 95%CI 1.33-6.33, p 0.0072, younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013 and body mass index (BMI (OR 1.11, 95%CI 1.01-1.23, p 0.023. As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002. Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187, females (OR 3.02, 95%CI 1.36-6.72, p 0.0067, younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007 and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023. The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.

  16. An uncommon case of dyspnea with unilateral laryngeal paralysis in acromegaly.

    Science.gov (United States)

    Lerat, Justine; Lacoste, Marie; Prechoux, Jean-Marc; Aubry, Karine; Nadalon, Sylvie; Ly, Kim Heang; Bessede, Jean-Pierre

    2016-02-01

    A 61-year-old man with obstructive sleep apnea syndrome and normal BMI complained of dyspnea. Nasofibroscopy revealed a global and major oedema of the glottis and supraglottis and also a paralysis of the left vocal fold. CT-scan pointed out a spontaneous hyperdensity of the left arytenoid cartilage. A tracheostomy was performed. Clinical examination revealed large hands and macroglossy with high IGF1 rate. MRI confirmed a supracentimetric pituitary adenoma. To our knowledge, this is the first description of a case of acute respiratory distress due to unilateral larynx paralysis leading to acromegaly diagnosis. This is due to submucosal hypertrophy and vocal cord immobility.

  17. Dyspnea and Wheezing after Adenosine Injection in a Patient with Eosinophilic Bronchitis

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    Rodrigo Cartin-Ceba

    2009-01-01

    Full Text Available A 58-year-old nonsmoker female was referred for evaluation of chronic cough of 13 months duration. After an initial work-up, the patient was diagnosed to have chronic cough due to eosinophilic bronchitis. The diagnostic work-up for eosinophilic bronchitis and bronchial biopsy is discussed. Eosinophilic bronchitis is differentiated from asthma. In addition, the patient developed dyspnea, flushing, and wheezing after the administration of adenosine during a cardiac stress test in spite of a negative methacholine challenge. This indirect stimulus of airway hyperresponsiveness suggests the possible involvement of mast cells in eosinophilic bronchitis.

  18. A 54-Year-Old Man With Anasarca, Dyspnea, and Recurrent Bilateral Pleural Effusions.

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    Patil, Pradnya D; Cua, Yvette M; Farver, Carol; Perez, Rafael L; Mehta, Atul C; Panchabhai, Tanmay S

    2017-08-01

    A 54-year-old African-American man presented with 2 years of progressively worsening dyspnea and anasarca. Over the past 6 months he gained 30 lbs with worsening lower extremity, abdominal wall, and scrotal edema. A recent workup for cardiac, renal, and liver disease, including two-dimensional echocardiogram, liver and renal function tests, and abdominal ultrasound, was unremarkable. He reported a 15-pack year history of smoking and quit 3 years ago. Chest radiograph at that time revealed bilateral pleural effusions that were both reportedly milky in appearance when drained by thoracenteses. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  19. Gender and respiratory factors associated with dyspnea in chronic obstructive pulmonary disease

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    Aguirre-Jaime Armando

    2007-03-01

    Full Text Available Abstract Rationale We had shown that COPD women expressed more dyspnea than men for the same degree of airway obstruction. Objectives Evaluate gender differences in respiratory factors associated with dyspnea in COPD patients. Methods In a FEV1 % matched population of 100 men and women with COPD we measured: age, MMRC, FEV1, FVC, TLC, IC/TLC, PaO2, PaCO2, DLCO, Pimax, P0.1, Ti/Ttot, BMI, ffmi, 6MWD and VAS scale before and after the test, the Charlson score and the SGRQ. We estimated the association between these parameters and MMRC scores. Multivariate analysis determined the independent strength of those associations. Results MMRC correlated with: BMI (men:-0.29, p = 0.04; women:-0.28, p = 0.05, ffmi (men:-0.39, p = 0.01, FEV1 % (men:-0.64, p 2 (men:-0.59, p 2 (men:0.27, p = 0.05, DLCO (men:-0.54, p 0.1/Pimax (men:0.46, p = 0.002; women:0.47, p = 0.005, dyspnea measured with the Visual Analog Scale before (men:0.37, p = 0.04; women:0.52, p = 0.004 and after 6MWD (men:0.52, p = 0.002; women:0.48, p = 0.004 and SGRQ total (men:0.50, p 0.1/Pimax in women (r2 = 0.30 and BMI, DLCO, PaO2 and P0.1/Pimax in men (r2 = 0.81 were the strongest predictors of MMRC scores. Conclusion In mild to severe COPD patients attending a pulmonary clinic, P0.1/Pimax was the unique predictor of MMRC scores only in women. Respiratory factors explain most of the variations of MMRC scores in men but not in women. Factors other than the respiratory ones should be included in the evaluation of dyspnea in women with COPD.

  20. Massive right atrial myxoma with dyspnea at rest in an elderly patient: A case report

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    Romanović Radoslav

    2015-01-01

    Full Text Available Introduction. Primary heart tumors are extremely rare and myxoma is the most common type of these tumors. Although intraatrial presentation is a predilection place, right atrial localization is atypical. The symptom triad is characteristic in the clinical presentation of the tumor: embolic complication, intracardiac blood flow obstruction and systemic manifestations like elevated erythrocyte sedimentation rate, fever, anemia, body weight loss. Case report. We presented an elderly female patient with massive myxoma in the right atrium, 77 × 44 mm in diameter, which filled the entire right atrium and spread into the right ventricle, causing the tricuspid valve obstruction and dyspnea. It was visualized by transthoracic echocardiography and small and insignificant pericardial effusion was also seen. After surgical removal of the tumor, the patient remained without any symptoms and pericardial effusion. Conclusion. Tumors of the right heart have to be considered in the differential diagnosis of unexplained dyspnea in elderly patients. Transthoracic echocardiography is certainly necessary and mostly available diagnostic tool that can be of great help in diagnosing heart tumor as well as planning cardiac surgery, as it provides in most cases excellent visualization of the tumor and its relationship with other parts of the heart.

  1. Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients

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    Antonio A.M. Castro

    2012-01-01

    Full Text Available OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room. RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85 and respiratory rate (r = 0.37 and negatively with peripheral oxygen saturation (r = -0.28. CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.

  2. Managing Dyspnea in Patients with Advanced Chronic Obstructive Pulmonary Disease: A Canadian Thoracic Society Clinical Practice Guideline

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    Darcy D Marciniuk

    2011-01-01

    Full Text Available Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD, and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts.

  3. A Case of Dyspnea in Pancreatic cancer Treated through Herbal Acupunture Treatment

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    Park Sang-Eun

    2006-02-01

    Full Text Available Objective : This study planed to evaluate effect of oriental medicine therapy treatment method of dyspnea that happen from cancer of the pancreas patient who accompany Multiple metasis Methods : Patient complained dyspnoea during admission into dept . Of internal medicine, college of oriental medicine, Dong-eui Univ ,was appealed patient treated by Oriental medicine therapy that is of use Herb Medication and Herbal -acupuncture Treatment being diagnosed in lung asthenia including deficiency of Eum and insufficiency of Gi of the lung(폐허(肺虛, the fire due to deficiency(허화(虛火, and loving warfare of symptoms evaluated through VAS (visual analog scales. Results & Conclusion : Patient's difficulty in breathing symptoms took a favorable turn after treatment. This study means that Oriental medicine therapy that is difficulty in breathing symptoms that happen from patient surely has effectiveness.

  4. Cardiac Fibroma in a Neonate Presenting With Dyspnea and Tachycardia: A Very Rare Case Tachycardia

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    Anvari Shahriar

    2016-01-01

    Full Text Available Introduction: Cardiac tumors can be divided to primary and secondary and to benign and malignant tumors. One of the benign tumors of the heart is cardiac fibroma. More than 80% of this tumor occurs in children; however its occurrence in neonates is very rare. Fewer than 100 cases have been reported. Case Presentation: Our patient is a 10 day’s girl neonate with severe dyspnea, mild cyanosis, tachycardia (heart rate = 170- 180/min and obstruction of right ventricle (RV outlet with very large tumor. Conclusion: Cardiac tumors in neonate population must be considered in the diagnosis of arrhythmias, cardiac insufficiency, valvular disease, cardiomegaly or presence of murmurs. Early diagnosis before birth should be appropriate and accurate imaging devices must be used in detecting these tumors.

  5. A 58-Year-Old Man With Position-Dependent Nocturnal Dyspnea.

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    Schertel, Anke; Horvath, Christian M; Pichler Hefti, Jacqueline; Aubert, John-David; Brill, Anne-Kathrin

    2017-08-01

    A 58-year-old man with idiopathic pulmonary fibrosis, who had received a right-sided single-lung transplant 2 years earlier, was referred to the sleep clinic for the assessment of nocturnal position-dependent episodes of dyspnea and frequent arousals when lying on his right side. There was no subjective worsening of daytime respiratory symptoms, but he complained of fatigue and unrefreshing sleep. His Epworth Sleepiness Scale score was 12/24. After lung transplantation he had a favorable course while receiving immunosuppression with prednisolone, everolimus, and mycophenolate mofetil. In addition, he had received diagnoses of stable coronary artery disease and moderate chronic kidney failure. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  6. Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea.

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    Brea Álvarez, B; Tuñón Gómez, M; Esteban García, L; García Hidalgo, C Y; Ruiz Peralbo, R M

    2016-01-01

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. EVALUATION OF UNEXPLAINED DYSPNEA IN A YOUNG ATHLETIC MALE WITH PECTUS EXCAVATUM

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    Gregory B. Tardie

    2005-09-01

    Full Text Available Pectus excavatum (PE is a relatively common congenital deformity of the anterior chest wall associated with reduced exercise capacity. Uncertainty exists over the nature of physiologic impairment in PE. Evidence suggests that myocardial compression exerted by the displaced sternum on the right heart chambers, disables the ability of the heart to augment stroke volume during exercise. This case study describes the evaluation of an athletic 20 year old Caucasian male, lifelong non-smoker, with severe pectus deformity and previous fixation procedure to repair a sternal fracture. The patient performed an incremental cycle ergometer exercise test to determine the etiology of his dyspnea with exertion. The patient demonstrated normal work output and normal aerobic capacity but displayed dynamic hyperinflation. Mechanical restriction of tidal volume expansion appeared to be the major contributors to exercise limitation. These results are compared and contrasted with similar cases reported in the literature

  8. Desensitization to dyspnea in COPD with specificity for exercise training mode

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    Christopher B Cooper

    2008-09-01

    Full Text Available Christopher B CooperDavid Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USAAbstract: Patients with chronic obstructive pulmonary disease (COPD exhibit improved exercise capacity after physical training due to reconditioning and improved ventilatory efficiency. Other possible effects are improved ventilatory muscle function and desensitization to dyspnea. We compared general physical training (GPT, consisting of walking and stair climbing exercises, with inspiratory muscle training (IMT, consisting of targeted breathing through inspiratory resistances, in two groups with severe COPD. Seven subjects; age 60 (8 years, forced expiratory volume in one second (FEV1 0.84 (0.35 L, arterial oxygen tension (PaO2 11.1 (0.8 kPa, arterial carbon dioxide tension (PaCO2 4.9 (0.3 kPa, had GPT and nine subjects; age 60 (9 years, FEV1 0.83 (0.31 L, PaO2 10.4 (0.8 kPa, PaCO2 4.4 (0.5 kPa had IMT. Each group trained daily for 30 minutes for eight weeks and 70% of the sessions were supervised. Six minute walking distance increased in both groups: 32 m (6.9% P < 0.05 with GPT and 23 m (4.8%; P < 0.05 with IMT but significant improvements in symptom-limited incremental cycle exercise performance were not detected. Breathlessness by visual analog scale was reduced following 6-minute walks after GPT (P < 0.05 but not after IMT. Following maximal incremental tests, breathlessness scores were unchanged for both groups. COPD patients performing regular physical exercise report reductions in breathlessness which are specific to the exercise training mode.Keywords: COPD, exercise, ventilatory muscles, dyspnea

  9. The Effects of Self-Management Program on Exercise Tolerance and Dyspnea in Patients With Chronic Obstructive Pulmonary Disease

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    Heidari

    2014-08-01

    Full Text Available Background Chronic obstructive pulmonary disease (COPD is a progressive process leading to major clinical problems in patients. There is no highly effective treatment for these patients and therapists only try to relieve the symptoms. Objectives The present study was performed to investigate the effects of self-management program on exercise tolerance and dyspnea in patients with COPD. Patients and Methods In this clinical trial, 50 patients with moderate and severe grade COPD who met the inclusion criteria were randomly assigned to control and intervention groups. The control group received usual care and the intervention group received usual care plus a self-management program based on the 5A model. Patients were assessed by six-minute walking test and the Borg scale for exercise tolerance and dyspnea at base line and after 12 weeks. SPSS software version 17, independent t-test, and chi-square test were used for data analysis. Results There was no significant difference between the groups in exercise tolerance at base line; but, they were significantly different at the end of 12 weeks (P = 0.007. In addition, a significant reduction was found in patients' dyspnea in the intervention group, compared with the control group after 12 weeks (P < 0.0001. Conclusions In short term, using the self-management program can lead to increased exercise tolerance and decreased dyspnea in patients with COPD; thus, this program is recommended as an effective way to improve the functional statuses of these patients.

  10. Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study

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    Cabrera, Carlos; Casanova, Ciro; Martín, Yolanda; Mirabal, Virginia; Sánchez, María del Carmen; Álvarez, Felisa; Juliá, Gabriel; Cabrera-Navarro, Pedro; García-Bello, Miguel Ángel; Marín, José María; de-Torres, Juan Pablo; Divo, Miguel; Celli, Bartolomé

    2016-01-01

    Introduction Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline. Methods We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations. Results We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort. Conclusion A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative. PMID:27354780

  11. Preliminary investigation of cardiopulmonary function in stroke patients with stable heart failure and exertional dyspnea

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    Liaw, Mei-Yun; Wang, Lin-Yi; Pong, Ya-Ping; Tsai, Yu-Chin; Huang, Yu-Chi; Yang, Tsung-Hsun; Lin, Meng-Chih

    2016-01-01

    Abstract The aim of this study was to investigate the relationships between pulmonary function, respiratory muscle strength, perceived dyspnea, degree of fatigue, and activity of daily living with motor function and neurological status in stroke patients with stable congestive heart failure (CHF). This was a cohort study in a tertiary care medical center. Stroke patients with CHF and exertional dyspnea (New York Heart Association class I–III) were recruited. The baseline characteristics included duration of disease, Brunnstrom stage, spirometry, resting heart rate, resting oxyhemoglobin saturation (SpO2), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Borg scale, fatigue scale, and Barthel index. A total of 47 stroke patients (24 males, 23 females, mean age 65.9 ± 11.5 years) were included. The average Brunnstrom stages of affected limbs were 3.6 ± 1.3 over the proximal parts and 3.5 ± 1.4 over the distal parts of upper limbs, and 3.9 ± 0.9 over lower limbs. The average forced vital capacity (FVC) was 2.0 ± 0.8 L, with a predicted FVC% of 67.9 ± 18.8%, forced expiratory volume in the first second (FEV1) of 1.6 ± 0.7 L, predicted FEV1% of 70.6 ± 20.1%, FEV1/FVC of 84.2 ± 10.5%, and maximum mid-expiratory flow of 65.4 ± 29.5%. The average MIP and MEP were −52.9 ± 33.3 cmH2O and 60.8 ± 29.0 cmH2O, respectively. The Borg scale was 1.5 ± 0.8. MIP was negatively associated with the average Brunnstrom stage of the proximal (r = −0.318, P lower extremities (r = −0.288, P lower extremities (r = −0.311, P limbs. FVC was more strongly associated with MIP and MEP than predicted FVC%. FEV1/FVC may be used as a reference for the pulmonary dysfunction. PMID:27749577

  12. Aerobic exercise training without weight loss reduces dyspnea on exertion in obese women

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    Bernhardt, Vipa; Stickford, Jonathon L.; Bhammar, Dharini M.; Babb, Tony G.

    2015-01-01

    Dyspnea on exertion (DOE) is a common symptom in obesity. We investigated whether aerobic exercise training without weight loss could reduce DOE. Twenty-two otherwise healthy obese women participated in a 12-week supervised aerobic exercise training program, exercising 30 min/day at 70–80% heart rate reserve, 4 days/week. Subjects were grouped based on their Ratings of Perceived Breathlessness (RPB) during constant load 60W cycling: +DOE (n = 12, RPB ≥ 4, 37 ± 7 years, 34 ± 4kg/m2) and −DOE (n = 10, RPB ≤ 2, 32 ± 6 years, 33 ± 3kg/m2). No significant differences between the groups in body composition, pulmonary function, or cardiorespiratory fitness were observed pre-training. Post-training, peak was improved significantly in both groups (+DOE: 12 ± 7, −DOE: 14 ± 8%). RPB was significantly decreased in the + DOE (4.7 ± 1.0–2.5 ± 1.0) and remained low in the −DOE group (1.2 ± 0.6–1.3 ± 1.0) (interaction p exercise training improved cardiorespiratory fitness and DOE and thus appears to be an effective treatment for DOE in obese women. PMID:26593640

  13. Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion.

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    De Guzman, Vanessa; Ballif, Catherine L; Maurer, Rie; Hartnick, Christopher J; Raol, Nikhila

    2014-09-01

    Paradoxical vocal fold motion (PVFM) affects almost 1 million adolescents in the United States. However, to date, no disease-specific objective measure exists to assess symptom severity and response to treatment in adolescents with exercise-induced PVFM. To validate the Dyspnea Index (DI) quality-of-life instrument (previously validated for adults with breathing disorders) in children aged 12 to 18 years with exercise-induced PVFM and to determine the minimum significant DI change corresponding to patient-reported or caregiver-reported improvement or worsening of symptoms. A longitudinal study of 56 patients (age range, 12-18 years) diagnosed as having exercise-induced PVFM and their caregivers from February 1, 2013, to September 30, 2013, in an outpatient pediatric otolaryngology office practice. The DI was administered to patients and caregivers, with items modified to reflect the perspective of caregivers. Appropriate DI change was measured to reflect improvement or worsening of symptoms. Test-retest reliability was accomplished by having a subset of patients and caregivers complete the instrument twice within 2 weeks before therapy. Internal consistency was assessed by calculation of Cronbach α. Discriminant validity and convergent validity were determined by comparing DIs with assessment of global change in symptoms. The patient and caregiver mean (SD) DI changes were -12.9 (9.6) and -14.7 (9.3), respectively (P therapy.

  14. The Barthel index-dyspnea a tool for respiratory rehabilitation: reply to the letter by Chuang [Letter of clarification

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    Carone M

    2017-03-01

    Full Text Available Mauro Carone,1 Michele Vitacca,2 Mara Paneroni,2 Paola Baiardi,3 Antonio Spanevello,4,5 Giorgio Bertolotti6 1Respiratory Division, ICS MAUGERI SPA SB, Institute of Cassano Murge (BA IRCCS, Italy; 2Respiratory Rehabilitation Division, ICS MAUGERI SPA SB, Institute of Lumezzane (BS IRCCS, Italy; 3Scientific Direction, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Italy; 4Respiratory Rehabilitation Division, ICS MAUGERI SPA SB, Institute of Tradate (VA IRCCS, Italy; 5Respiratory Diseases Unit, University of Insubria, Varese; 6Psychology Unit, ICS MAUGERI SPA SB, Institute of Tradate (VA IRCCS, Italy We read the remarkable letter by Chuang.1 We thank him for his valid suggestions on our paper. Interestingly, he focused on the two dimensions of the Barthel index-dyspnea (BI-d, which was exactly our goal. As rehabilitators, our goal is to provide patients with physical therapy depending on their health status and to improve their respiratory function. We need to verify and demonstrate the efficacy and the outcomes of respiratory rehabilitation, supported by physical therapy. For these reasons, we need an assessment device that measures respiratory improvement during daily motor activities that should be monitored.The modified Barthel index2 is a well-consolidated and widely used instrument to assess the performance of a person in a predetermined and fixed set of activities of daily living (ADLs. By proposing BI-d,3 we aimed to develop a scale to measure how dyspnea precludes or reduces the same ADLs, with the ultimate goal of globally assessing the effectiveness of rehabilitation. Hence, an assessment method that measures the impact of dyspnea on activities monitored by a rehabilitation program is of utmost importance for rehabilitators. Large part of Chuang’s letter is based on the Chronic Respiratory Questionnaire-dyspnea (CRQ-d. The CRQ-d is a health-related quality of life (health status questionnaire, with a dyspnea “domain”.4 However

  15. A 45-Year-Old Man With Recurrent Dyspnea and Hemoptysis during Exercise: Exercise-Induced Pulmonary Hemorrhage/Edema

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    Kim, Dae Sung; Lee, Minhyeok; Kwon, Oh Jung; Jeong, Inbeom; Son, Ji Woong; Na, Moon Jun

    2015-01-01

    A 45-year-old man presented with dyspnea and hemoptysis during exercise. A chest computed tomography (CT) revealed multifocal diffuse patchy ground glass opacity and interlobular septal thickening in both the lungs. Permeability pulmonary edema or pulmonary hemorrhage was suspected. Serologic studies for autoimmune disorders and vasculitis were negative. There was no laboratory evidence of coagulopathy, other hematopoietic disease or infectious disease. Considering correlation with exercise, we diagnosed exercise-induced pulmonary hemorrhage (EIPH) or exercise-induced pulmonary edema (EIPE). The patient was managed with antifibrinolytics, antibiotics, and antitussive agent. After a week, follow-up chest CT revealed completely resolved pulmonary hemorrhage. About 2 months after the first event, he visited again with dyspnea and hemoptysis during running. In the present study, we report a case of recurrent pulmonary hemorrhage after exercise. PMID:26508928

  16. Airflow limitation or static hyperinflation: which is more closely related to dyspnea with activities of daily living in patients with COPD?

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    Nishimura Takashi

    2011-10-01

    Full Text Available Abstract Background Dyspnea while performing the activities of daily living has been suggested to be a better measurement than peak dyspnea during exercise. Furthermore, the inspiratory capacity (IC has been shown to be more closely related to exercise tolerance and dyspnea than the FEV1, because dynamic hyperinflation is the main cause of shortness of breath in patients with COPD. However, breathlessness during exercise is measured in most studies to evaluate this relationship. Purpose To evaluate the correlation between breathlessness during daily activities and airflow limitation or static hyperinflation in COPD. Methods We examined 167 consecutive outpatients with stable COPD. The Baseline Dyspnea Index (BDI was used to evaluate dyspnea with activities of daily living. The relationship between the BDI score and the clinical measurements of pulmonary function was then investigated. Results The Spearman rank correlation coefficients (Rs between the BDI score and the FEV1(L, FEV1(%pred and FEV1/FVC were 0.60, 0.56 and 0.56, respectively. On the other hand, the BDI score also correlated with the IC, IC/predicted total lung capacity (TLC and IC/TLC (Rs = 0.45, 0.46 and 0.47, respectively. Although all of the relationships studied were strongly correlated, the correlation coefficients were better between dyspnea and airflow limitation than between dyspnea and static hyperinflation. In stepwise multiple regression analyses, the BDI score was most significantly explained by the FEV1 (R2 = 26.2% and the diffusion capacity for carbon monoxide (R2 = 14.4% (Cumulative R2 = 40.6%. Static hyperinflation was not a significant factor for clinical dyspnea on the stepwise multiple regression analysis. Conclusion Both static hyperinflation and airflow limitation contributed greatly to dyspnea in COPD patients.

  17. Value of orthopnea, paroxysmal nocturnal dyspnea, and medications in prospective population studies of incident heart failure.

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    Ekundayo, O James; Howard, Virginia J; Safford, Monika M; McClure, Leslie A; Arnett, Donna; Allman, Richard M; Howard, George; Ahmed, Ali

    2009-07-15

    Prospective population studies of incident heart failure (HF) are often limited by difficulties in assembling HF-free cohorts. In this study, public-use copies of the Cardiovascular Health Study (CHS) data sets were used to determine the sensitivity, specificity, and positive and negative predictive values of orthopnea and paroxysmal nocturnal dyspnea (PND), with and without the use of medications used in CHS HF criteria (diuretics plus digoxin or vasodilators), in the diagnosis of prevalent HF and in the assembly of a relatively HF-free population. Of the 5,771 community-dwelling older adults aged > or =65 years, 803 had orthopnea, 660 had PND, 1,075 had either symptom, 388 had both symptoms, 547 were using HF medications, and 4,315 had neither symptom and were not using HF medications. Definite HF was centrally adjudicated in 272 participants. The sensitivity, specificity, and positive and negative predictive values for either orthopnea or PND were 52% (95% confidence interval [CI] 46% to 58%), 83% (95% CI 82% to 84%), 13% (95% CI 11% to 15%), and 97% (95% CI 97% to 98%), respectively, and those for either orthopnea or PND or the use of HF medications were 77% (95% CI 72% to 82%), 77% (95% CI 76% to 79%), 14% (95% CI 13% to 16%), and 99% (95% CI 98% to 99%), respectively. In conclusion, only medications also did not have HF, which may be useful as a simple and inexpensive tool in assembling relatively HF-free cohorts for prospective population studies of incident HF.

  18. Unexplained exertional dyspnea caused by low ventricular filling pressures: results from clinical invasive cardiopulmonary exercise testing

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    Lewis, Gregory D.; Opotowsky, Alexander R.; Waxman, Aaron B.; Systrom, David M.

    2016-01-01

    Abstract To determine whether low ventricular filling pressures are a clinically relevant etiology of unexplained dyspnea on exertion, a database of 619 consecutive, clinically indicated invasive cardiopulmonary exercise tests (iCPETs) was reviewed to identify patients with low maximum aerobic capacity (V̇o2max) due to inadequate peak cardiac output (Qtmax) with normal biventricular ejection fractions and without pulmonary hypertension (impaired: n = 49, V̇o2max = 53% predicted [interquartile range (IQR): 47%–64%], Qtmax = 72% predicted [62%–76%]). These were compared to patients with a normal exercise response (normal: n = 28, V̇o2max = 86% predicted [84%–97%], Qtmax = 108% predicted [97%–115%]). Before exercise, all patients received up to 2 L of intravenous normal saline to target an upright pulmonary capillary wedge pressure (PCWP) of ≥5 mmHg. Despite this treatment, biventricular filling pressures at peak exercise were lower in the impaired group than in the normal group (right atrial pressure [RAP]: 6 [IQR: 5–8] vs. 9 [7–10] mmHg, P = 0.004; PCWP: 12 [10–16] vs. 17 [14–19] mmHg, P < 0.001), associated with decreased stroke volume (SV) augmentation with exercise (+13 ± 10 [standard deviation (SD)] vs. +18 ± 10 mL/m2, P = 0.014). A review of hemodynamic data from 23 patients with low RAP on an initial iCPET who underwent a second iCPET after saline infusion (2.0 ± 0.5 L) demonstrated that 16 of 23 patients responded with increases in Qtmax ([+24% predicted [IQR: 14%–34%]), V̇o2max (+10% predicted [7%–12%]), and maximum SV (+26% ± 17% [SD]). These data suggest that inadequate ventricular filling related to low venous pressure is a clinically relevant cause of exercise intolerance. PMID:27162614

  19. Effects of body mass index on task-related oxygen uptake and dyspnea during activities of daily life in COPD.

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    Anouk W Vaes

    Full Text Available BACKGROUND: Patients with COPD use a higher proportion of their peak aerobic capacity during the performance of domestic activities of daily life (ADLs compared to healthy peers, accompanied by a higher degree of task-related symptoms. To date, the influence of body mass index (BMI on the task-related metabolic demands remains unknown in patients with COPD. Therefore, the aim of our study was to determine the effects of BMI on metabolic load during the performance of 5 consecutive domestic ADLs in patients with COPD. METHODOLOGY: Ninety-four COPD patients and 20 healhty peers performed 5 consecutive, self-paced domestic ADLs putting on socks, shoes and vest; folding 8 towels; putting away groceries; washing up 4 dishes, cups and saucers; and sweeping the floor for 4 min. Task-related oxygen uptake and ventilation were assessed using a mobile oxycon, while Borg scores were used to assess task-related dyspnea and fatigue. PRINCIPAL FINDINGS: 1. Relative task-related oxygen uptake after the performance of domestic ADLs was increased in patients with COPD compared to healthy elderly, whereas absolute oxygen uptake is similar between groups; 2. Relative oxygen uptake and oxygen uptake per kilogram fat-free mass were comparable between BMI groups; and 3. Borg symptom scores for dyspnea en fatigue were comparable between BMI groups. CONCLUSION: Patients with COPD in different BMI groups perform self-paced domestic ADLs at the same relative metabolic load, accompanied by comparable Borg symptom scores for dyspnea and fatigue.

  20. Test–retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

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    Parshall Mark B

    2012-07-01

    Full Text Available Abstract Background Dyspnea is among the most common reasons for emergency department (ED visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients. Methods Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154 completed the Multidimensional Dyspnea Profile (MDP several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68. The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP or at the time of administration (“now” MDP. The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficients (ICCs for absolute agreement for individual items and domains. Results PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach’s alpha = .89 to .94; Emotional Response, 5 items; Cronbach’s alpha = .81 to .85. Test–retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66 and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively. Conclusions During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for

  1. Pretreatment with inhaled procaterol improves symptoms of dyspnea and quality of life in patients with severe COPD

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    Ohbayashi H

    2012-06-01

    Full Text Available Hiroyuki Ohbayashi,1,2 Mitsuru Adachi21Department of Allergy and Respiratory Medicine, Tohno-Kousei Hospital, Gifu; 2Department of Respiratory and Allergy Medicine, Showa University, Tokyo, JapanBackground: The clinical efficacy of short-acting β2-agonists administered before performing daily activities in chronic obstructive pulmonary disease (COPD is unclear. The aim of this study was to investigate the clinical effect of supplementary inhaled procaterol hydrochloride in patients with COPD.Methods: Thirty outpatients with moderate to severe COPD (Stage II–IV regularly using inhaled tiotropium bromide alone and with dyspnea during daily activities were enrolled. Subjects self-administered 20 µg of inhaled procaterol before daily activities no more than four times daily. Dyspnea symptom scores, St George's Respiratory Questionnaire (SGRQ activity domains, impulse oscillometry system parameters, and pulmonary function tests were recorded at the beginning and end of the 2-week study.Results: At baseline, more than 80% of subjects reported dyspnea when walking up a slope (100.0%, climbing stairs (100.0%, gardening (93.3%, walking on flat ground (90.0%, bathing (86.7%, getting on a bus or train (83.3%, and changing clothes (80.0%. After 2 weeks, subjects with Stage III symptoms had significantly improved dyspnea scores on walking up a slope (P = 0.047, climbing stairs (P = 0.014, gardening (P = 0.034, walking on flat ground (P = 0.006, getting on a bus or train (P = 0.039, and changing clothes (P = 0.045. Both symptom and activity SGRQ domains improved significantly in subjects with Stage III symptoms (P = 0.036 and P = 0.028, respectively. Resistance of small airways and low-frequency reactance area values improved significantly in subjects with Stage III symptoms (P = 0.003 and P = 0.004, respectively. No significant changes were found in pulmonary function tests.Conclusion: Use of supplementary inhaled procaterol before performing daily

  2. Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide

    DEFF Research Database (Denmark)

    Mogelvang, R; Goetze, JP; Schnohr, P;

    2007-01-01

    OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac...... the expected concentration of plasma proBNP based on age and gender was established for dyspneic subjects: an actual plasma proBNP concentration below half of the expected value ruled out left ventricular systolic and diastolic dysfunction (sensitivity 100%, 95% CI 100% to 100%; specificity 15%, 95% CI 12...

  3. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD.

    Science.gov (United States)

    Rocha, Flávia Roberta; Brüggemann, Ana Karla Vieira; Francisco, Davi de Souza; Medeiros, Caroline Semprebom de; Rosal, Danielle; Paulin, Elaine

    2017-01-01

    To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL. Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC. Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia. No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD. A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percep

  4. SHORT TERM EFFECT OF ACUPUNCTURE-TENS ON LUNG FUNCTIONS AND DYSPNEA FOR SUBJECTS WITH MODERATE COPD

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    Vinod Babu. K

    2015-10-01

    Full Text Available Background: Acupuncture TENS is used to improve pain instead of invasive acupuncture. Acupuncture shown to improve dyspnoea and lung functions in COPD (Chronic Obstructive Pulmonary Disease patients. The purpose of the study is to determine Short term effectiveness of Acupuncture-TENS in reducing dyspnea and improving lung functions for subjects with moderate COPD. Method: An experimental study design, selected 30 geriatric subjects with COPD randomized 15 subjects into each Study and Control group. Study group received Acu-TENS for 45 minutes for total 5 sessions, while control group received placebo TENS. Outcome measurements such as breathlessness using Modified Borg Scale (MBS, Lung functions using Pulmonary Function Test (PFT was measured before and after intervention. Results: Analysis from pre-intervention to post-intervention within study group found that there is statistically significant change in means of MBS, FEV1, FEV1/FVC ratio and within control group there is a statistically significant change in means of MBS, but there is no statistically significant change in means of FEV1, FVC and FEV1/FVC ratio. When post-intervention means were compared between the groups there is no statistically significant difference in means of MBS and FEV1, FVC and FEV1/FVC ratio. Conclusion: It is concluded that one week of Acu-TENS on EXL1 point found no significant effect on improving dyspnea and lung functions in subjects with moderate COPD in geriatric populations.

  5. Exertional dyspnea associated with chest wall strapping is reduced when external dead space substitutes for part of the exercise stimulus to ventilation.

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    Garske, Luke Albert; Lal, Ravin; Stewart, Ian Braidwood; Morris, Norman R; Cross, Troy James; Adams, Lewis

    2017-02-02

    Chest wall strapping has been used to assess mechanisms of dyspnea with restrictive lung disease. This study examined the hypothesis that dyspnea with restriction depends principally on the degree of reflex ventilatory stimulation. We compared dyspnea at the same (iso-)ventilation when added dead space provided a component of the ventilatory stimulus during constant work exercise. Eleven healthy males undertook a randomized controlled cross-over trial which compared four constant work exercise conditions (i) CTRL: unrestricted breathing at 90% Gas Exchange Threshold (GET), (ii) CTRL+DS: unrestricted breathing with 0.6 L dead space, at iso-ventilation to CTRL, (iii) CWS: chest strapping at 90% GET, (iv) CWS+DS: chest strapping with 0.6 L dead space, at iso-ventilation to CWS. Dead space was associated with reduced exercise intensity, and chest strapping reduced FVC by 30.4±2.2% (mean ± SE). Dyspnea at iso-ventilation was unchanged with CTRL+DS compared to CTRL (1.93±0.49 and 2.17±0.43, 0-10 numeric rating scale, respectively, P=0.244). Dyspnea was lower with CWS+DS compared to CWS (3.40±0.52 and 4.51±0.53 respectively, P=0.003). Perceived leg fatigue was reduced with CTRL+DS compared to CTRL (2.36±0.48 and 2.86±0.59 respectively, P=0.049) and lower with CWS+DS compared to CWS (1.86±0.30 and 4.00±0.79 respectively, P=0.006). With unrestricted breathing, dead space did not change dyspnea at iso-ventilation, inferring that dyspnea does not depend on the mode of reflex ventilatory stimulation in healthy individuals. With chest strapping, dead space presented a less potent stimulus to dyspnea. This suggests that dyspnea associated with chest strapping depends on the contribution of leg muscle work to ventilatory stimulation.

  6. Evaluation of a combination of low-dose ketamine and low-dose midazolam in terminal dyspnea-attenuation of "double-effect"

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    Abhijit Kanti Dam

    2008-01-01

    Full Text Available Aim: Of all symptoms in palliative medicine those concerning respiration are most excruciating and difficult to treat. Reticence about the use of morphine for palliation of dyspnea is common, especially in nonmalignant diseases, as there is a fear of causing respiratory depression, particularly where Chronic Obstructive Pulmonary Disease (COPD exists. This factor is also compounded by the lack of availability of morphine in parts of developing countries. Ketamine has excellent anesthetic and analgesic effects in addition to being easily available. It produces bronchodilatation and does not produce respiratory or cardiovascular depression. The author seeks to evaluate the role of low-dose (0.2 mg/kg ketamine and midazolam (0.02 mg/kg in the attenuation of terminal dyspnea. Methods: Sixteen patients with terminal dyspnea, admitted to the Critical Care Unit (CCU with cancer and other noncancer diagnoses were recruited. The subjective component of dyspnea was assessed using the Graphic Rating Scale (GRS, which has values from 0 - 10, 10 being maximum dyspnea. Each patient received a low-dose of ketamine and midazolam for relief of dyspnea. All the patients received low-flow (2 L/min. oxygen therapy via nasal cannula. Immediately after admission, all the patients were reassured and nursed in a decubitus position of their choice. The GRS was recorded at the point of admission, 10 minutes after starting oxygen therapy, and ten minutes after administration of low-dose ketamine and midazolam. Hemodynamic parameters were also recorded at these three points. Result: All the patients who enrolled in our study had significant dyspnea at admission, as was evident from the GRS scores of 8.250 (SD 0.91, respiratory rate of 28.56 (SD 5.0, mean arterial blood pressure (MABP of 102.7 (SD 14.63, pulse rate of 115.62 (SD 23.3, and SpO2 of 92.43 (SD 2.38. All the patients benefited from the combination of ketamine and midazolam, as evidenced by the statistically

  7. Sinus Venosus Atrial Septal Defect as a Cause of Palpitations and Dyspnea in an Adult: A Diagnostic Imaging Challenge

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    Michael S. Donovan

    2015-01-01

    Full Text Available Sinus venosus atrial septal defects (SV-ASD have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR. Cardiac magnetic resonance (CMR imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction.

  8. Unexplained hypotension and exertional dyspnea in a night-cycled peritoneal dialysis patient--a rare form of icodextrin hypersensitivity.

    Science.gov (United States)

    Onuigbo, Macaulay A C

    2014-01-01

    In recent years, icodextrin 7.5% has been used in PD as an alternative to glucose to achieve sustained reliable ultrafiltration (UF) and clearance without adversely increasing glucose absorption. Icodextrin is generally well tolerated. The most commonly reported adverse events are cutaneous reactions. We report a rare form of hypersensitivity to icodextrin 7.5% that was accompanied by dyspnea and symptomatic hypotension, without increased UF to account for the observed hypotension. Icodextrin produces symptomatic hypotension in up to 40% of patients by a known mechanism of increased UF and corresponding weight loss. However, it can also produce symptomatic hypotension accompanied by several other systemic symptoms in a hypersensitivity reaction. Discontinuation of the icodextrin results in prompt resolution of those symptoms. Treating nephrologists must be aware of this rare form of icodextrin hypersensitivity.

  9. Manejo paliativo de la disnea en el paciente terminal Palliative Management of Dyspnea in the Terminal Patient

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    Gabriel Carvajal-Valdy

    2011-06-01

    Full Text Available El manejo adecuado de síntomas en pacientes terminales permite a los pacientes y a sus seres queridos el espacio para resolver asuntos emocionales, psicológicos y espirituales. La disnea es un problema frecuente para los pacientes con condiciones terminales, y con estrategias clínicas efectivas puede aliviarse el síntoma, en la mayoría de los casos. El manejo sintomático puede llevarse a cabo concomitantemente con la corrección de la causa de fondo cuando esté justificada, y aunque los opioides son la terapia farmacológica de primera línea, el oxígeno suplementario y las benzodiacepinas pueden ser coadyuvantes cuando se encuentren indicados. En los casos refractarios a tratamiento, la sedación puede ser apropiada. Se realiza una revisión sobre el manejo óptimo de la disnea en pacientes con condiciones terminales, con base en la evidencia reciente más relevante.Proper management of symptoms allows terminal patients and their loved onesfamily the time to resolve emotional, psychological and spiritual issues. Dyspnea is a common problem for patients with terminal conditions and effective clinical strategies can relieve symptoms in most cases. Symptomatic management can be carried out concomitantly with the correction of the underlying cause when justified, although opioids are the first line of drug therapy, supplemental oxygen and benzodiazepines may help when they are indicated. In cases which are refractory to treatment sedation may be appropriate. We review in this paper the optimal management of dyspnea in patients with terminal conditions based on the most relevant recent evidence.

  10. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial

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    Rajashree Ranjita

    2016-07-01

    Conclusions: Findings indicate that IAYT benefits coal miners with COPD, reducing dyspnea; fatigue and PR, and improving functional performance and peripheral capillary SpO2%. Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation programs for COPD patients.

  11. Daily functioning of dyspnea, self-esteem and physical self in patients with moderate COPD before, during and after a first inpatient rehabilitation program.

    Science.gov (United States)

    Ninot, Gregory; Moullec, Gregory; Desplan, Jacques; Prefaut, Christian; Varray, Alain

    2007-11-30

    Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV1 = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p self-esteem and physical self scores between the two home periods (p self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p program increases the mean physical self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.

  12. Relationships between respiratory and airway resistances and activity-related dyspnea in patients with chronic obstructive pulmonary disease

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    Plantier L

    2012-03-01

    Full Text Available Bruno Mahut1,2, Aurore Caumont-Prim3,4, Laurent Plantier1,5, Karine Gillet-Juvin1,6, Etienne Callens1, Olivier Sanchez5,6, Brigitte Chevalier-Bidaud3, Plamen Bokov1, Christophe Delclaux1,5,71Assistance Publique – Hôpitaux de Paris (AP-HP, Hôpital Européen Georges Pompidou, Service de Physiologie – Clinique de la Dyspnée, F-75015 Paris, France; 2Cabinet La Berma, 4 avenue de la Providence; F-92160 Antony, France; 3AP-HP, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, F-75015 Paris, France; 4INSERM, Centre d'Investigation Épidémiologique 4, F-75015 Paris, France; 5Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75015 Paris, France; 6AP-HP, Hôpital Européen Georges Pompidou, Service de Pneumologie; F-75015 Paris, France; 7CIC 9201 Plurithématique, Hôpital Européen Georges Pompidou, F-75015 Paris, FranceBackground: The aims of the study were: (1 to compare numerical parameters of specific airway resistance (total, sRawtot, effective, sRaweff and at 0.5 L • s-1, sRaw0.5 and indices obtained from the forced oscillation technique (FOT: resistance extrapolated at 0 Hz [Rrs0 Hz], mean resistance [Rrsmean], and resistance/frequency slope [Rrsslope] and (2 to assess their relationships with dyspnea in chronic obstructive pulmonary disease (COPD.Methods: A specific statistical approach, principal component analysis that also allows graphic representation of all correlations between functional parameters was used. A total of 108 patients (mean ± SD age: 65 ± 9 years, 31 women; GOLD stages: I, 14; II, 47; III, 39 and IV, 8 underwent spirometry, body plethysmography, FOT, and Medical Research Council (MRC scale assessments.Results: Principal component analysis determined that the functional parameters were described by three independent dimensions (airway caliber, lung volumes and their combination, specific resistance and that resistance parameters of the two techniques

  13. A 15-Year-Old Boy with Anterior Chest Pain, Progressive Dyspnea, and Subcutaneous Emphysema of the Neck

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    Nicola Scichilone

    2009-01-01

    Full Text Available We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

  14. B-type Natriuretic Peptide Assay in Differentiating Congestive Heart Failure from Lung Disease in Patients Presenting with Dyspnea.

    Science.gov (United States)

    Islam, M A; Bari, M S; Islam, M N; Bari, M A; Siddique, S R; Islam, M Z; Begum, M S; Ahammed, S U; Rahman, M A

    2016-07-01

    This cross-sectional analytical study was conducted in Cardiology & Medicine Department of Mymensingh Medical College Hospital. After fulfilling the exclusion & inclusion criteria, B-type natriuretic peptide concentrations were measured in a convenience sample of 100 predominantly male (94%) dyspnic patients who got admitted in Cardiology & Medicine Department of Mymensingh Medical College & Hospital from November 2013 to October 2014. The diagnosis of Congestive Heart Failure (CHF) was based on generally accepted Framingham criteria with corroborative information including hospital course (response to diuretics, vasodilators, inotropes or hemodynamic monitoring) and results of further cardiac testing, including echocardiography. Patients with right heart failure from cor pulmonale were classified as having CHF. Pulmonary disease was confirmed by using the following diagnostic tools: i) A chest X-ray without signs of heart enlargement or pulmonary venous hypertension or a chest X-ray with signs of chronic obstructive lung disease, ii) Normal heart function as seen by echocardiography, iii) Abnormal pulmonary function tests or follow-up results and iv) A positive response to treatment with steroids, nebulizers or antibiotics in hospital. Patients with CHF (n=50) had mean BNP level 1146.72pg/ml (range 103 to 5000pg/ml), which is significantly higher than the group of patients with a final diagnosis of pulmonary disease (n=50) whose BNP was 34pg/ml (range 10 to 90pg/ml) (pcongestive heart failure from lung disease in patients presenting with dyspnea.

  15. Ranolazine versus placebo in patients with ischemic cardiomyopathy and persistent chest pain or dyspnea despite optimal medical and revascularization therapy: randomized, double-blind crossover pilot study

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    Shammas NW

    2015-03-01

    Full Text Available Nicolas W Shammas,1 Gail A Shammas,1 Kathleen Keyes,2 Shawna Duske,1 Ryan Kelly,1 Michael Jerin3 1Midwest Cardiovascular Research Foundation, 2Cardiovascular Medicine, Private Corporation, 3St Ambrose University, Davenport, IA, USA Background: Patients with ischemic cardiomyopathy (ICM may continue to experience persistent chest pain and/or dyspnea despite pharmacologic therapy and revascularization. We hypothesized that ranolazine would reduce anginal symptoms or dyspnea in optimally treated ICM patients.Methods: In this randomized, double-blind, crossover-design pilot study, 28 patients with ICM (ejection fraction less or equal 40% were included after providing informed consent. A total of 24 patients completed both placebo and ranolazine treatments and were analyzed. All patients were on treatment with a beta blocker, an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker, and at least one additional antianginal drug. After randomization, patients received up to 1,000 mg ranolazine orally twice a day, as tolerated, versus placebo. The primary end point was change in angina as assessed by the Seattle Angina Questionnaire (SAQ, or in dyspnea as assessed by the Rose Dyspnea Scale (RDS. Change in the RDS and SAQ score from baseline was compared, for ranolazine and placebo, using the Wilcoxon signed rank test or paired t-test.Results: Patients had the following demographic and clinical variables: mean age of 71.5 years; male (82.1%; prior coronary bypass surgery (67.9%; prior coronary percutaneous intervention (85.7%; prior myocardial infarction (82.1%; diabetes (67.9%; and mean ejection fraction of 33.1%. No statistical difference was seen between baseline RDS score and that after placebo or ranolazine (n=20 (P≥0.05. There was however, an improvement in anginal frequency (8/10 patients (P=0.058, quality of life (8/10 patients (P=0.048, and mean score of all components of the SAQ questionnaire (n=10 (P=0.047 with ranolazine

  16. Effect of dyspnea and clinical variables on the quality of life and functional capacity in patients with chronic obstructive pulmonary disease and congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Hale Karapolat; Sibel Eyigor; Alev Atasever; Mehdi Zoghi; Sanem Nalbantgil; Berrin Durmaz

    2008-01-01

    Background Chronic obstructive pulmonary disease(COPD)and congestive heart failure(CHF)are two chronic diseases that affect negatively the functional condition and quality of life of patients.We assessed the effect of symptoms and clinical variables on the functional capacity and quality of life in COPD and CHF patients.Methods The study included 42 COPD and 39 CHF patients.In both patient groups,dyspnea was assessed using Borg scale;functional capacity by shuttle-walk and cardiopulmonary exercise test and quailty of life by short fOrm-36 (SF36).Results No statistically significant difference was found in neither of the two disease groups regarding the dyspnea score,shuttle-walk test and the maiority of subgroup scores of SF36 (P>0.05).A statistically significant difference was obsewed in peak VO2 in favor of COPD group(P<0.05).No significant relationship was established between dyspnea score and forced expiratory volume in one second(FEV1)in COPD patients,and left ventricular ejection fraction(L.VEF)in CHF patients (P>0.05).A significant negative correlation was obsewed between dyspnea score and functional capacity tests in both disease groups(P<0.05).On the other hand,no relationship was found between L-VEF and FEV1 and quailty of life and functional capacity (P>0.05),Conclusions It was revealed that symptoms have an impact on functional capacity and quality of life in both disease groups,however,objective indicators of disease severity do not show a similar relationship.Therefore,in addition to the objective data related to the disease,we recommend that symptoms should also be taken into consideration to assess cardiopulmonary rehabilitation program and during following-up.

  17. A randomized controlled trial on the benefits and respiratory adverse effects of morphine for refractory dyspnea in patients with COPD: Protocol of the MORDYC study.

    Science.gov (United States)

    Verberkt, C A; van den Beuken-van Everdingen, M H J; Franssen, F M E; Dirksen, C D; Schols, J M G A; Wouters, E F M; Janssen, D J A

    2016-03-01

    Dyspnea is one of the most reported symptoms of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and is often undertreated. Morphine has proven to be an effective treatment for dyspnea and is recommended in clinical practice guidelines, but questions concerning benefits and respiratory adverse effects remain. This study primarily evaluates the impact of oral sustained release morphine (morphine SR) on health-related quality of life and respiratory adverse effects in patients with COPD. Secondary objectives include the impact on exercise capacity, the relationship between description and severity of dyspnea and the presence of a clinically relevant response to morphine, and cost-effectiveness. A single-center, randomized, double blind, placebo controlled intervention study will be performed in 124 patients with COPD who recently completed a comprehensive pulmonary rehabilitation program. Participants will receive 20-30 mg/24h morphine SR or placebo for four weeks. After the intervention, participants will be followed for twelve weeks. Outcomes include: the COPD Assessment Test, six minute walking test, Multidimensional Dyspnea Scale and a cost diary. Furthermore, lung function and arterial blood gasses will be measured. These measures will be assessed during a baseline and outcome assessment, two home visits, two phone calls, and three follow-up assessments. The intervention and control group will be compared using uni- and multivariate regression analysis and logistic regression analysis. Finally, an economic evaluation will be performed from a societal and healthcare perspective. The current manuscript describes the rationale and methods of this study and provides an outline of the possible strengths, weaknesses and clinical consequences.

  18. Effect of an aerobic exercise program and a weight circuit program on the quality of life, dyspnea, and cardiorespiratory resistance in subjects with chronic pulmonary disease

    Directory of Open Access Journals (Sweden)

    Henry Delgado Acosta

    2007-07-01

    Full Text Available The objective of this study was to determinate the effect of an aerobic exercise program and a weight circuit program on the quality of life, dyspnea and cardiorespiratory resistance in subjects with Chronic Pulmonary Disease (CPD. Methodology: the rehabilitation program was conducted for eight weeks, including a pre-test and a post-test, one on-site supervised session per week and two home sessions with direct telephone communication. Instruments: the St. George Respiratory Questionnaire was used to measure quality of life, the Borg Scale to measure dyspnea, and the Six Minute Walk Test to measure cardiorespiratory resistance. Subjects: 38 patients previously diagnosed with CPD, 18 men and 20 women; 27 subjects with an obstructive pathology and 11 with a restrictive pathology, with an average age of 69.8 ± 9.34 years.  Subjects were randomly divided into two groups: one did aerobic exercises (22 subjects and the other one did aerobic exercises and resistance training (16 subjects. Statistical Analysis: Four-Way ANOVA (2x2x2x2 for the variables sex, treatment, and pathology.  Results: significant differences were found between measurements of the following variables: dyspnea (pre-test: 7.18 ± 0.69 points and post-test: 4.89 ± 0.68 points (F = 228.770; p 0.05, or any interaction between variables (p>0.05. Conclusion: aerobic and anaerobic exercises improve the degree of dyspnea, the quality of life, and the cardiorespiratory resistance in CPD patients.

  19. Clinician gestalt estimate of pretest probability for acute coronary syndrome and pulmonary embolism in patients with chest pain and dyspnea.

    Science.gov (United States)

    Kline, Jeffrey A; Stubblefield, William B

    2014-03-01

    Pretest probability helps guide diagnostic testing for patients with suspected acute coronary syndrome and pulmonary embolism. Pretest probability derived from the clinician's unstructured gestalt estimate is easier and more readily available than methods that require computation. We compare the diagnostic accuracy of physician gestalt estimate for the pretest probability of acute coronary syndrome and pulmonary embolism with a validated, computerized method. This was a secondary analysis of a prospectively collected, multicenter study. Patients (N=840) had chest pain, dyspnea, nondiagnostic ECGs, and no obvious diagnosis. Clinician gestalt pretest probability for both acute coronary syndrome and pulmonary embolism was assessed by visual analog scale and from the method of attribute matching using a Web-based computer program. Patients were followed for outcomes at 90 days. Clinicians had significantly higher estimates than attribute matching for both acute coronary syndrome (17% versus 4%; Psyndrome (r(2)=0.15) and pulmonary embolism (r(2)=0.06). Areas under the receiver operating characteristic curve were lower for clinician estimate compared with the computerized method for acute coronary syndrome: 0.64 (95% confidence interval [CI] 0.51 to 0.77) for clinician gestalt versus 0.78 (95% CI 0.71 to 0.85) for attribute matching. For pulmonary embolism, these values were 0.81 (95% CI 0.79 to 0.92) for clinician gestalt and 0.84 (95% CI 0.76 to 0.93) for attribute matching. Compared with a validated machine-based method, clinicians consistently overestimated pretest probability but on receiver operating curve analysis were as accurate for pulmonary embolism but not acute coronary syndrome. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  20. Indacaterol on dyspnea in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized placebo-controlled trials.

    Science.gov (United States)

    Han, Jiangna; Dai, Lu; Zhong, Nanshan

    2013-04-25

    Indacaterol is a novel, once-daily (od), inhaled, long-acting β(2)-agonist bronchodilator for maintenance treatment of airflow limitation in patients with COPD. The aim of this study was to evaluate the efficacy of indacaterol on dyspnea, using available randomized placebo-controlled trials. A systematic search was made of MEDLINE, EMBASE, the Cochrane trials databases, and a manual search of journals. Randomized placebo-controlled trials of 12 weeks or more comparing indacaterol with placebo were reviewed, and eligible studies were included in a meta-analysis. The odds ratio (OR) for likelihood of achieving TDI score ≥ 1 after 12 weeks of treatment was used as an outcome measure to compare indacaterol to placebo. Six trials were included in the analysis. Relative to placebo, the overall ORs for response were: indacaterol 75 μg od 1.784 (95% CI 1.282 to 2.482); indacaterol 150 μg od 2.149 (95% CI 1.746 to 2.645); and indacaterol 300 μg od 2.458 (95% CI 2.010 to 3.006). Overall OR for response in TDI tended to increase with higher indacaterol doses. Patients receiving indacaterol had clinically significant improvements in symptoms of dyspnea compared to placebo. Incremental benefits in TDI were observed with increasing doses. Indacaterol may provide patients and physicians with a useful treatment option in symptomatic patients with dyspnea.

  1. Dyspnea during Advanced Cancer

    Science.gov (United States)

    ... by chemotherapy. Conditions that are not related to cancer: Chronic obstructive pulmonary disease (COPD), such as chronic bronchitis or emphysema . ... depends on the type and stage of the cancer being treated. Laser therapy for tumors inside large ... Postradiation bronchiolitis obliterans Steroid ...

  2. DYSPNEA AFTER PNEUMONECTOMY

    NARCIS (Netherlands)

    SMEENK, FWJM; TWISK, SPM; BERREKLOUW, E; GOOSZEN, HC; POSTMUS, PE

    1991-01-01

    We report the case of a 61 yr old male, who developed a severe right-to-left shunt through a patent foramen ovale, in the absence of elevated right-sided heart pressures, two months after a left-sided pneumonectomy. This is considered to be a rare complication after pneumonectomy. However, taking in

  3. Asynchrony and dyspnea.

    Science.gov (United States)

    Branson, Richard D; Blakeman, Thomas C; Robinson, Bryce R H

    2013-06-01

    Patient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony between the patient and ventilator is complex and can be affected by the ventilator settings, type of ventilator, patient-ventilator interface, and sedation. Inspections of airway pressure and flow waveforms are reliable methods for detecting asynchrony, and automated detection seems accurate. A number of types of asynchronies have been defined, and asynchrony during invasive and noninvasive ventilation have different calling cards. There is a clear association between asynchrony, ventilator-induced diaphragmatic dysfunction, and duration of mechanical ventilation. Whether these are cause and effect or simply associated remains to be determined.

  4. Self-Reported Dyspnea is Associated With Impaired Global Longitudinal Strain in Ambulatory Type 1 Diabetes Patients With Normal Ejection Fraction and Without Known Heart Disease - The Thousand & 1 Study

    DEFF Research Database (Denmark)

    Jensen, Magnus Thorsten; Risum, Niels; Rossing, Peter

    2016-01-01

    AIMS: Identification of early signs and symptoms of heart disease is important in type 1 diabetes (T1DM). Global longitudinal strain (GLS) by speckle-tracking echocardiography can detect subtle impairments in myocardial function. We investigated the association between myocardial function......-IV. LVEF did not differ between groups of dyspnea in neither univariable nor multivariable models (p>0.1). E/e' was associated with degree of dyspnea in both univariable (p

  5. The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients.

    Science.gov (United States)

    Weber, Cristina K; Miglioranza, Marcelo H; Moraes, Maria A P de; Sant'anna, Roberto T; Rover, Marciane M; Kalil, Renato A K; Leiria, Tiago Luiz L

    2014-01-01

    Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. We included 58 patients (65.5% male, age 43.5 ± 11 years) with a mean left ventricular ejection fraction of 27 ± 6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017). In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified.

  6. MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study

    Directory of Open Access Journals (Sweden)

    Roussos Charis

    2010-05-01

    Full Text Available Abstract Background Exertional dyspnea is the most prominent and disabling feature in idiopathic pulmonary fibrosis (IPF. The Medical Research Chronic (MRC chronic dyspnea score as well as physiological measurements obtained during cardiopulmonary exercise testing (CPET and the 6-minute walk test (6MWT are shown to provide information on the severity and survival of disease. Methods We prospectively recruited IPF patients and examined the relationship between the MRC score and either CPET or 6MWT parameters known to reflect physiologic derangements limiting exercise capacity in IPF patients Results Twenty-five patients with IPF were included in the study. Significant correlations were found between the MRC score and the distance (r = -.781, p 2 at the initiation and the end (r = -.542, p = 0.005 and r = -.713, p VO2 peak/kg (r = -.731, p 2 at peak exercise (r = -. 682, p 2 slope (r = .731, p 2 at AT (r = .630, p = 0.002 and the Borg scale at peak exercise (r = .50, p = 0.01 for the CPET. In multiple logistic regression analysis, the only variable independently related to the MRC is the distance walked at the 6MWT. Conclusion In this population of IPF patients a good correlation was found between the MRC chronic dyspnoea score and physiological parameters obtained during maximal and submaximal exercise testing known to reflect ventilatory impairment and exercise limitation as well as disease severity and survival. This finding is described for the first time in the literature in this group of patients as far as we know and could explain why a simple chronic dyspnea score provides reliable prognostic information on IPF.

  7. Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea

    Directory of Open Access Journals (Sweden)

    Daniel Mantuani, MD

    2016-01-01

    Full Text Available Introduction: Determining the etiology of acute dyspnea in emregency department (ED patients is often difficult. Point-of-care ultrasound (POCUS holds promise for improving immediate diagnostic accuracy (after history and physical, thus improving use of focused therapies. We evaluate the impact of a three-part POCUS exam, or “triple scan” (TS – composed of abbreviated echocardiography, lung ultrasound and inferior vena cava (IVC collapsibility assessment – on the treating physician’s immediate diagnostic impression. Methods: A convenience sample of adults presenting to our urban academic ED with acute dyspnea (Emergency Severity Index 1, 2 were prospectively enrolled when investigator sonographers were available. The method for performing components of the TS has been previously described in detail. Treating physicians rated the most likely diagnosis after history and physical but before other studies (except electrocardiogram returned. An investigator then performed TS and disclosed the results, after which most likely diagnosis was reassessed. Final diagnosis (criterion standard was based on medical record review by expert emergency medicine faculty blinded to TS result. We compared accuracy of pre-TS and post-TS impression (primary outcome with McNemar’s test. Test characteristics for treating physician impression were also calculated by dichotomizing acute decompensated heart failure (ADHF, chronic obstructive pulmonary disease (COPD and pneumonia as present or absent. Results: 57 patients were enrolled with the leading final diagnoses being ADHF (26%, COPD/ asthma (30%, and pneumonia (28%. Overall accuracy of the treating physician’s impression increased from 53% before TS to 77% after TS (p=0.003. The post-TS impression was 100% sensitive and 84% specific for ADHF. Conclusion: In this small study, POCUS evaluation of the heart, lungs and IVC improved the treating physician’s immediate overall diagnostic accuracy for ADHF

  8. Accuracy of point-of-care lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs and cats with acute dyspnea.

    Science.gov (United States)

    Ward, Jessica L; Lisciandro, Gregory R; Keene, Bruce W; Tou, Sandra P; DeFrancesco, Teresa C

    2017-03-15

    OBJECTIVE To determine the accuracy of a point-of-care lung ultrasonography (LUS) protocol designed to diagnose cardiogenic pulmonary edema (CPE) in dyspneic dogs and cats. DESIGN Diagnostic test evaluation. ANIMALS 76 dogs and 24 cats evaluated for dyspnea. PROCEDURES Dogs and cats were evaluated by LUS; B lines were counted at 4 anatomic sites on each hemithorax. A site was scored as positive when > 3 B lines were identified. Animals with ≥ 2 positive sites identified on each hemithorax were considered positive for CPE. Medical records were evaluated to obtain a final diagnosis (reference standard) for calculation of the sensitivity and specificity of LUS and thoracic radiography for the diagnosis of CPE. RESULTS Dogs and cats with a final diagnosis of CPE had a higher number of positive LUS sites than did those with noncardiac causes of dyspnea. Overall sensitivity and specificity of LUS for the diagnosis of CPE were 84% and 74%, respectively, and these values were similar to those of thoracic radiography (85% and 87%, respectively). Use of LUS generally led to the misdiagnosis of CPE (ie, a false-positive result) in animals with diffuse interstitial or alveolar disease. Interobserver agreement on LUS results was high (κ > 0.85). CONCLUSIONS AND CLINICAL RELEVANCE LUS was useful for predicting CPE as the cause of dyspnea in dogs and cats, although this technique could not be used to differentiate CPE from other causes of diffuse interstitial or alveolar disease. Point-of-care LUS has promise as a diagnostic tool for dyspneic dogs and cats.

  9. A very rare cause of dyspnea with a unique presentation on a computed tomography scan of the chest: macrophage activation syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Brandao-Neto, Rodrigo Antonio [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Clinical Emergency Dept.; Santana, Alfredo Nicodemos Cruz; Danilovic, Debora Lucia Seguro; Mendonca, Berenice Bilharinho de [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina]. E-mail: alfredonicodemos@hotmail.com; Bernardi, Fabiola Del Carlo [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Dept. of Pathology; Barbas, Carmen Silvia Valente [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Dept. of Pulmonology

    2008-02-15

    Macrophage activation syndrome is a rare and potentially life-threatening disease. It occurs due to immune dysregulation manifested as excessive macrophage proliferation, typically causing hepatosplenomegaly, pancytopenia and hepatic dysfunction. Here, we report an unusual case of macrophage activation syndrome presenting as dyspnea, as well as (reported here for the first time) high resolution computed tomography findings of an excavated nodule, diffuse ground glass opacities and consolidations (mimicking severe pneumonia or alveolar hemorrhage). The patient was successfully treated with human immunoglobulin. We recommend that macrophage activation syndrome be considered in the differential diagnosis of respiratory failure. Rapid diagnosis and treatment are essential to achieving favorable outcomes in patients with this syndrome. (author)

  10. Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD

    Directory of Open Access Journals (Sweden)

    Rhee CK

    2015-08-01

    Full Text Available Chin Kook Rhee,1 Jin Woo Kim,2 Yong Il Hwang,3 Jin Hwa Lee,4 Ki-Suck Jung,3 Myung Goo Lee,5 Kwang Ha Yoo,6 Sang Haak Lee,7 Kyeong-Cheol Shin,8 Hyoung Kyu Yoon9 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, 3Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 8Regional Center for Respiratory Disease, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Background and objective: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines, either a modified Medical Research Council (mMRC dyspnea score of ≥2 or a chronic obstructive pulmonary disease (COPD assessment test (CAT score of ≥10 is considered to represent COPD patients who are

  11. Postural correction for kyphosis improves the dyspnea index and pulmonary functions in patients with chronic obstructive pulmonary disease: A randomized trial over 12 weeks

    Directory of Open Access Journals (Sweden)

    Gajanan S Gaude

    2014-01-01

    Full Text Available Background: Patients with chronic obstructive pulmonary disease (COPD tend to attain forward shoulder posture and kyphosis and this affects their respiratory functions. Correcting this posture leads to straightening of the spine leading to improvement in the lung functions. The present study was carried out to evaluate the additional effect of correction of kyphosis in COPD patients. Objectives: The objective of the following study is to evaluate the effect of postural correction with respiratory muscle training in patients with COPD. Settings and Study Design: A randomized controlled prospective study in a tertiary care hospital in out-patients for 12 weeks. Materials and Methods: Confirmed cases of COPD were randomly divided into two groups by computer generated randomization: Study and control group. Study group patients received combination of respiratory muscle training and postural correction by a brace, whereas the control group received only respiratory muscle training exercises. The outcome measures evaluated were maximal inspiratory pressure, spirometry values, dyspnea scores and 6-min walk distance (MWD. Statistical Analysis: Statistical analysis was performed using Statistical Package for the Social Sciences version 16. Descriptive statistics are reported as means and standard deviation. Results: A total of 120 patients were included in the study with 60 in each group. Both groups showed a significant improvement in the inspiratory muscle strength, lung functions, dyspnea index and functional capacity at 8 weeks and 12 weeks of intervention. However, the interscapular distance, percentage of kyphotic index (KI and grades of a plumb line (PL measurement reduced significantly in the study group when compared to the control group (P < 0.01. There was also significant improvement in the 6-MWD and reduction of Borg scale of dyspnea when compared to the control group (P < 0.01. The pulmonary functions improvement was better in the study

  12. Reliability of the Brazilian Portuguese version of the fatigue severity scale and its correlation with pulmonary function, dyspnea, and functional capacity in patients with COPD

    Directory of Open Access Journals (Sweden)

    Silvia Valderramas

    2013-06-01

    Full Text Available OBJECTIVE: To describe the intra-rater and inter-rater reliability of the Brazilian Portuguese version of the fatigue severity scale (FSS in patients with COPD and to identify the presence of its association with parameters of pulmonary function, dyspnea, and functional capacity. METHODS: This was an observational cross-sectional study involving 50 patients with COPD, who completed the FSS in interviews with two researchers in two visits. The FSS scores were correlated with those of the Medical Research Council (MRC scale, as well as with FEV1, FVC, and six-minute walk distance (6MWD. RESULTS: The mean age of the patients was 69.4 ± 8.23 years, whereas the mean FEV1 was 46.5 ± 20.4% of the predicted value. The scale was reliable, with an intraclass correlation coefficient of 0.90 (95% CI, 0.81-0.94; p < 0.01. The FSS scores showed significant correlations with those of MRC scale (r = 0.70; p < 0.01, as well as with 6MWD (r = –0.77; p < 0.01, FEV1 (r = –0.38; p < 0.01, FVC (r = –0.35; p < 0.01, and stage of the disease in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria (r = 0.37; p < 0.01. CONCLUSIONS: The Brazilian Portuguese version of the FSS proved reliable for use in COPD patients in Brazil and showed significant correlations with sensation of dyspnea, functional capacity, pulmonary function, and stage of the disease.

  13. Reliability of the Brazilian Portuguese version of the fatigue severity scale and its correlation with pulmonary function, dyspnea, and functional capacity in patients with COPD*

    Science.gov (United States)

    Valderramas, Silvia; Camelier, Aquiles Assunção; da Silva, Sinara Alves; Mallmann, Renata; de Paulo, Hanna Karine; Rosa, Fernanda Warken

    2013-01-01

    OBJECTIVE: To describe the intra-rater and inter-rater reliability of the Brazilian Portuguese version of the fatigue severity scale (FSS) in patients with COPD and to identify the presence of its association with parameters of pulmonary function, dyspnea, and functional capacity. METHODS: This was an observational cross-sectional study involving 50 patients with COPD, who completed the FSS in interviews with two researchers in two visits. The FSS scores were correlated with those of the Medical Research Council (MRC) scale, as well as with FEV1, FVC, and six-minute walk distance (6MWD). RESULTS: The mean age of the patients was 69.4 ± 8.23 years, whereas the mean FEV1 was 46.5 ± 20.4% of the predicted value. The scale was reliable, with an intraclass correlation coefficient of 0.90 (95% CI, 0.81-0.94; p < 0.01). The FSS scores showed significant correlations with those of MRC scale (r = 0.70; p < 0.01), as well as with 6MWD (r = –0.77; p < 0.01), FEV1 (r = –0.38; p < 0.01), FVC (r = –0.35; p < 0.01), and stage of the disease in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria (r = 0.37; p < 0.01). CONCLUSIONS: The Brazilian Portuguese version of the FSS proved reliable for use in COPD patients in Brazil and showed significant correlations with sensation of dyspnea, functional capacity, pulmonary function, and stage of the disease. PMID:24068263

  14. Dispnéia por compressão de estruturas mediastinais por cisto pericárdico Dyspnea through compression of mediastinal structures due to pericardial cyst

    Directory of Open Access Journals (Sweden)

    Jeanine Eggers Caramori

    2005-06-01

    Full Text Available Caso de uma paciente com 65 anos, apresentando dispnéia aos esforços e dor torácica lateral direita como principais sintomas de um cisto no pericárdio, de aproximadamente 8 cm. Os exames físico, bioquímico e eletrocardiográfico não evidenciaram alterações. O resultado dos exames de radiografia de tórax, tomografia computadorizada e ecocardiograma foi sugestivo de cisto pericádico. Com base nessas evidências clínicas a paciente foi submetida à toracotomia em região torácica lateral direita e realizada excisão completa da massa mediastinal com remissão total dos sintomas.A case of a 65-year-old patient, showing dyspnea to strains and right side pain as main symptoms of an approximately 8 cm cyst in the pericardium. The physical, biochemical and electrocardiographic examinations did not evince any changes. The results from the thoracic radiography, CT scan and echocardiogram suggested pericardial cyst. Based on those clinical evidences, the patient was submitted to a thoracotomy in the right side thoracic region and a complete excision of the mediastinal mass was performed, with complete remission of the symptoms.

  15. 高热、咳嗽、呼吸困难、双肺多发实变%High Fever,Cough,Dyspnea and Bilateral Multiple Pulmonary Consolidation

    Institute of Scientific and Technical Information of China (English)

    余碧芸; 吴宏成; 汤耀东; 周莹艳; 汪春年

    2015-01-01

    临床有多种疾病可因双肺多发实变而发生急性呼吸衰竭,但病情危重病理检查又无法提供明确诊断时会让临床医师感到棘手。本文报道1例高热、咳嗽、呼吸困难、双肺多发实变的危重患者,经皮肺穿刺活检病理检查后诊断仍不明确,笔者所在科室对其临床资料进行了分析讨论,临床考虑为重症隐源性机化性肺炎或急性间质性肺炎,最终抢救成功。%many diseases cause acute respiratory failure as a result of bilateral multiple pulmonary consolidation,and it puts physicians in a difficult situation when the patients is in critical condition and the pathological examination can′t provide a definite diagnosis. This paper reported a case of a critical patient with high fever, cough, dyspnea and bilateral multiple pulmonary consolidation. The pathological examination by percutaneous pulmonary biopsy could not give a definite diagnosis. After the analysis of the clinical data,the possibility of critical cryptogenic organizing pneumonia or acute interstitial pneumonia was considered,and the patient was successfully salvaged.

  16. Efficacy of indacaterol 75 μg once-daily on dyspnea and health status: results of two double-blind, placebo-controlled 12-week studies.

    Science.gov (United States)

    Gotfried, Mark H; Kerwin, Edward M; Lawrence, David; Lassen, Cheryl; Kramer, Benjamin

    2012-12-01

    Indacaterol is an inhaled, once-daily, long-acting ®(2)-agonist for the treatment of COPD. Most previous studies were conducted with doses of 150 and/or 300 μg once-daily, and data with the 75 μg dose are limited. Two identically designed studies were, therefore, conducted to evaluate the efficacy and safety of the 75 μg once-daily dose. In two double-blind studies conducted in the USA, patients with moderate-to-severe COPD were randomized to treatment with indacaterol 75 μg once-daily (n = 163 and 159) or matching placebo (n = 160 and 159) for 12 weeks. The primary variable was forced expiratory volume in 1 s measured 24 h post-dose after 12 weeks (reported elsewhere). This report describes secondary efficacy endpoints, including transition dyspnea index (TDI) and St George's Respiratory Questionnaire (SGRQ) total scores, and the percentages of patients with improvements of or above the minimal clinically important difference (MCID; ≥1 in TDI score and ≥4 in SGRQ score). Differences between indacaterol and placebo for TDI total score at week 12 were 1.23 (p indacaterol at week 12 (2.0 and 0.9 with placebo), with odds ratios for achieving the MCID of 1.80 (p = 0.024) and 1.71 (p = 0.031). Patients receiving indacaterol had statistically significant or numerical improvements in diary-derived symptom variables compared with placebo. Treatment with indacaterol 75 μg may provide useful improvements in patient-reported outcomes in patients with moderate-to-severe COPD.

  17. Exercise capacity and physical activity in patients with COPD and healthy subjects classified as Medical Research Council dyspnea scale grade 2.

    Science.gov (United States)

    Johnson-Warrington, Vicki; Harrison, Samantha; Mitchell, Katy; Steiner, Mick; Morgan, Mike; Singh, Sally

    2014-01-01

    Patients with chronic obstructive pulmonary disease (COPD) are often classified by Medical Research Council (MRC) dyspnea grade and comparisons thus made to healthy individuals. The MRC grade of a healthy population is assumed to be grade 1, although this may be inaccurate. Physical activity and exercise capacity are not well-defined for those with MRC grade 2. This study was undertaken to establish whether there are differences in physical activity and exercise capacity between individuals with COPD and healthy controls, who have all assessed themselves as MRC grade 2. Patients with COPD (n = 83) and 19 healthy controls, with a self-selected MRC grade of 2, completed the Incremental Shuttle Walk Test (ISWT) and wore a SenseWear (BodyMedia, Pittsburgh, PA) activity monitor for 12 hours for 2 weekdays. Adjusting for age, step count and ISWT were significantly reduced for those with COPD, compared with healthy controls (P < .05). Patients with COPD achieved mean (SD) 425.5 (131.3) m on ISWT and took 6022 (3276) steps per day compared with 647.8 (146.3) m and 9462 (4141) steps per day for healthy controls. For subjects achieving 10 000 steps per day, 8 (42.11%) healthy controls achieved this level compared with 7 (8.43%) patients with COPD (P < .01). Healthy individuals may report functional limitations and categorize themselves as MRC grade 2. However, despite both groups subjectively considering themselves similarly functionally limited, exercise capacity and physical activity were significantly reduced in patients with COPD compared with healthy participants. This highlights the importance of early interventions to increase physical performance and prevent functional decline for patients with COPD.

  18. Analysis of the common causes of dyspnea in 198 uremic patients%198例尿毒症患者呼吸困难常见病因分析

    Institute of Scientific and Technical Information of China (English)

    何翠嫦; 马晓燕; 韦启麒

    2014-01-01

    目的:探讨尿毒症患者呼吸困难常见病因,以指导抢救及预防措施。方法对住院的198例尿毒症出现呼吸困难患者的临床资料进行回顾性分析。结果198例均予加强血液透析3次/周,同时结合其他内科治疗,196例好转,2例死亡。结论尿毒症患者呼吸困难常见原因为急性左心衰、重度代谢性酸中毒、急性左心衰合并重度代谢性酸中毒及大量胸腔积液等,其危险因素可能为血液透析不充分、高血压控制不佳、贫血、代谢性酸中毒、感染等。%Objective To explore the common causes of dyspnea in uremic patients in order to provide the guidance for making treament and prevention measures .Methods Clinical data of 198 uremic inpatients with dysp-nea were analyzed retrospectively .Results After strengthening hemodialysis three times a week and using other inter-nal medicine treatment, The improvement was obtained in 196 patients, 2 patients died.Conclusion The common causes of dyspnea in uremic patients included acute heart failure , seriously metabolic acidosis , acute heart failure combined with seriously metabolic acidosis , massive pleural effusions and so on .The risk factors included inadeguate hemodialysis, the hypertension not being well controlled , anemia, metabolic acidosis, infection and so on.

  19. The Effect of Methylprednisolone on the Quality of Life in Advanced Lung Cancer Patients with Dyspnea%甲强龙对晚期肺癌呼吸困难患者生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    赵欣欣; 王玉梅

    2015-01-01

    Objective To analyze the changes of the quality of life of patients with advanced lung cancer accompanied with dyspnea before and af⁃ter methylprednisolone therapy,so as to investigate the effects of methylprednisolone on the quality of life of the patients. Methods Totally 134 ad⁃vanced lung cancer patients with dyspnea were divided into two groups,the methylprednisolone group and the control group,according to whether they consented to the use of hormone therapy. All of them were followed with visual analog scale(VAS),the quality of life questionnaire⁃core 30 (EORTC QLQ⁃C30)and the quality of life questionnaire⁃lung cancer module 13(QLQ⁃LC13)questionnaire. Results At one hour after treatment compared to before treatment,the VAS scores for both groups were significantly decreased(P<0.01),and the score for the methylprednisolone group were lower than the control group(P<0.05). At two weeks after treatment compared to before treatment,social function,emotional function, and overall quality of life scores for both groups were decreased(P<0.05). But the scores of pain,dyspnea,insomnia,loss of appetite,constipation, dysphagia were increased(P<0.05). Compared to the methylprednisolone group,the dyspnea and pain score for the control group was higher(P<0.05). Conclusion Methylprednisolone may improve the quality of life of advanced lung cancer patients with dyspnea in short term and slow down the deteriorating process of their quality of life.%目的:通过分析甲强龙治疗晚期肺癌患者呼吸困难前后患者生活质量的变化,探讨甲强龙对患者生活质量的影响。方法选取已确诊为晚期肺癌的呼吸困难患者134例,根据患者是否同意使用激素治疗分成甲强龙组和对照组,进行视觉模拟量表(VAS)、生活质量核心量表(EORTC QLQ⁃C30)、肺癌特异性量表(QLQ⁃LC13)问卷调查。结果治疗后1 h 2组患者VAS评分均显著低于治疗前(P<0.01),甲强龙组治疗

  20. Uso de descritores de dispneia desenvolvidos no Brasil em pacientes com doenças cardiorrespiratórias ou obesidade Dyspnea descriptors developed in Brazil: application in obese patients and in patients with cardiorespiratory diseases

    Directory of Open Access Journals (Sweden)

    Christiane Aires Teixeira

    2011-08-01

    Full Text Available OBJETIVO: Desenvolver um conjunto de termos descritores de dispneia para uso no Brasil. Investigar a utilidade desses descritores em quatro condições distintas que cursam com dispneia. MÉTODOS: Um conjunto de 111 frases descritivas da sensação de falta de ar foi coletado a partir das informações de 67 pacientes e de 10 profissionais da saúde. Tais frases foram analisadas e reduzidas a 15 expressões, em função de sua frequência de citação, similaridade de significados e potencial importância fisiopatológica. O conjunto de expressões foi aplicado a 50 pacientes com asma, 50 com DPOC, 30 com insuficiência cardíaca e 50 com obesidade graus II ou III. Os três melhores termos selecionados pelos pacientes foram estudados por análise de agrupamentos. Também foram investigadas as possíveis associações entre os agrupamentos encontrados e as quatro condições clínicas incluídas. RESULTADOS: O emprego dessa lista de descritores levou a uma solução com sete agrupamentos, denominados sufoco, aperto, rápido, fadiga, abafado, trabalho/inspiração e falta de ar. Houve grande superposição no uso de descritores pelos pacientes com as quatro condições clínicas. A asma mostrou associações expressivas com sufoco e trabalho/inspiração, enquanto DPOC e insuficiência cardíaca, com sufoco, trabalho/inspiração e falta de ar; e obesidade, com falta de ar apenas. CONCLUSÕES: Pacientes no Brasil habituados a sentir dispneia utilizam diferentes termos para descrever seu sintoma, e tais descrições podem ser agrupadas em conjuntos por similaridade. Tais agrupamentos não mostraram utilidade na distinção diagnóstica entre os grupos avaliados neste estudo.OBJECTIVE: To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. METHODS: We collected 111

  1. Computer-Aided Tomographic Analysis of Interstitial Lung Disease (ILD in Patients with Systemic Sclerosis (SSc. Correlation with Pulmonary Physiologic Tests and Patient-Centred Measures of Perceived Dyspnea and Functional Disability.

    Directory of Open Access Journals (Sweden)

    Fausto Salaffi

    Full Text Available This study was designed (a to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM system in patients with systemic sclerosis (SSc,-related interstitial lung disease (SSc-ILD, (b to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO], patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR methods, and (c to identify potential surrogate measures from quantitative and visual HRCT measurement.126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score, VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI. HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted results and patient-centred measures, were calculated using linear regression analysis and Pearson's correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis.Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001. CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001. In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods.Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC, patient-centred measures of perceived

  2. Exploration on the Treatment of Dyspnea Syndrome by Zhang Zhongjing in Shanghan Zabing Lun%张仲景《伤寒杂病论》喘证治法探微

    Institute of Scientific and Technical Information of China (English)

    刘建新; 吴雪梅; 田新刚

    2012-01-01

    目的:探讨《伤寒杂病论》喘证的治疗.方法:解读张仲景有关喘证的原文.结果:通过对《伤寒杂病论》有关条文的理解,归纳、总结治喘13法:辛温发汗、宣肺平喘;解肌祛风、降气定喘;辛温解表、化饮平喘;辛凉清热、宣肺平喘;表里双解、清热平喘;荡涤燥热,泻实平喘;宣泄寒湿,搐鼻定喘;泻下逐痰 开肺平喘;宣肺泄热,降逆平喘;通阳散结,豁痰下气平喘;补虚散饮,通阳利水平喘;温运脾阳,除湿散寒平喘;扶正祛邪,标本兼顾以定喘.结论:《伤寒杂病论》辨治喘证,在辨证上,既言证候,又指病机.施治上,则根据病机、病性、病位不同,因势利导,立方严谨,用药精当.%Objective:To investigate the treatment of dyspnea syndrome in Shanghan Zabing Lun. Method:The original words of Zhang Zhongjing about dyspnea syndrome were interpreted. Results:Through the understanding of the relevant provisions of Shanghan Zabing Lun, 13 laws for curing dyspnea syndrome were summarized:sweating by taking medicinals with drugs pungent in flavor and warm in property,ventilating the lung to arrest asthma;expelling pathogenic factors from muscles and skin and dispersing pathogenic wind,relieving respiratory distress by guiding Qi downward;relieving the exterior syndrome with drugs pungent in flavor and warm in property,dissolving the water rentention and relieving asthma;clearing heat with drugs pungent in flavor and cool in property,faciliating the flow of lung qi to relieve asthma; relieving the internal and external of the body .clearing heat to relieve asthma ;Cleaning up the hot dryness, reducing excess and relieving asthma;ventilating and purging cold dampness,twitching nose and arresting asthma;purging and dispelling phlegm,facilitating the flow of lung qi and relieving asthma;promoting the dispersing function of the lung and clearing heat,lowering the adverse flow of qi and relieving asthma;activating Yang and removing obstruction

  3. Value of transthoracic lung ultrasound comet-tail in differential diagnosis of cardiogenic dyspnea%经胸肺超声彗尾征鉴别诊断心源性呼吸困难

    Institute of Scientific and Technical Information of China (English)

    胡敏; 江成璠; 王素霞; 胡剑平; 张晓轩

    2012-01-01

    目的 探讨经胸肺超声彗尾征在鉴别心源性与慢性阻塞性肺疾病(COPD)性呼吸困难的价值.方法 对比分析40例充血性心力衰竭患者(CHF组)、22例COPD患者(COPD组)和10例健康志愿者(NORM组)三组间、CHF组治疗前后彗尾数中位数,以及诊断肺水肿阳性率间的差异.以彗尾数>5诊断肺水肿,通过ROC曲线判断彗尾数的鉴别价值.结果 CHF组治疗前彗尾数中位数(25%~75%分位数)及诊断肺水肿阳性率分别为18(11~25)条、90%,与COPD组的2(0~8)条、27%和NORM组的2(0~5)条、10%比较差异均有统计学意义(P<0.01);CHF组治疗后彗尾数中位数(25%~75%分位数)及阳性率分别为5(2~11)条、38%,与治疗前比较差异有统计学意义(P<0.01).ROC曲线下面积为0.928(P<0.01),彗尾数>5条诊断充血性心力衰竭的敏感性、特异性分别为90%、78%.结论 肺超声彗尾征对鉴别心源性与COPD性呼吸困难有较高的敏感性和特异性,可在临床推广应用.%Objective To explore the value of transthoracic lung ultrasound(LUS) comet-tail in the differential diagnosis between cardiogenic dyspnea and chronic obstructive pulmonary disease ( COPD ) dyspnea. Method Forty patients with CHF (CHF group), 22 patients with COPD (COPD group) and 10 healthy volunteers (NORM group) were enrolled in the study. The comet-tail counts (B-lines) on the anterior and lateral chest were detected by LUS within 24 h after admission. The B-lines>5 was diagnosed as pulmonary edema. The differences of the B條ines among the three groups, medianins before and after treatment in CHF group and diagnostic positive rates of pulmonary edema were compared. The ROC curve was used to decide the value of B-lines in differential diagnosis between cardiogenic dyspnea and COPD dyspnea. Results The medianins of B -lines before treatment and diagnostic positive rates of pulmonary edema in CHF group, COPD group and NORM group were 18 (ll~25

  4. Correlation of the degree of dyspnea with health-related quality of life, functional abilities, and diffusing capacity for carbon monoxide in patients with systemic sclerosis and active alveolitis: results from the Scleroderma Lung Study.

    Science.gov (United States)

    Khanna, Dinesh; Clements, Philip J; Furst, Daniel E; Chon, Yun; Elashoff, Robert; Roth, Michael D; Sterz, Mildred G; Chung, Joannie; FitzGerald, John D; Seibold, James R; Varga, John; Theodore, Arthur; Wigley, Fredrick M; Silver, Richard M; Steen, Virginia D; Mayes, Maureen D; Connolly, M Kari; Fessler, Barri J; Rothfield, Naomi F; Mubarak, Kamal; Molitor, Jerry; Tashkin, Donald P

    2005-02-01

    To determine whether baseline self-assessment measures of health status and physiologic indices of disease severity in alveolitis-positive patients with systemic sclerosis (SSc) correlate with the severity of their dyspnea, and to quantify functional impairment in patients with scleroderma lung disease and compare it with that in patients with chronic obstructive pulmonary disease (COPD). SSc patients (n = 138) with diffuse (n = 81) or limited (n = 57) cutaneous disease and active alveolitis (determined by bronchoalveolar lavage and/or high-resolution computed tomography) who participated in the National Heart, Lung, and Blood Institute-sponsored, multicenter, parallel-group, double-blind, randomized, placebo-controlled trial of oral cyclophosphamide for treatment of SSc-associated interstitial lung disease were evaluated. Pearson's univariate correlations were determined between the Short Form 36 (SF-36) physical component summary (PCS) and mental component summary (MCS) scales, functional questionnaires, and physiologic parameters of breathing (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]). Student's t-test was used to compare subgroups. Scores from 2 instruments for self-assessment of breathlessness, Mahler's baseline dyspnea index (BDI) and a visual analog scale (VAS) for breathing, were divided at the median. Values for the DLCO and FVC (% predicted) were divided based on the American Thoracic Society guidelines for mild (>70% of predicted), moderate (50-70% of predicted), and severe (alveolitis, all 8 domains of the SF-36 were significantly impaired as compared with the healthy population and were similar to those reported by patients with COPD. The SF-36 was able to discriminate between scleroderma lung disease patients with more severe and less severe breathlessness, the primary symptom of active alveolitis. The SF-36 complements the BDI and VAS scores for breathing in scleroderma lung disease and is variably

  5. Study on the Influential Factors of Negative Emotion of Patients with Non-organic Dyspnea%非器质性呼吸困难急救患者的负性情绪影响因素研究

    Institute of Scientific and Technical Information of China (English)

    殷安康; 赵翔宇; 陈意飞

    2015-01-01

    [Objective]To explore the negative emotion of patients with non-organic dyspnea and its influential fac-tors.[Methods]Totally 80 patients with non-organic dyspnea in emergence department of our hospital from May 2011 to May 2015 were selected.Zung self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were used to evaluate the anxiety and depression of patients.According to the anxiety and depression status,all patients were divided into anxie-ty group,non-anxiety group,depression group and non-depression group.The relationship of the factors with anxiety and depression emotion was analyzed.[Results]There were 26 patients(32.50%)with anxiety,20 patients(25.00%)with depression and 6 patients(7.50%)with anxiety and depression in 80 patients.There were significant differences in gender, education level,insomnia and accompanying depression between anxiety group and non-anxiety group(P <0.05).There was significant difference in education level,insomnia and accompanying depression between depression group and non-de-pression group(P <0.05).Logistic regression analysis showed that the gender,education level,insomnia and accompan-ying depression were independent risk factors of the anxiety in patients with non-organic dyspnea,and education level,in-somnia and accompanying depression were independent risk factors of depression in patients with non-organic dyspnea.[Conclusion]The anxiety and depression of patients with non-organic dyspnea are influenced by gender,education level and insomnia.Psychological measures for the treatment should be taken actively.%【目的】探讨非器质性呼吸困难患者的焦虑抑郁情绪状态及其情绪影响因素。【方法】选取本院急诊科2011年5月至2015年5月收治的非器质性呼吸困难患者80例,采用 Zung 抑郁自评量表(SDS)和 Zung 焦虑自评量表(SAS)分别评测患者的抑郁和焦虑状况。根据焦虑抑郁状态分为焦虑组和非焦虑组,抑郁组和非抑郁组。分析各

  6. Phototherapy with combination of super-pulsed laser and light-emitting diodes is beneficial in improvement of muscular performance (strength and muscular endurance), dyspnea, and fatigue sensation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Miranda, Eduardo Foschini; de Oliveira, Luís Vicente Franco; Antonialli, Fernanda Colella; Vanin, Adriane Aver; de Carvalho, Paulo de Tarso Camillo; Leal-Junior, Ernesto Cesar Pinto

    2015-01-01

    Phototherapy is an electrophysical intervention being considered for the retardation of peripheral muscular fatigue usually observed in chronic obstructive pulmonary disease (COPD). The objective of this study was to evaluate the acute effects of combination of super-pulsed laser and light-emitting diodes phototherapy on isokinetic performance in patients with COPD. Thirteen patients performed muscular endurance tests in an isokinetic dynamometer. The maximum voluntary isometric contraction (MVIC), peak torque (PT), and total work (TW) of the non-dominant lower limb were measured in two visits. The application of phototherapy or placebo (PL) was conducted randomly in six locations of femoral quadriceps muscle by using a cluster of 12 diodes (4 of 905 nm super-pulsed lasers, 0.3125 mW each; 4 of 875 nm LEDs, 17.5 mW each; and 4 of 640 nm LEDs, 15 mW each, manufactured by Multi Radiance Medical™). We found statistically significant increases for PT (174.7 ± 35.7 N · m vs. 155.8 ± 23.3 N · m, p = 0.003) and TW after application of phototherapy when compared to placebo (778.0 ± 221.1 J vs. 696.3 ± 146.8 J, p = 0.005). Significant differences were also found for MVIC (104.8 ± 26.0 N · m vs. 87.2 ± 24.0 N · m, p = 0.000), sensation of dyspnea (1 [0-4] vs. 3 [0-6], p = 0.003), and fatigue in the lower limbs (2 [0-5] vs. 5 [0.5-9], p = 0.002) in favor of phototherapy. We conclude that the combination of super-pulsed lasers and LEDs administered to the femoral quadriceps muscle of patients with COPD increased the PT by 20.2% and the TW by 12%. Phototherapy with a combination of super-pulsed lasers and LEDs prior to exercise also led to decreased sensation of dyspnea and fatigue in the lower limbs in patients with COPD.

  7. Rosetta Application on Traditional Chinese Medicine Dyspnea Syndrome with Experience of Medication%应用 Rosetta 对中医喘证用药经验规律的挖掘研究

    Institute of Scientific and Technical Information of China (English)

    马会霞; 路振宇; 刘保相; 赵斗贵; 王国权; 于荣霞; 王巍; 包巨太

    2012-01-01

    Objective; In the traditional Chinese medicine (TCM) with the theory of drug intervention and formulas corresponding to syndromes, and on the basis of application rough concept lattice clustering technique and method for mining out the basic data of medication experience, the medication rules on dyspnea syndrome are summarized through the sorting, summarizing and analyzing the corresponding relationship between medicine syndrome. Method; Rosetta computer software is used for data mining and cluster analysis on the experience of medication. Result; The association and medication rules between all symptoms and various drugs are obtained. Conclusion; Rough concept lattice clustering technique and method can effectively dig out the rules of medication and clinical experience in treating with dyspnea syndrome by TCM, providing a new model for data mining study in the rules of medication and clinical experience by TCM.%目的:在遵循中医以药测症、方证对应规律的基础上,应用粗糙概念格聚类技术和方法挖掘喘证用药经验中的基础数据,通过整理、分析和归纳药症之间的对应关系,总结喘证的用药规律.方法:利用Rosetta计算机软件对喘证用药经验进行数据挖掘和聚类解析.结果:得到喘证各个症状与用药之间的关联规则和用药规律.结论:利用粗糙概念格聚类技术和方法可以有效地挖掘出中医喘证临症经验中药味的用药规律,为中医临床用药经验规律的数据挖掘研究提供了一个新模式.

  8. Respiration sound patterns used to distinguish the cardiogenic dyspnea from dyspnea all pulmonary own%呼吸音分析技术用于心源性和非心源性呼吸困难的鉴别诊断

    Institute of Scientific and Technical Information of China (English)

    王真; Smith Jean; Richard P Dellinger

    2009-01-01

    .01). Conclusions Compare with healthy volunteers, the geographic area of the image in patents with CHF is smaller,and there is no difference in peak I/E vibration ratio between two lungs. In patients with COPD, there is no difference in geographic area of the image in comparison with volunteers, and there is significant decrease in peak I/E ratio. In patients with asthma, the geographic area of the image is much smaller than that of volunteers, and the peak I/E ratio is even still decreased between two lungs. These characteristics may be helpful in distinguishing acute dyspnea due CHF from that due to COPD or asthma.

  9. 急诊科呼吸困难患儿预后影响因素的临床研究%Clinical study of prognosis factors for children with dyspnea in emergency department

    Institute of Scientific and Technical Information of China (English)

    杨蕾; 李德渊; 肖东琼; 李熙鸿

    2016-01-01

    困难患儿预后影响因素的非条件多因素logistic 回归分析结果显示,是否进行有创通气、是否入住 PICU、是否合并先天性疾病、血 Ca2+水平及 Sp O 2,为影响急诊科呼吸困难患儿预后的独立危险因素(OR =2.521、2.260、3.867、1.992、2.225,95% CI :1.244~5.109、1.112~4.594、2.122~7.045、1.068~3.719、1.059~4.677,P =0.010、0.024、0.000、0.030、0.035)。结论对于急诊科呼吸困难患儿,急诊科医师应高度重视患儿是否合并先天性疾病、是否进行有创通气、是否入住 PICU、血 Ca2+水平及 Sp O2等危险因素,这对呼吸困难患儿在急诊科的临床诊治具有指导意义。%Objective To identify the prognosis factors for children with dyspnea in emergency department.Methods From October 2013 to October 201 5,a total of 364 cases of children with dyspnea whose medical records were complete in Department of Emergency,West China Second University Hospital, Sichuan University were selected as research subjects. Among them, 230 (63.2%)cases were boys and 134 (36.8%)cases were girls.The age was 1 month to 13 years old and the median age was 7 months old.According to pediatric risk of mortality (PRISM)Ⅲ score, relevant references and biochemical indicators detected in emergency department, age, gender, received mechanical ventilation or not,combined with congenital disease or not,admitted to pediatric intensive care unit (PICU ) or not, heart rate, level of hemoglobin, hematocrit, serum Ca2+concentration,level of plasma albumin,arterial pH value,hemoglobin oxygen saturation by pulse oximetry (Sp O2 ),arterial oxygen saturation (Sa O2 ),partial pressure of carbon dioxide (Pa CO2 ), partial pressure of oxygen (Pa O2 ),level of blood lactate and base excess were selected as possible prognosis factors for children with dyspnea in emergency department.Retrospective method was used to analyze the clinical data,those 1 7 possible prognosis factors and the main diagnosis and

  10. Application value of dyspnea visual analog scale in directing glucocorticoid usage in AECOPD patients%呼吸困难可视模拟评分在AECOPD中指导激素使用的价值

    Institute of Scientific and Technical Information of China (English)

    毛玉巧; 胡先纬; 胡杰贵

    2014-01-01

    Objective To analyze the application of dyspnea VAS in the management of patients with AE-COPD, and to explore the value of the preliminary VAS assessment in guiding hormone use of AECOPD. Methods 69 AECOPD patients completed VAS, Modified Borg’s score (MBS), and modified Medical Research Council 24 hours before admission and discharge. The concentration of serum C-reactive protein ( CRP) , blood gas analysis, the duration of hospital stay and time exposed to glucocorticoid therapy were analyzed. Correlations between VAS, MBS and hormone therapy were examined. Results VAS at admission remained a good consistency with Borg score ( r=0. 936, P<0. 01), and a moderate correlation with mMRC score (r=0. 527, P<0. 01). After hormonal therapy, VAS and Modified Borg’ s score decreased significantly. VAS at admission was positively correlated with the duration of glucocorticoid usage (r=0. 706, P<0. 01). Conclusion VAS at admission can exactly assess AECOPD pa-tients’ dyspnea, which can guide the usage of glucocorticoid.%目的:探讨呼吸困难可视模拟评分在AECOPD病人中的临床使用价值,初步评估其在指导糖皮质激素使用方面的作用。方法收集2013年12月至2014年5月符合条件的AECOPD病人69例,在患者入院后及出院前24小时内采用呼吸困难可视Analog问卷、改良后Borg’ s评分及英国医学研究学会的呼吸困难量表( mMRC)对病人进行评估,并收集实验室生化指标包括CRP,血气分析等。统计患者住院总时间及激素使用总时间,并分析激素治疗与患者呼吸困难评分之间的相关性。结果入院可视Analog问卷与Borg评分间有良好的一致性(r=0.936,P<0.01),与mMRC评分间呈相关性(r=0.527,P<0.01)。治疗前后患者VAS问卷明显下降;入院可视Analog问卷得分值与激素使用之间呈正相关(r=0.706,P<0.01),相关回归分析示回归系数b=1.505,P<0.01。结论可视Analog问卷( VAS)具有准确评估患者呼吸困

  11. Respuesta al entrenamiento en EPOC: Diferencia entre limitación por fatiga muscular y por disnea Training response in COPD: Differences between fatigue-limited and dyspnea-limited patients

    Directory of Open Access Journals (Sweden)

    Martín Sívori

    2011-04-01

    Full Text Available Este estudio comparó la respuesta post entrenamiento al ejercicio en pacientes limitados por fatiga muscular (LF vs. disnea (LD. Se incluyeron pacientes con EPOC moderada y grave (definición GOLD, clasificándolos en LF si la respuesta a cicloergometría máxima tenía ≥ 2 puntos en la escala de Borg para fatiga muscular vs. disnea; LD a la inversa. Se realizaron ergometría submáxima, 6 minutos y pruebas de calidad de vida mediante cuestionario. Fueron entrenados 3 veces/semana, 90 min/sesión con ejercicios de fuerza y aeróbicos por 8 semanas, evaluándolos de la misma manera. Fueron estudiados 14 pacientes del grupo LF y 11 del LD. El promedio de edad fue 69 y 66 años respectivamente. Presentaban grave obstrucción bronquial (FEV1: 49%. No existían diferencias basales entre ambos grupos, excepto en el índice masa-corporal (IMC, menor en los LF. Luego del entrenamiento, ambos grupos mejoraron significativamente en variables de ejercicio y calidad de vida, excepto carga máxima en los LD. Comparando ambos grupos, se observó mejor respuesta en los LF en carga máxima (48.7 ± 9.2 vs. 40.04 ± 15.48 watts, p = 0.033, prueba de 6 minutos (505.42 ± 50.75 vs. 454.9 ± 64.3 metros, p = 0.048 y ergometría submáxima (14.57 ± 9.55 vs. 6.71 ± 4.18min, p = 0.025, respectivamente. Como conclusión, los pacientes LF tuvieron mayor respuesta al entrenamiento en ejercicios submáximos y carga máxima, presentando menor IMC. Posiblemente, deberían instrumentarse diferentes estrategias de entrenamiento para diferentes fenotipos de pacientes con EPOC.Our objective was to study the post-training response to exercise, comparing fatigue-limited (FL vs. dyspnea-limited (DL COPD patients. Moderate and severe COPD patients (GOLD definition were included. They were classified as FL if Borg score of fatigue at maximal exercise testing was ≥ 2 points vs. dyspnea; and DL if it was the reverse. Also, each patient was evaluated with submaximal

  12. " Comet -tail" of the Lung Ultrasoud - A New Strategy in the Diagnosis of Cardiogenic Dyspnea%心源性呼吸困难的诊断新策略-肺部超声“彗尾征”

    Institute of Scientific and Technical Information of China (English)

    吴文; 聂昆

    2015-01-01

    Acute decompensated heart failure( ADHF)is a common and potentially fatal cause of acute respiratory failure in emergency department. The diagnosis at an early stage and quantified monitoring of pulmonary edema are particularly important in managing the disease. The paper introduced the theoretical basis of lung ultrasound and reviewed the researches of the clinical application of lung ultrasound in patients with acute cardiogenic dyspnea in emergency department. As a simple, noninvasive,bedside tool for the semi - quantitative evaluation of extravascular lung water,the monitoring of " comet - tail" of lung ultrasoundhas been proposed as a reliable diagnostic tool for the assessment and grading of pulmonary congestion. and will gain more and more attention and application in clinical practice.%急性失代偿性心力衰竭(ADHF)引起的呼吸困难是常见的急诊科急危重症,早期准确的诊断和定量监测肺水肿在处理 ADHF 中至关重要。本文介绍了肺部超声的原理,总结了其在心源性呼吸困难急诊临床应用中的研究现状,认为监测肺部超声“彗尾征”是目前一种简易、无创、床边实施的半定量评估血管外肺水(EVLW)的技术,可作为一种可靠的评估肺淤血严重程度的诊断工具,将会在临床上得到越来越多的重视和应用。

  13. 支气管舒张剂对不同程度COPD患者呼吸困难及肺功能的影响%Effect of bronchodilators on dyspnea and pulmonary function in patients with COPD at different degrees

    Institute of Scientific and Technical Information of China (English)

    罗祥; 郭春丽; 程西安; 石志红

    2015-01-01

    目的:探讨支气管舒张剂对不同程度慢性阻塞性肺疾病患者( chronic obstruction pulmonary disease ,COPD)患者呼吸困难程度及肺功能变化的影响。方法选取2014年1月~2015年1月铜川市人民医院呼吸科收治的COPD患者50例,根据慢性阻塞性肺疾病诊治指南分为轻度14例、中度18例、重度18例,观察各组患者在吸入噻托溴铵后患者的Borg呼吸困难评分及肺功能指标一秒用力呼气容积( forced expiratory volume in one second , FEV1)、用力肺活量( forced vital capacity , FVC )、呼气峰流速值( peak expiratory flow,PEF)及深吸气量(inspiratory capacity,IC)的变化情况。结果轻、中、重度组患者在吸入噻托溴铵后FEV1、FVC、PEF及IC均显著改善,且改善率随着COPD患者的病情程度发生显著变化( P<0.05),FEV1、FVC及IC在重度患者治疗前后的改善率最大,PEF在轻度患者治疗前后的改善率最大( P<0.05)。轻、中、重度组患者在吸入噻托溴铵后Borg评分较吸入前均显著提高( P<0.05),吸入后重度COPD患者的Borg评分改善率最高(P<0.05)。 COPD患者的FEV1(r=0.372)、FVC(r=0.296)、PEF(r=0.284)及IC值(r=0.704)与患者的Borg评分呈显著的正相关(P<0.05)。结论 COPD患者吸入支气管扩张剂后呼吸困难程度及肺功能显著改善,其中重度COPD患者FEV1、FVC以及IC指标改善率最大,轻度患者PEF指标改善率最大,重度COPD患者呼吸困难程度Borg评分改善率最大。对气流受限的可逆程度的评估,需要对各指标进行综合分析。%Objective To investigate the effect of bronchodilators on dyspnea and pulmonary function in patients with chronic obstruction pulmonary disease (COPD) at different degrees.Methods 50 patients with COPD from January 2014 to January 2015 in pneumology department of Tongchuan City People's Hospital were selected

  14. Urinothorax: an unexpected cause of severe dyspnea.

    Science.gov (United States)

    Tortora, Alessandra; Casciani, Emanuele; Kharrub, Zaher; Gualdi, Gianfranco

    2006-05-01

    We report an unusual cause of the pleural effusion due to extravasation of urine from the retroperitoneal space into the thoracic cavity. In our case, the urinoma occurred owing to obstructing urinary tract lesion due to opaque stone. Although rare, urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma.

  15. Is acute dyspnea related to oxaliplatin administration?

    Institute of Scientific and Technical Information of China (English)

    LM Pasetto; S Monfardini

    2006-01-01

    The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin. Oxaliplatin improves the efficacy of this combination in patients with stage Ⅲ colon cancer and moreover its toxicity is well tolerable. We describe a rare clinical case of acute dyspnoea probably related to oxaliplatin at one month from the end of the adjuvant treatment. A 74-year-old man developed a locally advanced sigmoid carcinoma (pT3N1M0). A port a cath attached to an open-ended catheter was implanted in order to administer primary chemotherapy safely according to the FOLFOX4 schedule. One month following the end of the 6th cycle, the patient referred a persistent cough and moderate dyspnoea. Chest radiography displayed a change in the lung interstitium, chest CT scan confirmed this aspect of adult respiratory distress syndrome,spirometry reported a decreased carbon monoxide diffusion capacity. Antibiotic and corticosteroids were administered for 10 d, then a repeated chest X ray evidenced a progressive pulmonary infiltration. A transbronehial biopsy and cytology did not show an infective process,a CT scan reported radiological abnormalities including linear and nodular densities which were becoming confluents. Antimicotic and antiviral drugs did not evidence any benefit. The antiviral therapy was stopped and high dose metilprednisolone was started. The patient died of pulmonary distress after 10 d.

  16. Prevalência de dispnéia e possíveis mecanismos fisiopatológicos envolvidos em indivíduos com obesidade graus 2 e 3 Prevalence of and the potential physiopathological mechanisms involved in dyspnea in individuals with class II or III obesity

    Directory of Open Access Journals (Sweden)

    Christiane Aires Teixeira

    2007-02-01

    Full Text Available OBJETIVO: Investigar a dispnéia e correlações com dados respiratórios de obesos graus 2 e 3. MÉTODOS: Estudaram-se 49 indivíduos com índice de massa corporal >35 kg/m², em dois grupos (presença ou ausência do sintoma. Avaliaram-se índice de dispnéia basal, espirometria, pressões respiratórias máximas e gasometria arterial. RESULTADOS: Doze indivíduos negaram dispnéia e 37 a confirmaram. O índice de dispnéia basal diferiu entre os dois grupos. Os valores médios dos parâmetros para todos estiveram dentro da normalidade, exceto para: volume residual/capacidade pulmonar total, volume de reserva expiratório, diferença alvéolo-arterial de oxigênio. O grupo dispnéico mostrou valores significativamente inferiores de volume de reserva expiratório, pressão expiratória máxima e pH arterial. Para todos, o índice de massa corporal correlacionou-se significativamente com: índice de dispnéia basal, volume residual/capacidade pulmonar total, volume expiratório forçado no primeiro segundo/capacidade vital forçada, fluxo expiratório forçado entre 25% e 75% da capacidade vital forçada, pressão parcial de oxigênio no sangue arterial, diferença alvéolo-arterial de oxigênio e pressão parcial de gás carbônico no sangue arterial. O índice de dispnéia basal correlacionou-se significativamente com: volume residual/capacidade pulmonar total, volume de reserva expiratório, pressão parcial de oxigênio no sangue arterial, diferença alvéolo-arterial de oxigênio e pressão parcial de gás carbônico no sangue arterial. CONCLUSÃO: Dispnéia é uma queixa freqüente em obesos graus 2 e 3. Eles apresentam expressiva redução do volume de reserva expiratório e aumento da diferença alvéolo-arterial de oxigênio. As correlações encontradas apontam para comprometimento das pequenas vias aéreas na obesidade, o qual teria papel na gênese da dispnéia.OBJECTIVE: To investigate dyspnea in individuals with Class II or III

  17. CPAP联合肺表面活性物质治疗早产儿呼吸困难疗效观察%Efficacy Observation on CPAP Combined with Pulmonary Surfactant for Dyspnea of Premature Infant

    Institute of Scientific and Technical Information of China (English)

    陈跃宣

    2015-01-01

    目的:探讨持续气道正压通气(CPAP)联合肺表面活性物质(珂立苏)治疗早产儿呼吸窘迫综合征(NRDS)的疗效。方法:36例呼吸困难早产儿早期均采用CPAP联合珂立苏肺表面活性物质治疗,观察患儿治疗前后的CPAP参数及临床症状的变化。结果:33例患儿治疗后呼吸困难状况得到明显改善,X线片亦显示病情明显好转;治疗2小时后,患儿的FiO2、PEEP均较治疗前显著改善(P<0.05)。结论:CPAP联合肺表面活性物质早期治疗NRDS早产儿疗效显著,可减少并发症的发生,且对胎龄<32周的早产儿疗效更佳。%Objective:To investigate the efficacy of continuous positive-pressure ventilation (CPAP) combined with pulmonary surfactant (Calsurf) for neonatal respiratory distress syndrome (NRDS). Methods:36 cases of premature infants with NRDS were all treated by CPAP combined with Cal-surf, observed the change of CPAP parameters and clinlcal symptoms before and after treatment. Results:After treatment, the dyspnea status in 33 cases of children had significantly improved, the X ray also showed that their illness had significantly turned better;2 hours after treatment, com-pared with those of before treatment, the FiO2 and PEEP of all of the children had significantly improved (P<0.05). Conclusion:The treatment of CPAP combined with pulmonary surfactant has significant curative effect on premature infants with NRDS, which can reduce the occurrence of com-plications, and the efficacy would be better if the age of premature infant is less than 32 weeks.

  18. Reason Analysis of 1 Case of Dyspnea Induced by Aerosol Inhalation of Ambroxol%注射用氨溴索雾化吸入致呼吸困难1例分析

    Institute of Scientific and Technical Information of China (English)

    王明丽; 谢陶吟; 许建平

    2011-01-01

    目的:提示临床重视雾化吸入注射用氨溴索所致不良反应.方法:报道我院注射用氨溴索雾化使用致不良反应1例,并检索中国期刊全文数据库(CNKI)中注射用氨溴索致不良反应的相关文献,进行分析.结果:文献检索仅得到1例雾化吸入注射用氨溴索致过敏反应的报道,而我院近年注射用氨溴索雾化使用除1例致呼吸困难外,未见其他严重不良反应.氨溴索本身并不会引起呼吸困难,之所以出现不良反应可能与雾化因素和药物pH值有关.结论:注射用氨溴索的雾化使用需要谨慎,其长期安全性尚有待进一步考察.%OBJECTIVE: To explore the causes of adverse drug reaction of aerosol inhalation of ambroxol and make suggestions for safe drug use in the clinic. METHODS: The use of aerosol inhalation of ambroxol in our hospital was investigated. Relevant literatures of adverse drug reaction (ADR) of ambroxol were retrieved from CNKI and analyzed systematically. RESULTS: Only one allergy case was found in literature and no serious ADR was caused by aerosol inhalation of ambroxol in our hospital recently. Thus, there was little relationship between dyspnea and ambroxol itself. Aerosol inhalation and pH value of ambroxol injection were more important factors of ADR. CONCLUSION: The use of aerosol inhalation of ambroxol should be paid more attention. And there is further work needed to investigate its long-term safety.

  19. Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second Género y percepción de disnea: el rol de la variación del volumen espiratorio forzado en un segundo

    Directory of Open Access Journals (Sweden)

    Carlos A. Nigro

    2010-08-01

    Full Text Available During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1 to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2 to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095, females (OR 2.90, 95%CI 1.33-6.33, p 0.0072, younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013 and body mass index (BMI (OR 1.11, 95%CI 1.01-1.23, p 0.023. As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002. Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187, females (OR 3.02, 95%CI 1.36-6.72, p 0.0067, younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007 and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023. The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.Durante la broncoconstricción las mujeres perciben más disnea que los hombres. Los objetivos del estudio fueron evaluar: 1 si la calidad de la disnea durante la broncoconstricción fue diferente en mujeres y hombres, 2 si la diferencia entre sexos en la percepción de disnea podría relacionarse al nivel de broncoconstricción. 457 sujetos (257 mujeres inhalaron metacolina hasta un descenso del FEV1 ≥ 20% o 32 mg/ml. La

  20. The Value of Plasma Brain Natriuretic Peptide in Differentiating Acute Dyspnea from Aged Patients with Heart Failure%血液脑钠肽对鉴别老年心衰所致急性呼吸困难的价值

    Institute of Scientific and Technical Information of China (English)

    杨慧; 陈进军

    2009-01-01

    目的 探讨脑钠肽(BNP)对鉴别老年心衰所致急性呼吸困难的价值.方法 荧光免疫法测定145例以呼吸困难为主诉急诊人院或门诊老年患者血浆脑钠肽浓度.结果 心源性呼吸困难患者血液BNP浓度明显高于肺源性患者;BNP对于诊断左心衰有很强的预测价值,而早期诊断肺心病右心衰的价值尚待探讨;BNP值>100ng/L诊断心衰的灵敏度为94.1%,准确度93.1%,特异性79.5%,阳性预测值为91.3%,阴性预测值为85.4%.结论 快速检测血液BNP,用来诊断心力衰竭特别是左心衰,敏感、简便、快捷,可作为老年患者急性呼吸困难病因鉴别的一个重要检查方法 .%Objective To investigate the value of brain natriuretic peptide (BNP) in differentiating acute dyspnea from aged pa-tients with heart failure. Methods The concentration of plasma BNP was measured with immunofluorescence assay in 145 aged patients with dyspnea who admitted to hospital by emergency or were out - patients. Results The BNP level in patients with dyspnea caused by heart failure was significantly higher than that of lung disease patients. BNP for the diagnosis of left heart failure had a very strong predic-tive value, while the early diagnosis of pulmonary heart disease and right heart failure has yet to be explored. BNP values > 100ng / L for differentiating of heart failure was the following: the sensitivity of diagnosis was 94.1%, accuracy 93. I%, specificity 79.5%, positive predictive value was 91.3%, and negative predictive value was 85.4%. Conclusion BNP assay was a convenient, rapid and sensitive method for differentiating diagnosis in aged patients with heart failure, especially with left heart failure. It can be used as an important dif-ferential method in elderly patients with acute dyspnea.

  1. The impact of foot reflex zone therapy on exercise tolerance and dyspnea of stable COPD patients%足反射区疗法对稳定期COPD患者运动耐力和呼吸困难症状的影响

    Institute of Scientific and Technical Information of China (English)

    龚海蓉; 庄海林; 刘珍红

    2012-01-01

    Objective To explore the efficacy of reflex zone therapy on exercise tolerance and dyspnea in patients with stable COPD. Methods Sixty patients with stable COPD were randomly allocated into trial and control groups. Patients in control group received routine nursing care, and patients in trial group were treated on the basis of routine nursing in addition with intervention of reflex zone therapy for 3 months. Evaluation was carried out in patients of these two groups before and after intervention and on exercise tolerance in patients with symptoms of dyspnea. Results Patients in trial group were significantly improved in 6MWD ( the range of improvement was 31. 77 ± 10. 89 m ) after treatment for 3 months, and the difference in range of 6MWD after treatment between these two groups was statistically significant P <0.01 ); and the difference in improvement of dyspnea between patients of these two groups was significant ( P <0.05 ). Conclusion The application of foot reflex zone therapy in patients with stable COPD can improve their exercise tolerance, and thus it may improve the synptom of dyspnea.%目的 探讨足反射区疗法对稳定期慢性阻塞性肺疾病(COPD)患者运动耐力和呼吸困难症状的影响.方法 将60例稳定期COPD患者随机分为试验组与对照组.对照组进行常规护理,试验组在对照组的基础上进行足反射区疗法干预3个月.干预前后对两组患者的运动耐力和呼吸困难症状进行评价比较.结果 干预3个月后试验组测量6 min步行距离(6 MWD)明显提高(提高幅度为31.77±10.89 m),且将试验组与对照组试验后6 MWD的提高幅度即6 MWD差值进行组间比较,二者存在统计学显著差异(P<0.01);试验组患者的呼吸困难症状改善情况明显优于对照组,差异有统计学意义(P<0.05).结论 足反射区疗法能提高稳定期COPD患者的运动耐力,改善呼吸困难症状.

  2. Significance of monitoring beta-endorphin and B-type natriuretic peptide in etiological diagnosis of neonatal dyspnea%β-内啡肽和B型利钠肽对新生儿呼吸困难病因的早期诊断意义

    Institute of Scientific and Technical Information of China (English)

    蔡晋; 徐美玉; 胡新民; 周辉

    2009-01-01

    目的 探讨测定β-内啡肽和B型利钠肽在新生儿呼吸困难病因早期诊断中的意义.方法 采用放射免疫法测定36例新生儿呼吸困难患儿(心源性组11例,肺源性组13例,中枢神经组12例)β-内啡肽和B型利钠肽含量.并与15例健康对照组进行比较.结果 心源性组B型利钠肽含量为(512.36±189.45)pg/ml,显著高于肺源性组的(78.62±26.41)pg/ml、中枢神经组的(65.57±22.87)pg/ml及对照组的(66.41±19.01)pg/ml(P0.05).结论 β-内啡肽联合B型利钠肽的测定有助于早期鉴别新生儿呼吸困难病因.%Objective To study the significance of monitoring beta-endorphin and B-type natriuretic peptide in etiological diagnosis of neonatal dyspnea. Methods The levels of beta-endorphin and B-type natriuretic peptide were measured with radioimmunoassay (RIA) in 34 neonates with dyspnea, of whom dyspnea was cardiogenic in 11 cases(group A), repiratory in 13 cases(group B) and central nervous in 12 cases(group C). The results were compared with those in 15 healthy neonates as the controls(group D). Results The level of B-type natriuretic peptide was (512. 36±189. 45) pg/ml in group A, which was significantly higher than (78. 62±26. 41) pg/ml in group B, (65. 57±22. 87) pg/ml in group C and (66. 41±19. 01) pg/ml in group D (P<0. 01). The level of beta-endorphin was (187. 34±21. 31) pg/ml in group C, which was significantly higher than (72. 48±14. 36) pg/ml in group A, (63. 23±12. 87) pg/ml in group B. and (70. 52±13. 96) pg/ml in group D (F<0. 01). The level of beta-endorphin or B-type natriuretic peptide in group B was similar to that in group D. Conclusion Detection of beta-endorphin and B-type natriuretic peptide is helpful in etiological diagnosis of neonatal dyspnea.

  3. 踏车运动训练对慢性阻塞性肺病患者吸气肌力、呼吸困难和下肢疲劳程度的影响%The effects of treadmill training on inspiratory muscle strength,dyspnea and lower limb fatigue in chronic obstructive pulmonary disease patients

    Institute of Scientific and Technical Information of China (English)

    陈瑞; 陈荣昌; 毛晓群; 陈新

    2011-01-01

    目的 探讨踏车运动训练后慢性阻塞性肺病(COPD)患者运动耐力的改善与吸气肌力、呼吸困难和下肢疲劳程度的关系.方法 22例中、重度COPD患者分为康复组12例和对照组10例,康复组患者进行12周的下肢踏车运动训练.在运动训练前、后2组患者分别进行常规肺通气功能、弥散功能、肺容积、最大吸气压(MIP)、呼气气流受限(EFL)、症状限制递增功率心肺运动试验和恒定功率心肺运动试验.运动试验过程中同步进行Borg呼吸困难评分和下肢疲劳程度评分(BS).结果 训练后,康复组患者峰运动功率(WRpeak)显著提高(P0.05);最大吸气压显著增加(P<0.01);运动训练后等时间点Borg呼吸困难评分和下肢疲劳程度评分较前显著下降(P<0.01);△MIP(r=0.535,P<0.05)、△Borg(r=0.512,P<0.05)、△Bs(r=0.497,P<0.05)分别与△WRpeak呈显著正相关关系.结论 下肢踏车运动训练可能通过增加吸气肌肉力量,减轻COPD患者在运动过程中呼吸困难和下肢疲劳的主观感觉,改善运动耐力.%Objective To explore the relationship between improved exercise endurance and inspiratory muscle strength,dyspnea and lower limb fatigue in chronic obstructive pulmonary disease(COPD)patients. Methods Twelve moderate-to-severe COPD patients were given lower limb exercise training for 12 weeks.Routine tests of pulmonary ventilation function,diffusion function,lung volume,maximal inspiratory pressure(MIP),expiratory flow limitation(EFL),cycle ergometer exercise capacity and constant work rate capacity were administered before and after the training program.Borg's scale(BS)was used to assess dyspnea and lower limb fatigue was measured during the exercise tests.Results After training,the average peak work rate(W Rpeak)and average MIP both had increased significantly,but no significant change was observed in routine pulmonary ventilation function,diffusion function or lung volume.The 5-point EFL score showed no

  4. N-terminal pro-B-type natriuretic peptide detection for elderly emergency patients with dyspnea%快速检测氨基末端-脑钠肽前体在急诊老年呼吸困难患者中的应用价值

    Institute of Scientific and Technical Information of China (English)

    苏琴; 张宪; 党伟; 孙荣距; 马俊勋; 袁晓玲; 刘红升; 姚咏明; 赵晓东

    2011-01-01

    目的 探讨快速检测氨基末端-脑钠肽前体( NT-proBNP)在急诊老年呼吸困难患者中的临床应用价值.方法 根据病因将202例老年急性呼吸困难患者分为单纯肺源性呼吸困难组(A组);单纯心源性呼吸困难组(B组);混合性呼吸困难组(肺源性+心源性,C组).床旁快速检测NT-proBNP水平,并行超声心动图检查,测量左心室射血分数(LVEF).比较各组间NT-proBNP水平的差异及B,C两组中NT-proBNP水平与NYHA心功能分级和LVEF的相关性.结果 A组NT-proBNP水平明显低于B,C两组[(197.5±64.3) vs( 1873.9±857.1)和(1952.4±914.8) ng/L,P<0.01].B,C两组NT-proBNP水平差异无显著统计学意义(P>0.05),说明有心源性呼吸困难的患者NT-proBNP水平明显高于单纯肺源性呼吸困难患者.心功能Ⅱ级、Ⅲ级、Ⅳ级患者中,NT-proBNP水平依次升高,说明患者NT-proBNP水平越高,心功能分级越高[分别( 562.37±102.45),(2736.72±81.67),(5873.19±127.73) ng/L,P<0.01].Person直线相关分析发现,NT-proBNP水平与LVEF呈负相关(r=- 0.689,P<0.01),提示NT-proBNP水平越高,LVEF值越低,心功能越差.结论 NT-proBNP水平检测在判断老年肺源性与心源性呼吸困难方面具有较好的临床鉴别诊断价值,其水平高低与心力衰竭严重程度密切相关.%Objective To evaluate the clinical value of N-terminal pro-brain natriuretic peptide (NT-proBNP) detection in elderly patients with acute dyspnea. Methods Based on the etiology, 202 elderly patients with acute dyspnea were divided into three groups: simple pulmonary disease(PD) group(A), simple congestive heart failure(CHF) group (B), and CHF and PD combination group (C). NT-proBNP levels, echocardiogram, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) classification were assessed in all subjects. NT-proBNP levels were compared between different groups. Correlations of NT-proBNP levels with NYHA classification and LVEF in group B and

  5. 孟鲁司特联合噻托溴铵对稳定期COPD患者肺功能与呼吸困难症状的影响%Effect of Montelukast combined Tiotropium on lung function and dyspnea in stable COPD

    Institute of Scientific and Technical Information of China (English)

    糜晓光

    2015-01-01

    目的:探讨孟鲁斯特联合噻托溴铵对稳定期慢性阻塞性肺疾病( COPD)患者肺功能与呼吸困难症状的影响。方法将2010年1月至2013年1月180例稳定期COPD患者随机分作观察组与对照组,每组90例,观察组给予孟鲁司特(10 mg/次,每天1次,晚间口服)联合噻托溴铵(18μg/次,每天1次,吸入)治疗,对照组仅予以孟鲁司特(10 mg/次,每天1次,晚间口服)治疗。观察比较两组患者肺功能与呼吸困难症状的变化。结果治疗后两组肺功能指标1秒用力呼气量(FEV1)、FEV1/预计值百分比及FEV1/用力肺活量(FVC)均较治疗前有所改善,治疗后1个月观察组FEV1显著高于对照组( P0.05),治疗后3个月观察组FEV1、FEV1/预计值及FEV1/FVC均明显高于对照组(P0.05),而观察组治疗后3个月时显著低于对照组(P0. 05), FEV1, FEV1/predicted value and FEV1/FVC of observation group were significantly higher than control group (P<0. 05) 3 months after treatment;FRC in observation group and control group reduced and IC increased 1 month after treatment, and there was significant difference (P<0. 05), but there was no significant difference between the two groups;FRC in observation group and con-trol group reduced further and IC increased further 3 months after treatment (P<0. 05), there was significant difference between the two groups (P<0. 05); dyspnea score in two groups patients before treatment had no significant difference, dyspnea score reduced in two groups 1 month after treatment,but there was no significant difference,while 3 months dyspnea scores of observation group were significantly lower than control group after treatment for(P<0. 05). Conclusions Mon-telukast combined tiotropium can relieve lung hyperinflation in stable COPD patients, improve lung function, relieve diffi-culty breathing symptoms,increase exercise tolerance and improve quality of life.

  6. 慢性阻塞性肺疾病患者劳力性呼吸困难与动态肺过度充气的关系%Correlation between exertional dyspnea and dynamic hyperinflation in patients with chronic obstructive pulmonary diseases

    Institute of Scientific and Technical Information of China (English)

    陈瑞; 陈功; 陈荣昌; 陈新

    2011-01-01

    目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者在高强度恒定功率运动中呼吸困难的产生与动态肺过度充气的关系。方法对34例稳定期COPD患者和10例健康人进行常规肺通气功能、弥散功能、肺容量和症状限制递增功率心肺运动测试。以症状限制递增功率心肺运动测试获得的最大运动功率的2/3作为运动功率进行高强度恒定功率运动试验,在静息状态和运动过程中每隔1分钟记录受试者Borg呼吸困难评分、潮式呼吸-流速容积( TBFV)曲线和深吸气量(inspiratory capacity,IC)。结果COPD组在高强度恒定功率运动高峰时,IC[(1.56±0.29)L]较静息状态[(2.07±0.38)L]显著下降(t=-5.642,P<0. 01),ΔBorg与ΔIC呈显著负相关关系(r=-0. 59,P<0.01)。在运动高峰时COPD组平均呼气流速和呼气时间显著低于对照组。结论动态肺过度充气可能是COPD患者在高强度恒定功率运动中呼吸困难产生的主要原因之一;平均呼气流速下降和呼气时间缩短可能是COPD患者动态肺过度充气产生的原因。%Objective To study the correlation between exertional dyspnea and dynamic hyperinflation in patients with chronic obstructive pulmonary diseases (COPD). Methods Routine lung ventilation function, diffusing function, lung volume and symptom-limited progressive cycle ergometer exercise were tested in 34 stable COPD patients and 10 healthy controls. Two-thirds of their symptom-limited peak work rate was used to conduct high-intensity CWRE test. Borg dyspnea score, TBFV curve and inspiratory capability (IC) were detected every 1 min at rest and exercise. Results The IC was significantly lower in COPD patients at peak exercise than at rest (1.56 ±0.29 L vs 2.07 ±0. 38 L,t = -5. 642,P <0. 01). The Aborg was negatively correlated with the AIC in COPD patients (r = -0. 59, P <0. 01). The mean expiratory flow and time were significantly

  7. Dyspnea and dysentery: a case report of pleuropulmonary amebiasis.

    Science.gov (United States)

    Shrestha, Merica; Shah, Anita; Lettieri, Christopher

    2010-02-01

    Pleuropulmonary amebiasis is an uncommon complication of Entamoeba histolytica infection. It typically occurs in endemic regions including Central and South America, Africa and the Indian subcontinent. The case of a previously healthy US Army male stationed in Liberia with an acute onset of fevers, abdominal pain and bloody diarrhea is presented. He developed a productive cough with pleuritic chest pain and imaging revealed multiple liver abscesses, with rupture through the diaphragm causing a large right pleural empyema. A positive Entamoeba histolytica serum antibody and pleural fluid antigen confirmed the diagnosis. Surgical drainage of the pleural empyema and medical treatment with antiparasitics were necessary for symptom and disease resolution.

  8. A 62-year-old man with dyspnea

    Directory of Open Access Journals (Sweden)

    Misbah Baqir

    2016-01-01

    Full Text Available We describe the case of a 62-year-old man who presented with shortness of breath that had progressed over several years. He had a history of a paralyzed right hemidiaphragm for at least the previous 10 years. He also reported weakness in his proximal legs and daytime sleepiness. On examination, he was found to have thoracoabdominal paradox when in supine position. Pulmonary function testing revealed severe restriction; arterial blood gas showed chronic respiratory acidosis. Electromyography showed chronic phrenic neuropathy bilaterally, with mild proximal myopathy. Serum aldolase level was mildly elevated, but serologic tests for connective tissue disorders were within reference range. After extensive clinical investigations, the patient was found to have severely reduced acid α-glucosidase. Genetic analysis confirmed the diagnosis of adult-onset Pompe disease. The patient started treatment with bilevel positive airway pressure titrated during polysomnography, and acid α-glucosidase enzyme replacement was recommended.

  9. Importância da toxicidade pulmonar pela amiodarona no diagnóstico diferencial de paciente com dispnéia em fila para transplante cardíaco The importance of amiodarone pulmonary toxicity in the differential diagnosis of a patient with dyspnea awaiting a heart transplant

    Directory of Open Access Journals (Sweden)

    Christiano Pereira Silva

    2006-09-01

    , among others³. The objective of this case report is to discuss one of the most serious complications related to amiodarone, pulmonary toxicity, which is described as a differential diagnosis for a chagasic patient that was on the waiting list for a heart transplant. Amiodarone pneumonitis is a relevant differential diagnosis for heart failure (HF patients using amiodarone that are admitted to the emergency ward with dyspnea.

  10. [Fever, coughing and dyspnea in a 38-year-old female kidney transplant recipient].

    Science.gov (United States)

    Porsche, M; Künzli, E; Dickenmann, M; Hirsch, H H; Battegay, M; Khanna, N

    2012-12-01

    This article reports on a 38-year-old kidney transplant patient who presented with fever, coughing and dypnea. The patient was immunosuppressed with mycophenolate and prednisone. Due to the suspicion of community acquired pneumonia antibiotic treatment was initiated and the patient was admitted to the intensive care unit. Despite antibiotic treatment the condition did not improve and in the subsequently performed bronchioalveolar lavage parainfluenza virus was diagnosed.Infections with respiratory viruses can be fatal in immunosuppressed patients. Human parainfluenza virus is the third most common pathogen of viral pneumonia. Molecular genetic detection methods allow fast and sensitive diagnosis of respiratory materials. As the treatment options are limited for these infections prophylactic measurements are important.

  11. Thoracic ultrasonography: A new method for the work-up of patients with dyspnea().

    Science.gov (United States)

    Vitturi, N; Soattin, M; Allemand, E; Simoni, F; Realdi, G

    2011-09-01

    SommarioLa diagnosi differenziale di dispnea è fondamentale per la gestione dell’insufficienza respiratoria in cui, ai parametri routinari, può essere ora affiancata l’ecografia toracica. L’obiettivo di questo studio è stato valutare la validità e l’accuratezza di questa metodica anche in un reparto di medicina interna. MATERIALI E METODI: 152 pazienti ricoverati conseguentemente con diagnosi di dispnea sono stati esaminati dopo valutazione clinica, radiografia del torace, dosaggi bioumorali (NT-proBNP) e terapia d’emergenza. L’esame ecografico polmonare è stato considerato positivo qualora il numero totale di linee B fosse superiore ad 8. L’esame ecografico e il dosaggio dell’NT-proBNP sono stati ripetuti dopo 48 ore. Il gold standard di riferimento è stato la diagnosi clinica di scompenso cardiaco fatta da medici esperti secondo le linee guida dell’AHA. RISULTATI: Il gruppo di pazienti che mostrava un esame ecografico positivo riceveva in percentuale maggiore la diagnosi finale di insufficienza cardiaca (X 92.5; p medicina interna l’ecografia polmonare è uno strumento diagnostico utile per le gestione dell’insufficienza respiratoria e il suo monitoraggio durante la terapia.

  12. Multivariate Criteria Most Accurately Distinguish Cardiac from Noncardiac Causes of Dyspnea.

    Science.gov (United States)

    Ahmad, Mirza Nubair; Yusuf, Syed Hasan; Ullah, Rafath; Ahmad, Mirza Mujadil; Ellis, Mary K; Yousaf, Haroon; Paterick, Timothy E; Ammar, Khawaja Afzal

    2015-12-01

    Cardiopulmonary exercise testing provides oxygen pulse as a continuous measure of stroke volume, which is superior to other stress-testing methods in which systolic function is measured at baseline and at peak stress. However, the optimal peak oxygen pulse criterion for distinguishing cardiac from noncardiac causes of exercise limitation is unknown. In comparing several peak oxygen pulse criteria against the clinical standard of cardiopulmonary exercise testing, we retrospectively studied 54 consecutive patients referred for cardiopulmonary exercise testing. These exercise tests included measurement of oxygen consumption, carbon dioxide production, breathing reserve, arterial blood gases at baseline and at peak stress, exercise electrocardiogram, heart rate, and blood pressure response. Results were blindly interpreted and patients were categorized as members either of our Cardiac Group (abnormal result secondary to cardiac causes of exercise limitation) or of our Noncardiac Group (normal or abnormal result secondary to any noncardiac cause of exercise limitation). The accuracy of the peak oxygen pulse criteria ranged from 50% for univariate criterion (≤15 mL/beat), to 61% for oxygen pulse curve pattern, to 63% for bivariate criterion (≤15 mL/beat for men, ≤10 mL/beat for women), to as high as 81% for a multivariate criterion. All multivariate criteria outperformed oxygen pulse curve pattern, univariate, and bivariate criteria. This is the first study to evaluate the optimal peak oxygen pulse criterion for differentiating cardiac from noncardiac causes of exercise limitation. Multivariate criteria (especially a criterion incorporating age, sex, height, and weight) should be used preferentially, as opposed to the commonly used univariate and bivariate criteria.

  13. A Rare Cause of Dyspnea in Elderly Patients: Foreign Body Aspiration

    Directory of Open Access Journals (Sweden)

    Sevdegül Karadas

    2012-10-01

    Full Text Available Foreign body aspiration is frequently seen at childhood age group whereas various facilitator factors can be observed in adults particularly in the elderly group. In this study a 78 year-old male case who swallowed his dental prothesis and had a foreign substance detected in his chest X-ray was presented. In the cases that have nonspesific complaints such as incipient chest pain and difficulty in breathing and have no known underlying lung disease, foreign body aspiration must be suspected.

  14. Simultaneous staphylectomy and unilateral arytenoid lateralization in dogs presenting for dyspnea: 23 cases (2010-2013).

    Science.gov (United States)

    Heffernan, Ann E; Biskup, Jeffery J; Kramek, Betty A; Anderson, Greg M

    2016-10-01

    This retrospective study assesses postoperative complications with simultaneous staphylectomy and unilateral arytenoid lateralization (SP + UAL) in dogs with laryngeal paralysis and concurrent elongation of the soft palate compared to dogs having a UAL alone. Medical records of dogs having a UAL performed from 2010 to 2013 were reviewed. Twenty-three dogs were diagnosed with a concurrent elongated soft palate and had a SP + UAL performed and 89 dogs were diagnosed with an appropriate soft palate and had only a UAL performed. A telephone questionnaire for long-term postoperative outcomes was completed. Survival probability was not statistically different between the 2 groups. Dogs in the SP + UAL group were more likely to be seen for respiratory distress after surgery (P = 0.05). There was no significant difference between the 2 groups in the number of dogs which developed postoperative aspiration pneumonia. The overall complication rate for both groups was high, with postoperative pneumonia being the most common complication.

  15. Disnea súbita después del terremoto After the earthquake sudden dyspnea

    OpenAIRE

    CAROLINA PAZ M; XIMENA CEA B; SUSANA DURÁN G

    2010-01-01

    El síndrome de embolia grasa (SEG) sigue siendo un reto diagnóstico para los médicos. Se asocia fundamentalmente en fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. La mortalidad general se encuentra entre el 5 a 15% en todos los estudios. Esto nos motiva a presentar el caso de una mujer joven que 72 horas después de fracturas sufridas durante el terremoto ocurrido en Chile el 27 de febrero del 2010, presentó un SEG. Es impor...

  16. Disnea súbita después del terremoto After the earthquake sudden dyspnea

    Directory of Open Access Journals (Sweden)

    CAROLINA PAZ M

    2010-09-01

    Full Text Available El síndrome de embolia grasa (SEG sigue siendo un reto diagnóstico para los médicos. Se asocia fundamentalmente en fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. La mortalidad general se encuentra entre el 5 a 15% en todos los estudios. Esto nos motiva a presentar el caso de una mujer joven que 72 horas después de fracturas sufridas durante el terremoto ocurrido en Chile el 27 de febrero del 2010, presentó un SEG. Es importante conocer este síndrome, ya que se puede confundir con otras patologías graves que requieren un manejo distinto y al tener una alta sospecha en el contexto adecuado, se permite un diagnóstico oportuno, tratamiento precoz y mejorar el pronóstico.Fat embolism syndrome (FES remains a diagnostic challenge for physicians. It is commonly as associated with fractures of long bones and it is a major source of morbidity and mortality inpatients with multiple injuries. Overall mortality is between 5-15% in all studies. These facts motivate us to present the case of a young woman suffering bone fractures in both legs during the earthquake in Chile on February 27, 2010. She presented a FES 72 hours later. It is important to understand this syndrome, as it can be confused with other serious diseases that require different management. We should be able to have a high FES suspicion in the appropriate context, in as much as an early diagnosis, and treatment may improve the prognosis of this severe condition.

  17. An unusual cause of severe dyspnea: A laryngeal live leech: Case report

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    Said Anajar

    2017-01-01

    Conclusion: Leeches should be suspected as an airway foreign body in patients with a recent history of drinking from stream water. Prevention remains the best treatment for such cases based simply on hygiene measures like not drinking stream water directly and filtering drinking water before it is used.

  18. Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2011-01-01

    Full Text Available This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.

  19. 脓疱疹鼻塞呼吸困难%Impetigo, snuffle and dyspnea

    Institute of Scientific and Technical Information of China (English)

    王素珍; 李成柏; 刘伟

    2007-01-01

    @@ 1 病历摘要 患儿,女,生后2 d,因口周青紫、反应差1 d第1次入院.患儿系孕36周剖宫产,出生体重3100 g,Apgar评分8分,脐带绕颈2周,羊水多、略浑,胎盘偏大,重量不详.生后无抽搐,双手、足有数个疱疹.

  20. Not Just Another Cause of Dyspnea: Common Complaint Leads to a Rare Diagnosis

    Directory of Open Access Journals (Sweden)

    Hemant Goyal

    2013-01-01

    Full Text Available A 62-year-old man with past medical history of type 2 diabetes mellitus (DM-2 and hypertension presented with progressive shortness of breath since three months. He was diagnosed with diabetic polyradiculopathy with diaphragmatic involvement and was started on intravenous immunoglobulin (IVIg therapy. Rapid improvement was seen as evidenced by increased vital capacity and other pulmonary function parameters. Considering the patient’s positive response to intravenous immunoglobulins (IVIg, this case strengthens the fact that diaphragmatic involvement in Type 2 Diabetes Mellitus can be a part of focal or polyneuropathy and that the pathogenesis is immune mediated.

  1. Novel mutation in KCNA1 causes episodic ataxia with paroxysmal dyspnea.

    Science.gov (United States)

    Shook, Steven J; Mamsa, Hafsa; Jen, Joanna C; Baloh, Robert W; Zhou, Lan

    2008-03-01

    Episodic ataxia type 1 (EA1) is an autosomal-dominant neurological disease caused by point mutations in the potassium channel-encoding gene KCNA1. It is characterized by attacks of ataxia and continuous myokymia. Respiratory muscle involvement has not been previously reported in EA1. We clinically evaluated a family with features of EA1 and paroxysmal shortness of breath. Coding and flanking intronic regions of KCNA1 were sequenced. We identified a novel 3-nucleotide deletion mutation in KCNA1 in the affected individuals. Our findings of a deletion mutation with unusual respiratory muscle involvement expand the genetic and clinical spectrum of EA1.

  2. Role of quantitative CT in predicting postoperative FEV1 and chronic dyspnea in patients undergoing lung resection

    Directory of Open Access Journals (Sweden)

    Papageorgiou Chrysovalantis V

    2010-06-01

    Full Text Available Abstract Lung resection is the mainstay of treatment in patients with early stage non-small cell lung cancer. However, lung cancer patients often suffer from comorbidities and the respiratory reserve should be carefully evaluated preoperatively in order to avoid postoperative complications. Forced expiratory volume in 1 second (FEV1 is considered to be an index that depicts the patient's respiratory efficacy and its prediction has a key role in the preoperative evaluation of lung cancer patients with impaired lung function. Prediction of postoperative FEV1 is currently possible with the use of perfusion radionuclide lung scanning. Quantitative CT is the analysis of data acquired during normal chest CT scan using the system's software. By applying a dual threshold of -500 to -910 Hounsfield Units, functional lung volumes are estimated and postoperative FEV1 can be predicted by reducing the preoperative measurement by the fraction of the part to be resected. Studies have shown that preoperative predictions correlate well with the actual postoperative measurements. Additionally, quantitative CT results are in good agreement with perfusion scintigraphy predictions. Newer radiological techniques such as perfusion MRI and co-registered SPECT/CT have also been used in the preoperative evaluation with similar results. In conclusion, chest CT which is obligatory for staging, can be used for quantitative analysis of the already available data. It is technically simple, providing an accurate prediction of postoperative FEV1. Thus, quantitative CT appears to be a useful tool in the preoperative evaluation of lung cancer patients undergoing lung resection.

  3. Inspiratory high frequency airway oscillation attenuates resistive loaded dyspnea and modulates respiratory function in young healthy individuals.

    Directory of Open Access Journals (Sweden)

    Theresa Morris

    Full Text Available Direct chest-wall percussion can reduce breathlessness in Chronic Obstructive Pulmonary Disease and respiratory function may be improved, in health and disease, by respiratory muscle training (RMT. We tested whether high-frequency airway oscillation (HFAO, a novel form of airflow oscillation generation can modulate induced dyspnoea and respiratory strength and/or patterns following 5 weeks of HFAO training (n = 20 compared to a SHAM-RMT (conventional flow-resistive RMT device (n = 15 in healthy volunteers (13 males; aged 20-36 yrs. HFAO causes oscillations with peak-to-peak amplitude of 1 cm H2O, whereas the SHAM-RMT device was identical but created no pressure oscillation. Respiratory function, dyspnoea and ventilation during 3 minutes of spontaneous resting ventilation, 1 minute of maximal voluntary hyperventilation and 1 minute breathing against a moderate inspiratory resistance, were compared PRE and POST 5-weeks of training (2 × 30 breaths at 70% peak flow, 5 days a week. Training significantly reduced NRS dyspnoea scores during resistive loaded ventilation, both in the HFAO (p = 0.003 and SHAM-RMT (p = 0.005 groups. Maximum inspiratory static pressure (cm H2O was significantly increased by HFAO training (vs. PRE; p<0.001. Maximum inspiratory dynamic pressure was increased by training in both the HFAO (vs. PRE; p<0.001 and SHAM-RMT (vs. PRE; p = 0.021 groups. Peak inspiratory flow rate (L.s(-1 achieved during the maximum inspiratory dynamic pressure manoeuvre increased significantly POST (vs. PRE; p = 0.001 in the HFAO group only. HFAO reduced inspiratory resistive loading-induced dyspnoea and augments static and dynamic maximal respiratory manoeuvre performance in excess of flow-resistive IMT (SHAM-RMT in healthy individuals without the respiratory discomfort associated with RMT.

  4. Subglottic Chondrosarcoma Presenting Only Mild Acute-Onset Dyspnea: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Su-wei Tsai

    2014-01-01

    Full Text Available Chondrosarcoma is categorized as a malignant cartilaginous tumor, which occurs rarely in the craniofacial region. We report the case of a 68-year-old man with chondrosarcoma in the subglottic area. His chief symptoms were hoarseness and mild dysphagia. A computed tomography scan revealed a lesion with expansion of the cricoid cartilage and marked reduction of the airway. After biopsy, histological inspection showed that chondrocytes are multi-nucleus, their size does not differ much and mitosis is not obvious. These are all characteristics of a low-grade chondrosarcoma. We performed an organ-preserving operation by debulking the low-grade malignant tumor in order to keep a patent airway. No further metastasis or airway compromise was evident during the 1-year follow-up visit.

  5. Inspiratory high frequency airway oscillation attenuates resistive loaded dyspnea and modulates respiratory function in young healthy individuals.

    Science.gov (United States)

    Morris, Theresa; Sumners, David Paul; Green, David Andrew

    2014-01-01

    Direct chest-wall percussion can reduce breathlessness in Chronic Obstructive Pulmonary Disease and respiratory function may be improved, in health and disease, by respiratory muscle training (RMT). We tested whether high-frequency airway oscillation (HFAO), a novel form of airflow oscillation generation can modulate induced dyspnoea and respiratory strength and/or patterns following 5 weeks of HFAO training (n = 20) compared to a SHAM-RMT (conventional flow-resistive RMT) device (n = 15) in healthy volunteers (13 males; aged 20-36 yrs). HFAO causes oscillations with peak-to-peak amplitude of 1 cm H2O, whereas the SHAM-RMT device was identical but created no pressure oscillation. Respiratory function, dyspnoea and ventilation during 3 minutes of spontaneous resting ventilation, 1 minute of maximal voluntary hyperventilation and 1 minute breathing against a moderate inspiratory resistance, were compared PRE and POST 5-weeks of training (2 × 30 breaths at 70% peak flow, 5 days a week). Training significantly reduced NRS dyspnoea scores during resistive loaded ventilation, both in the HFAO (p = 0.003) and SHAM-RMT (p = 0.005) groups. Maximum inspiratory static pressure (cm H2O) was significantly increased by HFAO training (vs. PRE; pRMT (vs. PRE; p = 0.021) groups. Peak inspiratory flow rate (L.s(-1)) achieved during the maximum inspiratory dynamic pressure manoeuvre increased significantly POST (vs. PRE; p = 0.001) in the HFAO group only. HFAO reduced inspiratory resistive loading-induced dyspnoea and augments static and dynamic maximal respiratory manoeuvre performance in excess of flow-resistive IMT (SHAM-RMT) in healthy individuals without the respiratory discomfort associated with RMT.

  6. Aggravation of dyspnea in stage I non-small cell lung cancer patients following stereotactic body radiotherapy

    DEFF Research Database (Denmark)

    Paludan, Merete; Traberg Hansen, Anders; Petersen, Jørgen;

    2006-01-01

    In SBRT for NSCLC, highly potent radiation doses are delivered to patients with frequent pre-irradiatory compromise of pulmonary function. For the risk of pulmonary toxicity to be minimized during SBRT planning, data on its dose-volume dependency is needed. In the present study, we analyse the as...

  7. RELATION OF LUNG-FUNCTION, MAXIMAL INSPIRATORY PRESSURE, DYSPNEA, AND QUALITY-OF-LIFE WITH EXERCISE CAPACITY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

    NARCIS (Netherlands)

    WIJKSTRA, PJ; TENVERGERT, EM; VANDERMARK, TW; POSTMA, DS; VANALTENA, R; KRAAN, J; KOETER, GH

    1994-01-01

    Background - Several studies have shown that both objective and subjective measurements are related to exercise capacity in patients with chronic obstructive pulmonary disease (COPD). In this study the relative contribution of lung function, maximal inspiratory pressure, dyspnoea, and quality of lif

  8. The effects of extrafine beclometasone/formoterol (BDP/F) on lung function, dyspnea, hyperinflation, and airway geometry in COPD patients: novel insight using functional respiratory imaging

    OpenAIRE

    De Backer, Jan; Vos, Wim; Vinchurkar, Samir; van Holsbeke, Cedric; Poli, Gianluigi; Claes, Rita; Salgado,Rodrigo; De Backer, Wilfried

    2015-01-01

    Background: The efficacy of inhaled corticosteroids (ICS) in moderately severe COPD patients remains unclear. At the same time, the use of extrafine particles in COPD patients is a topic of ongoing research. Objectives: This study assessed the effect of ICS in steroid-naive mild COPD patients and the effect of reducing the ICS dose in more severe COPD patients previously using ICS when switching to an extrafine particle BDP/F formulation (Foster using Modulite technology, Chiesi Pharm...

  9. High affinity complexes of pannexin channels and L-type calcium channel splice-variants in human lung: Possible role in clevidipine-induced dyspnea relief in acute heart failure

    Directory of Open Access Journals (Sweden)

    Gerhard P. Dahl

    2016-08-01

    Research in Context: Clevidipine lowers blood pressure by inhibiting calcium channels in vascular smooth muscle. In patients with acute heart failure, clevidipine was shown to relieve breathing problems. This was only partially related to the blood pressure lowering actions of clevidipine and not conferred by another calcium channel inhibitor. We here found calcium channel variants in human lung that are more selectively inhibited by clevidipine, especially when associated with pannexin channels. This study gives a possible mechanism for clevidipine's relief of breathing problems and supports future clinical trials testing the role of clevidipine in the treatment of acute heart failure.

  10. Respuesta al entrenamiento en EPOC: Diferencia entre limitación por fatiga muscular y por disnea Training response in COPD: Differences between fatigue-limited and dyspnea-limited patients

    OpenAIRE

    Martín Sívori; Laura Bustamante; Alejandro Martínez Fraga; Marta de Almeida; César Saenz

    2011-01-01

    Este estudio comparó la respuesta post entrenamiento al ejercicio en pacientes limitados por fatiga muscular (LF) vs. disnea (LD). Se incluyeron pacientes con EPOC moderada y grave (definición GOLD), clasificándolos en LF si la respuesta a cicloergometría máxima tenía ≥ 2 puntos en la escala de Borg para fatiga muscular vs. disnea; LD a la inversa. Se realizaron ergometría submáxima, 6 minutos y pruebas de calidad de vida mediante cuestionario. Fueron entrenados 3 veces/semana, 90 min/s...

  11. Acute Pulmonary Edema in Patients with Cushing’s Syndrome

    OpenAIRE

    Mitra Niafar; Mehrnoush Toufan; Nooshin Milanchian; Farhad Niafar; Kavous Shahsavari Nia

    2015-01-01

    Introduction Dyspnea refers to difficulty in breathing, and short and shallow breaths. This sign is seen in numerous diseases due to pulmonary, cardiac, metabolic and neurological causes. Among cardiac causes, heart failure is considered the main cause of dyspnea. Cardiac failure is a clinical syndrome associated with a set of symptoms (dyspnea, and fatigue) and signs (edema and rales). Common causes of cardiac failure include: myocardial infarction, ischemic heart disease, hypertensi...

  12. Unruptured sinus of Valsalva aneurysm presenting with concurrent Morgagni hernia.

    Science.gov (United States)

    Masor, Jonathan J; Davis, S Scott; Chen, Edward P; Henry, Travis S; Book, Wendy M

    2015-10-01

    We describe a patient with dyspnea and intermittent cyanosis who was found to have concurrent right diaphragmatic and right atrial masses, initially thought to have advanced vascular sarcoma. She was ultimately diagnosed with an unruptured sinus of Valsalva aneurysm, a Morgagni hernia, and a patent foramen ovale. Her dyspnea and cyanosis resolved after sequential surgical correction of these defects.

  13. The effect of inhaled menthol on upper airway resistance in humans: A randomized controlled crossover study

    Directory of Open Access Journals (Sweden)

    Effie J Pereira

    2013-01-01

    Full Text Available BACKGROUND: Menthol (l-menthol is a naturally-occurring cold receptor agonist commonly used to provide symptomatic relief for upper airway congestion. Menthol can also reduce the sensation of dyspnea. It is unclear whether the physiological action of menthol in dyspnea reduction is through its cold receptor agonist effect or whether associated mechanical changes occur in the upper airway.

  14. [Impaired lung function and anemia from large hiatal hernia: a case report].

    Science.gov (United States)

    Suppa, Marianna; Colzi, Marina; Magnanelli, Elisa; Migliozzi, Elisa; Negri, Silvia; Millarelli, Federica; Coppola, Alessandro

    2013-05-01

    We present the clinical case of a 54 years old man who accessed for dyspnea and severe anemia. After being transfused, he underwent to gastroscopy, which showed an erosive gastritis with large hiatal hernia. The hernia was surgically reduced with laparoscopic hiatoplastic and Nissen-Rossetti fundoplication. In conclusion, dyspnea is not merely a medical competence but also a surgical one.

  15. A 55-year-old man with a small right lung and a right-sided heart.

    Science.gov (United States)

    Albores, Jeffrey; Bando, Joanne; Smith, M Iain

    2015-03-01

    A healthy 55-year-old man without known medical problems presented for a routine physical examination and was found to have an abnormal ECG. He denied chest pain, dyspnea, palpitations, dizziness, or syncopal episodes. He also denied orthopnea, paroxysmal nocturnal dyspnea, and lower-extremity edema. His exercise capacity had been excellent. He was a lifelong nonsmoker and never had lung problems.

  16. Effects of voluntary constraining of thoracic displacement during hypercapnia.

    Science.gov (United States)

    Chonan, T; Mulholland, M B; Cherniack, N S; Altose, M D

    1987-11-01

    The study evaluated the interrelationships between the extent of thoracic movements and respiratory chemical drive in shaping the intensity of the sensation of dyspnea. Normal subjects rated their sensations of dyspnea as PCO2 increased during free rebreathing and during rebreathing while ventilation was voluntarily maintained at a constant base-line level. Another trial evaluated the effects on the intensity of dyspnea, of voluntary reduction in the level of ventilation while PCO2 was held constant. During rebreathing, there was a power function relationship between changes in PCO2 and the intensity of dyspnea. At a given PCO2, constraining tidal volume and breathing frequency to the prerebreathing base-line level resulted in an increase in dyspnea. The fractional differences in the intensity of dyspnea between free and constrained rebreathing were independent of PCO2. However, the absolute difference in the intensity of dyspnea between free and constrained rebreathing enlarged with increasing hypercapnia. At PCO2 of 50 Torr, this difference correlated significantly with the increase in both minute ventilation (r = 0.675) and tidal volume (r = 0.757) above the base line during free rebreathing. Similarly, during steady-state hypercapnia at 50 Torr PCO2, the intensity of dyspnea increased progressively as ventilation was voluntarily reduced from the spontaneously adopted free-breathing level. These results indicate that dyspnea increases with the level of respiratory chemical drive but that the intensity of the sensation is further accentuated when ventilation is constrained below that demanded by the level of chemical drive. This may be explained by a loss of inhibitory feedback from lung or chest wall mechanoreceptors acting on brain stem and/or cortical centers.

  17. Pneumomediastinum Secondary to Foreign Body Aspiration: Clinical Features and Treatment Explorement in 39 Pediatric Patients

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jian Yang; Jie Zhang; Ping Chu; Yong-Li Guo; Jun Tai; Ya-Mei Zhang; Li-Xing Tang

    2016-01-01

    Background:Pneumomediastinum (PM) secondary to foreign body aspiration (FBA) is rare in children.Although it is mainly benign,some cases may be fatal.Due to the rare nature of this clinical entity,proper assessment and management have been poorly studied so far.Here,we characterized the presentation and management of this clinical entity and provided an evaluation system for the management.Methods:We retrospectively reviewed children with PM secondary to FBA,who were treated in Beijing Children's Hospital from January 2010 to December 2015.All patients were stratified according to the degree of dyspnea on admission,and interventions were given accordingly.Bronchoscopic removals of airway foreign bodies (FBs) were performed on all patients.For patients in acute respiratory distress,emergent air evacuation and/or resuscitations were performed first.Admission data,interventions,and clinical outcomes were recorded.Results:A total of 39 patients were included in this study.The clinical severity was divided into three grades (Grades Ⅰ,Ⅱ,and Ⅲ) according to the degree of dyspnea.Thirty-one patients were in Grade Ⅰ dyspnea,and they simply underwent bronchoscopic FBs removals.PM resolved spontaneously and all patients recovered uneventfully.Six patients were in Grade Ⅱ dyspnea,and emergent drainage preceded rigid bronchoscopy.They all recovered uneventfully under close observation.Two exhausted patients were in Grade Ⅲ dyspnea.They died from large PM and bilateral pneumothorax,respectively,despite of aggressive interventions in our hospital.Conclusions:PM secondary to FBA could be life-threatening in some patients.The degree of dyspnea should be evaluated immediately,and patients in different dyspnea should be treated accordingly.For patients in Grade Ⅰ dyspnea,simple bronchoscopic FBs removals could promise a good outcome.For patients in Grade Ⅱ dyspnea,emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become

  18. Respiratory Emergencies in Geriatric Patients.

    Science.gov (United States)

    Tyler, Katren; Stevenson, Dane

    2016-02-01

    Acute dyspnea in older patients is a common presentation to the emergency department. Acute dyspnea in older adults is often the consequence of multiple overlapping disorders, such as pneumonia precipitating acute heart failure. Emergency physicians must be comfortable managing patients with acute dyspnea of uncertain cause and varying goals of care. In addition to the important role noninvasive ventilation (NIV) plays in full resuscitation, NIV can be useful as a method of providing supportive or nearly fully supportive care while more information is gathered from the patients and their loved ones.

  19. High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition

    Directory of Open Access Journals (Sweden)

    Kenneth S. Whitlow,

    2014-11-01

    Full Text Available High altitude pulmonary edema (HAPE is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE. [West J Emerg Med. 2014;15(7:–0.

  20. High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition

    Science.gov (United States)

    Whitlow, Kenneth S.; Davis, Babette W.

    2014-01-01

    High altitude pulmonary edema (HAPE) is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE. PMID:25493133

  1. Pulmonary Hemorrhage in Cryoglobulinemia

    Directory of Open Access Journals (Sweden)

    G Kirkpatrick

    2015-01-01

    Full Text Available Pulmonary manifestations of cryoglobulinemia are uncommon and their clinical behaviour is unpredictable, ranging from mild dyspnea to life-threatening presentations. A patient with cryoglobulinemia who presented with hypoxic respiratory failure attributed to pulmonary hemorrhage is reported.

  2. IDENTIFICATION OF SPONTANEOUS FELINE IDIOPATHIC PULMONARY FIBROSIS: MORPHOLOGY AND ULTRASTRUCTURAL EVIDENCE FOR A TYPE II PNEUMOCYTE DEFECT

    Science.gov (United States)

    AbstractIdiopathic pulmonary fibrosis currently lacks an animal model that develops the persistent, progressive lung fibrosis characteristic of the disease. Sixteen domestic cats developed dyspnea that was not responsive to therapy and which rapidly progressed until death/eu...

  3. Determinants of health-related quality of life in patients with small cell lung cancer: a systematic PubMed review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Aristomenis Kossioris

    2016-03-01

    Conclusions ― Health professionals could pay more attention to the management of cancer-related fatigue and dyspnea as well as to the enhancement of patients’ mobility through low-impact exercise programs or appropriate assistive devices.

  4. Efficacy of melflufen, a peptidase targeted therapy, and dexamethasone in an ongoing open-label phase 2a study in patients with relapsed and relapsed-refractory multiple myeloma (RRMM) including an initial report on progression free survival

    DEFF Research Database (Denmark)

    Voorhees, P. M.; Magarotto, V.; Sonneveld, P.;

    2015-01-01

    in >10% of patients, regardless of relationship to study drug were thrombocytopenia (94%), anemia (84%), neutropenia (61%), leukopenia (42%), pyrexia (36%), asthenia (32%), fatigue and nausea (26%), bone pain (19%), cough, diarrhea, dyspnea, mucosal inflammation and upper respiratory infection (16...

  5. Laser Posterior Cordotomy: Is it a Good Choice in Treating Bilateral Vocal Fold Abductor Paralysis?

    National Research Council Canada - National Science Library

    Khalil, Mahmoud A; Abdel Tawab, Hazem M

    2014-01-01

    .... To assess the efficacy of CO2 laser unilateral posterior cordotomy in cases with bilateral abductor paralysis as regards improvement of dyspnea with preservation of satisfactory voice and swallowing after the operation...

  6. Common Acupoints in Chest and Abdomen

    Institute of Scientific and Technical Information of China (English)

    Journal of Acupuncture and Tuina Science Editor; CUI Xue-jun

    2003-01-01

    @@ Tiantu (CV 21) Location: In the center of the suprasternal fossa(Fig. l ). Indications: Cough, dyspnea, chest pain, pharyngolaryngeal swelling and pains, sudden hoarseness of the voice, goiter, globus hystericus, and dysphagia.

  7. Periapical abscess of the maxillary teeth and its fistulizations: Multi ...

    African Journals Online (AJOL)

    Sherif A. Shama

    2012-12-14

    Dec 14, 2012 ... als of previous extraction were also encountered. Conclusion: The MDCT with ... tooth pain, facial swelling, dysphagia, trismus, and possibly dyspnea. .... than a third of lesions detected with CBCT were missed with periapical ...

  8. A Systematic Review of Resistance Training Versus Endurance Training in COPD

    DEFF Research Database (Denmark)

    Iepsen, Ulrik Winning; Jørgensen, Karsten Juhl; Ringbaek, Thomas;

    2015-01-01

    controlled trials (328 participants). On the basis of moderate- to very low-quality evidence, we found no clinically important difference between RT and ET. We did not find sufficient data for a meta-analysis of total mortality, adverse events, dyspnea, or lean body mass. CONCLUSIONS:: We found......PURPOSE:: Endurance training (ET) as part of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to improve exercise capacity and health-related quality of life, but dyspnea limits the exercise intensity. Therefore, resistance training (RT), which...... may cause less dyspnea, could be an alternative. The purpose of this review was to formulate evidence-based recommendations on the use of RT in pulmonary rehabilitation of patients with COPD. Our primary outcomes were health-related quality of life, activities of daily living, dyspnea, possible harm...

  9. Subglottic adenoid cystic carcinoma mistaken for asthma

    Institute of Scientific and Technical Information of China (English)

    Hua-lin WANG; Lin XU; Fu-jun LI

    2009-01-01

    of the tumor. The diagnosis of subglottic adenoid cystic carcinoma should be considered in patients who are characterized by dyspnea, cough, and stridor, but do not respond to regular anti-asthmatic therapy.

  10. Computed Tomography of Prosthetic Heart Valves

    NARCIS (Netherlands)

    Habets, J.

    2012-01-01

    Prosthetic heart valve (PHV) dysfunction is an infrequent but potentially life-threatening disease with a heterogeneous clinical presentation. Patients with PHV dysfunction clinically can present with symptoms of congestive heart failure (dyspnea, fatigue, edema), fever, angina pectoris, dizziness d

  11. Breathing difficulties - first aid

    Science.gov (United States)

    Difficulty breathing - first aid; Dyspnea - first aid; Shortness of breath - first aid ... Breathing difficulty is almost always a medical emergency. An exception is feeling slightly winded from normal activity, ...

  12. A 75-year-old man with renal insufficiency and eosinophilia after coronary angiography

    Institute of Scientific and Technical Information of China (English)

    Zhaoping LU; Geng SHAO; Yong HUO; Wenhui DING; Yang YANG; Chen CHEN

    2007-01-01

    @@ Case presentation A 75-year-old male patient received esophageal carcinoma surgery in Oct 2005. The next day of the operation, he had dyspnea, chest discomfort and sweating when he was on some activities.

  13. Medical image of the week: carcinoid at the carina

    OpenAIRE

    Siddiqi TA; lzoubaidi N; Knepler J; Knox KS

    2015-01-01

    No abstract available. Article truncated at 150 words. A 74-year-old woman with history of 30 pack-year smoking, allergic rhinitis and asthma presented to pulmonary clinic with cough and dyspnea on exertion. She was placed on inhaled corticosteroids and long-acting beta-agonist. Pulmonary function test showed moderate obstructive ventilator defect and flow volume loop suggested variable intra-thoracic obstruction (Figure 1). In the meantime, she was hospitalized with complaint of dyspnea and ...

  14. Extended Storage of Pathogen-Reduced Platelet Concentrates (PRECON)

    Science.gov (United States)

    2016-10-01

    described in the original statement of work, Extended Storage of Pathogen-Reduced Platelet Concentrates (PRECON). 1. Determine the optimum conditions...platelet infusion, the subject will be carefully monitored for adverse reactions; i.e., fever , chills, dyspnea, urticaria or pain (infusion site, chest...adverse reactions; e.g., fever , chills, dyspnea, urticaria, or pain (infusion site, chest pain or other). Adverse reactions will be recorded in the

  15. Dynamic Multidetector CT Findings of Left Atrial Myxomas Causing Mitral Valve Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ji Yeon [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Kim, Dong Hun [Dept. of Radiology, Chosun University College of Medicine, Gwangju (Korea, Republic of); Seo, Hye Sun [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Her, Keun [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Kim, Hee Kyung [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

    2011-07-15

    We report multidetector row CT (MDCT) findings of two left atrial myxomas causing mitral valve obstruction and dyspnea of patients. Cardiac MDCT showed well-defined left atrial masses attached to the interatrial septum and shifting of tumors into the left ventricle causing mitral valve obstruction during diastole in a 37-year-old male and in a 69-year-old female. Also, we observed intratumoral hemorrhage in the second case. Myxomas were resected and the patients were discharged without dyspnea.

  16. Impact of bronchodilator therapy on exercise tolerance in COPD

    OpenAIRE

    Aguilaniu, B

    2010-01-01

    B AguilaniuHYLAB, Laboratory of Clinical Physiology and Exercise, Grenoble, FranceAbstract: Exercise tolerance is an important parameter in patients with COPD and a primary goal of treatment is to reduce dyspnea to facilitate physical activities and improve health-related quality of life. This review examines the link between expiratory flow limitation and dyspnea to explain the rationale for the use of bronchodilators and review the characteristics of different types of exercise tests, with ...

  17. Quantitative CT assessment in chronic obstructive pulmonary disease patients: Comparison of the patients with and without consistent clinical symptoms and pulmonary function results

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Boda; Hwang, Jung Hwa [Dept. of Radiology, Soonchunhyang University Hospital, Seoul (Korea, Republic of); Lee, Young Mok [Bangbae GF Allergy Clinic, Seoul (Korea, Republic of); Park, Jai Soung [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Kim, Young Bae [Dept. of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2015-09-15

    We compared the clinical and quantitative CT measurement parameters between chronic obstructive pulmonary disease (COPD) patients with and without consistent clinical symptoms and pulmonary function results. This study included 60 patients having a clinical diagnosis of COPD, who underwent chest CT scan and pulmonary function tests. These 60 patients were classified into typical and atypical groups, which were further sub-classified into 4 groups, based on their dyspnea score and the result of pulmonary function tests [typical 1: mild dyspnea and pulmonary function impairment (PFI); typical 2: severe dyspnea and PFI; atypical 1: mild dyspnea and severe PFI; atypical 2: severe dyspnea and mild PFI]. Quantitative measurements of the CT data for emphysema, bronchial wall thickness and air-trapping were performed using software analysis. Comparative statistical analysis was performed between the groups. The CT emphysema index correlated well with the results of the pulmonary functional test (typical 1 vs. atypical 1, p = 0.032), and the bronchial wall area ratio correlated with the dyspnea score (typical 1 vs. atypical 2, p = 0.033). CT air-trapping index also correlated with the results of the pulmonary function test (typical 1 vs. atypical 1, p = 0.012) and dyspnea score (typical 1 vs. atypical 2, p = 0.000), and was found to be the most significant parameter between the typical and atypical groups. Quantitative CT measurements for emphysema and airways correlated well with the dyspnea score and pulmonary function results in patients with COPD. Air-trapping was the most significant parameter between the typical vs. atypical group of COPD patients.

  18. Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.

    Science.gov (United States)

    Beaumont, M; Mialon, P; Le Ber-Moy, C; Lochon, C; Péran, L; Pichon, R; Gut-Gobert, C; Leroyer, C; Morelot-Panzini, C; Couturaud, F

    2015-11-01

    Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.

  19. Pharmacological treatment optimization for stable chronic obstructive pulmonary disease. Proposals from the Société de Pneumologie de Langue Française.

    Science.gov (United States)

    Zysman, M; Chabot, F; Devillier, P; Housset, B; Morelot-Panzini, C; Roche, N

    2016-12-01

    The Société de Pneumologie de Langue Française proposes a decision algorithm on long-term pharmacological COPD treatment. A working group reviewed the literature published between January 2009 and May 2016. This document lays out proposals and not guidelines. It only focuses on pharmacological treatments except vaccinations, smoking cessation treatments and oxygen therapy. Any COPD diagnosis, based on pulmonary function tests, should lead to recommend smoking cessation, vaccinations, physical activity, pulmonary rehabilitation in case of activity limitation, and short-acting bronchodilators. Symptoms like dyspnea and exacerbations determine the therapeutic choices. In case of daily dyspnea and/or exacerbations, a long-acting bronchodilator should be suggested (beta-2 agonist, LABA or anticholinergics, LAMA). A clinical and lung function reevaluation is suggested 1 to 3 months after any treatment modification and every 3-12 months according to the severity of the disease. In case of persisting dyspnea, a fixed dose LABA+LAMA combination improves pulmonary function (FEV1), quality of life, dyspnea and decreases exacerbations without increasing side effects. In case of frequent exacerbations and a FEV1≤70%, a fixed dose long-acting bronchodilator combination or a LABA+ inhaled corticosteroids (ICS) combination can be proposed. A triple combination (LABA+LAMA+ICS) is indicated when exacerbations persist despite one of these combinations. Dyspnea in spite of a bronchodilator combination or exacerbations in spite of a triple combination should lead to consider other pharmacological treatments (theophylline if dyspnea, macrolides if exacerbations, low-dose opioids if refractory dyspnea).

  20. Clinical utility of measures of breathlessness.

    Science.gov (United States)

    Cullen, Deborah L; Rodak, Bernadette

    2002-09-01

    The clinical utility of measures of dyspnea has been debated in the health care community. Although breathlessness can be evaluated with various instruments, the most effective dyspnea measurement tool for patients with chronic lung disease or for measuring treatment effectiveness remains uncertain. Understanding the evidence for the validity and reliability of these instruments may provide a basis for appropriate clinical application. Evaluate instruments designed to measure breathlessness, either as single-symptom or multidimensional instruments, based on psychometrics foundations such as validity, reliability, and discriminative and evaluative properties. Classification of each dyspnea measurement instrument will recommend clinical application in terms of exercise, benchmarking patients, activities of daily living, patient outcomes, clinical trials, and responsiveness to treatment. Eleven dyspnea measurement instruments were selected. Each instrument was assessed as discriminative or evaluative and then analyzed as to its psychometric properties and purpose of design. Descriptive data from all studies were described according to their primary patient application (ie, chronic obstructive pulmonary disease, asthma, or other patient populations). The Borg Scale and the Visual Analogue Scale are applicable to exertion and thus can be applied to any cardiopulmonary patient to determine dyspnea. All other measures were determined appropriate for chronic obstructive pulmonary disease, whereas the Shortness of Breath Questionnaire can be applied to cystic fibrosis and lung transplant patients. The most appropriate utility for all instruments was measuring the effects on activities of daily living and for benchmarking patient progress. Instruments that quantify function and health-related quality of life have great utility for documenting outcomes but may be limited as to documenting treatment responsiveness in terms of clinically important changes. The dyspnea

  1. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II.

    Science.gov (United States)

    Stein, Paul D; Beemath, Afzal; Matta, Fadi; Weg, John G; Yusen, Roger D; Hales, Charles A; Hull, Russell D; Leeper, Kenneth V; Sostman, H Dirk; Tapson, Victor F; Buckley, John D; Gottschalk, Alexander; Goodman, Lawrence R; Wakefied, Thomas W; Woodard, Pamela K

    2007-10-01

    Selection of patients for diagnostic tests for acute pulmonary embolism requires recognition of the possibility of pulmonary embolism on the basis of the clinical characteristics. Patients in the Prospective Investigation of Pulmonary Embolism Diagnosis II had a broad spectrum of severity, which permits an evaluation of the subtle characteristics of mild pulmonary embolism and the characteristics of severe pulmonary embolism. Data are from the national collaborative study, Prospective Investigation of Pulmonary Embolism Diagnosis II. There may be dyspnea only on exertion. The onset of dyspnea is usually, but not always, rapid. Orthopnea may occur. In patients with pulmonary embolism in the main or lobar pulmonary arteries, dyspnea or tachypnea occurred in 92%, but the largest pulmonary embolism was in the segmental pulmonary arteries in only 65%. In general, signs and symptoms were similar in elderly and younger patients, but dyspnea or tachypnea was less frequent in elderly patients with no previous cardiopulmonary disease. Dyspnea may be absent even in patients with circulatory collapse. Patients with a low-probability objective clinical assessment sometimes had pulmonary embolism, even in proximal vessels. Symptoms may be mild, and generally recognized symptoms may be absent, particularly in patients with pulmonary embolism only in the segmental pulmonary branches, but they may be absent even with severe pulmonary embolism. A high or intermediate-probability objective clinical assessment suggests the need for diagnostic studies, but a low-probability objective clinical assessment does not exclude the diagnosis. Maintenance of a high level of suspicion is critical.

  2. Clinical Characteristics of Patients with Acute Pulmonary Embolism

    Science.gov (United States)

    Stein, Paul D.; Beemath, Afzal; Matta, Fadi; Weg, John G.; Yusen, Roger D.; Hales, Charles A.; Hull, Russell D.; Leeper, Kenneth V.; Sostman, H Dirk; Tapson, Victor F.; Buckley, John D.; Gottschalk, Alexander; Goodman, Lawrence R.; Wakefied, Thomas W.; Woodard, Pamela K.

    2007-01-01

    BACKGROUND Selection of patients for diagnostic tests for acute pulmonary embolism requires recognition of the possibility of pulmonary embolism based on the clinical characteristics. Patients in the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) had a broad spectrum of severity, which permits an evaluation of the subtle characteristics of mild pulmonary embolism as well as the characteristics of severe pulmonary embolism. METHODS Data are from the national collaborative study, PIOPED II. RESULTS There may be dyspnea only on exertion. The onset of dyspnea is usually, but not always, rapid. Orthopnea may occur. In patients with pulmonary embolism in main or lobar pulmonary arteries, dyspnea or tachypnea occurred in 92%, but in only 65% in whom the largest pulmonary embolism was in segmental pulmonary arteries. In general, signs and symptoms were similar in elderly and younger patients, but dyspnea or tachypnea were less frequent in elderly patients with no prior cardiopulmonary disease. Dyspnea may be absent even in patients with circulatory collapse. Patients with a low probability objective clinical assessment sometimes had pulmonary embolism, even in proximal vessels. CONCLUSION Symptoms may be mild and generally recognized symptoms may be absent, particularly in patients with pulmonary embolism only in segmental pulmonary branches, but they may be absent even with severe pulmonary embolism. A high or intermediate probability objective clinical assessment may suggest the need for diagnostic studies, but a low probability objective clinical assessment does not exclude the diagnosis. Maintenance of a high level of suspicion is critical. PMID:17904458

  3. Acute Pulmonary Edema in Patients with Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Mitra Niafar

    2015-01-01

    Full Text Available IntroductionDyspnea refers to difficulty in breathing, and short and shallow breaths. This sign is seen in numerous diseases due to pulmonary, cardiac, metabolic and neurological causes. Among cardiac causes, heart failure is considered the main cause of dyspnea.Cardiac failure is a clinical syndrome associated with a set of symptoms (dyspnea, and fatigue and signs (edema and rales. Common causes of cardiac failure include: myocardial infarction, ischemic heart disease, hypertension, valvular heart diseases, and cardiomyopathy. Among uncommon causes of heart failure, endocrine disorders such as Cushing’s syndrome can be cited. Cushing’s syndrome can present itself in less common forms such as dyspnea due to heart failure. Cushing’s syndrome’s cardiovascular complications usually occur due to hypertension, end organ damage such as left ventricular heart failure, diastolic and ischemic myocardial heart failure, which are rather seen in chronic cases of the disease and are often irreversible.Transient heart failure in patients with Cushing’s syndrome, due to adrenal adenoma, has been reported in a number of patients. In this case report, a patient is introduced who presented to emergency department with severe dyspnea (FC III, and was ultimately diagnosed with Cushing’s syndrome after work up. Three months after treatment of Cushing’s syndrome, dramatic improvement was observed in this patient’s cardiac function.

  4. Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index.

    Science.gov (United States)

    Almagro, Pedro; Soriano, Joan B; Cabrera, Francisco J; Boixeda, Ramon; Alonso-Ortiz, M Belen; Barreiro, Bienvenido; Diez-Manglano, Jesus; Murio, Cristina; Heredia, Josep L

    2014-05-01

    No valid tools exist for evaluating the prognosis in the short and medium term after hospital discharge of patients with COPD. Our hypothesis was that a new index based on the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index can accurately predict mortality, hospital readmission, and their combination for the period from 3 months to 1 year after discharge in patients hospitalized for COPD. A multicenter study of patients hospitalized for COPD exacerbations was used to develop the CODEX index, and a different patient cohort was used for validation. Comorbidity was measured using the age-adjusted Charlson index, whereas dyspnea, obstruction, and severe exacerbations were calculated according to BODEX (BMI, airfl ow obstruction, dyspnea, and previous severe exacerbations) thresholds. Information about mortality and readmissions for COPD or other causes was collected at 3 and 12 months after hospital discharge. Two sets of 606 and 377 patients were included in the development and validation cohorts, respectively. The CODEX index was associated with mortality at 3 months ( P CODEX C statistics were superior to those of the BODEX, DOSE (dyspnea, airfl ow obstruction, smoking status, and exacerbation frequency), and updated ADO (age, dyspnea, and airfl ow obstruction) indexes. The CODEX index was a useful predictor of survival and readmission at both 3 months and 1 year after hospital discharge for a COPD exacerbation, with a prognostic capacity superior to other previously published indexes.

  5. Amino-terminal pro-B-type natriuretic peptide testing to assist the diagnostic evaluation of heart failure in symptomatic primary care patients

    DEFF Research Database (Denmark)

    Hildebrandt, P.; Collinson, P.O.

    2008-01-01

    When used for the evaluation of symptomatic patients in general practice, amino-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is highly sensitive, with an excellent negative predictive value for cost-effective exclusion of the diagnosis of heart failure (HF). Importantly (similar...... to other NP assays), lower values for NT-proBNP are expected among patients with HF in the primary care setting compared with patients with acute dyspnea. Among primary care patients with dyspnea, a noncardiac source of dyspnea is most likely in patients with findings below the recommended age......-stratified NT-proBNP cut points. Conversely, an NT-proBNP result above the age-stratified primary care cut points does not absolutely indicate the presence of HF; a more directed cardiovascular workup is indicated Udgivelsesdato: 2008/2/4...

  6. Semilobar Holoprosencephaly with Congenital Oropharyngeal Stenosis in a Term Neonate

    Directory of Open Access Journals (Sweden)

    Kenji Hishikawa

    2015-10-01

    Full Text Available Background - Holoprosencephaly (HPE is often accompanied by a deficit in midline facial development; however, congenital oropharyngeal stenosis in neonates with HPE has not been reported before. We describe a case of a neonate with prenatally diagnosed semilobar HPE accompanied by congenital oropharyngeal stenosis. Case Report - The patient was born at 39 weeks of gestation and developed dyspnea shortly after. Laryngoscopic test revealed oropharyngeal stenosis. Nasal continuous positive airway pressure, high-flow nasal cannula, and nasopharyngeal airway did not resolve her dyspnea; tracheostomy was required. Conclusion - Neonates with HPE might be at higher risk of pharyngeal stenosis because of the functional and/or anatomical abnormalities. In the case of dyspnea in neonates with HPE, laryngoscopic evaluation should be considered.

  7. Semilobar Holoprosencephaly with Congenital Oropharyngeal Stenosis in a Term Neonate.

    Science.gov (United States)

    Hishikawa, Kenji; Fujinaga, Hideshi; Nagata, Chie; Higuchi, Masataka; Ito, Yushi

    2015-10-01

    Background Holoprosencephaly (HPE) is often accompanied by a deficit in midline facial development; however, congenital oropharyngeal stenosis in neonates with HPE has not been reported before. We describe a case of a neonate with prenatally diagnosed semilobar HPE accompanied by congenital oropharyngeal stenosis. Case Report The patient was born at 39 weeks of gestation and developed dyspnea shortly after. Laryngoscopic test revealed oropharyngeal stenosis. Nasal continuous positive airway pressure, high-flow nasal cannula, and nasopharyngeal airway did not resolve her dyspnea; tracheostomy was required. Conclusion Neonates with HPE might be at higher risk of pharyngeal stenosis because of the functional and/or anatomical abnormalities. In the case of dyspnea in neonates with HPE, laryngoscopic evaluation should be considered.

  8. Atrial Septal Defect in a Very Old Woman

    Science.gov (United States)

    Pinho, Elika; Gomes, Andre Amaral; Silva, Maria Joao; Torres, Tiago Pinheiro; Coelho, Andreia; Almeida, Pedro Bernardo; Lourenco, Patricia; Bettencourt, Paulo

    2013-01-01

    Atrial Septal Defect (ASD) is one of the most frequently congenital heart diseases in adults and it is often asymptomatic until adulthood. We report a case of a 90-year-old woman admitted to hospital with dyspnea and orthopnea insidiously progressing over the preceding 5 years and becoming severe with dyspnea on minimal activities, orthopnea and paroxysmal nocturnal dyspnea, in the last 2 weeks. The transthoracic echocardiogram revealed an atrial septal defect ostium secundum type, with left-to-right shunt, moderate to severe tricuspid insufficiency, severe pulmonary hypertension (72 mmHg) and preserved biventricular function. With diuretic therapy optimization the patient showed symptomatic improvement. This present case represents and unusual and very late presentation of an atrial septal defect ostium secundum type, which is usually diagnosed at the mild adult age. Our patient lived symptom-free for over 80 years.

  9. Ultrasound for critical care physicians: really, at her age?

    Directory of Open Access Journals (Sweden)

    Wesselius LJ

    2014-05-01

    Full Text Available No abstract available. Article truncated after first page. A 71 year old woman presented with dyspnea since late 2013 and denies a prior history of dyspnea. She had a cardiac pacemaker placed in 2008 for sick sinus syndrome. Her physical exam was unremarkable and her SpO2 was 96% on room air. However, it decreased to 84% with exercise. Chest x-ray and pulmonary function testing were unremarkable (a DLco was unable to be performed. A transthoracic echocardiogram was performed (Figure 1. Which of the following best explains the patient's dyspnea and hypoxia? 1. Cardiac tamponade; 2. Decreased cardiac contractility; 3. Intracardiac shunt; 4. Mitral insufficiency; 5. Ventilation perfusion mismatch from COPD ...

  10. Aortic dissection accompanied by preeclampsia in a postpartum young woman

    Science.gov (United States)

    Park, Jin-Wan; Kim, Su-Mi; Yu, Gyu-Bong

    2016-01-01

    Aortic dissection is very rare in obstetrics, but it is a fatal disease. A 37-weeks primigravida woman with dyspnea and pitting edema presented to our emergency room. The patient was diagnosed with preeclampsia and underwent an emergency cesarean section under spinal anesthesia. The patient complained of severe dyspnea after the cesarean section, and the chest computed tomography scan was done. With the finding of aortic dissection, cardiopulmonary arrest occurred 5 hours after the cesarean section, and the patient died without reaction to cardio-pulmonary resuscitation. If a patient with preeclampsia complains of severe dyspnea or chest pain, aortic dissection needs to be suspected and a diagnosis should not be delayed. PMID:27668205

  11. Sporadic multicentric right atrial and right ventricular myxoma presenting as acute pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Satyajit Singh

    2016-01-01

    Full Text Available Multicentric cardiac myxoma is a rare syndrome; usually it is familial. We report a rare case of sporadic right atrium (RA and right ventricle (RV myxoma in a 26-year-old female presenting to our hospital for the evaluation of sudden onset of dyspnea and left precordial pain attributed to the embolization of degenerating tumor fragments to the pulmonary artery (PA. The exact incidence of sporadic multicentric RA and RV myxoma presenting as acute pulmonary embolism is unknown as multicentric RA and RV myxoma are very rare. Myxomas presenting as pulmonary embolism is <10%. Majority of cardiac myxomas present as exertional dyspnea, chest pain, positional syncope, fever, weight loss and other constitutional symptoms. Any young patient presenting with acute onset dyspnea with multiple cardiac masses may have tumor embolization to the PA diagnosis with transthoracic echocardiography and high-resolution computed tomography of thorax, fast-tracks patient transfer for urgent cardiac surgery to prevent further embolization.

  12. Real-time telehealth for COPD self-management using Skype™.

    Science.gov (United States)

    Nield, Margaret; Hoo, Guy W Soo

    2012-12-01

    The utility of real-time interactive voice and video telehealth for teaching pursed-lips breathing (PLB) in chronic obstructive pulmonary disease (COPD) is unknown. This was a pilot study to determine its feasibility and efficacy on the key variables of social support and dyspnea. A randomized control study design with repeated measures (baseline, 4 and 12 weeks) was used. All participants in the control and intervention groups received PLB instruction at baseline, but only the intervention group received one weekly PLB reinforcement session for 4 weeks via home computer and Skype™ software. Outcome measures were Medical Outcomes Study Social Support Survey and dyspnea assessment (visual analogue scales for intensity and distress, modified Borg after six-minute walk distance, and Shortness of Breath Questionnaire for activity-associated dyspnea). A total of 22 participants with COPD (mean FEV(1)% predicted = 56) were randomized; 16 (9 telehealth, 7 control) completed the protocol. Intent-to-treat analysis at week 4, but not week 12, demonstrated significantly improved total social support (P = 0.02) and emotional/informational subscale (P = 0.03) scores. Dyspnea intensity decreased (P = 0.08) for the intervention group with a minimal clinical important difference of 10.4 units. Analysis of only participants who completed the protocol demonstrated a significant decrease in dyspnea intensity (P = < 0.01) for the intervention group at both week 4 and 12. Real-time telehealth is a feasible, innovative approach for PLB instruction in the home with outcomes of improved social support and decreased dyspnea.

  13. Can "steroid switching" improve steroid-induced musical hallucinations in a patient with terminal cancer?

    Science.gov (United States)

    Kanemura, Seitetsu; Tanimukai, Hitoshi; Tsuneto, Satoru

    2010-12-01

    The patient was a 57-year-old woman with malignant pleural mesothelioma. She had a past history of anxiety neurosis but not had any history of otological diseases. On admission to our hospice (day 1), she complained of dyspnea and wheezing associated with the progression of her underlying disease. After we started oral betamethasone (2 mg/d), dyspnea was alleviated and the frequency of wheezing was reduced. On day 3, she began to experience musical hallucinations that were manifested in opera/piano concert music and a child's voice. The episodes of musical hallucinations occurred approximately 10 times a day and disappeared spontaneously within several minutes. She had not experienced these symptoms before. We reduced the dose of betamethasone to 1 mg/d, but the musical hallucinations continued. Then on day 11, we switched betamethasone (1 mg/d) to prednisolone (10 mg/d) and we then gradually tapered off prednisolone. The frequency of musical hallucinations decreased and she ceased to experience musical hallucinations on day 29. However, on day 40, her dyspnea was aggravated again, so we started treatment with prednisolone (5 mg/d). Dyspnea was alleviated and no musical hallucinations occurred. On Day 51, dyspnea was worsened and we switched prednisolone to betamethasone (4 mg/d), which she hoped to use. The betamethasone alleviated the dyspnea but she developed musical hallucinations that were similar to the previous episodes. The musical hallucinations disappeared spontaneously 4-5 days later without changing the betamethasone. Musical hallucinations never occurred thereafter. She later died due to the exacerbation of disease.

  14. Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

    Science.gov (United States)

    Ernst, Armin; Grosu, Horiana B.; Lei, Xiudong; Diaz-Mendoza, Javier; Slade, Mark; Gildea, Thomas R.; Machuzak, Michael S.; Jimenez, Carlos A.; Toth, Jennifer; Kovitz, Kevin L.; Ray, Cynthia; Greenhill, Sara; Casal, Roberto F.; Almeida, Francisco A.; Wahidi, Momen M.; Eapen, George A.; Feller-Kopman, David; Morice, Rodolfo C.; Benzaquen, Sadia; Tremblay, Alain; Simoff, Michael; Kovitz, Kevin; Greenhill, Sara; Gildea, Thomas R.; Machuzak, Michael; Almeida, Francisco A.; Cicenia, Joseph; Wahidi, Momen; Mahmood, Kamran; MacEachern, Paul; Tremblay, Alain; Simoff, Michael; Diaz-Mendoza, Javier; Ray, Cynthia; Feller-Kopman, David; Yarmus, Lonny; Estrada-Y-Martin, Rosa; Casal, Roberto F.; Toth, Jennifer; Karunakara, Raj; Slade, Mark; Ernst, Armin; Rafeq, Samaan; Ost, David; Eapen, George A.; Jimenez, Carlos A.; Morice, Rodolfo C.; Benzaquen, Sadia; Puchalski, Jonathan

    2015-01-01

    BACKGROUND: There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness. METHODS: This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D. RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements. CONCLUSIONS: Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most. PMID:25358019

  15. CT pulmonay angiography features of a hepatopulmonary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Chawla, Ashish; Gaikwad, Vishai; Dubey, Niraj; Bosco, Jerome [Dept. of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore (Singapore)

    2015-08-15

    A 59-year-old man presented a six-month history of worsening dyspnea and dry cough, and not responding to medication. There was no history of fever, hematemesis, loss of appetite, or chest pain. Physical examination revealed peripheral cyanosis and clubbing. Bibasilar crepitations were present but no murmur was auscultated. Platypnea (worsening of dyspnea in a standing position) was present. Arterial gas analysis showed a PaO2 of 52 mm when breathing ambient room air. Laboratory findings were significant for a mildly abnormal liver function test.

  16. Pulmonary toxocariasis: a case report and literature review.

    Science.gov (United States)

    Ranasuriya, G; Mian, A; Boujaoude, Z; Tsigrelis, C

    2014-06-01

    Toxocariasis is a parasitic disease caused by Toxocara canis or T. cati. We report a patient with toxocariasis who presented with dyspnea, high-grade eosinophilia, and bilateral pulmonary nodules. To further characterize the pulmonary manifestations of toxocariasis, we have reviewed 11 previously published pulmonary toxocariasis cases. The most common pulmonary symptoms in our review were cough and dyspnea, and the most common finding on chest imaging was bilateral pulmonary nodules. Risk factors for Toxocara infection primarily included exposure to dogs. Most patients received albendazole and responded well. A high index of suspicion is needed to diagnose this otherwise preventable parasitic disease.

  17. An Uncommon Cause of Shortness of Breath in a Young Puerpera

    Directory of Open Access Journals (Sweden)

    Suartcha Prueksaritanond

    2013-01-01

    Full Text Available Acute postpartum dyspnea in a young, previously healthy adult encompasses numerous conditions. One should be aware of various differential diagnoses including delayed postpartum preeclampsia-induced pulmonary edema where the occurrence is rare but a significant one due its deleterious consequences. We report a case of 26-year-old gravida 1/para 1 female who presented to the hospital with progressive dyspnea after 1 week of normal spontaneous vaginal delivery. On physical examination, her blood pressure was severely elevated. Her clinical signs and symptoms were consistent with pulmonary edema, but diagnostic tests excluded the cardiogenic causes. Further test revealed proteinuria. The patient was diagnosed with delayed postpartum preeclampsia.

  18. Concurrent early-onset peripartum cardiomyopathy in a preeclampsia patient with acute pulmonary edema.

    Science.gov (United States)

    Belen, Erdal; Tipi, Fahri Fatih; Helvaci, Aysen; Bayyigit, Akif

    2015-01-01

    We herein report the case of a preeclampsia patient with comorbid peripartum cardiomyopathy (PPCMP). A 22-year-old woman in the 26th week of gestation was admitted with acute pulmonary edema. Hypertension and proteinuria were detected, and echocardiography showed an ejection fraction of 33%. It is remarkable that PPCMP particularly that associated with preeclampsia was observed in the early gestational period. In conclusion, while dyspnea and pretibial edema are often noted during normal pregnancies, the potential for PPCMP should be considered if these symptoms are excessive and/or comorbid paroxysmal nocturnal dyspnea and orthopnea are present, even in patients with preeclampsia.

  19. Subcutaneous Emphysema in Acute Asthma: A Cause for Concern?

    Science.gov (United States)

    Mitchell, Patrick D; King, Thomas J; O'Shea, Donal B

    2015-08-01

    Pneumomediastinum has been described in patients with asthma. In this case report, we describe a young patient who presented to our medical assessment unit with an asthma exacerbation and progressive dyspnea. The patient developed pneumomediastinum, a rare complication of an asthma exacerbation. Pneumomediastinum is usually characterized by chest pain, dyspnea, and neck swelling caused by subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic compromise or respiratory failure through mechanisms similar to those seen in a tension pneumothorax.

  20. An Unusual Reason for Generalized Cardiac Enlargement

    Institute of Scientific and Technical Information of China (English)

    Gui-zhou MA; Hong TAN

    2009-01-01

    @@ CASE REPORT A 43-year-old Chinese male farmer presented to the hospital with complaints of exertional palpitation and dyspnea for 2 months. He had his discomforts often together with dry cough, and gradually appeared paroxysmal nocturnal dyspnea, but no chest pain. He had been diagnosed as dilated cardiomyopathy in other hospitals. However, the therapeutic effect was poor. There was no history of hypertension and diabetes mellitus, and no family history of heart diseases. He had smoked cigarettes for 20 years but did not drink alcohol.

  1. Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis

    Directory of Open Access Journals (Sweden)

    Jun Muratsu

    2013-01-01

    Full Text Available Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence.

  2. A case of fever of unknown origin: necrotizing sarcoid granulomatosis.

    Science.gov (United States)

    Unlü, G; Onyılmaz, T A; Barış, S A; Turhan, N; Vural, C; Başyiğit, I; Boyacı, H

    2014-01-01

    Necrotizing sarcoid granulomatosis is a rare type of vasculitis; its etiology and pathogenesis are still unknown. The disease primarily affects the lungs, although extra-pulmonary involvement has been reported. The typical symptoms are cough, chest pain, dyspnea, and weight loss; high temperatures have been reported in rare cases. We present the case of a 65-year-old woman who was diagnosed with lymph node tuberculosis, for which she received treatment for six months. The patient experienced no improvement in her symptoms, which included fever, weakness and dyspnea. A re-evaluation of previously collected thoracoscopic biopsy material revealed compatibility with necrotizing sarcoid granulomatosis.

  3. Effects of indacaterol versus tiotropium on exercise tolerance in patients with moderate COPD: a pilot randomized crossover study

    Directory of Open Access Journals (Sweden)

    Danilo Cortozi Berton

    Full Text Available Abstract Objective: To compare a once-daily long-acting β2 agonist (indacaterol 150 µg with a once-daily long-acting anticholinergic (tiotropium 5 µg in terms of their effects on exercise endurance (limit of tolerance, Tlim in patients with moderate COPD. Secondary endpoints were their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Methods: This was a randomized, single-blind, crossover pilot study involving 20 patients (mean age, 60.9 ± 10.0 years; mean FEV1, 69 ± 7% of predicted. Spirometric parameters, Transition Dyspnea Index scores, Tlim, and exertional dyspnea were compared after three weeks of each treatment (with a one-week washout period between treatments. Results: Nineteen patients completed the study (one having been excluded because of COPD exacerbation. Improvement in Tlim from baseline tended to be greater after treatment with tiotropium than after treatment with indacaterol (96 ± 163 s vs. 8 ± 82 s; p = 0.06. Tlim significantly improved from baseline after treatment with tiotropium (having increased from 396 ± 319 s to 493 ± 347 s; p = 0.010 but not after treatment with indacaterol (having increased from 393 ± 246 to 401 ± 254 s; p = 0.678. There were no differences between the two treatments regarding improvements in Borg dyspnea scores and lung hyperinflation at "isotime" and peak exercise. There were also no significant differences between treatments regarding Transition Dyspnea Index scores (1.5 ± 2.1 vs. 0.9 ± 2.3; p = 0.39. Conclusions: In patients with moderate COPD, tiotropium tends to improve Tlim in comparison with indacaterol. No significant differences were observed between the two treatments regarding their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Future studies, including a larger number of patients, are required in order to confirm our findings and explore mechanistic explanations. (ClinicalTrials.gov identifier: NCT01693003

  4. Bronchogenic cyst: an unexpected cause of respiratory complaints and a solid chest mass in an infant

    Directory of Open Access Journals (Sweden)

    Ayse Esin Kibar

    2013-04-01

    Full Text Available Bronchogenic cysts are congenital anomalies that result from abnormal budding of the tracheobronchial tree. Congenital bronchogenic cystic disease of the lung in infant is rare, generally benign lesions, which tend to produce few to no symptoms.The cyst can produce cough and dyspnea. Chest, radiograph shows usually a round or oval soft tissue mass in the lower mediastinum. They can occur in infants and children, they are frequently detected coincidentally. In this article, we present a case with bronchogenic cyst of the right middle lobe (14 month causing cough, dyspnea and radiologic findings. [Cukurova Med J 2013; 38(2.000: 338-341

  5. COPD and PE: A clinical dilemma

    Science.gov (United States)

    Moua, Teng; Wood, Kenneth

    2008-01-01

    Dyspnea in patients with known chronic obstructive pulmonary disease (COPD) can be a clinical challenge due to the nonspecific nature of atypical presentations. Typical features of fever, productive cough, and wheezing on presentation support COPD exacerbation, while absence of such findings may warrant further evaluation for underlying etiologies, including pulmonary embolism (PE). It is suspected that one in four patients with atypical COPD exacerbation may have PE as an underlying or concomitant cause of acute dyspnea. This review discusses the clinical presentation of COPD and PE, and presents an overview of the rationale for pursuing work-up for thromboembolic disease in the setting of known obstructive lung diseases. PMID:18686736

  6. Unexpected difficult intubation due to subglottic ring

    Directory of Open Access Journals (Sweden)

    Abdulkadir Atım

    2010-03-01

    Full Text Available Airway damages encountered during endotracheal intubationor tracheostomy may cause some complicationssuch as severe dyspnea. Upper airway diagnostic endoscopywas planned to find the etiology of effort dyspnea ina 5 years old girl who had endotracheal intubation beenperformed during newborn period. Her ASA score was 1,and Mallampati score for preoperative airway evaluationwas 1. Physical examination revealed neither dyspneanor stridor while the patient was not exerting effort. Herchest radiograms were normal. She had no history of previoussurgical or anesthetical intervention. In this reportwe presented a difficult intubation during the endoscopicexamination of upper airway in a patient who had dyspneawhile exerting effort.

  7. Respiratory disease associated with Bordetella bronchiseptica in a Hoffmann's two-toed sloth (Choloepus hoffmanni).

    Science.gov (United States)

    Hammond, Elizabeth E; Sosa, Daniel; Beckerman, Robert; Aguilar, Roberto F

    2009-06-01

    A 2-yr-old female captive-born Hoffmann's two-toed sloth (Choloepus hoffmanni) presented with respiratory disease. A severe inspiratory dyspnea with nasal congestion was observed with open-mouthed breathing and bilateral mucopurulent nasal exudate. Despite initial treatment with broad-spectrum antimicrobial therapy and anti-inflammatory and supportive care, the dyspnea persisted. The animal was anesthetized for bronchoscopy to obtain a deep tracheal sample. Based on culture of Bordetella bronchiseptica and sensitivity, a combination of systemic enrofloxacin, dexamethasone, and coupage with nebulization of saline, gentamicin, and albuterol as well as supportive care resulted in full recovery after 6 weeks of treatment.

  8. Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

    Directory of Open Access Journals (Sweden)

    Noha M. Attia

    2015-03-01

    Results: Dyspnea and RVD (RVD-ratio >1 were significantly more common in patients with central pulmonary emboli. The mean OI (35% ± 19% was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r = 0.66, p  43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825; p  43% proved to be an independent predictor of RVD.

  9. Interventional and surgical treatment of a hemothorax caused by a ruptured vertebral artery in a patient with neurofibromatosis type I

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hoon; Kim, Dong Hun; Kim, Dong Hyun; Seo, Hong Joo [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2014-04-15

    We report a case of a massive hemothorax arising from a ruptured vertebral artery aneurysm in a patient with neurofibromatosis type 1 suffering from sudden onset of dyspnea. The vertebral artery aneurysm was treated with endovascular coil embolization. Then, an open thoracotomy was performed to evacuate the hematoma.

  10. Identifying key domains of health-related quality of life for patients with Chronic Obstructive Pulmonary Disease : the patient perspective

    NARCIS (Netherlands)

    Paap, Muirne C. S.; Bode, Christina; Lenferink, Lonneke I. M.; Groen, Lianne C.; Terwee, Caroline B.; Ahmed, Sara; Eilayyan, Owis; van der Palen, Job

    2014-01-01

    Background: Numerous instruments are available to measure health-related quality of life (HRQoL) in patients with Chronic Obstructive Pulmonary Disease (COPD), covering a wide array of domains ranging from symptoms such as dyspnea, cough and wheezing, to social and emotional functioning. Currently n

  11. Neurofibromatosis Type I presenting with Spontaneous Pneumothorax: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, So Youn; Lee, Young Kyung; Moon, Ah Lim; Sung, Dong Wook [Kyunghee University College of Medicine, East-West Neo Medical Center, Seoul (Korea, Republic of)

    2010-08-15

    Neurofibromatosis type I is an autosomal dominant disease with variable clinical manifestations related to dermatologic, neurologic, skeletal, and endocrine system. Lung parenchymal involvement such as lung fibrosis and massive bullous emphysema is infrequent. Here, we report on a 36-year-old man with symptoms of dyspnea, and who has a spontaneous pneumothorax, multiple bullae, and pathologically confirmed neurofibromatosis type I

  12. Notes from the field: fatal yellow fever vaccine-associated viscerotropic disease--Oregon, September 2014.

    Science.gov (United States)

    DeSilva, Malini; Sharma, Arun; Staples, Erin; Arndt, Byron; Shieh, Wun-Ju; Shames, Jim; Cieslak, Paul

    2015-03-20

    In September 2014, a previously healthy Oregon woman in her 60s went to a hospital emergency department with malaise, dyspnea, vomiting, and diarrhea of 3-5 days' duration. She reported no recent travel, ill contacts, or dietary changes. Six days earlier, she had received a single dose of yellow fever vaccine and typhoid vaccine before planned travel to South America.

  13. Fulminant lymphocytic myocarditis associated with orbital myositis and diaphragmatic paralysis.

    Science.gov (United States)

    Kwon, Oh Hong; Kim, Mi-Na; Kim, Su-A; Seok, Hung Youl; Park, Seong-Mi; Kim, Byung-Jo; Kim, Chul-Hwan; Shim, Wan-Joo; Shim, Ju Sung; Lee, Min-Gu

    2016-01-01

    Although the clinical presentation of myocarditis is very diverse, ranging from mild dyspnea to hemodynamic collapse, myocarditis accompanied with extracardiac myositis is extremely rare. We report a single case of fulminant myocarditis associated with orbital myositis and diaphragmatic paralysis in a 40-year-old man, which was successfully managed by immunosuppressive therapy with steroid.

  14. False aneurysm of the left ventricle due to a penetrating chest wound.

    Science.gov (United States)

    Badui, E; Madrid, R; Ayala, F; Enciso, R; Verdin, R

    1991-11-01

    A 24-year-old white man had a knife chest wound, and four months after this event, manifested progressive dyspnea. A false aneurysm of the left ventricle was diagnosed by 2D echocardiogram. Surgical resection of the aneurysmal sac with closure of the orifice of the lateral wall of the left ventricle was performed successfully.

  15. The Groningen Laryngomalacia Classification System-Based on Systematic Review and Dynamic Airway Changes

    NARCIS (Netherlands)

    van der Heijden, Martijn; Dikkers, Frederik G.; Halmos, Gyorgy B.

    2015-01-01

    Objective: Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the past, different classification systems have been int

  16. Fibrous dysplasia of the rib presenting as a huge chest wall tumor: report of a case.

    Science.gov (United States)

    Chang, B S; Lee, S C; Harn, H J

    1994-07-01

    Fibrous dysplasia of the rib is not uncommon, but is rarely demonstrated as a huge chest wall mass with severe clinical symptoms. A 59-year-old patient, presenting with a huge, rapidly expanding chest wall tumor compressing the lung, liver and heart accompanied by chest pain and dyspnea, is reported. The tumor was success-fully excised by local radical resection.

  17. Biphasic pulmonary blastoma: An unusual presentation with chest wall, rib, and pleural involvement

    National Research Council Canada - National Science Library

    Dixit, Ramakant; Joshi, Nalin; Dave, Lokendra

    2014-01-01

    ... such as cough, hemoptysis, dyspnea, and chest pain. About 40% of cases are asymptomatic and found coincidentally. The usual radiological appearance consists of a well-circumscribed mass measuring 2.5-25 cm in diameter. [3] Pleural effusion occurs very occasionally and chest wall with rib involvement in adult BPB is probably not reported...

  18. Postpartum Acute Pulmonary Oedema with Sub clinical Rheumatic Heart Disease

    OpenAIRE

    2015-01-01

    Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician.

  19. Mitral Valve Aneurysm: A Rare Complication of Aortic Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    A Moaref

    2008-11-01

    Full Text Available A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophagealechocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of theanterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valverepair.

  20. Osteochondroma of the tracheal wall in a Fischer's lovebird (Agapornis fischeri, Reichenow 1887).

    Science.gov (United States)

    Weissengruber, G; Loupal, G

    1999-01-01

    A Fischer's lovebird with dyspnea and stridorous breathing was examined by endoscopy. Tracheal stenosis was observed slightly cranial of the middle of the cervical segment. Histologically, an osteochondroma was identified as the cause of this stenosis. This is the first description of a tracheal osteochondroma in a bird.

  1. Robot-assisted thoracoscopic lobectomy as treatment of a giant bulla

    NARCIS (Netherlands)

    Roemers, Rosa; Patberg, Kornelis; van de Wauwer, Caroline; Nguyen, Tam; Shahin, Ghada

    2017-01-01

    Background: A bulla is a marked enlarged space within the parenchyma of the lung. Bullae may cause dyspnea by compressing healthy lung parenchyma and can cause a pneumothorax. Also, bullae are associated with malignancy, therefore surgical bullectomy is indicated on preventive basis. This case is

  2. Effect of inspiratory muscle training on exercise performance and quality of life in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ahmed Saad Elmorsi

    2016-01-01

    Conclusion: For PImax, PEmax, and 6MWD; IMT provides additional benefits to peripheral muscle exercise training in COPD patients. However, this did not translate into additional improvement in dyspnea and quality of life compared with what is achieved by peripheral muscle exercise alone.

  3. Perception of fatigue and quality of life in patients with COPD

    NARCIS (Netherlands)

    Breslin, E; van der Schans, C; Breukink, S; Meek, P; Mercer, K; Volz, W; Louie, S

    1998-01-01

    Introduction: Although dyspnea is considered the primary activity-limiting symptom in patients with COPD, other symptoms, such as fatigue, are frequently reported, The purpose of this study was to determine the relationship between fatigue and pulmonary function, exercise tolerance, depression, and

  4. Intramural hematoma of the esophagus : Appearance on magnetic resonance imaging

    NARCIS (Netherlands)

    Kamphuis, AGA; Baur, CHJCM; Freling, NJM

    1995-01-01

    A 73-yr-old woman on anticoagulant therapy experienced progressive dyspnea and dysphagia due to a large compressing mass in the posterior mediastinum. Because her clinical condition deteriorated rapidly surgery was performed. A large intramural hematoma along the full length of the esophagus with di

  5. 9 CFR 113.68 - Pasteurella Haemolytica Vaccine, Bovine.

    Science.gov (United States)

    2010-01-01

    ... controls) for each route of administration recommended on the label. (2) An arithmetic mean count of the... vaccinates and controls shall each be challenged by the respiratory route with a (virulent) pneumonia..., mucoid nasal exudates, expiratory dyspnea, tachypnea, pulmonary rales, and cough possibly terminating...

  6. 9 CFR 113.69 - Pasteurella Multocida Vaccine, Bovine.

    Science.gov (United States)

    2010-01-01

    ... route of administration recommended on the label. (2) An arithmetic mean count of the colony forming... route with a (virulent) pneumonia producing Pasteurella multocida culture and observed for 4 to 10 days..., mucoid nasal exudate, expiratory dyspnea, tachypnea, pulmonary rales, and cough, possibly terminating...

  7. An incorrect diagnosis and an unexpected cause of respiratory failure.

    Science.gov (United States)

    Jandrin, Melanie; Breunig, Michael

    2016-06-01

    Thoracic aortic aneurysms often are asymptomatic or cause nonspecific symptoms such as cough, dyspnea, wheezing, or dysphagia. Acute onset of severe chest, neck, back, or abdominal pain may indicate an aortic rupture or dissection. Early identification and treatment, including optimized medical management and evaluation for surgical intervention, are necessary to improve patient outcomes.

  8. The Military Deployment Human Exposure Assessment Study (MDHEXAS): Blood and Urine Exposure Biomarkers as Environmental Surveillance Tools for Assessing Military Personnel Exposure to Chemicals During Deployment to Camp McGovern, Bosnia

    Science.gov (United States)

    2003-01-01

    dysp = Dyspnea euph = euphoria excitement = excited fib = fibrosis flush face = flush face ftg = fatigue Head = Headache Gidd = giddiness inco...nausea Neck = neck ache nose = irritated nose Pallor Pulm edema= pulmonar y edema Resp sys = Respiratory System skin = irritated skin som = somnolence

  9. Symptomatology, Clinical Presentation and Basic Work up in Patients with Suspected Pulmonary Embolism

    DEFF Research Database (Denmark)

    Madsen, Poul Henning; Hess, Søren

    2017-01-01

    referral to a relevant facility should be a part of the skills of all clinicians. Sudden onset dyspnea, chest pain, syncope and hemoptysis are essential symptoms of pulmonary embolism, and in most of these patients basic investigations like arterial blood gas analysis, electrocardiogram, chest x...

  10. Diuretic response and renal function in heart failure

    NARCIS (Netherlands)

    ter Maaten, Jozine Magdalena

    2016-01-01

    In patients with heart failure fluid overload is a frequently occurring problem, which is among others caused by an impaired function of the heart. This fluid overload may lead to severe dyspnea warranting an acute hospitalization. The first choice treatment of this fluid overload is administration

  11. Clinical benefit of fixed-dose dual bronchodilation with glycopyrronium and indacaterol once daily in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2014-01-01

    (salmeterol/fluticasone twice daily), once-daily fixed-dose indacaterol/glycopyrronium has clinically important effects on symptoms, including dyspnea score, health status, level of lung function, and rate of moderate or severe exacerbations in patients with moderate-to-very severe COPD (Global initiative...

  12. The relationship between inspiratory lung function parameters and airway hyper-responsiveness in subjects with mild to moderate COPD

    NARCIS (Netherlands)

    S.K. Ramlal (Sunil); F.J. Visser (Frank); W.C.J. Hop (Wim); B. Staffhorst (Bas); P.N.R. Dekhuijzen (Richard); Y.F. Heijdra (Yvonne)

    2012-01-01

    textabstractBackground: The aim of this study was to evaluate the effects of increasing doses of inhaled histamine on the forced expiratory volume in one second (FEV 1), inspiratory lung function parameters (ILPs) and dyspnea in subjects with mild to moderate chronic obstructive pulmonary disease (C

  13. An Echodensity in the Sinus of Valsalva

    NARCIS (Netherlands)

    Amir, Rabia; Yeh, Lu; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 60-YEAR-OLD woman was referred to the authors’ institution for surgical treatment of severe aortic valve stenosis with progressive exertional dyspnea. A few months before the current admission, she had been treated in an outside hospital for congestive heart failure. Cardiac catheterization

  14. Mitral valve perforation appearing years after radiofrequency ablation

    DEFF Research Database (Denmark)

    Fisch-Thomsen, Marie; Jensen, Jesper K; Egeblad, Henrik

    2011-01-01

    The case is reported of a young adult with Wolff-Parkinson-White (WPW) syndrome who, three years after a complicated radiofrequency (RF) catheter ablation procedure, developed dyspnea on exertion. Echocardiography revealed severe mitral valve regurgitation caused by a perforation of the posterior...

  15. The relationship of skin test positivity, high serum total IgE levels, and peripheral blood eosinophilia to symptomatic and asymptomatic airway hyperresponsiveness

    NARCIS (Netherlands)

    Jansen, DF; Rijcken, B; Schouten, JP; Kraan, J; Weiss, ST; Timens, W; Postma, DS

    The relationships of skin test positivity, high serum total IgE levels (> 100 kU/L), and peripheral blood eosinophilia (greater than or equal to 275 cells/mu l) to symptomatic (either chronic cough, chronic phlegm, bronchitis episodes, dyspnea, wheeze, or asthma) and asymptomatic bronchial

  16. An Echodensity in the Sinus of Valsalva

    NARCIS (Netherlands)

    Amir, Rabia; Yeh, Lu; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 60-YEAR-OLD woman was referred to the authors’ institution for surgical treatment of severe aortic valve stenosis with progressive exertional dyspnea. A few months before the current admission, she had been treated in an outside hospital for congestive heart failure. Cardiac catheterization confir

  17. Unilateral pulmonary agenesis.

    Science.gov (United States)

    Malcon, Maura Cavada; Malcon, Claudio Mattar; Cavada, Marina Neves; Caruso, Paulo Eduardo Macedo; Real, Lara Flório

    2012-01-01

    Pulmonary agenesis is a rare congenital anomaly. We report the case of an 8-year-old boy with left lung agenesis, without any other congenital malformations. When the patient presented symptoms, including cough, wheezing, and dyspnea, with no clinical improvement after a period of 30 days, imaging studies were conducted and the diagnosis was made.

  18. A systematic review of the effects of bronchodilators on exercise capacity in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Wijkstra, PJ; Ten Hacken, NHT; Koeter, GH; Postma, DS; Kerstjens, HAM

    2002-01-01

    One of the major goals of bronchodilator therapy in patients with COPD is to decrease airflow limitation in the airways and, as a consequence, improve dyspnea and exercise tolerance. The focus of this systematic review is to assess the effects of treatment with beta-agonists, anticholinergics, and t

  19. Laser Therapy for an Obstructing Primary Tracheal Lymphoma in a Patient With AIDS

    Directory of Open Access Journals (Sweden)

    Brian E Louie

    2005-01-01

    Full Text Available A patient with AIDS presented with progressive dyspnea leading to respiratory failure with near complete airway obstruction due to primary tracheal lymphoma. Laser therapy was used locally to debulk the tumour, which facilitated extubation and led to definitive treatment with chemotherapy. Alternatives for local airway control are discussed.

  20. Temazepam 10mg does not affect breathing and gas exchange in patients with severe normocapnic COPD.

    NARCIS (Netherlands)

    Stege, G.; Heijdra, Y.F.; Elshout, F.J.J. van den; Ven, M.J.T. van de; Bruijn, P.J. de; Sorge, A.A. van; Dekhuijzen, P.N.R.; Vos, P.J.E.

    2010-01-01

    BACKGROUND: Benzodiazepines can improve sleep quality, but are also thought to cause respiratory depression in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the effects of temazepam on indices of circadian respiratory function, dyspnea, sleep

  1. Transcutaneous carbon-dioxide partial pressure trends during six-minute walk test in patients with very severe COPD.

    Science.gov (United States)

    Andrianopoulos, Vasileios; Vanfleteren, Lowie E G W; Jarosch, Inga; Gloeckl, Rainer; Schneeberger, Tessa; Wouters, Emiel F M; Spruit, Martijn A; Kenn, Klaus

    2016-11-01

    Transcutaneous carbon-dioxide partial-pressure (TCPCO2) can be reliably measured and may be of clinical relevance in COPD. Changes in TCPCO2 and exercise-induced hypercapnia (EIH) during six-minute walk test (6MWT) need further investigation. We aimed (1) to define patterns of TCPCO2 trends during 6MWT and (2) to study determinants of CO2-retention and EIH. Sixty-two COPD patients (age: 63±8years, FEV1: 33±10%pred.) were recruited and TCPCO2 was recorded by SenTec digital-monitoring-system during 6MWT. Half of patients (50%) exhibited CO2-retention (TCPCO2[Δ]>4mmHg); 26% preserved and 24% reduced TCPCO2. Nineteen (31%) patients presented EIH (TCPCO2>45mmHg). EIH was associated to higher baseline-PCCO2, worse FEV1, lower inspiratory-pressures, underweight/normal BMI, and pre-walk dyspnea. Stronger determinants of CO2-retention were FEV1 and pre-walk dyspnea, whereas baseline-PCCO2 and pre-walk dyspnea better predict EIH. PCO2 response to 6MWT is highly heterogeneous; however, very low FEV1 and elevated baseline-PCCO2 together with pre-walk dyspnea increase the risk for CO2-retention and EIH. Overweight-BMI seems to carry a protective effect against EIH in very severe COPD. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Increasing awareness of corticosteroid hypersensitivity reactions is important

    DEFF Research Database (Denmark)

    Knarborg, Malene; Bendstrup, Elisabeth; Hilberg, Ole

    2013-01-01

    the tolerability to other corticosteroid preparations and thus identify a safe treatment alternative. We report a case of corticosteroid hypersensitivity in a 65-year-old woman with a history of difficult-to-treat asthma and systemic corticosteroid allergy admitted with increasing dyspnea and dry cough...

  3. Pulmonary Mycobacterium szulgai infection and treatment in a patient receiving anti-tumor necrosis factor therapy.

    NARCIS (Netherlands)

    Ingen, J. van; Boeree, M.J.; Janssen, M.; Ullmann, E.F.; Lange, W.; Haas, P. de; Dekhuijzen, P.N.R.; Soolingen, D. van

    2007-01-01

    BACKGROUND: A 54-year-old man with a 22-year history of rheumatoid arthritis and an 8-year history of chronic obstructive pulmonary disease presented with dyspnea on exertion, nonproductive cough and fatigue of 1 month's duration. His medication at presentation consisted of etanercept, azathioprine,

  4. PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Gupta A K

    2009-09-01

    Full Text Available A 67 year old male patient was scheduled for implant removal from right upper limb under supraclavicular block. During procedure patient develops right phrenic nerve palsy & complains of dyspnea which was managed conservatively and no intervention done except chest x-ray for confirming the diagnosis. Surgeons completed the implant removal without any invasive intervention or interruption.

  5. Clinical characteristics, diagnosis and surgical management of ...

    African Journals Online (AJOL)

    course in the sense of high rate of recurrence, which further .... cough, chest pain and dyspnea. Rupture of cyst ... of the spine. ... Plain radiography has a role in lung and bone cysts. Uncomplicated cyst(s) in the lung appear( s) on plain film of.

  6. Case series

    African Journals Online (AJOL)

    abp

    30 janv. 2017 ... Clinical symptoms were mainly cough (32.8% of cases), dyspnea (23.7% of ... of cases, sarcomas in 7.8% of cases, renal cancers in 5.2% of cases, bladder ..... Prognosis of osteosarcoma with pulmonary metastases at initial.

  7. Local pulmonary administration of factor VIIa (rFVIIa) in diffuse alveolar hemorrhage (DAH) - a review of a new treatment paradigm

    DEFF Research Database (Denmark)

    Heslet, Lars; Nielsen, Jørn Dalsgaard; Nepper-Christensen, Steen

    2012-01-01

    Diffuse alveolar hemorrhage (DAH) is a clinical syndrome with typical symptoms dyspnea and hemoptysis. DAH is a complication of specific diseases, in some cases with acute catastrophic hemoptysis, while other patients present low grade alveolar bleeding with a need of chronic transfusion as in pu...

  8. Congenital left ventricular splint in an adult patient with unrepaired anomalous left coronary artery from the pulmonary artery.

    Science.gov (United States)

    Sabbath, Adam M; Trivedi, Kalyani; Klewer, Scott E; Sorrell, Vincent L

    2007-01-01

    A 24-year-old woman presented with a recent increase in dyspnea on exertion and development of presyncope. The patient stated that she has reproducible episodes of dizziness and near fainting when she climbs a flight of stairs and activity is limited to a slow gait.

  9. Pulmonary artery stent for bronchial adenoid cystic carcinoma causing pulmonary artery stenosis

    DEFF Research Database (Denmark)

    Smith, Corey Allister; Kotlyar, Eugene; Mellemkjaer, Soren;

    2014-01-01

    A 46-year-old woman presented with a 6-month history of dyspnea and weight loss on a background of previous pneumonectomy for bronchial adenoid cystic carcinoma 14 years beforehand. Several years prior to this presentation, she had developed left vocal cord palsy and a metastatic lesion...

  10. Cryorecanalization after cryosurgery for immediate treatment on central airway obstruction via flexible bronchoscope

    Institute of Scientific and Technical Information of China (English)

    Yongqun Li; Huasong Feng; Zhoushan Nie; Jiguang Meng; Xinmin Ding; Zhihai Han

    2012-01-01

    Objective: In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope. Methods: A total of 64 cases of patients in all suffered from central airway obstruction were observed and treated by applying cryorecanalization after cryosurgery via flexible bronchoscope. Divide the operation into two steps, including cryosurgery and cryorecanalization. Evaluate the therapeutic effect immediately after the treatment, wherein the evaluating indicator includes preoperative and postoperative dyspnea indexes, quality of life score, bronchoscopy, etc. The surgical safety assessment is mainly by observing the risk of bleeding in the surgery. Results: Forty cases (62.5%) has postoperative dyspnea score improved at least one level compared with preoperative dyspnea score, 24 patients (37.5%) have no significant improvement on dyspnea score. Quality of life score (Karnofsky score): preoperative 52 ± 18.7 points, postoperative 70 ± 9.2 points. Bronchoscopy review: complete success in 12 cases (18.8%), partial success in 45 cases (70.3%), no success in 7 cases (12%).89.1% overall clinical efficiency was achieved. In the surgery, the control to bleeding was satisfactory since no severe bleeding, moderate bleeding in 14 cases (21.9%) and mild bleeding in 50 cases (78.1%) were found as well as rigid bronchoscope was free. Conclusion: The central airway obstruction can be immediately relieved by cryorecanalization after cryosurgery via flexible bronchoscope with satisfactory effects and higher surgical safety.

  11. The Development of a Micro Assay for Natural Killer and Lymphokine-Activated Killer Activity and Its Use in Monitoring the Purification of an Interleukin-2 Inhibitor

    Science.gov (United States)

    1989-05-01

    malaise, weight gain, diarrhea, rash, arthralgia, myalgia, fluid retention, anemia , 6 hypotension, dyspnea, and hyperbilirubinemia (21-23). There was...inhibitor levels in humans with these autoimune diseases to determine if there was any correlation between the inhibitor levels and disease activity

  12. Radical Carinal Resection for a Glomic Tumor.

    Science.gov (United States)

    Bellier, Jocelyn; Sage, Edouard; Gonin, François; Longchampt, Elisabeth; Chapelier, Alain

    2016-08-01

    We report the case of a 33-year-old woman who presented with increasing dyspnea secondary to a tumor arising from the carina. After desobstruction by bronchoscopy, the pathologic analysis revealed a glomic tumor. Carinal resection and reconstruction were performed with venoarterial extracorporeal membrane oxygenation support. The patient's postoperative course was uneventful, and the long-term result was excellent.

  13. Determinants of poor 6-min walking distance in patients with COPD: the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Spruit, Martijn A; Watkins, Michael L; Edwards, Lisa D

    2010-01-01

    for Epidemiologic Studies of Depression Scale; COPD-specific St Georges Respiratory Questionnaire; modified Medical Research Council (mMRC) dyspnea scale as part of the baseline assessment of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. RESULTS: Patients...

  14. Severe pulmonary arterial hypertension due to Angiostrongylosus vasorum in a dog.

    Science.gov (United States)

    Nicolle, Audrey P; Chetboul, Valérie; Tessier-Vetzel, Dominique; Carlos Sampedrano, Carolina; Aletti, Edouard; Pouchelon, Jean-Louis

    2006-08-01

    A dog was presented with a history of dyspnea, coughing, and ascites. Angiostrongylosis and severe pulmonary arterial hypertension (PAH) were found, as well as a marked discordance between the electrical and mechanical events of the heart. Pulmonary arterial hypertension related to Angiostrongylus vasorum has rarely been reported.

  15. Danish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Fonsmark, Lise; Hein, Lars; Nibroe, Helle;

    2015-01-01

    should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough...

  16. Multiple applications of the Boussignac continuous positive airway pressure system

    NARCIS (Netherlands)

    Dieperink, Willem

    2008-01-01

    Continuous positive airway pressure, (CPAP) is a form of treatment to support patients with dyspnea. For the application of CPAP a mechanical ventilator or complex CPAP apparatus is mostly used. The Boussignac CPAP (BCPAP) system developed by George Boussignac does not need such apparatus. The BCPAP

  17. Ventilation and Speech Characteristics during Submaximal Aerobic Exercise

    Science.gov (United States)

    Baker, Susan E.; Hipp, Jenny; Alessio, Helaine

    2008-01-01

    Purpose: This study examined alterations in ventilation and speech characteristics as well as perceived dyspnea during submaximal aerobic exercise tasks. Method: Twelve healthy participants completed aerobic exercise-only and simultaneous speaking and aerobic exercise tasks at 50% and 75% of their maximum oxygen consumption (VO[subscript 2] max).…

  18. [Primary left atrial hemangiopericytoma. Report of one case].

    Science.gov (United States)

    Bedmar, Daniel; Varela, Cecilia; Squella, Gina; Belletti, José; Donoso, María Victoria

    2011-06-01

    We report a 41-year-old male presenting with progressive dyspnea lasting one month. A CAT scan disclosed a left atrial mass, that was surgically excised. The pathological study of the surgical piece showed a primary hemangiopericytoma. One month later, the patient consulted for cervical pain and a positron emission tomography showed multiple metastases. The patient died two months later.

  19. An uncommon cause of acute pulmonary edema.

    Science.gov (United States)

    Nepal, Santosh; Giri, Smith; Bhusal, Mohan; Siwakoti, Krishmita; Pathak, Ranjan

    2016-09-01

    Acute cardiogenic pulmonary edema secondary to catecholamine-induced cardiomyopathy is a very uncommon and fatal initial presentation of pheochromocytoma. However, with early clinical suspicion and aggressive management, the condition is reversible. This case report describes a patient who presented with hypertension, dyspnea, and cough with bloody streaks, and who recovered within 48 hours after appropriate treatment.

  20. Opioids prescription for symptoms relief and the impact on respiratory function: updated evidence.

    Science.gov (United States)

    López-Saca, José Mario; Centeno, Carlos

    2014-12-01

    Opioids are used for treating dyspnea and other symptoms in oncological and nononcological patients. The relief of respiratory fatigue and anxiety that these opioids offer is well known. One of the scarcely frequent, but very much feared, side-effects is respiratory depression. The purpose of this review is to determine whether or not the situation of an advanced-stage patient under palliative care and the use of opioids are risk factors for respiratory depression. Studies conducted on respiratory function and opioids have proliferated in the past 10 years, but there is no recent review that groups the results together and evaluates their safe use in end-stage patients. A bibliographic review found three randomized double-blinded placebo-controlled studies and five prospective studies, six of which showed that opioids significantly relieve dyspnea (P<0.001). The use of morphine for symptomatic relief does not significantly change the level of saturation of oxygen in the blood. In addition, the functional studies do not indicate that the use of opioids for dyspnea relief causes high CO2 levels in blood (P=0.05). The opioids used for treating dyspnea do not significantly compromise respiratory function; they are safe and effective.

  1. Communication between the right and circumflex coronary arteries discovered incidentally by multidetector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Se Hwan; Kim, Eui Jong; Woo, Jong Shin; Kim, Soo Joong; Youn, Hyo Chul; Oh, Joo Hyeong [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2016-09-15

    Intercoronary communication is a rare congenital coronary anomaly. We present a case of a 48-year-old man with an incidentally discovered communication between the right and circumflex coronary arteries, who was admitted with chest tightness and exertional dyspnea. The initial diagnosis was made using electrocardiogram-gated multidetector computed tomography.

  2. 喉咽部血管纤维瘤1例%Hypopharyngeal angiofibroma: a case report

    Institute of Scientific and Technical Information of China (English)

    陶平; 甄宏韬

    2016-01-01

    Swallowing obstruction,gradually increase,with a sore throat,no fever,no haemoptysis,no dyspnea,routine tests:blood routine,biochemical examination,blood coagulation routine,electrocardiogram,chest X-ray,did not show abnormalities.

  3. Cardiac calcified amorphous tumor: A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Quentin de Hemptinne

    2015-06-01

    Conclusion: In this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.

  4. Two Cases of Carcinoma with Tracheobronchial Stenosis Treated by Self-expanding Nitinol Stents(Sens)

    OpenAIRE

    山本,夏男; 宮下,義啓; 千葉,成宏

    1999-01-01

    Two cases with tracheobronchial stenosis due to tumors(lung and esophageal cancer) were treated by Self-expanding nitinol stent(Ultraflex). Severe dyspnea and stridor were markedly impromed after placement of nitinol stents. Insertion of Ultraflex is easy and useful for prevention and improvement of airway obstruction.

  5. Acute respiratory distress syndrome in an alpaca cria

    Science.gov (United States)

    Simpson, Katharine M.; Streeter, Robert N.; Genova, Suzanne G.

    2011-01-01

    A 7-hour-old alpaca was presented for lethargy and depression. The cria responded favorably to initial treatment but developed acute-onset dyspnea 48 hours later. Acute respiratory distress syndrome was diagnosed by thoracic imaging and blood gas analysis. The cria was successfully treated with corticosteroids and discharged from the hospital. PMID:22210945

  6. Libman–Sacks endocarditis, and other echocardiographic findings in systemic lupus erythematosus: Case report

    Directory of Open Access Journals (Sweden)

    Mohamed Atef Hamza

    2012-09-01

    Full Text Available Case report of a 19 year-old female patient with systemic lupus erythematosus (SLE who was presented to Ain Shams University Hospital complaining of dyspnea on moderate exertion. Echocardiography showed the presence of sterile vegetation on the mitral valve, Libman–Sacks endocarditis (LSE.

  7. Removal of a giant intrathoracic cyst from the anterior mediastinum

    NARCIS (Netherlands)

    Bouma, Wobbe; Klinkenberg, Theo J.; Van De Wauwer, Caroline; Timens, Wim; Mariani, Massimo A.

    2014-01-01

    A 45-year-old caucasian man with progressive dyspnea appeared to have a giant intrathoracic cyst in the anterior mediastinum encasing the heart and compressing both lungs. He underwent succesful removal of the cyst through a median sternotomy. Recovery was uneventful. Gross examination revealed a th

  8. Exercise-induced asthma and the asthmatic athlete.

    Science.gov (United States)

    Enright, T

    1996-06-01

    Almost all asthmatics involved in moderate to heavy exercise will experience exercise-induced asthma (EIA). Up to 14% of athletes exhibit EIA, symptoms of which include dyspnea, coughing, chest tightness and wheezing. Education, warm-up exercises and pre-treatment with the appropriate medications can enable an athlete to excel and even win a gold medal in the 1996 Olympic games.

  9. Side effects of vagus nerve stimulation during physical exercise

    NARCIS (Netherlands)

    Mulders, D.M.; de Vos, Cecilia Cecilia Clementine; Vosman, I.; Driesse, M.J.; van Putten, Michel Johannes Antonius Maria

    2012-01-01

    RATIONALE: Vagus nerve stimulation (VNS) is a treatment option in the case of refractory epilepsy. However, several side effects have been reported, including dyspnea, coughing and bradycardias [JCA 2010: 22;213-222]. Although some patients experience hardly any side effects from the stimulation

  10. The effect of vagus nerve stimulation on cardiorespiratory parameters during rest and exercise

    NARCIS (Netherlands)

    Mulders, D.M.; de Vos, Cecilia Cecilia Clementine; Vosman, I.; van Putten, Michel Johannes Antonius Maria

    2015-01-01

    Purpose: Vagus nerve stimulation (VNS) has been successfully applied to reduce seizure frequency in numerous patients with epilepsy. However, various side effects, including dyspnea and bradycardia have been reported, that appear exercise related in some patients. This pilot study aims to obtain

  11. Variations in the severity of classical swine fever infections in Danish pigs - the clinical perspective

    DEFF Research Database (Denmark)

    Lohse, Louise; Uttenthal, Åse; Bruun, Camilla S.

    were observed few days after inoculation, soft feces from several pigs were observed from PID 2. At PID 5, one pig (pig 52) was lethargic with pyrexia, anorexia and dyspnea. Further progression of disease, including watery diarrhea, ataxia, intermittent convulsions and purple discoloration...

  12. 78 FR 14241 - Acetonitrile; Community Right-to-Know Toxic Chemical Release Reporting

    Science.gov (United States)

    2013-03-05

    ..., confusion, hyperpnea, dyspnea, rapid pulse, unconsciousness, and convulsions (Ref. 9). Cyanide was detected... convulsions in various studies (Ref. 9). 2. Effects of Subchronic and Chronic Exposure Subchronic inhalation... week. Ataxia, abnormal posture, and clonic convulsions occurred in the 1,600 ppm males that died....

  13. Once-daily NVA237 improves exercise tolerance from the first dose in patients with COPD: the GLOW3 trial

    Directory of Open Access Journals (Sweden)

    Beeh KM

    2012-07-01

    Full Text Available Kai M Beeh,1 Dave Singh,2 Lilla Di Scala,3 Anton Drollmann31insaf Respiratory Research Institute, Wiesbaden, Germany; 2University Of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester, Manchester, UK; 3Novartis Pharma AG, Basel, SwitzerlandIntroduction: Exercise limitation, dynamic hyperinflation, and exertional dyspnea are key features of symptomatic chronic obstructive pulmonary disease (COPD. We assessed the effects of glycopyrronium bromide (NVA237, a once-daily, long-acting muscarinic antagonist, on exercise tolerance in patients with moderate to severe COPD.Methods: Patients were randomized to a cross-over design of once-daily NVA237 50 µg or placebo for 3 weeks, with a 14-day washout. Exercise endurance, inspiratory capacity (IC during exercise, IC and expiratory volumes from spirometry, plethysmographic lung volumes, leg discomfort and dyspnea under exercise (Borg scales, and transition dyspnea index were measured on Days 1 and 21 of treatment. The primary endpoint was endurance time during a submaximal constant-load cycle ergometry test on Day 21.Results: A total of 108 patients were randomized to different treatment groups (mean age, 60.5 years; mean post-bronchodilator, forced expiratory volume in 1 second [FEV1] 57.1% predicted. Ninety-five patients completed the study. On Day 21, a 21% difference in endurance time was observed between patients treated with NVA237 and those treated with placebo (P < 0.001; the effect was also significant from Day 1, with an increase of 10%. Dynamic IC at exercise isotime and trough FEV1 showed significant and clinically relevant improvements from Day 1 of treatment that were maintained throughout the study. This was accompanied by inverse decreases in residual volume and functional residual capacity. NVA237 was superior to placebo (P < 0.05 in decreasing leg discomfort (Borg CR10 scale on Day 21 and exertional dyspnea on Days 1 and 21 (transition dyspnea index and Borg CR

  14. Fibrothorax and Severe Lung Restriction Secondary to Lupus Pleuritis and Its Successful Treatment by Pleurectomy

    Directory of Open Access Journals (Sweden)

    Sat Sharma

    2002-01-01

    Full Text Available Pleural disease is a common pulmonary manifestation of systemic lupus erythematosus (SLE that usually responds to corticosteroids and other immunosuppressive agents. In the present report, a new approach, pleural decortication, was used in a patient with medically refractory chronic pleuritis secondary to severe SLE. A 26-year-old woman with known SLE developed progressive dyspnea and pleuritic chest pain over several months. The other systemic manifestations of her lupus were controlled with cyclophosphamide and prednisone. A computed tomography scan revealed a persistent, small, loculated right pleural effusion; pleural thickening; and atelectasis of the right middle and lower lobes. Pulmonary function tests showed a severe restrictive defect. The patient was disabled by her severe dyspnea despite maximal medical therapy, and, therefore, surgery was considered. A right thoracotomy revealed entrapment of the right lung by dense visceral pleura. Decortication was performed. On pathology, pleuritis with vascular pleural adhesions was found. No lupus pneumonitis was noted. Postoperatively, a significant clinical improvement in dyspnea was evident within several weeks. On a 6 min walk test, the patient achieved 384 m with a Borg dyspnea scale rating of 2 compared with 220 m and a Borg dyspnea scale rating of 4 preoperatively. Her forced vital capacity improved from 24% predicted to 47% predicted, and her total lung capacity improved from 35% predicted to 54% predicted. Medical therapy of systemic lupus erythematosus has been proven to be effective in controlling pleuritis in most cases. However, in the event of refractory pleuritis or pleural thickening, decortication may be a viable alternative.

  15. Upper airway obstruction caused by bilateral giant tonsilloliths

    Directory of Open Access Journals (Sweden)

    Ru-Hsiao Lo

    2011-07-01

    Full Text Available Tonsilloliths are rare dystrophic calcifications caused by chronic inflammation of the tonsils. They are usually small and occur on one side. Herein, we report a case involving a 75-year-old man presenting odynophagia and progressive dyspnea for days who was found by computed tomography image to have bilateral giant tonsilloliths. Hyperdensity lesions were found over the tonsillar fossa on both sides. Tonsillectomy was performed leading to immediate relief of symptoms. A review of relevant literature revealed that most patients with tonsilloliths are asymptomatic and need only conservative treatment. Severe symptoms such as dyspnea are extremely rare. Although tonsillolith can be easily diagnosed by computed tomography, otolaryngologists should be careful to differentiate this entity.

  16. Respiratory symptoms were associated with lower spirometry results during the first examination of WTC responders.

    Science.gov (United States)

    Udasin, Iris; Schechter, Clyde; Crowley, Laura; Sotolongo, Anays; Gochfeld, Michael; Luft, Benjamin; Moline, Jacqueline; Harrison, Denise; Enright, Paul

    2011-01-01

    Determine if World Trade Center (WTC) disaster responders had lower lung function and higher bronchodilator responsiveness than those with respiratory symptoms and conditions. We evaluated cardinal respiratory symptoms (dyspnea, wheezing, dry cough, productive cough) and determined the difference in FEV1, FVC, and bronchodilator responsiveness. All respiratory symptoms were associated with a lower FEV1 and FVC, and a larger bronchodilator response. Responders reporting chronic productive cough, starting during WTC work and persisting, had a mean FEV1 109 mL lower than those without chronic persistent cough; their odds of having abnormally low FEV1 was 1.40 times higher; and they were 1.65 times as likely to demonstrate bronchodilator responsiveness. Responders reporting chronic persistent cough, wheezing or dyspnea at first medical examination were more likely to have lower lung function and bronchodilator responsiveness.

  17. Diagnosis and treatment of congestive heart failure secondary to hypertrophic cardiomyopathy in a kinkajou (Potos flavus).

    Science.gov (United States)

    Eshar, David; Peddle, Gordon D; Briscoe, Jeleen A

    2010-06-01

    An adult castrated male pet kinkajou (Potos flavus) presented with dyspnea due to congestive heart failure and was diagnosed with hypertrophic cardiomyopathy (HCM) and suspected pulmonary arterial hypertension. Diagnosis was based on history, clinical signs, clinical pathology, radiographs, abdominal ultrasonography, abdominal fluid analysis, electrocardiography, and echocardiogram. An undetermined hepatopathy also was found at presentation and resolved after metronidazole antimicrobial treatment. Cardiopulmonary medical treatment, including a loop diuretic, an angiotensin-converting enzyme inhibitor, a beta-adrenergic receptor blocker, and a bronchodilator provided improvement of the clinical signs. To the best of our knowledge, this is the first reported case of antemortem diagnosis and treatment of congestive heart failure and cardiomyopathy in a member of the family Procyonidae, suggesting that HCM should be considered as a differential diagnosis in kinkajous displaying clinical signs of dyspnea and exercise intolerance.

  18. Evidence-based approaches to other symptoms in advanced cancer.

    Science.gov (United States)

    Dy, Sydney Morss; Apostol, Colleen C

    2010-01-01

    Dyspnea, nausea and vomiting, anorexia, fatigue, and sleep disturbances are common and distressing in advanced cancer. We updated previous systematic reviews of how these symptoms can be alleviated with targeted literature searches. The approach to these symptoms requires comprehensive symptom assessment; treating underlying causes when benefits exceed risks; prioritizing treatment, as patients usually have many symptoms; and addressing psychosocial and spiritual distress. For dyspnea, evidence supports systemic opioids and nonpharmacological treatments such as a fan. The strongest evidence supports metoclopramide for cancer-related nausea and octreotide for bowel obstruction. For anorexia, enteral or parenteral nutrition is indicated with obstruction and expected prognosis of at least 6 weeks. Evidence supports several drugs for appetite affecting quality of life. For fatigue, evidence supports psychosocial interventions and methylphenidate. For insomnia, evidence supports cognitive-behavioral therapy in cancer; no sleep agents have superior effectiveness.

  19. Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Pulmonary Disease: Review of Selected Guidelines: AN OFFICIAL STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION.

    Science.gov (United States)

    Garvey, Chris; Bayles, Madeline Paternostro; Hamm, Larry F; Hill, Kylie; Holland, Anne; Limberg, Trina M; Spruit, Martijn A

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is associated with disabling dyspnea, skeletal muscle dysfunction, and significant morbidity and mortality. Current guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Translating exercise science into safe and effective exercise training requires interpretation and use of multiple guidelines and recommendations. The purpose of this statement is to summarize for clinicians 3 current chronic obstructive pulmonary disease guidelines for exercise that may be used to develop exercise prescriptions in the PR setting. The 3 guidelines have been published by the American College of Sports Medicine, the American Thoracic Society/European Respiratory Society, and the American Association of Cardiovascular and Pulmonary Rehabilitation. In addition to summarizing these 3 guidelines, this statement describes clinical applications, explores areas of uncertainty, and suggests strategies for providing effective exercise training, given the diversity of guidelines and patient complexity.

  20. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Maryam Esmaeilzadeh

    2015-10-01

    Full Text Available Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion.Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea.This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction

  1. Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

    Science.gov (United States)

    Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

    2009-03-01

    An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds.

  2. [An unusual cause of acute respiratory distress: obstructive bronchial aspergillosis].

    Science.gov (United States)

    Margery, J; Perez, J-P; Vaylet, F; Bordier, E; Dot, J-M; Saint-Blancard, P; Bonnichon, A; Guigay, J; Pats, B; L'Her, P

    2004-06-01

    We report the case of a 77-Year-old immunocompetent woman who required intensive care for acute dyspnea revealing complete atelectasia of the left lung related to an aspergillus mycelium plug blocking the principal bronchus. The clinical course was favorable after deobstruction by thermocoagulation and oral itraconazole given for six Months. The patient was free of parenchymatous or endobronchial sequelae. Adjuvant oral corticoid therapy was given temporarily during the second Month of treatment when signs of transition towards allergic aspergillosis developed. Four Months after discontinuing the antifungal treatment, the patient developed a new episode of acute dyspnea caused by atelectasia limited to the right lower lobe. Treatment by itraconazole was resumed and continued as long-term therapy. No recurrence has been observed for eighteen Months. The diagnostic and therapeutic problems raised by Aspergillus fumigatus are well known in the immunocompromised subject, but can also be encountered in the immunocompetent subject.

  3. Familial thymic cyst.

    Science.gov (United States)

    Joshua, Ben Zion; Raveh, Eyal; Saute, Milton; Schwarz, Michael; Tobar, Ana; Feinmesser, Raphael

    2004-05-01

    Thymic cysts are rare lesions of the anterior mediastinum or neck. The majority are asymptomatic, and the remainder are associated mainly with symptoms of dysphagia or dyspnea. Diagnosis is difficult before surgery. Cervical thymic cysts are relatively rare; age at presentation ranges from the neonatal period to adulthood, and the most frequent presenting sign is a lateral neck mass. Mediastinal thymic cysts are more common and account for 1% of all mediastinal masses. They tend to occur in the older age group and are usually detected incidentally on chest X-ray film or computed tomography scans. Dysphagia and dyspnea are the main symptoms. We describe two brothers, aged 5 and 8 years, with mediastinal thymic cysts that presented as low cervical masses and review the embryology, diagnosis and management of thymic cysts.

  4. Body position and oxygenation: An intriguing relationship.

    Science.gov (United States)

    Rodrigues, Patrícia; Monteiro, Marta; Palma, Paulo; Sousa-Pereira, Luís; Cabral, Sofia; Oliveira, Filomena; Dias, Vasco; Torres, Severo

    2014-06-01

    Dyspnea and hypoxemia are among the most common symptoms and signs that need to be assessed in clinical practice. This case illustrates how simple steps in history taking and physical examination can be crucial for diagnosis. We present a patient with intermittent hypoxemia, initially attributed to a pulmonary infection. However, the hypoxemia persisted even after successful treatment of the infection. Computed tomography angiography of the chest and ventilation/perfusion lung scan excluded pulmonary embolism. We then observed that the hypoxemia and dyspnea were triggered by orthostatism. An echocardiogram with a bubble test showed a patent foramen ovale, with a right-to-left shunt, without pulmonary hypertension. After percutaneous closure of the foramen ovale, the symptoms completely resolved. This is a case of platypnea-orthodeoxia syndrome, which is usually associated with patent foramen ovale or atrial septal defect and is typically observed in the elderly. The features and causes of this curious syndrome are discussed.

  5. Acute eosinophilic pneumonia: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Gyoo; Sik; Oh, Kyung Seung; Kim, Jong Min; Huh, Jin Do; Joh, Young Duk; Jang, Tae Won; Jung, Man Hong [Kosin Medical College, Busan (Korea, Republic of)

    1995-10-15

    Acute eosinophilic pneumonia is one of a recently described idiopathic eosinophilic lung disease, which differs from chronic eosinophilic pneumonia. Patients with acute eosinophilic pneumonia develop acute onset of dyspnea, hypoxemia, diffuse pulmonary infiltrates and pleural effusion on chest radiograph, and show an increase in number of eosinophils in bronchoalveolar lavage fluid or lung biopsy specimen. Prompt and complete response to corticosteroid therapy without any recurrence is characteristically seen in patient with this disease. Although the etiology of acute eosinophilic pneumonia is not known, it has been suggested to be related to a hypersensitivity phenomenon to an unidentified inhaled antigen. We report four cases of acute eosinophilic pneumonia presented with acute onset of dyspnea, diffuse pulmonary infiltrates on chest radiograph, and eosinophilia in bronchoalveolar lavage fluid in previously healthy adults.

  6. Hydatid cyst and fungal infection: a case report

    Directory of Open Access Journals (Sweden)

    Haji Nasrollah E

    2009-02-01

    Full Text Available "nBackground: Hydatid cyst is a zoonosis rarely occurred except in endemic areas that capable of making pulmonary cavities fascilating fungus growth within it. Aspergillo-ma is a glob formed by hyphae from saprophyte growth of aspergillous specious in previously performed cavities within pulmonary parenchyma. "nCase report: A 28 years old male patient without any comorbidity presented in emergency department with progressive two month dyspnea. Tube thoracostomy is done because of respiratory distress and massive hydropneumothorax. Thoracotomy and lobectomy is performed due to complicated hydatid cyst. Histopathologic investigation reveals hydatid cyst layers with fungal hyphae within it on granulomatous background. "nConclusion: Hydatid cyst with fungal contamination must be mentioned in differentials of dyspnea with lower segment lung cavities, especially in endemic areas. Thoracic CT scan with IV contrast can reveal fungus ball. Surgery is a treatment of choice and capitonage can be a prophylactic measure from secondary fungal infection in hydatid cyst surgery.

  7. Thoracic surgery in solving enormous elevation of the left hemidiaphragm

    Directory of Open Access Journals (Sweden)

    Cvijanović Vlado

    2007-01-01

    Full Text Available Background. Acquired elevation of the diaphragm is mostly the result of phrenic nerve paralysis, some of thoracic and abdominal patological states, and also some of neuromuscular diseases. Surgical treatment is rarely performed and is indicated when lung compression produces disabilitating dyspnea, and includes plication of diaphragm. The goal of this case report has been to show completely documented diagnostic procedures and surgical treatment one of rare pathological condition. Case report. A 62-year-old patient was admitted to our clinic because of surgical treatment of the enormous elevation of the left hemidiaphragm. After thoracotomy and plication of the bulging diaphragm, lung compression did not exist any more and mediastinum went back in the normal position. Conclusion. Elevation of the diaphragm rarely demands surgical correction. When it is complicated with lung compression and disabilitating dyspnea, surgical treatment has extremely useful functional effect.

  8. Bronchoscopic lung volume reduction in a single-lung transplant recipient with natal lung hyperinflation: a case report.

    Science.gov (United States)

    Pato, O; Rama, P; Allegue, M; Fernández, R; González, D; Borro, J M

    2010-06-01

    After single lung transplantation for emphysema native lung hyperinflation is a common complication that may cause respiratory failure. Herein we have reported satisfactory bronchoscopic lung volume reduction in a left single-lung transplant recipient with native lung hyperinflation, who suffered from Medical Research Council (MRC) class 3 dyspnea and chest pain. Three endobronchial valves (Zephyr; Emphasys Medical, Redwood, Calif, United States) were placed into the segmental bronchi of the right upper lobe, using videobronchoscopy under general anesthesia. Postoperative chest computed tomography revealed subsegmental atelectasis in that lobe. The clinical benefit was an improved MRC dyspnea class from 3 to 2, which was still present at 4 months after the procedure, although there were no remarkable changes in spirometric parameters.

  9. A Pancreaticobronchial Fistula Associated With Previous Trauma and Pancreas Pseudocysts: A Case Report

    Science.gov (United States)

    Venesmaa, Sari; Juvonen, Petri; Kettunen, Hannu-Pekka

    2013-01-01

    We describe a rare case of a pancreaticobronchial fistula caused by pancreatic pseudocysts due to previous trauma. A 54-year-old man with a history of traumatic hemothorax was referred to central hospital for investigations due to cough, dyspnea, vertigo and fever. An ultrasound scan and abdominal computed tomography scan showed huge pancreatic pseudocysts around the pancreas extending to the right side of the mediastinum with gas. The etiology for the pseudocysts was unconfirmed. First, the patient recovered with antibiotics and external pseudocyst drainage. After five months the patient started to suffer from respiratory symptoms again, such as coughing with sputum, dyspnea and mild fever. The computer tomography scan confirmed the pancreaticobronchial fistula as a diagnosis and the patient was referred to the university hospital for further treatment.

  10. Distraction Osteogenesis of Multiple Ribs for the Treatment of Acquired Thoracic Dystrophy.

    Science.gov (United States)

    Piper, Merisa L; Delrosario, Lawrence; Hoffman, William Y

    2016-03-01

    Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.

  11. Reversible bilateral blepharoptosis following oxaliplatin infusion: a case report and literature review.

    Science.gov (United States)

    Fanetti, Giuseppe; Ferrari, Laura A M; Pietrantonio, Filippo; Buzzoni, Roberto

    2013-01-01

    Oxaliplatin, a platinum analogue employed in the treatment of colorectal cancer and various other neoplasms, is characterized by a broad range of adverse events. Peripheral neuropathy is probably the most peculiar and clinically relevant toxicity associated with its use and can be distinguished into two types: acute and chronic neurotoxicity.We report a case of acute reversible bilateral palpebral ptosis and dyspnea without bronchospasm or laryngospasm which occurred at the end of the third administration of adjuvant oxaliplatin by infusion for stage III colon cancer in a 54-year-old woman. Chlorphenamine and hydrocortisone were administered with fast resolution of dyspnea and slight improvement of ptosis. Complete resolution with no sequelae occurred in one hour. No further recurrence of blepharoptosis was described during the following days. The subsequent cycles were prescribed at reduced dosage without acute complications.

  12. Granulomatose de Wegener e estenose subglótica: descrição de caso Wegener's granulomatosis and subglottic stenosis: case description

    Directory of Open Access Journals (Sweden)

    Fernanda Guidolin

    2004-06-01

    Full Text Available Descreve-se o caso de um paciente com Granulomatose de Wegener, em tratamento com esteróides e ciclofosfamida, que, apesar do tratamento, evoluiu com dispnéia progressiva e rouquidão. A investigação mostrou tratar-se de uma estenose subglótica, sendo a dispnéia prontamente aliviada com a traqueostomia. São discutidos diagnósticos diferenciais e modalidades de tratamentos de estenose subglótica em portadores de Wegener.We describe a patient with Wegener Granulomatosis being treated with steroids and cyclofosfamide that developed progressive dyspnea and hoarseness despite of treatment. Investigation showed a subglotic stenosis. The dyspnea was relieved by tracheotomy. We discuss the differential diagnosis as well as a number of treatment modalities in patients with Wegener granulomatosis and subglottic stenosis.

  13. The modification of breathing behavior. Pavlovian and operant control in emotion and cognition.

    Science.gov (United States)

    Ley, R

    1999-07-01

    The purpose of this article is to bring attention to breathing as a behavior that can be modified by means of Pavlovian and operant principles of control. With this aim in mind, this paper (a) reviews a selection of early and recent conditioning studies (Pavlovian and operant paradigms) in respiratory psychophysiology, (b) discusses the bidirectional relationship between breathing and emotion/cognition, and (c) discusses theoretical and applied implications that point to new directions for research in the laboratory and clinic. Emphasis is placed on dyspnea/suffocation fear and the acquisition of anticipatory dyspnea/suffocation fear in panic, anxiety, and stress disorders and their concomitant cognitive deficits. Discussions throughout the article focus on research relevant to theory and application, especially applications in programs of remedial breathing (breathing retraining) designed for the treatment of psychophysiological disorders (e.g., panic, anxiety, and stress) and the accompanying cognitive deficits that result from cerebral hypoxia induced by conditioned hyperventilation.

  14. Cardiac Resynchronization Therapy Device Implantation in a Patient with Congenitally Corrected Transposition of Great Vessels

    Directory of Open Access Journals (Sweden)

    Reza Mollazadeh

    2017-03-01

    Full Text Available A 29-year-old woman was referred to our hospital due to exacerbation in dyspnea on exertion and easy fatigability. A known case of congenitally corrected transposition of the great vessels and congenital complete heart block, she had already received a permanent single-chamber pacemaker. Decision was made to implant a biventricular pacemaker for the treatment of the failing heart. Excellent coronary sinus lead implantation was done, conferring amelioration of symptoms, QRS narrowing in the electrocardiogram, and improvement of systemic ventricular systolic function in echocardiography. Over a 15-month follow-up period, she had no dyspnea on exertion. This case highlights the significance of upgrading pacemakers in patients with heart failure.

  15. [Amyotrophic lateral sclerosis and respiratory insufficiency].

    Science.gov (United States)

    Siirala, Waltteri; Korpela, Jaana; Vuori, Arno; Saaresranta, Tarja; Olkkola, Klaus T; Aantaa, Riku

    2015-01-01

    Amyotrophic lateral sclerosis (ALS) is a disease causing degeneration of motor neurons, without any curative treatment. The most common cause of death is respiratory arrest due to atrophy of the respiratory musculature. ALS-associated respiratory insufficiency differs in mechanism from the more common causes of dyspnea, such as diseases of pulmonary or cardiac origin. Recognizing the respiratory insufficiency can be challenging for a clinician. It should be possible to predict the development of respiratory insufficiency in order to avoid leaving the treatment decisions concerning respiratory insufficiency to emergency services. Noninvasive ventilatory support can be used to alleviate the patient's dyspnea. It is actually recommended as the first-line treatment of ALS-associated respiratory insufficiency.

  16. October 2015 Phoenix pulmonary journal club: lung volume reduction

    Directory of Open Access Journals (Sweden)

    Mathew M

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. The October 2015 pulmonary journal club focused on the review of older studies evaluating lung volume reduction surgery and how this has transitioned toward the development of non-surgical modes of lung volume reduction. The physiology behind dyspnea in chronic obstructive pulmonary disease (COPD is a complex process. One of the proposed mechanisms has been hyperinflation associated with air trapping. In the mid 1990s studies by Cooper and Peterson (1 offered a promising approach in which lung volume reduction (LVR could improve ventilatory mechanics and improve dyspnea. As the procedure gained more popularity, additional larger scale trials were performed to support its validity. We reviewed 2 studies looking at lung volume reduction. The first was "The Effect of Lung Volume Reduction Surgery In Patients With Severe Emphysema” (2 . This was a smaller, randomized controlled trial (RCT that looked at 2 groups of 24 patients. Once group received LVR while the ...

  17. A STUDY ON SPIROMETRIC EVALUATION OF LUNG VOLUME RESTRICTION IN PREDIAGNOSED CASES OF SKELETAL FLUOROSIS

    Directory of Open Access Journals (Sweden)

    Abhijit

    2014-07-01

    Full Text Available Fluorosis is an important public health problem in India. Skeletal changes and mottled enamel may result when drinking water contains excess fluoride. Due to involvement of ribcage skeletal fluorosis causes restrictive lung disease causing reduction in vital capacity. This cross sectional observational study has been done on 55 pre diagnosed patients of skeletal fluorosis, they have been classified according to MMRC dyspnea grading & lung volume has been measured. Among 55 patients, 43 patients (78.18% have shortness of breath, it also has been seen that 13.95% patients have MMRC grade 4 dyspnea, i.e. too breathless to leave the home & 21.81% of cases have FVC < 34% of predicted, i.e. very severe lung volume restriction.

  18. March 2013 imaging case of the month

    Directory of Open Access Journals (Sweden)

    Penulopu S

    2013-03-01

    Full Text Available No abstract available. Article truncated after first page. Clinical History: A 54-year old Hispanic woman with no significant past medical history presented with complaints of cough and worsening dyspnea. She was in her usual state of health until 4-5 weeks prior to presentation when she started noticing gradually worsening dyspnea on exertion. She reported a dry cough initially which subsequently became productive of whitish, mucoid sputum. The patient denied chest pain, sore throat, sick contacts, or recent travel history. A chest x-ray was performed (Figure 1. Which of the following statements regarding the chest radiograph is most accurate?1.The chest radiograph shows bilateral linear and reticular abnormalities 2.The chest radiograph shows nodular interstitial thickening 3.The chest radiograph shows multiple, bilateral circumscribed nodules 4.The chest radiograph shows mediastinal and hilar lymph node enlargement 5.The chest radiograph shows mediastinal widening

  19. 充血性心力衰竭与肺源性心脏病患者血浆BNP水平的比较%Comparison of plasma levels of brain natriuretic peptide in patients with congestive heart failure or lung-derived heart disease

    Institute of Scientific and Technical Information of China (English)

    韦彩雯; 李宏松; 章敬玉; 姚能才; 窦存芳; 石来新; 卢英民

    2011-01-01

    目的:比较充血性心力衰竭(congestive heart failure,CHF)及肺源性心脏病(pulmonary heart disease,PHD)患者急性呼吸困难发作时及缓解后1周血浆脑钠尿肽(BNP)水平的变化并分析其临床意义.方法:采用全血化学发光法测定CHF及PHD患者急性呼吸困难发作时及缓解后1周血浆BNP水平.结果:CHF患者呼吸困难发作时血浆BNP水平明显高于病情缓解后1周血浆BNP水平[(1997 ±865)ng/L vs.(184±114)ng/L,P<0.05],PHD患者呼吸困难发作时血浆BNP水平明显高于病情缓解后1周血浆BNP水平[(679±202)ng/L vs.(145±48)ng/L,P<0.05],呼吸困难发作时CHF组患者血浆BNP水平明显高于PHD组(P<0.05),呼吸困难缓解后1周两组间无显著差异.结论:BNP水平可作为CHF患者病情严重程度及疗效判断的评价指标.也可作为临床协助鉴别CHF呼吸困难与PHD重度肺功能不全呼吸困难的检测指标之一.%AIM: To compare the changes of plasma brain natriuretic peptide ( BNP) levels in patients with congestive heart failure (CHF) or lung-derived heart disease (pulmonary heart disease, PHD) with dyspnea at onset and 1 week after remission. METHODS: Using the whole blood chemiluminescence method, plasma BNP levels in patients with dyspnea were determined at onset and 1 week after remission. RESULTS: At the onset of dyspnea in patients with CHF, plasma BNP levels were significantly higher than those 1 week after remission [ (1997 ±865) ng/L vs. (184 ± 114) ng/L, P <0.05]. Likewise, at the onset of dyspnea in patients with PHD, plasma BNP levels were also significantly higher than those 1 week after remission [(679 ±202) ng/L vs. (145 ±48) ng/L, P<0.05]. However, at the onset of dyspnea, plasma BNP levels in patients with CHF were significantly higher than those in patients with PHD (P <0.05), but no significant difference was observed between groups at 1 week after remission. CONCLUSION; BNP levels reduce with dyspnea remission. BNP levels can serve

  20. Disease: H01093 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available emoptysis Paragonimiasis is a zoonotic disease caused by a parasite belonging to Paragonimus genus. Humans m...n, and dyspnea. Infectious disease Paragonimus westermani Paragonimus kellicotti Paragonimus miyazakii Paragonimus skrjabini Paragoni...mus heterotremus Paragonimus hueitungensis Paragonimus uterobilateralis Paragonimus africanus Paragonimus...env_factor, marker) Procop GW North American paragonimiasis (Caused by Paragonimus... sequences from individual metacercariae of Paragonimus mexicanus from Guatemala and Ecuador. J Helminthol 77:33-8 (2003) ...

  1. Hazelnut allergy in children and adults: diagnosis and underlying mechanisms

    OpenAIRE

    Masthoff, L.J.N.

    2013-01-01

    Hazelnut is a frequently consumed tree nut. This thesis shows that allergic symptoms to hazelnut are common but highly variable in severity, and they differ between children and adults. Hazelnut allergy in adults is generally limited to mild and local symptoms in the oral cavity, whereas in children, more severe symptoms such as angio-edema, urticaria and dyspnea are frequently observed. In adults, hazelnut allergy is associated with birch pollen allergy, whereas in children, it is often acco...

  2. Revisiting 'Respiratory Function in Emphysema in Relation to Prognosis'

    Directory of Open Access Journals (Sweden)

    David V Bates

    2000-01-01

    Full Text Available BACKGROUND: The 1956 paper by DV Bates, JMS Knott and RV Christie, "Respiratory function in emphysema in relation to prognosis" Quart J Med 1956;97:137-157 is largely reprinted with a commentary by the first author, Dr David Bates. Although the pathology of emphysema was well recognized at the time, the clinical diagnosis and assessment of its severity were known to be imprecise; physiological measurements assessing and following the clinical course had not been established. The study aimed to follow systematically a group of patients, selected by clinical criteria using standardized clinical and physiological techniques, over four years and correlate physiological and clinical changes in relation to prognosis and eventually to postmortem findings. Fifty-nine patients were recruited to an emphysema clinic at St Bartholomew's Hospital, London, England. Inclusion criteria were dyspnea without other causes and no cor pulmonale present. Patients' symptoms were assessed by a standardized questionnaire, and measurements were taken of lung volumes, maximal ventilatory volume, carbon monoxide diffusing capacity at rest, exercise and oxygen saturation by oximetry.  During the four years of the study, 17 patients died (actuarial expected - four and 13 presented with signs of pulmonary heart failure. All postmortem examinations (n=9 showed advanced emphysema. A seasonal variation in dyspnea was established (the period included the infamous 1952 London smog. Four patients improved, and the remainder were unchanged or deteriorated. Close relationships were shown between dyspnea and function results, particularly for the diffusing capacity of lungs for carbon monoxide (DLCO. A comparison among a group of patients with chronic bronchitis without dyspnea showed that the DLCO discriminated between them. A loss of the normal increase in DLCO during exercise was shown in emphysema.

  3. Proventricular dilatation disease (PDD) and megaesophagus in a blue-fronted Amazon parrot (Amazona aestiva) - case report.

    OpenAIRE

    Marietto-Goncalves, Guilherme Augusto; Zampoli Troncarelli, Marcella; Lopes Sequeira, Julio; Andreatti Filho, Raphael Lucio

    2009-01-01

    The present article relates the occurrence of Proventricular Dilatation Disease (PDD) in a 20 years old blue-fronted amazon parrot (Amazona aestiva). The bird was raised in captivity and was examined at the Ornitopathology Laboratory of São Paulo State University's Veterinarian Hospital, São Paulo State, Brazil. The parrot clinically presented regurgitation, tremors and dyspnea. This is the first case of PDD followed by megaesophagus in a blue-fronted amazon parrot (A. aestiva). This patholog...

  4. October 2014 imaging case of the month

    Directory of Open Access Journals (Sweden)

    Sakla S

    2014-10-01

    Full Text Available No abstract available. Article truncated after first page. A 53-year-old man presents with fatigue and dyspnea on exertion. An admission chest radiograph (Figure 1 was obtained. What is the best term or phrase used to describe the salient radiographic abnormality? 1. Diffuse thick-walled cavitary lesions; 2. Interstitial and alveolar pulmonary edema with effusions; 3. Miliary nodules; 4. Patchy consolidation; 5. Tension pneumothorax.

  5. Laryngeal Spasm Mimicking Asthma and Vitamin D Deficiency

    OpenAIRE

    Masoero, Monica; Bellocchia, Michela; Ciuffreda, Antonio; Ricciardolo, Fabio LM; Rolla, Giovanni; Bucca, Caterina

    2014-01-01

    We present a woman with heterozygous carnitine palmitoyl transferase 2 (CPT-2) deficiency who in the last 6 months suffered from episodic dyspnea and choking. Symptoms could not be attributed to her muscular energy defect, since heterozygous CPT-2 deficiency is usually asymptomatic or causes only mild muscle fatigability. Myopathy is usually triggered by concurrent factors, either genetic (additional muscle enzymes defects) or acquired (metabolic stress). The patient was referred to our respi...

  6. A descriptive epidemiological study of interstitial lung disease in the United Kingdom general population

    OpenAIRE

    Amar, Rajeev K.

    2012-01-01

    Interstitial lung disease (ILD) is a heterogeneous group of parenchymal lung disorders having varied histopathologies. Although histologically different, the ILDs have rather similar clinical presentations consisting of increasing dyspnea, a restrictive lung function, impaired gas exchange, and widespread shadowing on chest radiography. Approximately two-thirds of ILD cases have no known etiology. The remaining one-third is either associated with connective tissue disease (CTD) or caused by v...

  7. April 2015 imaging case of the month

    OpenAIRE

    Gotway MB

    2015-01-01

    No abstract available. Article truncated at end of first page. Clinical History: A 73-year-old woman with a history of ovarian malignancy in remission for several years and treated with hysterectomy and oopherectomy, hypothyroidism, and hypertension, presented with rather abrupt onset cough, chest pain, dyspnea and low-grade fever (99.6°F). Her past medical history was otherwise unremarkable. Her medications included thyroid replacement, amlodipine, benazepril, and, recently, calcium and magn...

  8. Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

    Directory of Open Access Journals (Sweden)

    Fuyuki Tateno

    2014-08-01

    Full Text Available It is rare that amyotrophic lateral sclerosis (ALS presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness.

  9. Pulmonary intravascular large B-cell lymphoma successfully treated with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone immunochemotherapy: Report of a patient surviving for over 1 year

    OpenAIRE

    NISHII-ITO, SHIZUKA; Izumi, Hiroki; Touge, Hirokazu; TAKEDA, KENICHI; Hosoda, Yuzuru; Yamasaki, Akira; Kuwamoto, Satoshi; Shimizu, Eiji; Motokura, Toru

    2016-01-01

    A 73-year-old man with a history of lethargy, fever and dyspnea was admitted to Tottori University Hospital. A computed tomography (CT) scan revealed splenomegaly and diffusely spreading ground-glass opacities (GGOs) in both lungs. A video-assisted thoracoscopic surgery (VATS)-guided lung biopsy revealed intravascular proliferation of large atypical lymphoid cells in the arteries, veins and alveolar walls. The patient was diagnosed with intravascular large B-cell lymphoma (IVLBCL); he receive...

  10. Pulmonary manifestations of heartworm disease.

    Science.gov (United States)

    Calvert, C A; Rawlings, C A

    1985-09-01

    The clinical signs associated with heartworm disease are the result of changes in the pulmonary arterial system. These clinical signs are the result of either pulmonary hypertension or lung parenchymal disease associated with vascular changes. An increase in pulmonary arterial pressure produces an increase in right ventricular afterload, which may lead to exercise intolerance, syncope, and right-sided congestive heart failure. Coughing, dyspnea, and hemoptysis are the results of pulmonary parenchymal disease.

  11. A Case of Amyopathic Dermatomyositis with Pneumomediastinum and Subcutaneous Emphysema

    Directory of Open Access Journals (Sweden)

    Aslıhan Gürün Kaya

    2015-01-01

    Full Text Available A 34-year-old man was admitted with dyspnea, cough, and fever. Thorax computed tomography revealed ground glass opacities and pneumomediastinum. The patient was diagnosed as amyopathic dermatomyositis due to skin lesions and radiological findings. Despite immunosuppressive treatment clinical deterioration and radiological progression were observed and the patient died because of severe hypoxemic respiratory failure. The patient presented with extremely rare occurrence of pneumomediastinum and subcutaneous emphysema in amyopathic dermatomyositis with a poor prognosis.

  12. Hypothyroidism and non-cardiogenic pulmonary edema: are we missing something here?

    OpenAIRE

    Al-Sofiani, Mohammed; Nikolla, Dhimitri; Metta, V V S Ramesh

    2015-01-01

    Summary We report the case of a 42-year-old female with a history of hypothyroidism and asthma presenting with progressive dyspnea and orthopnea after 2 days of an upper respiratory tract infection (URTI). Based on the clinical and radiological findings, the patient was admitted as a case of cardiogenic pulmonary edema secondary to possible viral myocarditis. However, a normal brain natriuretic peptide (BNP) level with a normal ejection fraction (EF) on echocardiogram changed our working diag...

  13. A Case of Newcastle Disease Virus in Red-Headed Lovebird in Sudan

    OpenAIRE

    Egbal Sidahmed Abdelrahim; Jedda Elhag

    2014-01-01

    Two diseased red-headed lovebirds were presented for diagnosis to the Department of Avian Diseases and Diagnosis, Veterinary Research Institute, aged 37 days and 4 years. The symptoms were dyspnea, cyanosis of the comb, diarrhea, and fever. Postmortem lesions included pale liver and bloody enteritis. Newcastle disease virus was isolated from lungs, trachea, and intestines following inoculation in the allantoic cavity of 10-day-old fertile eggs; the NDV was identified by the means of HA&HI tes...

  14. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

    Science.gov (United States)

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    Clinical trials identifier NCT02329873 Background Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. Objective To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. Methods A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10–30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. Results All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05). Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth day (all P<0.05). Conclusion Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD. PMID:26345529

  15. The concept of Maslow's pyramid for cardiovascular health and its impact on “change cycle”

    OpenAIRE

    Behjati, Mohaddeseh

    2014-01-01

    Since the leading cause of morbidity and mortality is cardiovascular diseases, every individual should think regularly about possessing and maintaining cardiovascular health. In reality, this self-processing is delayed until the occurrence of complications related to cardiovascular inefficiency manifested as chest pain and/or dyspnea. However, people should be trained to think about their cardiovascular health issues as a vital need from early childhood. This goal is achievable by understandi...

  16. Semilobar Holoprosencephaly with Congenital Oropharyngeal Stenosis in a Term Neonate

    OpenAIRE

    Kenji Hishikawa; Hideshi Fujinaga; Chie Nagata; Masataka Higuchi; Yushi Ito

    2015-01-01

    Background - Holoprosencephaly (HPE) is often accompanied by a deficit in midline facial development; however, congenital oropharyngeal stenosis in neonates with HPE has not been reported before. We describe a case of a neonate with prenatally diagnosed semilobar HPE accompanied by congenital oropharyngeal stenosis. Case Report - The patient was born at 39 weeks of gestation and developed dyspnea shortly after. Laryngoscopic test revealed oropharyngeal stenosis. Nasal continuous positive ...

  17. Tension Hydrothorax Related to Disseminated Endometriosis

    Directory of Open Access Journals (Sweden)

    AnnaKate Deal, MD

    2016-01-01

    Full Text Available We present the case of a 34-year-old woman presenting to the emergency department (ED with dyspnea, cough, and fever. She was found to have a tension hydrothorax and was treated with ultrasound-guided thoracentesis in the ED. Subsequent inpatient evaluation showed the patient had disseminated endometriosis. Tension hydrothorax has not been previously described in the literature as a complication of this disease.

  18. Medical image of the week: CREST plus ILD

    OpenAIRE

    Oliva I; Knox KS

    2013-01-01

    A 60 year old female with a history of fibromyalgia presented with dyspnea and skin changes, predominantly on the hands. Physical exam and imaging showed classic findings of limited cutaneous systemic sclerosis (scleroderma) CREST syndrome. Calcinosis cutis (Figure 1A), Raynaud’s (not shown but endorsed by the patient), Esophageal dysmotility (Figure 1B, dilated esophagus), Sclerodactyly (Figure 1C), and Teleganectasias (Figure 1D) were all present. Ground glass opacities were seen predomi...

  19. Hematoma subcapsular esplénico en paciente portador de rasgo falciforme

    OpenAIRE

    Ugalde,Diego; Conte,Guillermo; Ugalde,Héctor; Figueroa,Gastón; Cuneo,Marianela; Muñoz,Macarena; Mayor,Javiera

    2011-01-01

    Drepanocytic anemia is an uncommon hereditary disease in Chile. The heterozygous state of drepanocytic anemia or "sickle trait" has a frequency of 8% among Afro-Americans. A small number of patients carrying hemoglobin S are homozygous, with clinical manifestations of hemolytic anemia and thrombotic disease. Sickle trait is usually asymptomatic. We report a 59-year-old male who presented an acute abdominal pain and dyspnea while staying at high altitude. Six days later, an angio CAT scan show...

  20. Immunotherapeutic Strategies in Breast Cancer: Preclinical and Clinical Trials

    Science.gov (United States)

    2004-09-01

    TILs sorted maintained treated with CT clone and from untreated in vitro CTL clone 4-1 BO antibody MMT mice TA 1 12 1.1 e’ ’ ’ PaPa 0 B1 P,00• 0...below: CTC Category Adverse Baseline Each event/Symptoms evaluation Constitutional Symptoms Fatigue X X Dermatology /Skin Injection site reaction X Rash...2. Unlikely Related: anemia, superior vena cava syndrome , dyspnea, malignant ascites, post-operative bleeding, hepatic failure, renal failure, post

  1. Singleton Merten Syndrome: A Rare Cause of Early Onset Aortic Stenosis

    Directory of Open Access Journals (Sweden)

    Harshavardhan Ghadiam

    2017-01-01

    Full Text Available Singleton Merten syndrome (SMS is a rare autosomal dominant genetic disorder with variable expression. Its characteristic features include abnormal aortic calcification, abnormal ossification of extremities, and dental anomalies. We present a young man with dyspnea who was noted to have aortic stenosis in the background of glaucoma, psoriasis, dental anomalies, hand and foot deformities, Achilles tendinitis, osteopenia, and nephrolithiasis. The conglomeration of features led to the diagnosis of SMS. His mother had a very similar phenotype.

  2. Cytopathological findings of primary pulmonary Ewing family of tumors with EWSR1 translocation: A case report

    OpenAIRE

    Mizuguchi, Keishi; Minato, Hiroshi; Onishi, Hitomi; Mitani, Yuki; Kawai, Jun

    2016-01-01

    Primary pulmonary neoplasms of the Ewing family of tumors (EFT) are extremely rare and usually occur in adolescents or young adults. Only about 40 cases of pulmonary EFT have been reported in English literature, and no cytological studies have been documented. In this report, we describe the cytopathological findings of a primary pulmonary EFT in an elderly patient. A 70‐year‐old man sought care because of a progressing cough and dyspnea. Chest computed tomography revealed a circumscribed mas...

  3. Heart and Lung Metastases From Endometrial Stromal Sarcoma in a Forty-Two-Year-Old Woman

    OpenAIRE

    Shakerian, Behnam; Mandegar, Mohammad Hossein; Moradi, Bahieh; Roshanali, Farideh

    2015-01-01

    Introduction: Low-grade endometrial stromal sarcoma (LG-ESS) is a malignant intrauterine tumor that rarely presents with distant metastasis. Simultaneous lung and cardiac metastases from LG-ESS is also an extremely rare event. Case Presentation: A 42-year-old woman presented with dyspnea and exercise intolerance. She had a history of hysterectomy and left salpingoophorectomy. She underwent second laparotomy as well as right oophorectomy after new finding of vaginal mass with histopathologic d...

  4. The nervous system of airways and its remodeling in inflammatory lung diseases.

    Science.gov (United States)

    Audrit, Katrin Julia; Delventhal, Lucas; Aydin, Öznur; Nassenstein, Christina

    2017-03-01

    Inflammatory lung diseases are associated with bronchospasm, cough, dyspnea and airway hyperreactivity. The majority of these symptoms cannot be primarily explained by immune cell infiltration. Evidence has been provided that vagal efferent and afferent neurons play a pivotal role in this regard. Their functions can be altered by inflammatory mediators that induce long-lasting changes in vagal nerve activity and gene expression in both peripheral and central neurons, providing new targets for treatment of pulmonary inflammatory diseases.

  5. Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

    Energy Technology Data Exchange (ETDEWEB)

    Chabbert, Valerie; Canevet, Guillaume; Otal, Philippe; Joffre, Francis [Department of Radiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Baixas, Cecile; Galinier, Michel [Department of Cardiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Deken, Valerie; Duhamel, Alain [Department of Medical Statistics, University of Lille, Place de Verdun, 59037, Lille Cedex (France); Remy, Jacques; Remy-Jardin, Martine [Department of Radiology, Hospital Calmette, University Center of Lille, Boulevard Jules Leclerc, 59037, Lille Cedex (France)

    2004-05-01

    The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean{+-}SD value: 34{+-}12.9 vs 43{+-}13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean{+-}SD value: 17{+-}2.75 vs 14{+-}3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%). (orig.)

  6. Comparison of indacaterol with tiotropium or twice-daily long-acting β -agonists for stable COPD: a systematic review.

    Science.gov (United States)

    Rodrigo, Gustavo J; Neffen, Hugo

    2012-11-01

    Bronchodilators are central to the symptomatic management of patients with COPD.Previous data have shown that inhaled indacaterol improved numerous clinical outcomes over placebo. This systematic review explored the efficacy and safety of indacaterol in comparison with tiotropium or bid long-acting β 2 -agonists (TD-LABAs) for treatment of moderate to severe COPD. Randomized controlled trials were identified after a search of different databases of published and unpublished trials. Five trials (5,920 participants) were included. Compared with tiotropium, indacaterol showed statistically and clinically significant reductions in the use of rescue medication and dyspnea(43% greater likelihood of achieving a minimal clinically important difference [MCID] in the transitional dyspnea index [TDI]; number needed to treat for benefit [NNTB] 5 10). Additionally,the MCID in health status was more likely to be achieved with indacaterol than with tiotropium (OR = 1.43; 95% CI, 1.22–1.68; P = .00001; [NNTB ]= 10). Trough FEV 1 was significantly higher at the end of treatment with indacaterol than with TD-LABAs (80 mL, P = .00001). Similarly, indacaterol signifi cantly improved dyspnea (61% greater likelihood of achieving an MCID in TDI, P = .008) and health status (21% greater likelihood of achieving an MCID in St. George’s Respiratory Questionnaire, P 5 .04) than TD-LABA. Indacaterol showed similar levels of safety and tolerability to both comparators. Available evidence suggests that indacaterol may prove useful as an alternative to tiotropium or TD-LABA due to its effects on health status, dyspnea, and pulmonary function.

  7. [Alveolar hemorrhage und cocaine: cause or coincidence?].

    Science.gov (United States)

    Plessl, Astrid; Buser, Paul J; Daikeler, Thomas; Steveling, Esther; Halter, Jörg; Holbro, Andreas

    2014-10-29

    We report the case of a previously healthy young man who presented to the hospital with hemoptysis and dyspnea. Hemoptysis is a frequently encountered symptom in daily routine and investigations can easily be deferred to a longer time frame. Our case illustrates the importance of a prompt investigation and treatment of underlying causes. Furthermore one should not hesitate to include rare, yet life threatening conditions in differential diagnosis.

  8. [Treatment of COPD].

    Science.gov (United States)

    Roche, Nicolas; Huchon, Gérard

    2011-06-01

    COPD treatment begins with smoking cessation and influenza and pneumococcal vaccines. Bronchodilators are indicated when dyspnea on exertion is reported (usually, FEV1 COPD has to integrate treatment of comorbidities such as cardio-vascular diseases, anxiety-depression, malnutrition, muscle dysfunction, osteoporosis, anemia ... Ongoing research aims at identifying new therapeutic targets, focusing on inflammation, remodeling, protease-antiprotease balance, oxidative stress, lung regeneration/repair and mucus production.

  9. Pulmonary Cement Embolism following Percutaneous Vertebroplasty

    Directory of Open Access Journals (Sweden)

    Ümran Toru

    2014-01-01

    Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

  10. Beta Blockers for the Prevention of Acute Exacerbations of COPD

    Science.gov (United States)

    2016-10-01

    site. Dr. Lebo is responsible for producing, labeling, and distributing the study drug for this project. Mr. Lebo oversees the supply chain of...mortality; lung function (forced expiratory volume in 1 s (FEV1)); dyspnea; quality of life; exercise capacity; markers of cardiac stretch (pro-NT brain ...NT brain natriuretic peptide) and systemic inflammation (high-sensitivity C reactive protein and fibrinogen). Analyses will be performed on an intent

  11. Heat-Related Illnesses

    Science.gov (United States)

    1988-04-01

    to cold stress. Despite this ability, man has been plagued by heat illness throughout recorded history. The Old Testament describes a young man’s...encounter heat illness because of the requirement to train unacclimatized men by means of forced heavy physical cxercise. The United States Army...dyspnea, dysphagia , and urinary incontinence. 2 6 Although the muscular rigidity and hyperthermia are reminiscent of malignant hyperthermia, the putative

  12. Safely Using TCM Herbs: Adverse Reaction and Precautions

    Institute of Scientific and Technical Information of China (English)

    陈楷; AngelaBerscheid

    2004-01-01

    Adverse reactions and toxicity: Amygdalin is the main toxic constituent, which can be decomposed to hydrocyanic acid. Toxicity is dose related; 55--60 pieces of Xing ren, containing approximately 1.8 g of amygdalin, is often the fatal dose in adults. Two hours after administration, the first symptoms often appear, such as a bitter taste in mouth accompanied with oversalivation, nausea, vomiting, abdominal pain, diarrhea, headache, dizziness, palpitations, dyspnea, cyanosis, which may lead to coma and death due to respiratory arrest .

  13. Isolated Left Pulmonary Artery Agenesis: A Case Report

    OpenAIRE

    Tansel Ansal Balcı; Zehra Pınar Koç; Gamze Kırkıl; Ahmet Kürşad Poyraz

    2012-01-01

    Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung w...

  14. Correlation of Airway Hyper-responsiveness with Obstructive with Spirometric Indices and FEV1 90% Predicted

    Science.gov (United States)

    2012-04-01

    carbon monoxide], gas exchange evaluation, and measurement of muscle strength or exercise testing.1 There is a lack of evidence supporting this...these, 62 (32%) were prescribed daily inhaled pulmonary med- ications. The symptomatic group on medications included 49 asthma patients and 13 COPD ...patients. Indications for spirometry in the symptomatic non-medication group in- cluded dyspnea (no. 55), cough (no. 14), diagnosed COPD and asthma

  15. Acute pulmonary emphysema cum pulmonary edema apparently associated with feeding of Brassica juncea in a dairy buffalo

    OpenAIRE

    Muhammad, Ghulam; Saqib, Muhammad; Naureen, Abeera

    2010-01-01

    This preliminary report describes the occurrence of acute pulmonary emphysema cum pulmonary edema ensuing in extensive subcutaneous emphysematous swellings in a dairy buffalo (Bubalus bubalis) apparently associated with a sudden shift from berseem (Trifolium alexendrinum) to Brassica juncea fodder. Tachypnea, expiratory dyspnea, open-mouth breathing, loud expiratory grunt with abdominal lift, and crackles in ventral aspects of the lungs with normal rectal temperature characterized the conditi...

  16. The diagnosis and treatment of the laryngeal chondrosarcoma

    Institute of Scientific and Technical Information of China (English)

    Wenwei Zhang; Jie Qiu; Xinyu Zhang

    2012-01-01

    Chondrosarcoma (CS) of larynx is uncommon and predominantly affects the cricoid cartilage. A 70% to 75% of these tumors arise on the endolaryngeal surface of the posterior lamina of the cricoid cartilage. The clinical presentation include hoarseness, stridor, dyspnea, or a neck mass etc. The diagnosis is suggested when calcification is identified in a laryngeal tumor. Computed tomography (CT) is the best noninvasive technique for imaging the lesion. Surgical extirpation is the standard therapy with no role for radiation therapy or chemotherapy.

  17. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005186 The diagnostic application of bedside measurement of plasma brain natriuretic in patients with heart failure. SHAO Le-wen (邵乐文) , Advanced Ward Dept, 1st Hosp, Med Sch, Zhejiang Univ, Hangzhou 310003. Chin J Intern Med, 2005;44(2): 99-101. Objective: To investigate differential diagnosis value of ultra-rapid bedside measurement of brain na-triuretic peptide (BNP) in patients with dyspnea.

  18. Exophiala Pneumonia Presenting with a Cough Productive of Black Sputum

    OpenAIRE

    2015-01-01

    Exophiala species are black, yeast-like molds that can cause subcutaneous cysts as well as disseminated disease. Isolated pneumonia due to Exophiala species is extremely uncommon. We report a case of isolated Exophiala pneumonia in a patient with bronchiectasis who presented with worsening dyspnea and a cough productive of black sputum. The production of black sputum, known as melanoptysis, is an uncommon physical finding with a limited differential diagnosis. To our knowledge, this is the fi...

  19. Physiologic Determinants of Exercise Capacity in Pulmonary Langerhans Cell Histiocytosis: A Multidimensional Analysis

    Science.gov (United States)

    Fry, Stephanie; Giovannelli, Jonathan; Langlois, Carole; Bricout, Nicolas; Aguilaniu, Bernard; Bellocq, Agnes; Le Rouzic, Olivier; Dominique, Stephane; Delobbe, Alain; François, Geraldine; Tazi, Abdellatif; Wallaert, Benoit; Chenivesse, Cecile

    2017-01-01

    Background Reduced exercise capacity severely impacts quality of life in pulmonary Langerhans cell histiocytosis. Ascertaining mechanisms that impair exercise capacity is necessary to identify targets for symptomatic treatments. Methods Dyspnea, pulmonary function tests and cardiopulmonary exercise test were analysed in 62 study participants. Data were compared between subjects with impaired and normal aerobic capacity (V’O2 peak less than 84% versus 84% predicted or more). Data were reduced using a principal component analysis. Multivariate analysis included V’O2 peak as the dependent variable and principal components as covariates. Results V’O2 peak was reduced in 44 subjects (71%). Subjects with impaired aerobic capacity presented: (i) decreased FEV1, FVC, FEV1/FVC, DLCO and DLCO/VA and increased AaDO2, (ii) increased ventilatory equivalents at ventilatory threshold, VD/VT peak, AaDO2 peak and PaCO2 peak and decreased ventilatory reserve and PaO2 peak. There was no difference between groups in dyspnea scores. Principal component analysis extracted 4 principal components interpreted as follows: PC1: gas exchange; PC2: “pseudorestriction”; PC3: exercise-induced hyperpnea; PC4: air trapping. Multivariate analysis explained 65% of V’O2 peak. The 4 principal components were independently associated with V’O2 peak (βcoefficients: PC1: 9.3 [4.6; 14], PC2: 7.5 [3; 11.9], PC3: -5.3 [-9.6;-1.], PC4: -9.8 [-14,9;-4.7]). Conclusion Impaired exercise capacity is frequent in pulmonary Langerhans cell histiocytosis. It is mainly caused by pulmonary changes but is not associated with increased dyspnea intensity. Therefore, treating the lung represents a relevant approach for improving exercise capacity, even in patients experiencing mild dyspnea. PMID:28072848

  20. Effects of tiotropium on sympathetic activation during exercise in stable chronic obstructive pulmonary disease patients

    Directory of Open Access Journals (Sweden)

    Kitada S

    2012-05-01

    Full Text Available Kenji Yoshimura, Ryoji Maekura, Toru Hiraga, Seigo Kitada, Keisuke Miki, Mari Miki, Yoshitaka TateishiDepartment of Respiratory Medicine, Toneyama National Hospital, Osaka, JapanBackground: Tiotropium partially relieves exertional dyspnea and reduces the risk of congestive heart failure in chronic obstructive pulmonary disease (COPD patients. However, its effect on the sympathetic activation response to exercise is unknown.Aims: This study aimed to determine whether tiotropium use results in a sustained reduction in sympathetic activation during exercise.Methods: We conducted a 12-week, open-label (treatments: tiotropium 18 µg or oxitropium 0.2 mg × 3 mg, crossover study in 17 COPD patients. Treatment order was randomized across subjects. The subjects underwent a pulmonary function test and two modes of cardiopulmonary exercise (constant work rate and incremental exercise testing using a cycle ergometer, with measurement of arterial catecholamines after each treatment period.Results: Forced expiratory volume in 1 second and forced vital capacity were significantly larger in the tiotropium treatment group. In constant exercise testing, exercise endurance time was longer, with improvement in dyspnea during exercise and reduction in dynamic hyperinflation in the tiotropium treatment group. Similarly, in incremental exercise testing, exercise time, carbon dioxide production, and minute ventilation at peak exercise were significantly higher in the tiotropium treatment group. Plasma norepinephrine concentrations and dyspnea intensity were also lower during submaximal isotime exercise and throughout the incremental workload exercise in the tiotropium treatment group.Conclusion: Tiotropium suppressed the increase of sympathetic activation during exercise at the end of the 6-week treatment, as compared with the effect of oxipropium. This effect might be attributed to improvement in lung function and exercise capacity and reduction in exertional dyspnea

  1. Amiodaron-induced pulmonary toxicity with fatal outcome

    Energy Technology Data Exchange (ETDEWEB)

    Brachtel, D.; Krischel, W.

    1984-12-01

    Three month after initiation of amiodarone treatment wih 1000 mg daily a 62 years old man with refractory ventricular tachycardia developed increasing dyspnea. Chest X-ray findings consisted of patchy alveolar infiltrates and interstitial changes. Despite withdrawal of amiodarone and institution of prednisolone treatment the patient died of cardiorespiratory failure. Chest X-ray examinations at frequent intervals should be performed during the first year of high dose amiodarone therapy to detect early signs of pulmonary toxicity.

  2. Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing.

    Science.gov (United States)

    Youssef, Amir A; Machaly, Shereen A; El-Dosoky, Mohammed E; El-Maghraby, Nermeen M

    2012-07-01

    Pulmonary disease is the most frequent and among the most severe extra-articular manifestation of rheumatoid arthritis (RA). However, this issue has not been sufficiently studied in Egyptian patients. The objectives of the present study are to investigate the prevalence and types of pulmonary involvement using high-resolution computed tomography scan (HRCT) and pulmonary function tests (PFT) and evaluate the association between respiratory symptoms and RA-lung disease in a group of Egyptian RA patients. Thirty-six RA patients were recruited; 34 females (94.4%) and 2 males (5.6%) with median age of 48.5 years, and none of them was smoker. Detailed medical and drug histories were obtained. PFT, plain X-ray of the chest, and HRCT were performed to all subjects involved. Nearly 64% of RA patients demonstrated abnormalities in PFT and 47% in HRCT. Mixed restrictive and obstructive pattern was the commonest. Nearly two-thirds of our patients reported one or more pulmonary symptom whether dyspnea, cough, wheezing, or phlegm. Dyspnea was the most frequent symptom. Respiratory symptoms were statistically more common in patients with lung disease. The advanced age, high radiological score, and severity of rheumatoid disease were found to be predictive of lung involvement. Among respiratory symptoms, dyspnea and cough were associated with any pulmonary abnormalities. When specific pulmonary abnormalities were considered, only dyspnea was identified as predictor for restriction. For obstructive abnormality, both cough and wheezing provided valid prediction. We conclude that pulmonary involvement is a common manifestation in Egyptian RA patients, and the pattern of involvement is generally consistent with other studies that were performed worldwide. Specific respiratory symptoms could be used as practical, easy, and cost-effective method, especially in older and with more severe RA patients, to discriminate patients in need of subsequent PFT and HRCT imaging.

  3. Evaluation of Hemodynamic Changes and Respiratory Physical Findings in Patients with Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Masome Rabieepour

    2014-07-01

    Full Text Available Introduction: Pulmonary thromboembolism (PTE is a potentially fatal disease with nonspecific symptoms and signs. Patients with Pulmonary embolism often have dyspnea, chest pain, haemoptysis, tachycardia tachypnea and respiratory physical finding including hypoxia and decreased ETCO2. Daily patients with Pulmonary embolism are very few in hospital course and we aimed to determine clinical and paraclinical findings in hospital pulmonary embolism patients. Methods: we assessed in hospital course of 104 patients with pulmonary embolism with symptom (dyspnea, chest pain, and hemoptysis and signs (tachypnea, tachycardia, DVT signs, blood pressure and respiratory physical findings (PO2, ETCO2. Results: majority of patients had risk factor for PTE; the most common was cancer. 21.2% of patients had apparent DVT in Doppler sonography. Isolated dyspnea (38%, chest pain with and without hemoptysis (60% and syncope (2% were observed in patients. Mean duration of dyspnea resolution was 3.4 days. Mean duration of chest pain resolution was 1.76 days. Mean duration of hemoptysis resolution was 2 days. 64.4% of the patients were hypoxic and mean duration of hypoxic resolution was 2.63 days. Mean duration of tachycardia resolution was 2.37 days. No relation was observed between size of PTE and mortality or hypotension and PO2. Mean ETCO2 was 23±2 mmHg and 86.5% of patients had ETCO2 lower than 28. Mean duration of ETCO2 resolution was 3.6 days. Most common physical finding that resolved later than others was ETCO2. In 32.7% of patients, ETCO2 did not resolve.   Key words: Pulmonary thromboembolism; Tachycardia; Tachypnea; Hemoptysis; Hypoxic; ETCO2

  4. Multiple coarctation of the pulmonary artery

    Energy Technology Data Exchange (ETDEWEB)

    Dicle, Oguz; Yilmaz, Erkan E-mail: eyilmaz@kordon.deu.edu.tr

    2000-12-01

    Pulmonary artery coarctation is a rare congenital anomaly characterized by single or multiple stenoses of the pulmonary arteries and their branches. There are only a few reports describing the radiological film of this entity. In this paper we report the case of a 68 year-old woman who presented with dyspnea. The scintigraphic, examination of the lungs gave the misleading impression of pulmonary embolism, and only angiography and magnetic resonance imaging established the correct diagnosis of multiple coarctations of the pulmonary artery.

  5. Human Vagus Nerve Branching in the Cervical Region

    OpenAIRE

    Niels Hammer; Juliane Glätzner; Christine Feja; Christian Kühne; Jürgen Meixensberger; Uwe Planitzer; Stefan Schleifenbaum; Tillmann, Bernhard N.; Dirk Winkler

    2015-01-01

    Background: Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve...

  6. 47 Year Old Patient with Pseudo-Asthma

    Directory of Open Access Journals (Sweden)

    Bulent Altinsoy

    2011-01-01

    Full Text Available 47- year- old female patient presented in out-patient department in Afyon Chest Disease Hospital with dyspnea, cough and purulent sputum. She has been receiving regular inhaler β-agonist and corticosteroids with the diagnosis of asthma bronchial since childhood. However, the patient had a history of very often upper and lower respiratory tract infections. The patient did not smoke, drink alcohol, or use illicit drugs intravenously. She was currently on asthma medications.

  7. Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review

    OpenAIRE

    Song, Jae-Won; Jang, Young-Sook; Jung, Moon-Chan; Kim, Joo-Hee; Choi, Jeong-Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki-Suck

    2017-01-01

    Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodroprop...

  8. Research Priorities in Geriatric Palliative Care: Nonpain Symptoms

    OpenAIRE

    Combs, Sara; Kluger, Benzi M.; Kutner, Jean S.

    2013-01-01

    Research addressing the burden, assessment, and management of nonpain symptoms associated with advanced illness in older adults is limited. While nonpain symptoms such as fatigue, sleep, dyspnea, anxiety, depression, cognitive impairment, nausea, and anorexia-cachexia are commonly noted by patients and clinicians, research quantifying their effects on quality of life, function, and other outcomes are lacking and there is scant evidence regarding management. Most available studies have focused...

  9. Esophageal Gastrointestinal Stromal Tumors Presenting as Mediastinal Mass

    Directory of Open Access Journals (Sweden)

    M. Kafeel

    2013-11-01

    Full Text Available Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract and are predominant in the stomach and intestine but rare in the esophagus. Here, we report a case of esophageal GIST which presented as a mediastinal mass on chest X-ray and dyspnea. The case was initially diagnosed as leiomyosarcoma, which could create a diagnostic dilemma. Therefore, recognizing this uncommon presentation as a mediastinal mass with esophageal GIST is important in the differential diagnosis.

  10. A case of taurine-containing drink induced anaphylaxis

    OpenAIRE

    Lee, Seung-Eun; Lee, Suh-Young; Jo, Eun-Jung; Kim, Mi-Young; Yang, Min-Suk; Chang, Yoon-Seok; Kim, Sae-Hoon

    2013-01-01

    Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks. The patient also showed positive response with synthetic taurine but not with natural taurine....

  11. TRPV1 and TRPM8 in Treatment of Chronic Cough

    OpenAIRE

    Eva Millqvist

    2016-01-01

    Chronic cough is common in the population, and among some there is no evident medical explanation for the symptoms. Such a refractory or idiopathic cough is now often regarded as a neuropathic disease due to dysfunctional airway ion channels, though the knowledge in this field is still limited. Persistent coughing and a cough reflex easily triggered by irritating stimuli, often in combination with perceived dyspnea, are characteristics of this disease. The patients have impaired quality of li...

  12. Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD.

    Science.gov (United States)

    Luo, Yuwen; Zhou, Luqian; Li, Yun; Guo, Songwen; Li, Xiuxia; Zheng, Jingjing; Zhu, Zhe; Chen, Yitai; Huang, Yuxia; Chen, Rui; Chen, Xin

    2016-05-01

    Despite the high prevalence of weight loss in subjects with COPD, the 2011 COPD management guidelines do not include an index measuring nutritional status. Fat-free mass index (FFMI) can accurately determine the nutritional status of subjects and may be closely correlated with COPD severity. We aimed to determine the nutritional status evaluated by FFMI according to the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) levels in stable subjects with COPD and the association between nutritional status and respiratory symptoms, exercise capacity, and respiratory muscle function. We included 235 stable subjects with COPD in this cross-sectional study. All of the subjects were divided into the 2011 GOLD Groups A, B, C, and D. FFMI (measured by bioelectrical impedance), spirometry (FEV1, percent-of-predicted FEV1, and FEV1/FVC), respiratory muscle function (peak inspiratory and peak expiratory pressures), exercise capacity (6-min walk distance), and dyspnea severity (Modified Medical Research Council dyspnea scale) were measured and compared between the GOLD groups. Malnutrition was identified in 48.5% of subjects and most prevalent in Group D (Group A: 41%, Group B: 41%, Group C: 31%, and Group D: 62%). FFMI was significantly lower in Group D (P pulmonary function, 6-min walk distance, peak inspiratory pressure, and worsened dyspnea. FFMI was significantly lower in the emphysema-dominant phenotype and mixed phenotype compared with the normal phenotype and airway-dominant phenotype. A stepwise multiple linear regression analysis identified peak inspiratory pressures and older age as independent predictors of FFMI. Malnutrition is highly prevalent in all COPD groups, particularly in Group D subjects, who warrant special attention for nutritional intervention and pulmonary rehabilitation. FFMI significantly correlated with exercise capacity, dyspnea, respiratory muscle function, and pulmonary function and may be a useful predictor of COPD severity

  13. Spontaneous pneumothorax due to recently diagnosed active pulmonary tuberculosis

    OpenAIRE

    Carrillo, Leonidas; 1 Facultad de Medicina, UNMSM. Lima, Perú. 2 Hospital Nacional Arzobispo Loayza, Ministerio de Salud. Lima, Perú.; Pintado, Silvia; Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú.; Cueva, Luis; Facultad de Medicina, UNMSM. Lima, Perú.

    2011-01-01

    We describe the case of a male patient aged 17, Lima student who had no history of known tuberculosis contact, nonreactive HIV ELISA, diagnosed 21 days befote admission with active pulmonary tuberculosis, sputum smear 3 +, who was started with first line antituberculosis drugs. He was admitted to the hospital for pleural chest pain of sudden onset, and moderate dyspnea; on physical examination there was abolition of vocal vibrations, absence of breath sounds and hyperresonance in right hemith...

  14. Outcomes in COPD patients receiving tiotropium or salmeterol plus treatment with inhaled corticosteroids

    OpenAIRE

    Hodder, Richard; Kesten, Steven; Menjoge, Shailendra; Viel, Klaus

    2007-01-01

    Patients with COPD are frequently prescribed inhaled corticosteroids (ICS); however, it is unclear whether the treatment with ICS might modify responses to inhaled bronchodilators. Two 6-month, randomized, placebo-controlled, double-blind, double-dummy, parallel-group studies of tiotropium 18 μg once daily, compared with salmeterol, 50 μg bid, had been conducted in patients with moderate-to-severe COPD. Efficacy was assessed by spirometry, transition dyspnea index (TDI), St. George’s Respirat...

  15. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  16. Aorto-right ventricular fistula: a complication of aortic valve replacement.

    Science.gov (United States)

    Najib, Mohammad Q; Ng, Daniel; Vinales, Karyne L; Chaliki, Hari P

    2012-01-01

    The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-year-old woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula.

  17. Activity restriction in mild COPD: a challenging clinical problem

    Directory of Open Access Journals (Sweden)

    O'Donnell DE

    2014-06-01

    Full Text Available Denis E O'Donnell,1 Kevin B Gebke2 1Division of Respiratory and Critical Care Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada; 2Primary Care Sports Medicine Program, Indiana University School of Medicine, Indianapolis, IN, USA Abstract: Dyspnea, exercise intolerance, and activity restriction are already apparent in mild chronic obstructive pulmonary disease (COPD. However, patients may not seek medical help until their symptoms become troublesome and persistent and significant respiratory impairment is already present; as a consequence, further sustained physical inactivity may contribute to disease progression. Ventilatory and gas exchange impairment, cardiac dysfunction, and skeletal muscle dysfunction are present to a variable degree in patients with mild COPD, and collectively may contribute to exercise intolerance. As such, there is increasing interest in evaluating exercise tolerance and physical activity in symptomatic patients with COPD who have mild airway obstruction, as defined by spirometry. Simple questionnaires, eg, the modified British Medical Research Council dyspnea scale and the COPD Assessment Test, or exercise tests, eg, the 6-minute or incremental and endurance exercise tests can be used to assess exercise performance and functional status. Pedometers and accelerometers are used to evaluate physical activity, and endurance tests (cycle or treadmill using constant work rate protocols are used to assess the effects of interventions such as pulmonary rehabilitation. In addition, alternative outcome measurements, such as tests of small airway dysfunction and laboratory-based exercise tests, are used to measure the extent of physiological impairment in individuals with persistent dyspnea. This review describes the mechanisms of exercise limitation in patients with mild COPD and the interventions that can potentially improve exercise tolerance. Also discussed are the

  18. Ippolito Albertini and Michael Albertus: disparate old and innovative theories on dropsy and edema.

    Science.gov (United States)

    Timio, Mario; Capodicasa, Enrico

    2002-07-01

    The concept of edema and dropsy as a part of heart and renal failure developed in the 17th and 18th centuries with the observations of Albertini, who realized that two clinical entities were derived from the blood rather than the tissues. Albertus, who lived in the same period, was the last physician to interpret fluid accumulation according to the old, scholastic and dogmatic procedures of medicine. The fundamental concepts of Albertus held little in addition to the classification and categories of the physicians of the Middle Ages. Bloody congestions were distinguished from stagnation: the former have the purpose of reducing superfluites of blood and occurred in plethoric patients. Plethora in turn is caused by the ancient villain, inculpated since Hippocrates and Galen: suppressed hemorrhoids, suppressed menstrual evacuation and cutaneous eruption driven inward. Because of its suppression, transfer of blood occurs toward the chest, which impedes thoracic expansion and contraction, then asthma and dyspnea occur. On the contrary, Albertini with his clinical and autoptic observations and pronouncements filled in the anatomical and clinical picture of fluid accumulation and created the rudiments of diagnostic criteria. Edema, dropsy, asthma, dyspnea were, according to Albertini, the signs and symptoms of heart and renal failure. Albertini was the first to point out that dyspnea is apt to arise with special rapidity when a lesion occurs in the left atrial chamber and ventricle and by implication the mitral valve. In modern physiopathological terms, he discovered the picture of pulmonary edema. To this important discovery, he added a number of extremely important comments: changes in the respiratory organs are secondary to changes in the cardiovascular system; edema that is accompanied by dyspnea also affects the viscera, most especially the lungs, and finally dropsy of the lungs must be differentiated anatomically and clinically from dropsy of the chest (hydrothorax

  19. Coronary artery bypass and superior vena cava syndrome.

    OpenAIRE

    Thomas, T V; Masrani, K; Thomas, J.L.

    1999-01-01

    Superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary...

  20. Hypersensitivity to Etoposide in Case of Metastatic Gestational Choriocarcinoma

    Directory of Open Access Journals (Sweden)

    Biljana Lazović

    2013-09-01

    Full Text Available Etoposide is commonly used in the treatment of a variety of neoplasms. Hypersensitivity reactions to etoposide are infrequently reported and include hypotension, hypertension, flushing, diaphoresis, chest discomfort, dyspnea, bronchospasm and loss of consciousness. We report the case of a 39-year-old woman who experienced acute bronchospasm, tachycardia, hypoxia and hypotension. The symptoms resolved within an hour after administration of intravenous fluids, methylprednisolone, diphenhydramine and oxygen. Subsequently, the patient was given etoposide phosphate without incident.

  1. Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

    OpenAIRE

    Mehdi Bakhsaee; Mohammad Hassan Jokar; Zahra Mirfeizi; Elham Atabati; Somayeh Tarighat

    2017-01-01

    Introduction:Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM) and polymyositis (PM), both of which can be fatal. Case Report:A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT) scan revealed ground glass opacities i...

  2. Singleton Merten Syndrome: A Rare Cause of Early Onset Aortic Stenosis

    Science.gov (United States)

    Mungee, Sudhir

    2017-01-01

    Singleton Merten syndrome (SMS) is a rare autosomal dominant genetic disorder with variable expression. Its characteristic features include abnormal aortic calcification, abnormal ossification of extremities, and dental anomalies. We present a young man with dyspnea who was noted to have aortic stenosis in the background of glaucoma, psoriasis, dental anomalies, hand and foot deformities, Achilles tendinitis, osteopenia, and nephrolithiasis. The conglomeration of features led to the diagnosis of SMS. His mother had a very similar phenotype. PMID:28321341

  3. Detection of abnormalities in dyspneic patients using a new lung imaging modality

    Institute of Scientific and Technical Information of China (English)

    Wang Zhen; Xiong Yingxia

    2014-01-01

    Background Although chest radiography is a useful examination tool,it has limitations.Because not all chest conditions can be detected on a radiograph,radiography cannot necessarily rule out all irregularities in the chest.Therefore,further imaging studies may be required to clarify the results of a chest radiograph,or to identify abnormalities that are not readily visible.The aim of this study was to compare traditional chest radiography with acoustic-based imaging (vibration response imaging) for the detection of lung abnormalities in patients with acute dyspnea.Methods The current investigation was a pilot study.Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique.Consecutive patients who presented to the emergency department with acute dyspnea and a normal chest radiograph on admission were enrolled and underwent imaging at the time of presentation.Dynamic and static images of vibration (breath sounds) and a dynamic image score were generated,and assessments were made using an evaluation form.Results In healthy volunteer controls (n=61),the mean dynamic image score was 6.3±1.9.In dyspneic patients with normal chest radiographs (n=51) and abnormal chest radiographs (n=48),the dynamic image scores were 4.7±2.7 and 5.1±2.5,respectively (P <0.05).The final assessment of the vibration images indicated abnormal findings in 15%,86% and 90% of the participants in the above groups,respectively (P <0.05).Conclusions In patients with acute dyspnea who present with normal chest radiographs,respiratory sound analyses often showed abnormal values.Hence,the ability of acoustic-based recordings to offer objective and noninvasive measurements of abnormal sound transmission may be useful in the clinical setting for patients presenting with acute dyspnea.

  4. Transarterial embolization treatment for aberrant systemic arterial supply to the normal lung: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Ra; Jo, Jeong Hyun; Park, Byeong Ho [Dept. of Radiology, Dong A University Hospital, Dong A University College of Medicine, Busan (Korea, Republic of)

    2017-06-15

    A 24-year-old man presented with dyspnea on exertion and intermittent blood-tinged sputum. He was diagnosed with aberrant systemic arterial supply to the normal lung (ASANL) based on the results of imaging studies. The patient was successfully treated with transarterial embolization using coils and a vascular plug and his symptoms disappeared during the follow-up. Herein, we reported the imaging findings of ASANL, differential diagnoses, and its treatment options. In addition, we reviewed the relevant literature.

  5. [Respiratory insufficiency due to duplications of the oesophagus].

    Science.gov (United States)

    Luoma, Reijo

    2015-01-01

    Duplications of the oesophagus are uncommon congenital malformations with possible occurrence in any part of the gastrointestinal tract. The duplications may be cysts, diverticula or tubular-shaped. Cysts may even occur further away from the gastrointestinal tract, not necessarily having contact with it. I present a patient case, in which a 13-month-old child was brought to the emergency room due to gradually increasing dyspnea. The child made a full recovery after the surgical procedure.

  6. [A misleading form of hypersensitivity pneumonitis].

    Science.gov (United States)

    Gainet, M; Chaudemanche, H; Westeel, V; Lounici, A; Dubiez, A; Depierre, A; Dalphin, J C

    2000-11-01

    A 47-year-old woman, without significant past medical history, presented an acute dyspnea with hypoxia, marked pulmonary arterial hypertension (PAH) and signs of right heart failure. Chest x-ray showed a moderate dilatation of the right heart cavities. Pulmonary embolism was suggested. After detailed questioning and complete explorations, a bird hypersensitivity pneumonitis (HP) was demonstrated. This case illustrates a misleading presentation of an acute form of HP consisting of apparently isolated PAH.

  7. A functional assessment of patients two years after lung transplantation in Poland

    Science.gov (United States)

    Gumola, Anna; Wojarski, Jacek; Żegleń, Sławomir; Ochman, Marek; Czyżewski, Damian; Ziora, Dariusz; Zembala, Marian; Kozielski, Jerzy

    2014-01-01

    The aim of the study The aim of the study was to assess the long-term results of lung transplantation (LT) in Poland two years after the procedure. Material and methods The study included patients who underwent LT between December 2004 and December 2009 in the Silesian Center for Heart Diseases in Zabrze. Various lung functions (forced vital capacity – FVC; forced expiratory volume in 1 second – FEV1), the quality of life (SF-36 questionnaire), the level of perceived dyspnea (Medical Research Council – MRC; basic dyspnea index – BDI), and the patient's mobility (the 6-minute walking test – 6MWT) were assessed before and approximately 24 months after LT. Among 35 patients who underwent LT, 20 patients were referred to our study (mean age: 46.6 ± 9.03 years). Results After LT, a statistically significant increase was observed in the distance achieved in the 6MWT (323.8 vs. 505.8 m), FVC (1.64 vs. 2.88 L), and FEV1 (1.37 vs. 2.09 L). An improvement in perceived dyspnea in MRC and BDI questionnaires was observed in patients with chronic obstructive pulmonary disease (COPD) after LT. The assessment of the quality of life, excluding perceived pain, showed the most significant improvement in the physical cumulative score (PCS; 25 vs. 45 points), especially in patients with idiopathic pulmonary fibrosis. Conclusions Lung transplantation in Poland, in patients who live longer than 2 years after the procedure, significantly improves the mobility, lung function, perceived dyspnea, and the quality of life. PMID:26336415

  8. Experimental poisoning by Callaeum psilophyllum in rabbits and goats
    Intoxicação experimental por Callaeum psilophyllum em coelhos e caprinos

    OpenAIRE

    2013-01-01

    Callaeum (Mascagnia) psilophyllum is found in the same regions than Amorimia (Mascagnia) rigida, a sodium monofluoroacetate containing plant that cause sudden death associated with exercise in ruminants. With the objective to determine the toxicity of C. psilophyllum, leaves of the plant were administered to rabbits and goats. In rabbits doses of 6-12 g.kg-1 body weight caused tachycardia, dyspnea, and mydriasis. One rabbit, that ingested 10 g/kg, showed clinical signs similar to those caused...

  9. Cartap poisoning: A rare case report

    Directory of Open Access Journals (Sweden)

    A S Praveen Kumar

    2011-01-01

    Full Text Available Cartap is a pesticide commonly used to control weevil and caterpillars. It is an analogue of nereistoxin, a neurotoxic substance isolated from the marine annelid Lumbriconereis heteropoda. It causes neuromuscular blockade. Poisoning with cartap is very rare and not yet reported from India. We report a 35-year-old lady with cartap poisoning who presented with nausea, vomiting, and dyspnea. She improved with N-acetyl cysteine and symptomatic management.

  10. Cartap poisoning: A rare case report

    OpenAIRE

    A S Praveen Kumar; Deepak Amalnath; T K Dutta

    2011-01-01

    Cartap is a pesticide commonly used to control weevil and caterpillars. It is an analogue of nereistoxin, a neurotoxic substance isolated from the marine annelid Lumbriconereis heteropoda. It causes neuromuscular blockade. Poisoning with cartap is very rare and not yet reported from India. We report a 35-year-old lady with cartap poisoning who presented with nausea, vomiting, and dyspnea. She improved with N-acetyl cysteine and symptomatic management.

  11. Cartap poisoning: A rare case report.

    Science.gov (United States)

    Kumar, A S Praveen; Amalnath, Deepak; Dutta, T K

    2011-10-01

    Cartap is a pesticide commonly used to control weevil and caterpillars. It is an analogue of nereistoxin, a neurotoxic substance isolated from the marine annelid Lumbriconereis heteropoda. It causes neuromuscular blockade. Poisoning with cartap is very rare and not yet reported from India. We report a 35-year-old lady with cartap poisoning who presented with nausea, vomiting, and dyspnea. She improved with N-acetyl cysteine and symptomatic management.

  12. The effects of high intensity exercise during pulmonary rehabilitation on ventilatory parameters in people with moderate to severe stable COPD: a systematic review

    Directory of Open Access Journals (Sweden)

    Osterling K

    2014-10-01

    Full Text Available Kristin Osterling,1 Kimbly MacFadyen,1 Robert Gilbert,2 Gail Dechman1 1School of Physiotherapy, 2School of Health Sciences, Dalhousie University, Halifax, NS, Canada Objective: The objective of this systematic review was to determine whether people with moderate to severe COPD who are participating in pulmonary rehabilitation and exercising at high intensity demonstrate the changes in ventilatory parameters that are associated with decreased dyspnea. Data sources: The authors searched EMBASE, The Cochrane Library, and CINAHL databases up to December 2013 for relevant randomized control trials, systematic reviews, and observational studies. References of identified studies were also screened. Study selection: Studies conducted in a pulmonary rehabilitation setting that included education and exercise were included. Symptom-limited, graded exercise testing that measured tidal volume, respiratory rate, minute ventilation, and inspiratory capacity was required. The studies that contained these keywords in the title or the abstract were selected for further evaluation of the text. Disagreements between reviewers were resolved by consensus. Four studies met these inclusion criteria. Data extraction: Quality assessment and data extraction were performed independently by two reviewers. Risk of bias and quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data synthesis: Participants in three studies trained at high intensity (70%–80% maximum workload, demonstrating statistically significant changes in tidal volume and respiratory rate. One study did not demonstrate positive ventilatory benefits; however, participants may not have met the desired training intensity. Two studies reported improvement in dyspnea at submaximal exercise intensities. One study noted an increased maximum workload with no significant change in dyspnea at peak exercise. Conclusion: People with moderate to severe, stable COPD were able

  13. An Unusual Case of Pulmonary Nocardiosis in Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Zehra Yaşar

    2014-01-01

    Full Text Available Pulmonary nocardiosis is a subacute or chronic necrotizing pneumonia caused by aerobic actinomycetes of the genus Nocardia and rare in immune-competent patients. A 35-year-old male, who had treated with antituberculosis drugs, presented with cough, dyspnea, and expectoration with episodes of hemoptysis with purulent sputum. The diagnosis of nocardiosis was made by microscopic examination of the surgically resected portion of the lung and revealed filamentous Gram-positive bacteria.

  14. [Aortic Valve Replacement Via a Partial Sternotomy in an Ankylosing Skeletal Hyperostosis Patient after Prophylactic Tracheostomy;Report of a Case].

    Science.gov (United States)

    Saito, Shogo; Misawa, Yoshio; Kurumisawa, Soki; Aizawa, Kei; Kawahito, Koji

    2017-07-01

    A 77-year-old man presented with exertional dyspnea. The patient had a history of ankylosing skeletal hyperostosis and sleep apnea syndrome. Echocardiographic examination revealed severe aortic valve regurgitation. The patient underwent a prophylactic tracheostomy 2 weeks before cardiac surgery to decrease his risk of perioperative respiratory failure. He successfully underwent aortic valve replacement through a lower partial sternotomy. His postoperative course was uneventful, and the tracheostoma was closed 6 months after the cardiac surgery.

  15. Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation.

    Science.gov (United States)

    Greco, Antonio; Fusconi, Massimo; Macri, Gian Franco; Marinelli, Caterina; Polettini, Elisabetta; Benincasa, Anna Teresa; de Vincentiis, Marco

    2012-01-01

    Rheumatoid arthritis rarely involves the cricoarytenoid joint. The possible consequent symptom includes hoarseness, dysphagia, odynophagia, dysfunctional dysphonia, and acute dyspnea. Etiologic diagnosis is possible with high-resolution computed tomography, which can show spacing of the articular cartilage, density and volume alterations, and subluxation of the cartilage. However, these radiologic signs are not pathognomonic for rheumatoid arthritis, and they should be combined with anamnestic data.

  16. A Case of Severe Pulmonary Thromboembolism in a Young Male With Klinefelter Syndrome

    OpenAIRE

    Kang, Byung-Soo; Cho, Deok-Kyu; Koh, Won-Jun; Yoo, Seung-Hoon; Won, Ki-Bum; Cho, Yun-Hyeong; Hwang, Eui-Seock; Koh, Jong-Hoon

    2012-01-01

    A young male patient diagnosed with Klinefelter syndrome was admitted to our hospital via the emergency room with chief complaints of acute chest pain and dyspnea. Pulmonary thromboembolism was diagnosed from his chest CT images. His symptoms improved after he underwent thrombolysis and anticoagulation treatment. Klinefelter syndrome has a tendency towards hypercoagulability due to hormonal imbalance and one or more inherited thromophilic factors. Thus, Klinefelter syndrome patients with a pa...

  17. Anthracosis of the Lungs: Etiology, Clinical Manifestations and Diagnosis: A Review

    OpenAIRE

    Mirsadraee, Majid

    2014-01-01

    Anthracosis of the lungs is black discoloration of bronchial mucosa that can occlude bronchial lumen and is associated with bronchial anthracofibrosis (BAF). This disease usually presents with a chronic course of dyspnea and or cough in an elderly non-smoker woman or man. In addition, concomitant exposure to dust and wood smoke is the most postulated etiology for anthracosis. Pulmonary function tests usually show an obstructive pattern with no response to bronchodilators and normal DLCO, but ...

  18. The concept of Maslow's pyramid for cardiovascular health and its impact on “change cycle”

    OpenAIRE

    Behjati, Mohaddeseh

    2014-01-01

    Since the leading cause of morbidity and mortality is cardiovascular diseases, every individual should think regularly about possessing and maintaining cardiovascular health. In reality, this self-processing is delayed until the occurrence of complications related to cardiovascular inefficiency manifested as chest pain and/or dyspnea. However, people should be trained to think about their cardiovascular health issues as a vital need from early childhood. This goal is achievable by understandi...

  19. Intestinal obstruction caused by Taenia taeniaeformis infection in a cat.

    Science.gov (United States)

    Wilcox, Rebbecca S; Bowman, Dwight D; Barr, Stephen C; Euclid, James M

    2009-01-01

    An adult domestic shorthair (DSH) cat was presented with acute vomiting, anorexia, lethargy, and dyspnea. The cat's clinical status worsened over 24 hours with conservative medical management. An exploratory celiotomy was performed. Acute intestinal obstruction resulting from infection with Taenia (T.) taeniaeformis was diagnosed. Surgical removal of the cestodes via multiple enterotomies resolved the obstruction. This paper reports, for the first time, small intestinal obstruction caused by T. taeniaeformis infection in a cat.

  20. Journal of Special Operations Medicine. Volume 4, Edition 1, Winter 2004

    Science.gov (United States)

    2004-01-01

    Presenting signs are localized and may include itching, angioedema , or urticaria . These symptoms are caused when mast cells and basophils degranulate...experienced urticaria . One of these had an “allergic reaction” consisting of wheezing, dyspnea, and urticaria --which sounds a lot like anaphylaxis...such as urticaria .2 It was further believed that a nega- tive feedback reaction was associated with the administration of H2 blockers in the setting of

  1. A rare case of watermelon stomach in woman with continuous ambulatory peritoneal dialysis and systemic lupus erythematosus.

    Science.gov (United States)

    Jinga, Mariana; Checheriţă, I A; Becheanu, G; Jinga, V; Peride, Ileana; Niculae, A

    2013-01-01

    We report a case of a 42-year-old woman with systemic lupus erythematosus and chronic kidney disease stage 5 undergoing continuous ambulatory peritoneal dialysis, presenting asthenia, dizziness, abdominal pain and small efforts dyspnea. After a complete physical and clinical examination, including laboratory tests, esophagogastroduodenal endoscopy and gastric lesions biopsy, she was diagnosed with gastric antral vascular ectasia. We are facing a rare case of antral vascular ectasia in a patient associating both chronic kidney disease and autoimmune disease.

  2. Throat infection, neck and chest pain and cardiac response: a persistent infection-related clinical syndrome.

    Science.gov (United States)

    Zhou, Changqing; Fu, Xiangning; Yan, Jiangtao; Fan, Qiao; Li, Zhuoya; Cianflone, Katherine; Wang, Daowen

    2009-02-01

    Dizziness, chest discomfort, chest depression and dyspnea are a group of symptoms that are common complaints in clinical practice. Patients with these symptoms are usually informed that while neurosis consequent to coronary heart disease is excluded nonetheless they remain unhealthy with no rational explanation or treatment. 165 cases of these symptoms and 85 control subjects were reviewed and underwent further medical history inquiry, routine EKG test and cardiac ultrasound examination. Thirty-five patients received coronary artery angiography to exclude coronary heart disease. Serum myocardial autoantibodies against beta(1)-adrenoceptor, alpha-myosin heavy chain, M(2)-muscarinic receptor and adenine-nucleotide translocator were tested, and inflammatory cytokines and high sensitivity C-reaction protein were measured and lymphocyte subclass was assayed by flow cytometry. All patients had a complex of four symptoms or tetralogy: (1) persistent throat or upper respiratory tract infection, (2) neck pain, (3) chest pain and (4) chest depression or dyspnea, some of them with anxiety. Anti-myocardial autoantibodies (AMCAs) were present in all patients vs. 8% in controls. TNF-alpha, IL-1 and IL-6 were significantly higher in patients than in controls (Prib cartilage inflammation, symptoms of cardiac depression and dyspnea with or without anxiety.

  3. Inhalational exposure to dimethyl sulfate vapor followed by reactive airway dysfunction syndrome

    Directory of Open Access Journals (Sweden)

    Aghabiklooei Abbas

    2010-01-01

    Full Text Available Dimethyl sulfate (DMS is an oily liquid used as a solvent, stabilizer, sulfonation agent, and catalyst. Exposure to DMS primarily happens in the workplace via inhalational contact and damages the upper and lower airways. Our manuscript reports a case of DMS-related reactive airway dysfunction syndrome ( RADS. The patient was a healthy 29-year-old man who was referred to our ER after accidental exposure to the vapor of DMS with the complaint of dyspnea, dry cough, photophobia, and hoarseness. His vital signs were normal except for a low-grade fever. Redness of the pharynx, conjunctivitis, and cholinergic signs and symptoms were present. Conservative management with O 2 and fluid therapy was initiated. Twenty hours later, the patient became drowsy and his respiratory symptoms exacerbated; chest X-ray revealed haziness in the base of the right lung and prominence of the vessels of the lung hillum. After 1 week, the liver transaminases rose and C-reactive protein elevated (2+. The patient got better with conservative treatment and was discharged after 9 days; however, exertional dyspnea, wheezing, and thick white sputum persisted and therefore, reactive airway dysfunction syndrome (RADS related to DMS vapor was confirmed which was treated by prednisolone. Exertional dyspnea continued up to 10 months. Hoarseness lasted for 6 months. This case shows that DMS vapor inhalation can cause RADS especially in the chemical workers who continue working in the contaminated place despite the relatively good air conditioning.

  4. Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography – a cross sectional study

    Directory of Open Access Journals (Sweden)

    Hanestad Berit R

    2008-05-01

    Full Text Available Abstract Background In patients with suspected coronary artery disease (CAD, the overall aim was to analyse the relationships between disease severity and both mental and physical dimensions of health related quality of life (HRQOL using a modified version of the Wilson and Cleary model. Methods Using a cross-sectional design, 753 patients (74% men, mean age 62 years, referred for elective cardiac catheterisation were included. The measures included 1 physiological factors 2 symptoms (disease severity, self-reported symptoms, anxiety and depression 3 self-reported functional status, 4 coping, 5 perceived disease burden, 6 general health perception and 7 overall quality of life. To analyse relationships, we performed linear and ordinal logistic regressions. Results CAD and left ventricular ejection fraction (LVEF were significantly associated with symptoms of angina pectoris and dyspnea. CAD was not related to symptoms of anxiety and depression, but less depression was found in patients with low LVEF. Angina pectoris and dyspnea were both associated with impaired physical function, and dyspnea was also negatively related to social function. Overall, less perceived burden and better overall QOL were observed in patients using more confronting coping strategy. Conclusion The present study demonstrated that data from cardiac patients to a large extent support the suggested model by Wilson and Cleary.

  5. The Role of Inspiratory Muscle Training in Sickle Cell Anemia Related Pulmonary Damage due to Recurrent Acute Chest Syndrome Attacks

    Directory of Open Access Journals (Sweden)

    Burcu Camcıoğlu

    2015-01-01

    Full Text Available Background. The sickling of red blood cells causes a constellation of musculoskeletal, cardiovascular, and pulmonary manifestations. A 32-year-old gentleman with sickle cell anemia (SCA had been suffering from recurrent acute chest syndrome (ACS. Aim. To examine the effects of inspiratory muscle training (IMT on pulmonary functions, respiratory and peripheral muscle strength, functional exercise capacity, and quality of life in this patient with SCA. Methods. Functional exercise capacity was evaluated using six-minute walk test, respiratory muscle strength using mouth pressure device, hand grip strength using hand-held dynamometer, pain using Visual Analogue Scale, fatigue using Fatigue Severity Scale, dyspnea using Modified Medical Research Council Scale, and health related quality of life using European Organization for Research and Treatment of Cancer QOL measurement. Results. A significant improvement has been demonstrated in respiratory muscle strength, functional exercise capacity, pain, fatigue, dyspnea, and quality of life. There was no admission to emergency department due to acute chest syndrome in the following 12 months after commencing regular erythrocytapheresis. Conclusion. This is the first report demonstrating the beneficial effects of inspiratory muscle training on functional exercise capacity, respiratory muscle strength, pain, fatigue, dyspnea, and quality of life in a patient with recurrent ACS.

  6. Effect of obesity on constant workrate exercise in hyperinflated men with COPD

    Science.gov (United States)

    2010-01-01

    Background Chronic obstructive pulmonary disease (COPD) and a high body mass index (BMI) can both affect pulmonary volumes as well as exercise tolerance, but their combined effect on these outcomes is not well known. The aim of this study was to investigate the effects of increased BMI during constant workrate cycle ergometry in patients with COPD. Methods Men with COPD and hyperinflation were divided according to World Health Organization BMI classification: 84 normal BMI (NBMI), 130 overweight (OW) and 64 obese (OB). Patients underwent spirometric and lung volumes assessment and an incremental cycling exercise test. This was followed by a constant workrate exercise test (CET) at 75% of peak capacity. Inspiratory capacity and Borg dyspnea scores were measured at baseline, during and at the end of CET. Results and discussion FEV1 % predicted was not different across BMI classes. Total lung capacity and functional residual capacity were significantly lower in OB and OW compared to NBMI patients. Peak VO2 in L·min-1 was significantly higher in OB and OW patients than in NBMI patients. CET time was not different across BMI classes (p = 0.11). Changes in lung volumes and dyspnea during CET were not different between BMI categories. Conclusions OB and OW patients with COPD had a higher peak VO2 than their lean counterparts. Endurance time, dyspnea and changes in lung volumes during CET were similar between BMI categories. PMID:20509967

  7. Effect of obesity on constant workrate exercise in hyperinflated men with COPD

    Directory of Open Access Journals (Sweden)

    Hamilton Alan L

    2010-05-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD and a high body mass index (BMI can both affect pulmonary volumes as well as exercise tolerance, but their combined effect on these outcomes is not well known. The aim of this study was to investigate the effects of increased BMI during constant workrate cycle ergometry in patients with COPD. Methods Men with COPD and hyperinflation were divided according to World Health Organization BMI classification: 84 normal BMI (NBMI, 130 overweight (OW and 64 obese (OB. Patients underwent spirometric and lung volumes assessment and an incremental cycling exercise test. This was followed by a constant workrate exercise test (CET at 75% of peak capacity. Inspiratory capacity and Borg dyspnea scores were measured at baseline, during and at the end of CET. Results and discussion FEV1 % predicted was not different across BMI classes. Total lung capacity and functional residual capacity were significantly lower in OB and OW compared to NBMI patients. Peak VO2 in L·min-1 was significantly higher in OB and OW patients than in NBMI patients. CET time was not different across BMI classes (p = 0.11. Changes in lung volumes and dyspnea during CET were not different between BMI categories. Conclusions OB and OW patients with COPD had a higher peak VO2 than their lean counterparts. Endurance time, dyspnea and changes in lung volumes during CET were similar between BMI categories.

  8. Acute lung affection in an endurance-trained man under amiodarone medication

    Directory of Open Access Journals (Sweden)

    Saurbier, Bernward

    2005-06-01

    Full Text Available Patients undergoing treatment with amiodarone can develop severe pulmonary side effects. This effect, which is often highly underestimated, can lead to dyspnea, pneumonitis, and further fibrosis. A recent change in the labeling of amdiodarone by the American Food and Drug Administration (FDA supports this suspicion. Tracing the symptoms back to the causing agent can be difficult, as shown in our report. The subject of this case report is an endurance-trained 65 year old male marathon runner who appeared with atrial fibrillation during a routine check up in autumn 2003. After medical cardioversion with flecainide a complaint free interval of 8 months was followed by a relapse, which resulted in a change of medication to amiodarone. Due to misunderstandings the patient kept on taking the amiodarone loading dose for six weeks and returned with severe dyspnea on exertion. Losses in CO diffusing capacity, a lowered macrophages count and a positive lymphocyte transformation test were the only first hand clinical evidence of amiodarone intoxication, despite the sensation of dyspnea. This case shows that special care has to be taken in treatment with amiodarone. Side effects can be hard to trace and do not evidently show a clear connection to amiodarone.

  9. Effect of obesity on respiratory mechanics during rest and exercise in COPD.

    Science.gov (United States)

    Ora, Josuel; Laveneziana, Pierantonio; Wadell, Karin; Preston, Megan; Webb, Katherine A; O'Donnell, Denis E

    2011-07-01

    The presence of obesity in COPD appears not to be a disadvantage with respect to dyspnea and weight-supported cycle exercise performance. We hypothesized that one explanation for this might be that the volume-reducing effects of obesity convey mechanical and respiratory muscle function advantages. Twelve obese chronic obstructive pulmonary disease (COPD) (OB) [forced expiratory volume in 1 s (FEV(1)) = 60%predicted; body mass index (BMI) = 32 ± 1 kg/m(2); mean ± SD] and 12 age-matched, normal-weight COPD (NW) (FEV(1) = 59%predicted; BMI = 23 ± 2 kg/m(2)) subjects were compared at rest and during symptom-limited constant-work-rate exercise at 75% of their maximum. Measurements included pulmonary function tests, operating lung volumes, esophageal pressure, and gastric pressure. OB vs. NW had a reduced total lung capacity (109 vs. 124%predicted; P exercise endurance times were similar in OB and NW. Pulmonary resistance fell (P exercise in OB but not in NW. Resting inspiratory capacity, dyspnea/ventilation plots, and the ratio of respiratory muscle effort to tidal volume displacement were similar, as was the dynamic performance of the respiratory muscles including the diaphragm. In conclusion, the lack of increase in dyspnea and exercise intolerance in OB vs. NW could not be attributed to improvement in respiratory muscle function. Potential contributory factors included alterations in the elastic properties of the lungs, raised intra-abdominal pressures, reduced lung hyperinflation, and preserved inspiratory capacity.

  10. Acute Postpartum Pulmonary Edema in a 32-Year-Old Woman Five Days after Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Masuda Islam Khan

    2013-07-01

    Full Text Available Acute dyspnea after pregnancy is a rare presentation, and a number of important conditions may accompany it. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary edema are some of the potential causes that must be considered. The percentage of pregnancies that are complicated by acute pulmonary edema has been estimated 0.08%. The most common contributing factors include the administration of tocolytic agents, underlying cardiac disease, iatrogenic fluid overload and preeclampsia. Here we report a case of 32- year-old woman of 5th postpartum day following lower uterine cesarean section with acute dyspnea from her first pregnancy who was admitted in coronary care unit with history of one episode of raised blood pressure 160/90 mm Hg and cough on 1st postoperative day. Clinical examination and relevant investigations explored that it was a case of bilateral pulmonary edema. Patient was kept in ventilator and was treated with nitroglycerine (GTN, frusemide and ACE inhibitor. After diuresis, considerable improvement was observed in her respiratory status. From the 4th day, the patient became hemodynamically stable and was weaned off the ventilator. After five days, all the biochemical parameters became normal and she had no dyspnea.

  11. Laser tracheobronchoplasty: a novel technique for the treatment of symptomatic tracheobronchomalacia.

    Science.gov (United States)

    Castellanos, Paul; Mk, Manjunath; Atallah, Ihab

    2017-03-01

    The management of tracheobronchomalacia is a very challenging problem with few treatment options. This study aims to evaluate the outcomes of a novel surgical treatment for membranous tracheobronchomalacia. A consecutive series of patients with tracheobronchomalacia were treated with two to three holmium laser scarring surgeries of the hyperdynamic tracheal and bronchial walls for the purpose of stiffening them through fibrosis. Patients filled out a Dyspnea Index questionnaire before and after treatment. Ten patients were treated for their tracheobronchomalacia with a mean age of 54 years. Symptoms included severe dyspnea, dry cough, recurrent pulmonary infections, and respiratory failure. Fifty percent of patients presented with wheezing refractory to traditional treatment. Tracheobronchomalacia was associated with gastroesophageal reflux disease (n = 8), obstructive sleep apnea (n = 5), and tracheal stenosis (n = 3). Only 50 % of patients presented with morbid obesity. All cases showed significant improvement of their respiratory symptoms with a mean postoperative difference of 22.3 out of a maximum impairment score of 40 (P < 0.01) on the Dyspnea Index. The mean number of procedures was 2.3 per patient with the average laser energy delivered per procedure of 1600 J. Laser tracheobronchoplasty is a safe, easy to adopt, and effective technique for the treatment of membranous tracheobronchomalacia. It presents a simple alternative to the commonly used procedures like endoluminal stenting and open tracheobronchoplasty.

  12. Respiratory Consequences of Mild-to-Moderate Obesity: Impact on Exercise Performance in Health and in Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Denis E. O'Donnell

    2012-01-01

    Full Text Available In many parts of the world, the prevalence of obesity is increasing at an alarming rate. The association between obesity, multiple comorbidities, and increased mortality is now firmly established in many epidemiological studies. However, the link between obesity and exercise intolerance is less well studied and is the focus of this paper. Although exercise limitation is likely to be multifactorial in obesity, it is widely believed that the respiratory mechanical constraints and the attendant dyspnea are important contributors. In this paper, we examined the evidence that critical ventilatory constraint is a proximate source of exercise limitation in individuals with mild-to-moderate obesity. We first reviewed existing information on exercise performance, including ventilatory and perceptual response patterns, in obese individuals who are otherwise healthy. We then considered the impact of obesity in patients with preexisting respiratory mechanical abnormalities due to chronic obstructive pulmonary disease (COPD, with particular reference to the effect on dyspnea and exercise performance. Our main conclusion, based on the existing and rather sparse literature on the subject, is that abnormalities of dynamic respiratory mechanics are not likely to be the dominant source of dyspnea and exercise intolerance in otherwise healthy individuals or in patients with COPD with mild-to-moderate obesity.

  13. The influence of respiratory muscle training upon intermittent exercise performance.

    Science.gov (United States)

    Nicks, C R; Morgan, D W; Fuller, D K; Caputo, J L

    2009-01-01

    The purpose of this study was to determine the effect of respiratory muscle training (RMT) on intermittent exercise performance, respiratory muscle strength (PI (max)), respiratory muscle fatigue (RMF), and dyspnea in soccer athletes. Collegiate soccer athletes (20 male, 7 female) were randomly divided into either a RMT or control condition during off-season conditioning. The RMT group performed a 30RM protocol (10 times weekly) for 5 weeks using a commercially-available training device, while the controls received no RMT. Performance was evaluated utilizing Level 1 of the Yo-Yo Intermittent Recovery Test (IRT) and dyspnea was assessed during and immediately following the IRT. RMF was quantified within 2 minutes (RMF2) and 10 minutes (RMF10) after completing the IRT. Following training, the RMT group significantly increased IRT performance by 216.6 +/- 231.0 meters (p = .008) while the 49.2 +/- 75.1 meter increase observed in the controls was not significant. PI (max) in the RMT group increased from 138.1 +/- 19.6 to 165.3 +/- 23.5 cmH (2)O (p RMT did not significantly affect RMF or dyspnea. In conclusion, RMT improved intermittent exercise performance in these soccer athletes. The mechanisms by which RMT improves performance warrant further study.

  14. Povidone-Iodine and Bleomycin in the Management of Malignant Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Ali Asghar Alavi

    2011-09-01

    Full Text Available "nMalignant pleural effusion is a common complication in certain malignancies. Pleurodesis is the best option most of the time. The purpose of this study was to compare the choice of belomycin with povidone-iodine, which is not only determined by the efficacy of the agent but also by its cost, accessibility, safety, ease of administration and the number of administrations to achieve a complete response. We performed a randomized clinical trial on 39 patients presenting with symptomatic malignant pleural effusion. Patients were selected and randomly assigned to undergo chemical pleurodesis with either bleomycin or povidone-iodine. Primary characteristics of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. A complete response was obtained in 79% of belomycin group and 75% of povidone-iodine group which was not statistically significant. Patients on belomycin treatment had a significantly lower score for dyspnea in one month follow up. This was significant after controlling for age, pain score and dyspnea score after drainage, using general linear model. Due to similar effect and significant cost advantage between bleomycin and povidone-iodine, we conclude that povidone- iodine is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.

  15. A Case of Recurrent Breast Cancer Identified by Pulmonary Tumor Thrombotic Microangiopathy

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    Tomomi Abe

    2017-07-01

    Full Text Available Pulmonary tumor thrombotic microangiopathy (PTTM is a rare, cancer-related, pulmonary complication that causes hypoxia and pulmonary hypertension. We report on a 42-year-old woman who was diagnosed with recurrent breast cancer that was detected due to the presence of PTTM. Eleven months after surgery for heterochronous bilateral cancer of the left breast, she developed progressive dyspnea but computerized tomography showed no pulmonary thromboembolism, and a transthoracic echocardiography revealed mild pulmonary hypertension. She was diagnosed with PTTM by cytology from pulmonary artery catheterization and perfusion lung scintigraphy. Also, the patients complained of back pain after admission, bone scintigraphy showed multiple bone metastases. Despite the early diagnosis of PTTM, her platelet count decreased, her performance status rapidly deteriorated, and her dyspnea worsened. Thus, we could not treat her with chemotherapy. She died due to respiratory failure 19 days after admission. To the best of our knowledge, this is the first report of recurrent breast cancer identified by the manifestation of PTTM. Although PTTM is a rare phenomenon, it should be considered in the differential diagnosis of acute dyspnea or pulmonary hypertension in patients with breast cancer. Furthermore, upon diagnosis, the patient should be referred to a cardiologist as soon as possible.

  16. Long-Term Mortality of Emergency Medical Services Patients

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Terkelsen, Christian Juhl; Sørensen, Jan N

    2017-01-01

    , and vital status data from 3 of 5 geographic regions in Denmark. We included events from July 1, 2011, to December 31, 2012. We classified EMS events according to primary dispatch category (unconsciousness/cardiac arrest, accidents/trauma, chest pain, dyspnea, neurologic symptoms, and other EMS patients......). The primary outcome was 1-year mortality adjusted for age, sex, and Charlson comorbidity index. RESULTS: Among 142,125 EMS events, primary dispatch categories were unconsciousness or cardiac arrest 5,563 (3.9%), accidents or trauma 40,784 (28.7%), chest pain 20,945 (14.7%), dyspnea 9,607 (6.8%), neurologic...... symptoms 17,804 (12.5%), and other EMS patients 47,422 (33.4%). One-year mortality rates were unconscious or cardiac arrest 54.7% (95% confidence interval [CI] 53.4% to 56.1%), accidents or trauma 7.8 (95% CI 7.5% to 8.1%), chest pain 8.5% (95% CI 8.1% to 9.0%), dyspnea 27.7% (95% CI 26.7% to 28...

  17. Comparison of Different Disease-Specific Health-Related Quality of Life Measurements in Patients with Long-Term Noninvasive Ventilation

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    Toru Oga

    2017-01-01

    Full Text Available Background. Two disease-specific questionnaires have been developed to assess health-related quality of life (HRQL in patients with chronic respiratory failure: the Severe Respiratory Insufficiency (SRI Questionnaire and the Maugeri Respiratory Failure (MRF Questionnaire. We aimed to compare the characteristics of the SRI, MRF-26, and St. George’s Respiratory Questionnaire (SGRQ for use in patients with home noninvasive ventilation (NIV. Methods. Fifty-six outpatients receiving long-term NIV were recruited and underwent assessments of pulmonary function, arterial blood gas, HRQL, dyspnea, and psychological status. Results. Correlations of the SRI and MRF-26 with the SGRQ were modest. While pulmonary function was weakly related to only some domains of the SRI and MRF-26, the modified Medical Research Council (mMRC dyspnea scale and Hospital Anxiety and Depression Scale (HADS were significantly related to all domains of the SRI and MRF-26. Multiple regression analyses showed that HADS depression and mMRC accounted for 34% and 27% of the variance in the SRI, 24% and 37% in the MRF-26, and 17% and 46% in the SGRQ, respectively. Conclusions. The SRI and MRF-26 were reliable questionnaires for patients receiving long-term NIV. Dyspnea and psychological status were their main common determinants. The SRI covers more psychological health impairments than the MRF. This trial is registered with ClinicalTrials.gov Identifier: NCT00905476.

  18. Decompensated porto-pulmonary hypertension in a cirrhotic patient with thrombosis of portocaval shunt

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a case of decompensated porto-pulmonary hypertension closely associated with the development of intra-portocaval shunt thrombosis. A woman with Laennec's cirrhosis was hospitalized because of severe dyspnea and edema. She underwent surgical portocaval anastomosis ten years ago. Imaging studies showed massive intra-shunt thrombosis, portal hypertension, ascites, pleuro-pericardial effusions and enlargement of right cardiac cavities. Cardiac catheterization allowed to rule out coronary and leftsided heart abnormalities and led to the diagnosis of pre-capillary pulmonary hypertension. Antithrombotic treatment with low molecular weight heparin was instituted. The management also included ACE inhibitors,spironolactone, low-salt diet and lactulose. The patient was discharged and three months later we observed the disappearance of edema, ascites and pleuropericardial effusions, a marked body weight reduction and improved dyspnea and liver function tests. A possible link between the development of intra-shunt thrombosis and clinical decompensation in our patient was hypothesized. In fact, it has been demonstrated that the increased portal pressure, caused by occlusion of portosystemic shunt, reduces renal plasma flow and increases systemic endothelin-1 concentration. In our patient the disappearance of edematous state and improved dyspnea observed after recanalization of the shunt strongly support this hypothesis.

  19. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial.

    Science.gov (United States)

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    NCT02329873. Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10-30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all Pexercise tolerance significantly improved in the experimental group by the end of the fourth day (all Pexercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.

  20. Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD

    Directory of Open Access Journals (Sweden)

    Petrovic M

    2012-11-01

    Full Text Available Milos Petrovic,1 Michael Reiter,2 Harald Zipko,3 Wolfgang Pohl,1 Theodor Wanke11Pulmonary Department and Karl Landsteiner Institute for Clinical and Experimental Pulmology, Hietzing Hospital, Vienna, Austria; 2Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria; 3FH Campus Vienna, University of Applied Sciences – Health Department, Vienna, AustriaAbstract: Dynamic hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD. Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT. The aim of the study was to analyze the effects of IMT on exercise capacity, dyspnea, and inspiratory fraction (IF during exercise in patients with COPD. Daily inspiratory muscle strength and endurance training was performed for 8 weeks in 10 patients with COPD GOLD II and III. Ten patients with COPD II and III served as a control group. Maximal inspiratory pressure (Pimax and endurance time during resistive breathing maneuvers (tlim served as parameter for inspiratory muscle capacity. Before and after training, the patients performed an incremental symptom limited exercise test to maximum and a constant load test on a cycle ergometer at 75% of the peak work rate obtained in the pretraining incremental test. ET was defined as the duration of loaded pedaling. Following IMT, there was a statistically significant increase in inspiratory muscle performance of the Pimax from 7.75 ± 0.47 to 9.15 ± 0.73 kPa (P < 0.01 and of tlim from 348 ± 54 to 467 ± 58 seconds (P < 0.01. A significant increase in IF, indicating decreased dynamic hyperinflation, was observed during both exercise tests. Further, the ratio of breathing frequency to minute ventilation (bf/V'E decreased significantly, indicating an improved breathing pattern. A significant decrease in

  1. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care

    Directory of Open Access Journals (Sweden)

    Theander K

    2014-07-01

    Full Text Available Kersti Theander,1,2 Mikael Hasselgren,2,3 Kristina Luhr,4 Jeanette Eckerblad,5 Mitra Unosson,5 Ingela Karlsson1 1Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden; 2Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden; 3Department of Medicine, Örebro University, Örebro, Sweden; 4Family Medicine Research Centre, Örebro County Council, Örebro, Sweden; 5Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Background: Patients with chronic obstructive pulmonary disease (COPD and chronic heart failure (CHF seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare. Aim: Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC. Method: The study is cross sectional, including patients with COPD (n=437 and CHF (n=388, registered in the patient administrative systems of PHC. The patients received specific questionnaires – the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale – by mail and additional questions about psychological and physical health. Results: The mean age was 70±10 years and 78±10 years for patients with COPD and CHF respectively (P=0.001. Patients with COPD (n=273 experienced more symptoms (11±7.5 than the CHF patients (n=211 (10±7.6. The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background

  2. Expiratory flow limitation detected by negative expiratory pressure in children with asthma%呼气相气道内负压法检测呼气流速受限在哮喘患儿中的应用

    Institute of Scientific and Technical Information of China (English)

    李俊梅; 郑成中; 陈爱欢

    2013-01-01

    目的 探讨呼气相气道内负压法(NEP)检测呼气流速受限(EFL)在儿童哮喘患者中实施的可行性,及其与常规阻塞性肺通气功能指标第一秒用力呼气容积(FEV1)、加拿大医学研究委员会推荐的呼吸困难严重程度分级标准(MRC评分)的相关性.方法 选取2012年6~12月在该院就诊的儿童哮喘患者64例,其中46例稳定期,18例急性发作,给予MRC评分,然后分别进行常规肺通气功能检测及NEP检测EFL.结果 (1)所有哮喘患儿均能很好耐受NEP.(2)肺通气功能情况:64例哮喘患儿的FEV1均值为(71.33±13.92)% pred,18例急性发作患儿FEV1均值为(52.91±13.87)% pred.(3)MRC评分:64例哮喘患儿中10例MRC评分为2分,其余54例MRC评分为1分.MRC与FEV1的相关系数是-0.635(P<0.05).(4)NEP检测EFL情况:46例哮喘患儿坐位和仰卧位均未出现EFL,8例坐位和仰卧位均有EFL,10例坐位时无EFL,仅仰卧位出现EFL.3分法EFL与FEV1及MRC的相关系数分别为-0.607、0.964(P <0.05).5分法EFL与FEV1及MRC的相关系数分别为-0.626、0.966(P<0.05).结论 (1)NEP可用于检测儿童哮喘的EFL情况.(2)NEP检测EFL与FEV1显著相关.(3)NEP检测EFL指标和FEV1均与MRC评分显著相关,但EFL与MRC评分的相关性更强.%Objective The purpose of this study was to evaluate the feasibility of expiratory flow limitation(EFL) detected by negative(NEP) and the correlation between EFL and routine lung function measurements(Forced expiratory volume in first second,FEV1),EFL and MRC dyspnea scale,in patients with stable and acute asthma,to find a simple,reliable and objective method for the diagnosis,differential diagnosis,the severity of disease and evaluation of severity and efficacy of treatment for asthma,and a objective method reflecting the severity of dyspnea.Methods Sixty-four children enrolled in No.306 Hospital of PLA from Jun.to Dec.in 2012 were included in this study.The severity of dyspnea was rated according to the dyspnea

  3. 血BNP在急诊呼吸困难原因鉴别及心力衰竭危险分层中的作用%The diagnostic value of B-type natriuretic peptide in the patients with dyspean and effection of rish stratification with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    张卓一; 黄小民; 何煜舟; 周晶晶; 吴丽娟

    2011-01-01

    目的 探讨B型脑钠肽(BNP)在鉴别急诊呼吸困难病因中的价值及心力衰竭(以下简称心衰)分层中的作用.方法呼吸困难患者共204例,由两位不知BNP测定结果的心内科医师判断诊断,比较心源性呼吸困难、肺源性呼吸困难BNP值,心源性呼吸困难根据心功能(NYHA)分Ⅱ~Ⅳ级,分别测定BNP值和左室射血分数(LVEF),并比较左侧心衰和右侧心衰BNP值.结果心源性呼吸困难BNP值明显高于肺源性呼吸困难.NYHA分级为III、IV级的患者血BNP水平均高于II级患者(P<0.05或0.01);而NYHA分级为IV级患者的血BNP水平明显高于III级(P<0.01).NYHA分级为III、IV级患者血LVEF水平均低于II级患者(均P<0.05);而NYHA分级为IV级患者的血LVEF水平则低于III级(P<0.05).左侧心衰和右侧心衰BNP值均升高,但左侧心衰BNP升值大于右侧心衰.结论对急诊呼吸困难患者测定BNP可以鉴别心源性呼吸困难和肺源性呼吸困难,BNP含量变化与心功能变化密切相关.%Objective To evaluate the diagnostic value of B- type natriuretic peptide in the patients with dyspean and effection ofrish stratification of B-type natriuretic peptide for patients with congestive heart failure.Methods Plasma BNP were measured with rapid assay in 204 patients with dyspnea.The clinical diagnosis was adjudicated by two cardiologists, who were blinded to the results of the BNP assay.The level of BNP were compared between Cardie dyspnea group and pulmonary dyspnea group. The level of BNP and LVEF were determined in the different NYHA functional class of Cardic dyspnea group.The BNP were compared between patients with left heart failure and patients right heart failure. Results The level of BNP was significantly higher in the Cardie dyspnea group than pulmonary dyspnea group. The level of BNP relates with the NYHA heart function class and LVEF of patient. The BNP increased significantly in patients with left heart failure or with right

  4. Dimensión respiratoria de la escala ALSFRS-R y la función respiratoria en la esclerosis lateral amiotrófica Respiratory domain of revised amyotrophic lateral sclerosis: Functional Rating Scale

    Directory of Open Access Journals (Sweden)

    Sandra E. Lima

    2009-10-01

    Full Text Available Virtualmente todos los pacientes con esclerosis lateral amiotrófica tendrán disnea, que es quizá el síntoma más penoso de esta devastadora enfermedad. El objetivo de este estudio fue correlacionar la dimensión respiratoria de la escala ALSFRS-R, la capacidad vital forzada y las presiones estáticas máximas bucales. Se estudiaron prospectivamente 20 pacientes consecutivos sin disnea durante 24 meses. El puntaje total de la escala ALSFRS-R disminuyó de 34.3 ± 10.3 a 22.1 ± 8.0 (p = 0.0325; la contribución de la dimensión respiratoria fue insignificante. En quienes refirieron disnea (n: 12, la capacidad vital forzada cayó un 41 ± 21 % del valor inicial pero con similar caída (46 ± 23%, 8 pacientes no refirieron disnea. La correlación entre la escala ALSFRS-R con la capacidad vital forzada (litros fue r: 0.73, (p = 0.0016 y con la presión inspiratoria máxima (cm H2O, r: 0.84, p = 0.0038. La correlación entre la capacidad vital forzada (% con la disnea fue r s: 0.23, p = 0.1400. La correlación de la disnea con la presión inspiratoria máxima (% fue r s: 0.58, p = 0.0300 y con la presión espiratoria máxima (%, r s: 0.49, p = 0.0400. La dimensión respiratoria de la escala ALSFRS-R no permitió predecir el grado de deterioro funcional respiratorio. Esto sugiere que dicha dimensión no reemplaza a las mediciones funcionales respiratorias y, debido a que la insuficiencia respiratoria puede no ser evidente, la realización de dichas pruebas provee una base objetiva de seguimiento y permite planear medidas con anticipación.Virtually all patients with amyotrophic lateral sclerosis will complain of dyspnea, which is perhaps the most distressing symptom of this devastating disease. The objective was to correlate respiratory domain of ALSFRS-R with forced vital capacity and maximal static pressures in the mouth. We designed a prospective study in 20 consecutive patients without dyspnea during 24 months. The global decline of ALSFRS

  5. Effects of indacaterol versus tiotropium on exercise tolerance in patients with moderate COPD: a pilot randomized crossover study.

    Science.gov (United States)

    Berton, Danilo Cortozi; Santos, Álvaro Huber Dos; Bohn, Ivo; Lima, Rodrigo Quevedo de; Breda, Vanderléia; Teixeira, Paulo José Zimermann

    2016-01-01

    To compare a once-daily long-acting β2 agonist (indacaterol 150 µg) with a once-daily long-acting anticholinergic (tiotropium 5 µg) in terms of their effects on exercise endurance (limit of tolerance, Tlim) in patients with moderate COPD. Secondary endpoints were their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. This was a randomized, single-blind, crossover pilot study involving 20 patients (mean age, 60.9 ± 10.0 years; mean FEV1, 69 ± 7% of predicted). Spirometric parameters, Transition Dyspnea Index scores, Tlim, and exertional dyspnea were compared after three weeks of each treatment (with a one-week washout period between treatments). Nineteen patients completed the study (one having been excluded because of COPD exacerbation). Improvement in Tlim from baseline tended to be greater after treatment with tiotropium than after treatment with indacaterol (96 ± 163 s vs. 8 ± 82 s; p = 0.06). Tlim significantly improved from baseline after treatment with tiotropium (having increased from 396 ± 319 s to 493 ± 347 s; p = 0.010) but not after treatment with indacaterol (having increased from 393 ± 246 to 401 ± 254 s; p = 0.678). There were no differences between the two treatments regarding improvements in Borg dyspnea scores and lung hyperinflation at "isotime" and peak exercise. There were also no significant differences between treatments regarding Transition Dyspnea Index scores (1.5 ± 2.1 vs. 0.9 ± 2.3; p = 0.39). In patients with moderate COPD, tiotropium tends to improve Tlim in comparison with indacaterol. No significant differences were observed between the two treatments regarding their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Future studies, including a larger number of patients, are required in order to confirm our findings and explore mechanistic explanations. (ClinicalTrials.gov identifier: NCT01693003 [http://www.clinicaltrials.gov/]). Comparar um β2-agonista de

  6. Physiological measurements corroborate symptomatic improvement after therapeutic leukapheresis in a pregnant woman with chronic myelogenous leukemia.

    Science.gov (United States)

    Galera, Pallavi; Haynes, Stefanie; Sulmasy, Paula; Bailey, Jeffrey A; Greene, Mindy; Vauthrin, Michelle; Brettler, Doreen; Liebmann, James; Mark Madison, J; Weinstein, Robert

    2016-08-01

    Therapeutic leukapheresis can control the white blood cell count (WBC) of pregnant women with chronic myelogenous leukemia (CML) who have hyperleukocytosis without leukostasis. The medical justification for this treatment has not been objectively documented. We report a 27-year-old woman, diagnosed with CML at 10-week gestation, who developed severe dyspnea on exertion. A workup that included chest CT and echocardiography with a bubble study detected no cardiopulmonary pathology to explain her symptoms, and thus she was referred for leukapheresis. Prior to her first leukapheresis, which lowered her WBC from 154 × 10(3) /μL to 133 × 10(3) /μL, her oxygen saturation (SpO2 ) on room air decreased from 98 to 93% during 100 feet of slow ambulation and she was dyspneic. Just after the leukapheresis, her dyspnea on exertion was much improved and her SpO2 remained at 98% with repeat ambulation. Spirometry and lung volume studies obtained before and after her first leukapheresis demonstrated 32 and 31% improvements in forced vital capacity and forced expiratory volume in 1 s respectively, a 25% increase in functional residual capacity, and a 142% improvement in expiratory reserve volume. Residual volume decreased by almost 20%. Three times in a week, leukapheresis was continued until her WBC was controlled with interferon α-2b approximately 4 weeks later. Her dyspnea had completely resolved. She gave birth by elective caesarean section to a healthy boy at 32 weeks. Corroboration of symptom relief by leukapheresis with physiological data may justify such treatment in pregnant patients with CML. J. Clin. Apheresis 31:393-397, 2016. © 2015 Wiley Periodicals, Inc.

  7. Association Between Rectus Abdominis Denervation and Ventilation Dysfunction in Patients with Amyotrophic Lateral Sclerosis

    Institute of Scientific and Technical Information of China (English)

    Hua-Gang Zhang; Shuo Zhang; Ying-Sheng Xu; Nan Zhang; Dong-Sheng Fan

    2016-01-01

    Background:Spontaneous potentials in electromyography (EMG) ofparaspinal muscles are associated with diaphragm denervation and,therefore,poor respiratory function in amyotrophic lateral sclerosis (ALS) is understandable.EMG changes in the rectus abdominis (RA)display an effect similar to those in paraspinal muscles with respect to the function of lower motor neurons in the thoracic spinal cord.The RA denervation was examined to determine its association with ventilation dysfunction in ALS.Methods:We collected the clinical data of 128 patients with sporadic ALS in Department of Neurology of Peking University Third Hospital from 2009 to 2013.EMG,Revised ALS Functional Rating Scale (ALSFRS-R) and forced vital capacity (FVC) were performed in all patients and the differences in the EMG changes in RA between those with and without FVC ≥ 80% were analysed.Results:The mean FVC value was 83.4% ± 17.1% (range:45%-131%) of the predicted value.A total of 79 patients displayed FVC ≥80%,and 49 patients displayed FVC <80%.Compared with the patients displaying a normal FVC (60/79,75.9%),spontaneous activity in RA was significantly different among those patients displaying an FVC <80% (47/49,95.9%).In addition,spontaneous potentials in RA were more frequently detected in patients exhibiting dyspnea (32/33,97.0%) than in patients without dyspnea (75/95,78.9%).Conclusion:Spontaneous potentials in RA are associated with ventilation dysfunction and dyspnea in ALS patients.

  8. Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

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    Ana Lúcia Soares Soutello

    2015-04-01

    Full Text Available Introductions: In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL recently adapted to the Brazilian culture. Objective: To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Methods: Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. Results: The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. Conclusion: The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.

  9. Comparing the Effect of Resistive Inspiratory Muscle Training and Incentive Spirometry on Respiratory Pattern of COPD patients

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    Seyed Hossien Ahmadi Hosseini

    2016-10-01

    Full Text Available Background: Resistive Inspiratory Muscle Training (RIMT is a well-known technique for rehabilitation of patients with Chronic Obstructive Pulmonary Disease (COPD. Incentive spirometry is another technique with potential viability for this application, but there is limited evidence in support of its efficacy in the rehabilitation of COPD patients. Aim: The objective of this study was to compare the effect ofresistive inspiratory muscle training and incentive spirometry on respiratory pattern of COPD patients. Method: This study was a randomized clinical trial on 30 patients with moderate COPD who were referred, in 2011, to the pulmonary clinic of Emamreza Hospital of Mashhad (Iran. The patients were randomly divided into the RIMT and the IS treatment group. In both groups, exercise regimen consisted of two 15-minute sessions of exercise per day, in the morning and evening, four days a week for 4 weeks. Respiratory pattern (respiratory rate and depth and dyspnea (at rest and during activity were measured before and after exercise. Data was analyzed with the Mann-Whitney and ratio difference tests using SPSS v.11.5. Results: The average age was 50.8±10.7 in the IS group and 51±10.8 in the RIMT group. The statistical tests found no significant difference between the groups in terms of post-intervention exertional dyspnea, dyspnea at rest, tidal volume, and respiratory rate (P>0.05; but post-intervention maximal inspiratory pressure and maximal voluntary ventilation in the two groups were found to be significantly different (P

  10. Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV

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    Mehta Shruti H

    2010-05-01

    Full Text Available Abstract Background Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV infection and with obstructive lung diseases (OLD. Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs. Methods Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea. Results Of 974 participants, 835 (86% were current smokers and 288 (29.6% were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70 was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively. COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively. Conclusions While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.

  11. Use of a respiratory clinical score among different providers.

    Science.gov (United States)

    Liu, Lenna L; Gallaher, Margaret M; Davis, Robert L; Rutter, Carolyn M; Lewis, Toby C; Marcuse, Edgar K

    2004-03-01

    Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.

  12. The continuum of physiological impairment during treadmill walking in patients with mild-to-moderate COPD: patient characterization phase of a randomized clinical trial.

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    Denis E O'Donnell

    Full Text Available BACKGROUND: To have a better understanding of the mechanisms of exercise limitation in mild-to-moderate chronic obstructive pulmonary disease (COPD, we compared detailed respiratory physiology in patients with COPD and healthy age- and sex-matched controls. METHODS: Data were collected during the pre-treatment, patient characterization phase of a multicenter, randomized, double-blind, crossover study. Patients with COPD met Global Initiative for Chronic Obstructive Lung Disease (GOLD 1 or 2 spirometric criteria, were symptomatic, and had evidence of gas trapping during exercise. All participants completed pulmonary function and symptom-limited incremental treadmill exercise tests. RESULTS: Chronic activity-related dyspnea measured by Baseline Dyspnea Index was similarly increased in patients with GOLD 1 (n = 41 and 2 (n = 63 COPD compared with controls (n = 104. Plethysmographic lung volumes were increased and lung diffusing capacity was decreased in both GOLD groups. Peak oxygen uptake and work rate were reduced in both GOLD groups compared with controls (p<0.001. Submaximal ventilation, dyspnea, and leg discomfort ratings were higher for a given work rate in both GOLD groups compared with controls. Resting inspiratory capacity, peak ventilation, and tidal volume were reduced in patients with GOLD 2 COPD compared with patients with GOLD 1 COPD and controls (p<0.001. CONCLUSIONS: Lower exercise tolerance in patients with GOLD 1 and 2 COPD compared with controls was explained by greater mechanical abnormalities, greater ventilatory requirements, and increased subjective discomfort. Lower resting inspiratory capacity in patients with GOLD 2 COPD was associated with greater mechanical constraints and lower peak ventilation compared with patients with GOLD 1 COPD and controls. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01072396.

  13. BODE-index, modified BODE-index and ADO-score in chronic obstructive pulmonary disease: relationship with COPD phenotypes and CT lung density changes.

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    Camiciottoli, Gianna; Bigazzi, Francesca; Bartolucci, Maurizio; Cestelli, Lucia; Paoletti, Matteo; Diciotti, Stefano; Cavigli, Edoardo; Magni, Chiara; Buonasera, Luigi; Mascalchi, Mario; Pistolesi, Massimo

    2012-06-01

    COPD is a heterogeneous disorder whose assessment is going to be increasingly multidimensional. Grading systems such as BODE (Body-Mass Index, Obstruction, Dyspnea, Exercise), mBODE (BODE modified in grading of walked distance), ADO (Age, Dyspnea, Obstruction) are proposed to assess COPD severity and outcome. Computed tomography (CT) is deemed to reflect COPD lung pathologic changes. We studied the relationship of multidimensional grading systems (MGS) with clinically determined COPD phenotypes and CT lung density. Seventy-two patients underwent clinical and chest x-ray evaluation, pulmonary function tests (PFT), 6-minute walking test (6MWT) to derive: predominant COPD clinical phenotype, BODE, mBODE, ADO. Inspiratory and expiratory CT was performed to calculate mean lung attenuation (MLA), relative area with density below-950 HU at inspiration (RAI(-950)), and below -910 HU at expiration (RAE(-910)). MGS, PFT, and CT data were compared between bronchial versus emphysematous COPD phenotype. MGS were correlated with CT data. The prediction of CT density by means of MGS was investigated by direct and stepwise multivariate regression. MGS did not differ in clinically determined COPD phenotypes. BODE was more closely related and better predicted CT findings than mBODE and ADO; the better predictive model was obtained for CT expiratory data; stepwise regression models of CT data did not include 6MWT distance; the dyspnea score MRC was included only to predict RA-950 and RA-910 which quantify emphysema extent. BODE reflect COPD severity better than other MGS, but not its clinical heterogeneity. 6MWT does not significantly increase BODE predictivity of CT lung density changes.

  14. Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

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    Soutello, Ana Lúcia Soares; Rodrigues, Roberta Cunha Matheus; Jannuzzi, Fernanda Freire; São-João, Thaís Moreira, E-mail: thaisms@gmail.com; Martini, Gabriela Giordano; Nadruz Jr, Wilson [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil); Gallani, Maria-Cecília Bueno Jayme [Université Laval (Canada)

    2015-04-15

    In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture. To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.

  15. FACTORS ASSOCIATED WITH QUALITY OF LIFE IN ACUTE EXACERBATION OF COPD

    Institute of Scientific and Technical Information of China (English)

    CAO Zhen-ying; Tan Wan Cheng; Ng Tze Pin

    2005-01-01

    Objective To measure the QOL in patients with AECOPD and the frequency of potential risk factors, and to evaluate the association of risk factors with poor QOL in patients with AECOPD. Methods A study sample of 196 patients with moderate to severe COPD admitted for acute exacerbations to two large general hospitals were studied. The St George QOL (SGQOL) scale, socio-demographic, clinical and patient care characteristics, including depression and spirometry were ascertained in the stable state before discharge and at one-month post discharge. Results There was a high prevalence of current or ex-heavy smokers, depression and consumption of psychotropic drugs, and low prevalence of care giver support, pulmonary rehabilitation and vaccination. The mean scores for the different domains were 55.9 for Symptoms; 65.1 for Activity; 32.9 for Impact; and the mean of overall Total scores was 46.5. Multiple regression analysis showed that CMH, male, depression, previous frequent hospital readmissions and poor therapy compliance were independently related to worse Symptoms Scores. Previous frequent readmissions, depression, severe dyspnea and older age (>72 years) were related to worse Activity Scores of SGQOL. Depression, previous frequent readmissions, severe dyspnea, long COPD duration(≥5years) and severe smoking were related to worse Impact Scores of SGQOL. Depression, previous frequent readmissions, severe dyspnea and long COPD duration(≥5years) were independently related to worse Total Scores of SGQOL.Conclusion Poor QOL in patients with COPD exacerbation was associated with disease severity, psychosocial and health care factors which are modifiable.

  16. Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

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    Park, Jong Woong; Jung, Gyoo Sik; Kim, Seong Min; Lee, Seung Ryong; Kim, Hyun Sook; Huh, Jin Do; Joh, Young Duk [Kosin Medical College, Pusan (Korea, Republic of)

    1998-05-01

    The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs.

  17. Predictive validity of BODE index for anxious and depressive symptoms in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    AN Li; LIN Ying-xiang; YANG Ting; ZHANG Hong; JIAO Xia; ZHANG Shu; CHANG Xiao-hong; WANG Zhao-mei; WANG Chen

    2010-01-01

    Background Anxiety and depression are two of the commonest and most modifiable comorbidities of chronic obstructive pulmonary disease (COPD) and have an independent effect on health and prognosis. FEV1% has been shown to be a poor predictor of anxiety and depression. The body mass index, degree of airflow obstruction, dyspnea,and exercise capacity (BODE) index is a multidimensional assessment system which may predict health outcome in COPD patients. The purpose of this study was to investigate the predictive validity of the BODE index for anxious and depressive symptoms in COPD patients.Methods This was a multicenter prospective cross-sectional study in 256 patients with stable COPD. Anxious and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). The relationships between anxiety, depression and potential predictors (including the BODE index) were analyzed by a binary Logistic regression model. Results Subjects who were anxious and depressive walked a shorter six-minute walking distance (6MWD), had more dyspnea, a higher BODE index, and lower health-related quality of life (P <0.01). Anxiety and depression score was significantly correlated with BODE index, respectively (r=0.335, P <0.001; r=0.306, P <0.001). The prevalence of anxiety and depression increased with BODE stage increasing (P <0.05). On the basis of binary Logistic regression, the BODE index was a good and independent predictor of anxiety and depression because it comprised dyspnea and 6MWD, which were shown to be the main determinants.Conclusions The predictive validity of the BODE index for anxiety and depression was demonstrated. We propose that the BODE index should be included in assessment of COPD severity.

  18. Patients hospitalized for community-acquired pneumonia present reduced functional performance

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    Anderson José

    2013-08-01

    Full Text Available BACKGROUND: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP could affect the patients' exercise tolerance and peripheral muscle strength (PMS. OBJECTIVE: To evaluate the functional capacity (FC of patients hospitalized for CAP and to correlate the FC with length of hospital stay. METHOD: We prospectively evaluated 45 patients (49±16 years; CAP group and 20 healthy subjects (53±17 years; control group. They were randomized to perform, on separate days, a 6-minute walk test (6MWT, a test of PMS, and the Glittre test (GT. Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. RESULTS: There were significant differences between the groups (CAP and controls for the 6MWT (381.3±108 vs. 587.1±86.8 m and GT (272.8±104.3 vs. 174±39 sec. The CAP group also presented worse health-related quality of life (HRQoL scores, reduced strength (quadriceps and biceps, and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02 and dyspnea (r=0.36, P=0.02. Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001 and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001. CONCLUSIONS: Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay.

  19. Evaluation of a classical unani pharmacopeial formulation safoof-e-muhazzil in hyperlipidemia: A randomized, standard controlled clinical study

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    Umar Jahangir

    2014-01-01

    Full Text Available Aim of the Study: The aim of the following study is to evaluate the efficacy and tolerability of a compound Unani formulation in hyperlipidemia on clinical and biochemical parameters. Materials and Methods: A total of 90 patients with total cholesterol level of 220 mg/dl and above were included. In Group ′A′ thirty patients with total cholesterol 243.5 ± 5.294 mg/dl received Unani formulation safoof-e-muhazzil (SM in its classical powder form 5 g twice daily orally, in Group ′B′ thirty patients with total cholesterol 234 ± 3.822 mg/dl received the SM but in compressed tablet form in the same dosage and in Group ′C′ 30 patients with total cholesterol 242.7 ± 5.563 mg/dl received atorvastatin 10 mg as a standard control. Follow-up was carried out on second, fourth and 6th week and patients were evaluated on clinical as well as biochemical parameters. Results: Group A before treatment had mean total cholesterol of 243.5 ± 5.294 mg/dl which decreased significantly after treatment to 225.6 ± 5.953 mg/dl (P 0.5 relief in palpitation and 26.17% (P < 0.001 relief in dyspnea post-treatment. Group B fatigue decreased significantly by 18.14% (P < 0.01, palpitation by 22.91% (P < 0.01 and dyspnea by 20.46% (P < 0.01. In Group C a non-significant increase of 2.2% was observed in fatigue post-treatment, palpitation decreased by 10.22% non-significantly and dyspnea decreased significantly by 17.64% (P < 0.001. Results indicate that the test drug safely and effectively ameliorates the clinical condition of patients with hyperlipidemia while decreasing cholesterol level as well.

  20. The clinical utility of cardiopulmonary exercise testing: results of a university hospital

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    Tajana Jalusic-Gluncic

    2012-08-01

    Full Text Available Objective: To determine the main reasons for cardiopulmonary exercise test (CPET referrals in our hospital over the last two years; to evaluate clinical usefulness of CPET. Methods: We included 207 patients between 17 and 76 years of age. For every patient, we measured electrocardigraphy (ECG, arterial blood gases, spirometry, maximal voluntary ventilation (MVV and diffusing capacity. CPET was then performed; using a treadmill, according to the modified Bruce protocol; then spirometry and diffusing capacity were repeated. Results: The most common reason for sending patients for CPET was dyspnea during exertion (85%, then preoperative assessment of lung cancer patients (11.6%, and preoperative assessment of heart transplant candidates (3.4%. After CPET in a dyspnea group, 33.5% had normal findings, 22.2% had pulmonary limitation, 31.8% had non pulmonary pathology, and 12.5% reached submaximal effort due to subjective problems (poor condition, feeling discomfort but no objective reasons to stop. From a lung cancer group, 25% were deemed unsuitable surgical candidates, and 14.29% of a heart transplant group was recommended immediate surgery, the remainder needed re-evaluation. Conclusion: Dyspnea of unknown cause is optimally investigated with CPET, allowing us to differentiate between the major causes of limitation (lung, heart, cardiovascular, muscular and, within each area, the specific causes of limitation. The most common diagnoses after CPET are pulmonary and cardiac diagnoses. CPET helps us to detect concurrent cardiovascular disease at respiratory impaired patients. CPET is the gold standard for evaluation of morbidity and mortality risk of lung cancer surgery and for selection of patients for heart transplant. [J Exp Integr Med 2012; 2(4: 297-303

  1. Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

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    Preetham R Muskula

    2017-04-01

    Full Text Available An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4. Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7. The patient underwent resection of the massive left atrial thrombus (Fig. 2D but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2. This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

  2. High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial

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    Lewis Stephanie

    2011-09-01

    Full Text Available Abstract Background High frequency chest wall oscillation (HFCWO is used for airway mucus clearance. The objective of this study was to evaluate the use of HFCWO early in the treatment of adults hospitalized for acute asthma or chronic obstructive pulmonary disease (COPD. Methods Randomized, multi-center, double-masked phase II clinical trial of active or sham treatment initiated within 24 hours of hospital admission for acute asthma or COPD at four academic medical centers. Patients received active or sham treatment for 15 minutes three times a day for four treatments. Medical management was standardized across groups. The primary outcomes were patient adherence to therapy after four treatments (minutes used/60 minutes prescribed and satisfaction. Secondary outcomes included change in Borg dyspnea score (≥ 1 unit indicates a clinically significant change, spontaneously expectorated sputum volume, and forced expired volume in 1 second. Results Fifty-two participants were randomized to active (n = 25 or sham (n = 27 treatment. Patient adherence was similarly high in both groups (91% vs. 93%; p = 0.70. Patient satisfaction was also similarly high in both groups. After four treatments, a higher proportion of patients in the active treatment group had a clinically significant improvement in dyspnea (70.8% vs. 42.3%, p = 0.04. There were no significant differences in other secondary outcomes. Conclusions HFCWO is well tolerated in adults hospitalized for acute asthma or COPD and significantly improves dyspnea. The high levels of patient satisfaction in both treatment groups justify the need for sham controls when evaluating the use of HFCWO on patient-reported outcomes. Additional studies are needed to more fully evaluate the role of HFCWO in improving in-hospital and post-discharge outcomes in this population. Trial Registration ClinicalTrials.gov: NCT00181285

  3. Occurrence of respiratory symptoms in persons with restrictive ventilatory impairment compared with persons with chronic obstructive pulmonary disease: The PLATINO study.

    Science.gov (United States)

    Nonato, Nívia L; Nascimento, Oliver A; Padilla, Rogelio P; de Oca, Maria M; Tálamo, Carlos; Valdivia, Gonzalo; Lisboa, Carmen; López, Maria V; Celli, Bartolomé; Menezes, Ana Maria B; Jardim, José R

    2015-08-01

    Patients with chronic obstructive pulmonary disease (COPD) usually complain of symptoms such as cough, sputum, wheezing, and dyspnea. Little is known about clinical symptoms in individuals with restrictive ventilatory impairment. The aim of this study was to compare the prevalence and type of respiratory symptoms in patients with COPD to those reported by individuals with restrictive ventilatory impairment in the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study. Between 2002 and 2004, individuals ≥40 years of age from five cities in Latin America performed pre and post-bronchodilator spirometry and had their respiratory symptoms recorded in a standardized questionnaire. Among the 5315 individuals evaluated, 260 (5.1%) had a restrictive spirometric diagnosis (forced vital capacity (FVC) < lower limit of normal (LLN) with forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≥ LLN; American Thoracic Society (ATS)/European Respiratory Society (ERS) 2005) and 610 (11.9%) were diagnosed with an obstructive pattern (FEV1/FVC < LLN; ATS/ERS 2005). Patients with mild restriction wheezed more ((30.8%) vs. (17.8%); p < 0.028). No difference was seen in dyspnea, cough, and sputum between the two groups after adjusting for severity stage. The health status scores for the short form 12 questionnaire were similar in restricted and obstructed patients for both physical (48.4 ± 9.4 vs. 48.3 ± 9.8) and mental (50.8 ± 10.6 vs. 50.0 ± 11.5) domains. Overall, respiratory symptoms are not frequently reported by patients with restricted and obstructed patterns as defined by spirometry. Wheezing was more frequent in patients with restricted pattern compared with those with obstructive ventilatory defect. However, the prevalence of cough, sputum production, and dyspnea are not different between the two groups when adjusted by the same severity stage. © The Author(s) 2015.

  4. Effectiveness of itraconazole on clinical symptoms and radiologic findings in patients with recurrent chronic rhinosinusitis and nasal polyposis

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    Mostafa Hashemi

    2014-01-01

    Full Text Available Background: This study was done to evaluate the effect of itraconazole on clinical symptoms and radiologic findings in patients with chronic rhinosinusitis and nasal polyposis after surgery. Materials and Methods: In a clinical trial which was conducted in Alzahra and Kashani hospitals, from November 2011 to December 2012, 22 patients with recurrent postsurgical chronic sinusitis and polyposis entered the study. At the start of the study demographic data, subjective clinical symptoms (severity of rhinorrhea, nasal obstruction, hyposmia, and dyspnea, quality of life (QoL by sinonasal outcome test-20 (SNOT-20, serum immunoglobulin E (IgE, and score of computed tomography (CT scan (by Lund-Mackay were recorded. Itraconazole (100 mg, twice per day prescribed for 3 months and patients were followed in the 1 st , 3 rd , and 6 th months. Liver enzyme tests and side effects were evaluated monthly. Results: Severity of rhinorrhea, nasal obstruction, hyposmia, dyspnea, and QoL (by SNOT-20 improved during 3 months of treatment. Serum IgE was 265 (±277 at the start of the study, and decrease to 193 (±183 after 3 month. After 3 month, Lund-Mackay score of CT scan lowered from 19 (±4 to 15 (±6 (P < 0.05. At the 6 th month, severity of clinical symptoms except dyspnea and QoL were better than first evaluation. Conclusion: This study showed the beneficial effect of 3-month itraconazole treatment on clinical symptoms and radiologic findings and QoL in patients with recurrent postsurgical chronic rhinosinusitis and nasal polyposis.

  5. Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery.

    Science.gov (United States)

    Celik, Sezai; Aydemir, Cüneyt; Gürer, Onur; Işık, Omer

    2013-01-01

    Patient: Male, 60Final Diagnosis: Iatrogenic intercostal lung herniaSymptoms: -Medication: No medicationClinical Procedure: Surgically cerrectedSpecialty: Thoracic surgery. Unusual clinical course. Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea. A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well. Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.

  6. Pulmonary Rehabilitation in Advanced Lung Cancer Patients During Chemotherapy.

    Science.gov (United States)

    Jastrzębski, D; Maksymiak, M; Kostorz, S; Bezubka, B; Osmanska, I; Młynczak, T; Rutkowska, A; Baczek, Z; Ziora, D; Kozielski, J

    2015-01-01

    The aim of this study was to investigate the utility of pulmonary rehabilitation for improving of exercises efficiency, dyspnea, and quality of life of patients with lung cancer during chemotherapy. After the enrollment selection, the study included 20 patients with newly diagnosed advanced lung cancer and performance status 0-2. There were 12 patients randomly allocated to the pulmonary rehabilitation group and another 8 constituted the control group that did not undergo physical rehabilitation. Both groups of patients had continual cycles of chemotherapy. Data were analyzed before and after 8 weeks of physical rehabilitation, and before and after 8 weeks of observation without rehabilitation in controls. The inpatient rehabilitation program was based on exercise training with ski poles and respiratory muscle training. We found a tendency for enhanced mobility (6 Minute Walk Test: 527.3 ± 107.4 vs. 563.9 ±64.6 m; p > 0.05) and a significant increase in forced expired volume in 1 s (66.9 ± 13.2 vs. 78.4 ± 17.7 %predicted; p = 0.016), less dyspnea (p = 0.05), and a tendency for improvement in the general quality of life questionnaire after completion of pulmonary rehabilitation as compared with the control group. This report suggests that pulmonary rehabilitation in advanced lung cancer patients during chemotherapy is a beneficial intervention to reduce dyspnea and enhance the quality of life and mobility.

  7. Directly measured secondhand smoke exposure and COPD health outcomes

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    Balmes John

    2006-06-01

    Full Text Available Abstract Background Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD, secondhand smoke (SHS exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. Methods We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL, and dyspnea measured at one year follow-up. Results The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9 and dyspnea (1.0 pts; 95% CI 0.4 to 1.7 after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054, disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063, and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p Conclusion Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.

  8. Bartonella henselae Infective Endocarditis Detected by a Prolonged Blood Culture

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    Mito, Tsutomu; Hirota, Yusuke; Suzuki, Shingo; Noda, Kazutaka; Uehara, Takanori; Ohira, Yoshiyuki; Ikusaka, Masatomi

    2016-01-01

    A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient's history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis. This case demonstrates that B. henselae may be detected by prolonged incubation of blood cultures. PMID:27746451

  9. Clinical and electrodiagnostic findings in cyhalothrine poisoning

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    Keivan Basiri

    2016-01-01

    Full Text Available Acute onset bulbar symptoms with respiratory failure and descending paralysis may occur in several neuromuscular disorders including variants of Guillain-Barre syndrome (GBS, diphtheria, botulism and toxins. We present a 51-year-old man who presented with complains of ptosis and dyspnea following pyrethroids spraying in an enclosed area for eradication of flea. Within 5-6 days of admission limb weakness, dysphagia, dysarthria, blurred vision, diplopia, tremor and respiratory distress added to previous symptoms. Temporal profile of events after exposure, development of similar symptoms in patient's son, electrodiagnostic findings and exclusion of other etiologies confirms intoxication etiology. We reviewed the literature and provide an extensive electrodiagnostic overview.

  10. Interstitial lung disease in the connective tissue diseases.

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    Antin-Ozerkis, Danielle; Rubinowitz, Ami; Evans, Janine; Homer, Robert J; Matthay, Richard A

    2012-03-01

    The connective tissue diseases (CTDs) are inflammatory, immune-mediated disorders in which interstitial lung disease (ILD) is common and clinically important. Interstitial lung disease may be the first manifestation of a CTD in a previously healthy patient. CTD-associated ILD frequently presents with the gradual onset of cough and dyspnea, although rarely may present with fulminant respiratory failure. Infection and drug reaction should always be ruled out. A diagnosis of idiopathic ILD should never be made without a careful search for subtle evidence of underlying CTD. Treatment of CTD-ILD typically includes corticosteroids and immunosuppressive agents.

  11. PROSPECTS FOR CYTOPROTECTORS USE IN THE ELDERLY PATIENTS THROUGH THE EXAMPLE OF CALCIFIED AORTIC STENOSIS AND ISCHEMIC HEART DISEASE

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    N. Yu. Karpova

    2015-09-01

    Full Text Available Issues of pathogenesis of the calcified aortic stenosis and ischemic heart disease in the elderly are considered. The relevance of early detection of angina, syncope, and dyspnea in view of their non-specific and subclinical course for early detection of heart disease is specified. Current scientific views on the myocardial bioenergy and its role in the genesis of chronic heart failure are presented. Particular attention is paid to the place of cytoprotectors, especially trimetazidine, in the management of patients with cardiac N.Yu. Karpova1diseases.

  12. Right ventricular wall abscess in structurally normal heart after leg osteomyelitis: First case.

    Science.gov (United States)

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-09-01

    A 3-year-old girl presented with fever and acute dyspnea for 4 days. She had suffered an injury to the left lower leg 3 weeks earlier, with abscess formation. Magnetic resonance imaging showed osteomyelitis of the lower tibia. Echocardiography showed a mass in the right ventricular wall. She underwent concomitant heart surgery for removal of the right ventricular mass and limb arthrotomy. We believe this is a first reported case in which a ventricular wall abscess developed in a structurally normal heart following leg osteomyelitis.

  13. [Giant congenital intrapericardial left atrial appendage aneurysm: about a case and review of the literature].

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    Zhari, Bouchra; Bellamlih, Habib; Boumdine, Hassan; Amil, Touriya; Bamous, Mehdi; En-Nouali, Hassan

    2016-01-01

    Left atrial appendage aneurysm is a very rare heart anomaly. It may be congenital or acquired, secondary to inflammatory or degenerative processes. Most cases are asymptomatic. The prevalence of these lesions in pediatric age has been very rarely reported. As it can cause potentially fatal arrhythmias or thrombus, surgery is required immediately after diagnosis. This study reports the case of a 14-year-old boy with rapidly progressive dyspnea, palpitations, sensation of repetitive dizziness and fainting, in whom congenital left atrial appendage aneurysm was detected. Diagnosis was based on coronary CTA data. The patient was successfully treated with surgical resection of the aneurysm.

  14. Pertussis in adulthood: report of two cases and review of the literature.

    Science.gov (United States)

    Poirrier, Anne-Lise; Gillard-Tromme, Noelle; Lefebvre, Philippe P; El-Shazly, Amr

    2009-09-01

    Whooping cough is resurgent in the developed world. Systematic vaccination has changed its epidemiology, with the majority of cases now primarily affecting adolescents and adults. A 46-year-old male physiotherapist presented with a 1-week history of bothersome cough and respiratory difficulties, and a 51-year-old man was admitted to the emergency department with a 4-week history of increasing cough and dyspnea. Polymerase chain reaction of nasopharyngeal swab were positive for Bordetella pertussis. These cases illustrate pertussis in adulthood. We review the clinical features, the prevalence, the diagnostic tools, and the management of the patients and their relatives to increase awareness of this highly contagious disease.

  15. A Case of Sarcoidosis with Unusual Radiographic Findings that Developed 5 Years after Silicone Augmentation Mammoplasty Complicated by Miliary Tuberculosis during Corticosteroid Treatment

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    Tomoko Miyashita

    2011-01-01

    Full Text Available A 54-year-old woman with a past history of silicone augmentation mammoplasty was admitted with fever and dyspnea with diffuse interstitial shadows on computed tomography (CT. Although radiological findings were atypical, we diagnosed sarcoidosis by laboratory, microbiological, and bronchoalveolar lavage fluid analysis. Corticosteroids ameliorated the condition, but she had recurrent of fever and CT revealed miliary nodules while interstitial shadows disappeared. Liver biopsy showed that noncaseating granuloma and Ziehl-Neelsen stain was positive. We diagnosed miliary tuberculosis which developed during corticosteroid therapy. Antituberculotic therapy resulted in favorable outcome. Possibility exists that onset of sarcoidosis was induced by mammoplasty, namely, human adjuvant disease.

  16. Non-infectious Pseudoaneurysm of Ascending Aorta Following Redo-Aortic Valve Replacement

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    Nozari Younes

    2009-05-01

    Full Text Available A 46 year old man had been undergone Aortic valve replacement (AVR due to mechanical aortic valve endocarditis two month ago. He was referred to Imam Khomeini hospital because of dyspnea since two weeks ago. Echocardiography showed the false aneurysm, with an area of flow beyond the lumen of the aorta. This patient underwent reoperation, the previously implanted aortic valve was removed, meticulous debridement was performed in aortic valve annulus and adjacent part of the ascending aorta, and aortic valve and root replacement were performed.

  17. LYMP HANGIOMYOMATOSIS PRESENTING AS RECURRENT PNEUMOTHORAX IN A FEMALE CHILD: A CASE REPORT

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    Meenakshi

    2015-06-01

    Full Text Available Lymphangiomyomatosis (LAM is a rare, idiopathic, cystic, progressive disease seen almost exclusively in women of child bearing age which occurs sporadically or in association with tuberous sclerosis. It is clinically characterized by progressive dyspnea, recurrent pneumothorax, hemoptysis and chylous effusions. Due to its unusual and nonspecific symptoms, patients often receive a delayed diagnosis and despite a variety of treatments many patients require lung transplantation. Here we report the case of a 1 6 year s old girl with lymphangiomyomatosis presenting as recurrent pneumothorax.

  18. Relationship between ADP-induced platelet-fibrin clot strength and anti-platelet responsiveness in ticagrelor treated ACS patients

    Science.gov (United States)

    Li, Dan-Dan; Wang, Xu-Yun; Xi, Shao-Zhi; Liu, Jia; Qin, Liu-An; Jing, Jing; Yin, Tong; Chen, Yun-Dai

    2016-01-01

    Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength (MAADP) and clinical outcomes in acute coronary syndrome (ACS) patients treated by ticagrelor. Methods Consecutive Chinese-Han patients with ACS who received maintenance dose of ticagrelor on top of aspirin were recruited. After 5-day ticagrelor maintenance treatment, MAADP measured by thrombelastography (TEG) were recorded for the evaluation of ticagrelor anti-platelet reactivity. Pre-specified cutoffs of MAADP > 47 mm for high on-treatment platelet reactivity (HTPR) and MAADP < 31 mm for low on-treatment platelet reactivity (LTPR) were applied for evaluation. The occurrences of primary ischemic cardiovascular events (including a composite of cardiac death, non-fatal myocardial infarction and stroke), the Thrombolysis in Myocardial Infarction (TIMI) defined bleeding events, and ticagrelor related dyspnea were recorded after a follow-up of three months. Results Overall, 176 ACS patients (Male: 79.55%, Age: 59.91 ± 10.54 years) under ticagrelor maintenance treatment were recruited. The value of MAADP ranged from 4.80% to 72.90% (21.27% ± 12.07% on average), with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, seven patients (3.98%) were identified as HTPR and 144 patients (81.82%) as LTPR. After a follow-up of three months in 172 patients, major cardiovascular events occurred in no patient, but TIMI bleeding events in 81 (47.09%) with major bleedings in three patients. All patients with major bleedings were classified as LTPR. Ticagrelor related dyspnea occurred in 31 (18.02%) patients, with 30 (21.28%) classified as LTPR and no one as HTPR (P = 0.02). Conclusions In ticagrelor treated ACS patients, MAADP measured by TEG might be valuable for the prediction of major bleeding and ticagrelor related dyspnea

  19. [Adenoid cystic carcinoma of the larynx, trachea and thyroid].

    Science.gov (United States)

    Gryczyński, M; Piotrowski, S

    1995-01-01

    The aim of this article was to describe rarely occurred carcinoma adenoides cysticum located in the larynx, trachea and thyroid. Epidemiology, clinical course and medical therapy was demonstrated. In reported case concerning 65-year old woman early bilateral paresis of vocal folds was observed as results of the perineural infiltration. That caused sudden laryngeal dyspnea. It is important to pay attention on local extensiveness of neoplasm. Besides changes in larynx, neoplastic infiltration was found in trachea, preesophageal tissues and right lobe of thyroid. For above reasons there is no possible to exclude thyroid as a primary tumor of carcinoma adenoides cysticum.

  20. Massive pulmonary embolism at the onset of acute promyelocytic leukemia

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    Federica Sorà

    2016-07-01

    Full Text Available Life-threatening bleeding is a major and early complication of acute promyelocytic leukemia (APL, but in the last years there is a growing evidence of thromboses in  APL. We report the first case of a young woman with dyspnea as the first symptom of APL due to massive pulmonary embolism (PE successfully treated with thrombolysis for PE and heparin. APL has been processed with a combination of all-trans retinoic acid (ATRA and arsenic trioxide (ATO obtaining complete remission.