Borg Score Research Articles

Effect of 8-week Pulmonary Rehabilitation Program on Dyspnea and Functional Capacity of Patients on Waiting List for Lung Transplantation.

The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung transplantation (LTx) candidates. Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical Research Council (MRC) dyspnea scale were recorded. Of 23 patients 57% were males; the mean age was 35±10 (range: 16-48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic pulmonary fibrosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there was a significant improvement (median: 60 m) in 6MWT scores (360 [70-254] m vs. 300 [139-489] m; p=0.018). In addition, a clinical improvement was observed in Borg (p=0.000) and MRC scores (p=0.008). Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.

Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial

BackgroundRespiratory complications remain a leading cause of morbidity and mortality in people with acute and chronic tetraplegia. Respiratory muscle weakness following spinal cord injury-induced tetraplegia impairs lung function and the...

The Pleural Effusion And Symptom Evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion.

Pathophysiology changes associated with pleural effusion, its drainage and factors governing symptom response are poorly understood. Our objective was to determine: 1) the effect of pleural effusion (and its drainage) on cardiorespiratory, functional and diaphragmatic parameters; and 2) the proportion as well as characteristics of patients with breathlessness relief post-drainage. Prospectively enrolled patients with symptomatic pleural effusions were assessed at both pre-therapeutic drainage and at 24-36 h post-therapeutic drainage. 145 participants completed pre-drainage and post-drainage tests; 93% had effusions ≥25% of hemithorax. The median volume drained was 1.68 L. Breathlessness scores improved post-drainage (mean visual analogue scale (VAS) score by 28.0±24 mm; dyspnoea-12 (D12) score by 10.5±8.8; resting Borg score before 6-min walk test (6-MWT) by 0.6±1.7; all p<0.0001). The 6-min walk distance (6-MWD) increased by 29.7±73.5 m, p<0.0001. Improvements in vital signs and spirometry were modest (forced expiratory volume in 1 s (FEV1) by 0.22 L, 95% CI 0.18-0.27; forced vital capacity (FVC) by 0.30 L, 95% CI 0.24-0.37). The ipsilateral hemi-diaphragm was flattened/everted in 50% of participants pre-drainage and 48% of participants exhibited paradoxical or no diaphragmatic movement. Post-drainage, hemi-diaphragm shape and movement were normal in 94% and 73% of participants, respectively. Drainage provided meaningful breathlessness relief (VAS score improved ≥14 mm) in 73% of participants irrespective of whether the lung expanded (mean difference 0.14, 95% CI 10.02-0.29; p=0.13). Multivariate analyses found that breathlessness relief was associated with significant breathlessness pre-drainage (odds ratio (OR) 5.83 per standard deviation (sd) decrease), baseline abnormal/paralyzed/paradoxical diaphragm movement (OR 4.37), benign aetiology (OR 3.39), higher pleural pH (OR per sd increase 1.92) and higher serum albumin level (OR per sd increase 1.73). Breathlessness and exercise tolerance improved in most patients with only a small mean improvement in spirometry and no change in oxygenation. Breathlessness improvement was similar in participants with and without trapped lung. Abnormal hemi-diaphragm shape and movement were independently associated with relief of breathlessness post-drainage.

Borg Score Outcomes in Respiratory Compromised Acute Exacerbating Chronic Obstructive Pulmonary Disease (COPD) Patients Receiving Treatment Via Vibrating Mesh Nebuliser Versus Jet Nebuliser in the Emergency Department

Borg Score Outcomes in Respiratory Compromised Acute Exacerbating Chronic Obstructive Pulmonary Disease (COPD) Patients Receiving Treatment Via Vibrating Mesh Nebuliser Versus Jet Nebuliser in the Emergency Department

Association between depressive symptoms and perceived exertion during exercise: observational population-based cohort study of European, Indian Asian, and African-Caribbean older adults

BackgroundExercise interventions are increasingly recognised to help reduce depressive symptoms; however, fatigue and perception of increased energy expenditure, which are often associated with depression, may be barriers to adherence. Although depression has been associated with a blunted cardiovascular stress response, little evidence exists describing perceived exertion during exercise and depression. Furthermore, cardiorespiratory fitness and depression vary by ethnicity across a range of ages. We investigated associations between depressive scores and perception of exertion and physiologically measured exertion during exercise in a tri-ethnic population of older adults. MethodsParticipants were older adults enrolled in a tri-ethnic population-based cohort originally recruited in west London (UK), the Southall and Brent REvisited (SABRE) study. 691 participants (57% men, 43% women; mean age 71·3 years, SD 6·5 years; ethnicity European [n=304], Indian Asian [n=222], or African-Caribbean [n=165]) underwent assessment of depression on the ten-item Geriatric Depression Scale (GDS) and undertook a self-paced 6-min step test. Outcomes measured were rate of perceived exertion (assessed using a 0–10 Borg score immediately after exercise) and exertion (steps completed and highest achieved whole-body oxygen consumption in mL/min per kg). Linear relationships were summarised using β-coefficients with 95% CI from regression models adjusted for age, sex, and ethnicity. An interaction term was used to assess the effect of ethnicity on associations. Ethics approval was from the National Research Ethics Service Committee Fulham, London. All participants gave written consent to undertake the tests. FindingsIn all participants, higher rate of perceived exertion was associated with greater GDS (β 0·10, 95% CI 0·01 to 0·19, p=0·03). GDS was inversely associated with objectively measured exertion (β −6·8, 95% CI −9·9 to −3·8 for steps, p<0·001; and −7·0, −10·0 to −4·0 for whole-body oxygen consumption, p<0·001). The effect of GDS on rate of perceived exertion persisted following adjustment for steps achieved during the test (adjusted β 0·12, 95% CI 0·02 to 0·21, p=0·01) or whole-body oxygen consumption (0·14, 0·05 to 0·25, p=0·01). Ethnicity did not modify these associations. InterpretationOlder adults with higher depression scores had an increased perception of exertion independent of objectively measured exertion during exercise. This result is consistent with previous findings and a well-documented blunted cardio-respiratory response to exercise in the presence of depression. Greater perceptions of exertion could hinder compliance in exercise training programmes targeting depressive symptoms in older adults. FundingThe SABRE study was funded by a grant from the British Heart Foundation.

Elaboration of a rest index for a sewing post in a clothing industry

The textile industry of clothing causes professional diseases in particular the musculoskeletal disorders (MSDs). The application of the culture of technical ergonomics and the methods of ergonomic analysis is to reduce the risk of the diseases. The main objective of this study is to elaborate a rest index which allows giving a recovery period for the sewing post to reduce the risk of MSDs. The method of experimental designs is used to find a model which contains the parameters: the force multiplier, the frequency of technical actions per minute, the posture multiplier and the recovery period multiplier. Then the analysis of results was done by MINITAB Software. The method of General Sewing Data is used to analyze the gesture of the technical actions. The standard ISO 11228-3 is used to determine the posture analysis and the recovery period multiplier. Then, the force analysis is realized by the Borg Score. The model proposed is statistically significant (p value = 0), representative (R2 = 96.5%) and validated according to the predictor Fisher test. The practical study was made in two companies of clothing to validate the rest index which varies between 1.14 and 1.22.

Improvement of Anxiety, Coughing, Breathlessness and Pain Control in The Management of Bronchoscopy by Adding Alprazolam

Background: Anxiolytic premedication can reduce anxiety, improving procedural tolerance, and reduce postbronchoscopic complications. There was ongoing debate about the safety of bronchoscopist-administered sedation. Alprazolam as a surgical premedication can reduce anxiety. Alprazolam can be used as an adjuvant analgesic, to reduce anxiety-related breathlessness, and to reduce coughing as adjuvant antitussive. The study aimed to evaluate the effectiveness of alprazolam in patients undergoing bronchoscopy.&#x0D; Methods: A clinical study with experimental quasi pre-post test control group design, using consecutive sampling was performed in patients with lung tumor undergoing bronchoscopy in dr.Moewardi Hospital from February to March 2019. The study subjects were divided in experimental (alprazolam) and control groups (without alprazolam). The Hospital Anxiety and Depression Scale (HADS), VAS for pain score, modified Borg score, and VAS for cough were measured in baseline, before, and after bronchoscopy. &#x0D; Results: Thirty two lung subjects were included in this study. The intervention groups showed decreased HADS score pre and post bronchoscopy (6.56±2.83 and 6.88±2.63), pain VAS scores (15.00±10.95 and 9.69±11.61), cough VAS score (11.56±8.89 and 27.19±17.89), and these were different significantly compared to control group. We found decreased mean of modified Borg in the study group though they were not significant compared to the control group. &#x0D; Conclusion: Alprazolam controlled anxiety, coughing, and pain in patients undergoing bronchoscopy. Alprazolam minimized breathlessness after bronchoscopy. (J Respir Indo. 2019; 39(4): 245-55)

Effects of tailored telemonitoring on functional status and health-related quality of life in patients with heart failure.

BackgroundFunctional status and health-related quality of life (HRQoL) are important in patients with heart failure (HF). Little is known about the effect of telemonitoring on functional status and HRQoL in that population.Methods and resultsA total of 382 patients with HF (New York Heart Association class 2–4) were included in a randomised controlled trial to investigate the effect of tailored telemonitoring on improving HRQoL and functional status in HF patients. Randomisation was computer-generated with stratification per centre. At baseline and after 12 months, patients’ functional status was determined by metabolic equivalent scores (METS). HRQoL was measured with the EuroQol five dimensions questionnaire (EQ-5D), visual analogue scale (VAS) and Borg rating of perceived exertion scale (Borg). Additional outcome data included number of HF-related outpatient clinic visits and mortality. Telemonitoring was statistically significantly related to an increase in METS after 1 year (regression coefficient 0.318; p = 0.01). Telemonitoring did not improve Borg, EQ-5D or VAS scores after 1 year. EQ-5D [hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.07–0.54], VAS (HR 0.98, 95% CI 0.96–0.99), Borg (HR 1.21, 95% CI 1.11–1.31) and METS (HR 0.73, 95% CI 0.58–0.93) at baseline were significantly associated with survival after 12 months.ConclusionsTailored telemonitoring stabilised the functional status of HF patients but did not improve HRQoL. Therefore, telemonitoring may help to prevent deterioration of exercise capacity in patients with HF. However, because our study is a reanalysis of a randomised controlled trial (RCT), this is considered hypothesis-generating and should be confirmed by adequately powered RCTs.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01323-x) contains supplementary material, which is available to authorized users.

Clinical and Airway Inflammation Features of COPD Patients with Positive Bronchodilator Test

To explore the difference in clinical characteristics and airway inflammation in chronic obstructive pulmonary disease (COPD) patients on the positive bronchodilator tests. Descriptive study. Affiliated Hospital of Shaoxing University, Shaoxing, China, from January to December 2017. A total of 200 COPD patients were subjected to COPD Assessment Test (CAT), modified Medicine Research Council (mMRC) score, 6-minute walk distance, Rating of Perceived Exertion Scale (Borg), pulmonary function, serum IgE, and cell count in induced sputum. They were divided into a positive group and a negative group according to the response to the bronchodilator test, and the results were compared. There were 46 cases (23.00%) in the positive group, and 154 cases (77.00%) in the negative group. There were evident differences in the history of smoking and serum IgE. The positive group had better outcomes than those of the negative group regarding forced expired volume in one second to total predicted value ratio (FEV1% pred), forced vital capacity to total predicted value ratio (FVC% pred), improvement rate of maximum expiratory flow of 75% of lung capacity (MEF75%), and MEF50%. CAT score, mMRC score, Borg score, meters in 6-minute walking test (all p<0.05). There was no significant difference in cell count in induced sputum between the two groups. COPD patients having a positive response to the bronchodilator had better lung function, better CAT score, better mMRC score, and Borg scale score. They also had further 6-minute walking distance. It suggests that a positive bronchodilator response might be a clinical phenotype of COPD.

Janitor ergonomics and injuries in the safe workload ergonomic exposure project (SWEEP) study

IntroductionA Minnesota union identified to researchers at the University of Minnesota a concern relevant to a possible relation between their daily workload and outcome of occupational injuries among a population of janitors. ObjectiveTo assess if the ergonomic workload is related to injuries among janitors. MethodsFollowing an initial group discussion among janitors, which identified common and hazardous tasks potentially leading to occupational injuries, a questionnaire was developed, pre-tested, and distributed to the janitors. Questions addressed various exposures, including workload, and comprehensive information regarding injury occurrence over two six-month sequential periods (May 2016–October 2016, November 2016–April 2017). Quantitative ergonomic analyses were performed on a sub-group of janitors (n = 30); these included data collection to identify Borg Perceived Exertion (Borg) and Rapid Entire Body Assessment (REBA) scores. Descriptive, multivariable with bias adjustment analyses were conducted on the resulting data. ResultsEight tasks were found to be common for janitors. All average REBA scores for the tasks were identified in the high-risk category. The task of repeatedly emptying small trash cans (<25lb) was significantly related to injuries. Average Borg scores fell between the very light perceived exertion and somewhat difficult perceived exertion categories. Multivariable regression analyses indicated that age-sex-standardized ergonomic workload, measured by task frequencies and REBA or Borg scores, was positively related to injury occurrence. ConclusionsStandardized ergonomic workload was positively related to injury occurrence. This information serves as a basis for further research and potential intervention efforts.

Bendopnoea in exercise limited patients with COPD.

Dyspnoea on bending over (bendopnoea) is most commonly associated with systolic heart failure. COPD patients often also complain of bendopnoea but little is known about this symptom in this patient group. We objectively assessed 44 COPD patients attending pulmonary rehabilitation for bendopnoea in a tertiary referral centre to determine the potential mechanism and clinical implications of this symptom. Bendopnoea was assessed by timing the duration of onset to breathlessness on bending forward at the waist for 30 s. BORG score, oxygen saturations and blood pressure measurements were obtained before and after. Of 44 patients (mean age±SD 66.7 ± 8.4 years; 22 male, BMI 28.1 ± 6.4), bendopnoea was present in 23 (52.3%) patients. This was significantly associated with a lower FEV1% (p = 0.02) and TLCO% (<0.001) and higher CAT score (p = 0.03). A strong trend was also noted with higher waist/hip ratio (p = 0.06). There were no associations with age, BMI, oxygen saturation, static lung volumes, exercise capacity or non-invasive haemodynamic markers such as pro-BNP, physiological changes or echocardiography findings.

Six Hours of Manual Ventilation With a Bag-Valve-Mask Device Is Feasible and Clinically Consistent.

Manual ventilation of intubated patients is a common intervention. It requires skill as well as physical effort and is typically restricted to brief periods. Prolonged manual ventilation may be unavoidable in some scenarios, for example, extreme mass casualty incidents. The present study tested whether nurses are capable of appropriately manually ventilating patients for 6 hours. Volunteers performed ventilation on an electronic simulator for 6 hours while their own cardiorespiratory variables and the quality of the delivered ventilation were measured and recorded. The volunteers scored their perceived level of effort on a standard Borg Scale. Research laboratory at the Emergency Department, Tel Aviv Medical Center. Ten nursing staff members of the Tel Aviv Sourasky Medical Center, 25-43 years old. Volunteers ventilated manually a lung simulator for 6 hours. The subjects' physiologic states, including blood pressure, heart rate, respiratory rate, and oxygen saturation, showed no significant changes over time. The quality of delivered ventilation was somewhat variable, but it was stable on the average: average tidal volume ranged between 524.8 and 607.0 mL (p = 0.33). There was a slight but significant increase (7.3-10.9 L/min [p = 0.048]) in minute volume throughout the test period, reaching values consistent with mild hyperventilation. The subjects scored their perceived working effort as very light to fairly light, with a nonsignificant gradual increase in the Borg score as the study progressed. Manual ventilation of intubated patients can be performed continuously for 6 hours without excessive physical effort on the part of the operator. The quality of delivered ventilation was clinically adequate for all of them. There was a mild but significant trend toward hyperventilation, albeit within safe clinical levels, which was due to an increasing ventilatory rate rather than an increase in tidal volume.

Effects of Pursed Lip Breathing on Exercise Capacity and Dyspnea in Patients With Interstitial Lung Disease: A RANDOMIZED, CROSSOVER STUDY.

Although mainly described in patients with chronic obstructive pulmonary disease, pursed lip breathing (PLB) could prove useful in patients with interstitial lung disease (ILD) by improving exertional tachypnea and respiratory control. This prospective, randomized, crossover trial aimed at evaluating the impact of PLB on dyspnea and walking distance in ILD patients. ILD patients with total lung capacity of <80% predicted were randomized to 6-min walk tests using either PLB or usual breathing. Patients were crossed over for the second 6-min walk tests and served as their own controls. Ventilatory and metabolic variables were recorded using a portable metabolic cart and were compared at 1-min intervals. Thirty-five patients were included (mean forced vital capacity of 64 ± 10% predicted). Use of PLB resulted in lower mean respiratory rates and larger tidal volumes (both P < .001), worsened dyspnea ratings (post-6-min walk test Borg score: 5.2 ± 2.6 vs 4.2 ± 2.3, P < .001), and walking distance (403 ± 102 m vs 429 ± 93 m, P < .001). Twenty-nine patients (83%) described PLB as less comfortable than usual breathing. Both groups had similar total ventilation and oxygen saturation (all P > .05), but PLB resulted in higher mean oxygen uptake (13.9 ± 3.6 vs 12.9 ± 3.2 mL/kg/min, P = .02), even when corrected for walking distance (P < .001). In ILD patients, acute exposure to PLB did not improve exertional dyspnea, walking distance, or gas exchange, and was associated with higher metabolic demands than usual breathing. These results cast doubt on the usefulness of this technique in ILD patients and should be taken into account when tailoring pulmonary rehabilitation programs to this population.

Associations of AMP and adenosine induced dyspnea sensation to large and small airways dysfunction in asthma

BackgroundBronchial provocation is often used to confirm asthma. Dyspnea sensation, however, associates poorly with the evoked drop in FEV1. Provocation tests only use the large airways parameter FEV1, although dyspnea is associated with both large- and small airways dysfunction. Aim of this study was to explore if adenosine 5′-monophosphate (AMP) and adenosine evoke an equal dyspnea sensation and if dyspnea associates better with large or small airways dysfunction.MethodsWe targeted large airways with AMP and small airways with dry powder adenosine in 59 asthmatic (ex)-smokers with ≥5 packyears, 14 ± 7 days apart. All subjects performed spirometry, impulse oscillometry (IOS), and Borg dyspnea score. In 36 subjects multiple breath nitrogen washout (MBNW) was additionally performed. We analyzed the association of the change (Δ) in Borg score with the change in large and small airways parameters, using univariate and multivariate linear regression analyses. MBNW was analyzed separately.ResultsProvocation with AMP and adenosine evoked similar levels of dyspnea. ΔFEV1 was not significantly associated with ΔBorg after either AMP or adenosine provocation, in both univariate and multivariate analyses. In multivariate linear regression, a decrease in FEF25–75 during adenosine provocation was independently associated with an increase in Borg. In the multivariate analyses for AMP provocation, no significant associations were found between ΔBorg and any large or small airways parameters.ConclusionAMP and adenosine induce equally severe dyspnea sensations. Our results suggest that dyspnea induced with dry powder adenosine is related to small airways involvement, while neither large nor small airways dysfunction was associated with AMP-induced dyspnea.Trail registrationNCT01741285 at www.clinicaltrials.gov, first registered Dec 4th, 2012.

Functional and Respiratory Capacity of Patients with Chronic Kidney Disease Undergoing Cycle Ergometer Training during Hemodialysis Sessions: A Randomized Clinical Trial.

Purpose Exercise is recommended for patients undergoing hemodialysis, to reduce the decrease in functional capacity secondary to the progression of chronic kidney disease. A cycle ergometer can be easily added to an exercise routine during hemodialysis sessions. The purpose of this article was to assess the results of a training protocol with the cycle ergometer during hemodialysis sessions on the respiratory function and functional capacity of patients with chronic kidney disease on hemodialysis. Method In this randomized clinical trial (NCT no. 02834026), 39 patients undergoing hemodialysis were randomly allocated into two groups: the treatment group (TG, n = 20), who underwent a cycle ergometer protocol training, and the control group (GC, n = 19), not trained. The TG attended 24 training sessions, three times a week, during the intradialytic period. Training intensity was aimed at keeping the heart rate between 50 and 70% of its maximum. All participants were evaluated before and after the eight consecutive weeks of follow-up and had biochemicals data, anthropometric, functional, and respiratory outcomes evaluated. Results A significant difference was observed between groups in forced vital capacity, forced expiratory volume in the first second, peak expiratory flow, maximal inspiratory and expiratory pressure, and Borg score and distance covered in the six-minute walk test. Improvement was also observed in biochemical and Kt/V test results for the TG. Conclusion The systematic training regimen with a cycle ergometer resulted in benefits in the respiratory function and functional capacity in patients with chronic kidney disease undergoing hemodialysis.

Clinical and hemodynamic benefit of macitentan and riociguat upfront combination in patients with pulmonary arterial hypertension.

In this open-label study, we evaluated the effect of upfront macitentan and riociguat combination in newly diagnosed pulmonary arterial hypertension (PAH) patients. In 15 consecutive PAH patients, we collected clinical and hemodynamic data at baseline, visit 1 (median 4 months) and visit 2 (median 12 months). Survival and transplantation status were analyzed over 36 months. Statistical analysis included student t-test and 95% confidence interval (CI) (t-statistic or Clopper-Pearson). Kaplan-Meier was used to estimate survival rate. There were 11/15 women (mean age 56 years), in World Health Organization (WHO) functional class (FC) III (n = 14) or IV (n = 1). The 6 min walk distance increased from 281.6 m (baseline) to 315.7 m (visit 1) and visit 2 (313.9 m), representing a 34- and 32-m change (P < 0.05), respectively, associated with Borg score improvements. Brain natriuretic peptide decreased: 318.2 pg/mL (baseline) to 122.0 pg/mL (visit 1) and 98.6 pg/mL (visit 2) (P < 0.05). WHO FC improved in eight patients (53%, 95% CI 27%–79%). Pulmonary vascular resistance (9.2 to 5.7 Wood Units) and mean pulmonary artery pressure (47.3 to 38.9 mmHg) decreased; cardiac index increased (2.3 to 3.0 L/min/m2) (baseline to visit 2, all P < 0.05). All patients had intermediate and high risk score (baseline); at 1-year follow-up, dual therapy led to reduction to low risk score in 7/15 (47%) patients. There were no unexpected or serious side effects. Three patients died due to unrelated causes; one patient received a lung transplant. Transplant-free survival rate (36 months) was 85%. Preliminary evidence is provided for effectiveness of initial macitentan and riociguat combination therapy in PAH.

Impact of pulmonary rehabilitation on activities of daily living in patients with chronic obstructive pulmonary disease.

A high proportion of patients with chronic obstructive pulmonary disease (COPD) experience problems during the performance of activities of daily living (ADLs). We aimed to determine the effects of a comprehensive 8-wk pulmonary rehabilitation program on the physiologic response to and performance of ADLs in patients with COPD. Before and after pulmonary rehabilitation, 31 patients with COPD [71% men; mean age: 64.2 (SD 8.4) years; mean forced expiratory volume in the first second: 54.6 (SD 19.9) % predicted] performed physical function tests, the Canadian Occupational Performance Measure (COPM), and an ADL test consisting of the following: putting on socks, shoes, and vest; stair climbing; washing up four dishes, cups, and saucers; doing groceries and putting away groceries in a cupboard; folding eight towels; and vacuum cleaning for 4 min. Metabolic load, ventilation, and dynamic hyperinflation were assessed using an Oxycon mobile device. In addition, symptoms of dyspnea and fatigue and time to complete ADLs were recorded. After rehabilitation, patients with COPD used a significantly lower proportion of their peak aerobic capacity and ventilation to perform ADLs, accompanied by lower Borg scores for dyspnea and fatigue. Furthermore, patients needed significantly less time to complete ADLs. Dynamic hyperinflation occurred during the performance of ADLs, which did not change following pulmonary rehabilitation. Changes in physical function, including six-min walk distance, constant work rate test, quadriceps muscle strength, and COPM were significantly correlated with change in average total oxygen uptake during the performance of the ADL test. A comprehensive pulmonary rehabilitation program can improve the physiologic response to and actual performance of ADLs in patients with COPD. NEW & NOTEWORTHY A high proportion of patients with chronic obstructive pulmonary disease (COPD) experience problems during the performance of activities of daily living (ADLs). This study clearly demonstrated that a comprehensive pulmonary rehabilitation program can improve the performance of ADLs in patients with COPD, indicated by a significantly shorter time to perform ADLs and a lower metabolic load and dyspnea sensation.

Respiratory Failure, Noninvasive Ventilation, and Symptom Burden: An Observational Study

BackgroundNoninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population. MeasuresFifty consecutive, consenting, English-speaking, cognitively intact patients, admitted to wards other than the intensive care unit in a tertiary teaching hospital and treated with NIV for hypercapnic respiratory failure, were recruited. The 14-item Condensed Memorial Symptom Assessment Scale was used to assess physical and psychological symptoms within 36 hours of commencing NIV. Breathlessness (using Borg score), pain location and intensity using a numerical rating scale, and four symptoms potentially prevalent in patients undergoing NIV (cough, sputum, gastric bloating, and dry eyes) were also assessed. OutcomesPatients reported a median of 10 symptoms (IQR 9–13). A median of five symptoms (IQR 3–7) were rated as severe. Breathlessness was the most prevalent and most distressing symptom, with participants reporting a mean maximum Borg score of 7.55 over the 24 hours before admission. Dry mouth, lack of energy, cough, sputum, difficulty sleeping, and psychological symptoms were prevalent. Pain, when reported, was of moderate intensity and contributed to distress. Conclusions/Lessons learnedThis study describes the patient-reported symptoms occurring during an episode of acute respiratory failure. Understanding the symptom profile of patients in this setting may allow clinicians to target symptom relief while simultaneously managing respiratory failure, enhancing care.

Alterations in energy consumption and plantar pressure distribution during walking in young adults with patellofemoral pain syndrome

ObjectiveThe aim of this study was to determine the alterations of walking energy expenditure and plantar pressure distribution in young adults with patellofemoral pain syndrome (PFPS). MethodsThirty five individuals (mean age: 21.31 ± 1.76) with PFPS constituted the patient group and forty healthy participants (mean age: 21.40 ± 2.11) the control group. Preferred walking speeds (PWS) were determined on the over ground. Individuals walked on a treadmill for 7 min at their PWS and 30% above PWS and oxygen consumption was recorded via a metabolic analyzer. Net oxygen consumption was calculated for each walking trial. Borg scale was applied to assess perceived exertion during walking trial. Plantar pressure distributions were measured by a pedobarography device. Plantar area was subdivided into six zones to evaluate the dynamic plantar pressure data. ResultsThe mean PWS of PFPS and control groups were 4.69 ± 0.51 and 4.52 ± 0.60 km/h, respectively (p > .09). No significant difference was observed in energy expenditure during walking at PWS between 2 groups while oxygen consumption during 30% above PWS was higher in patient group (18.72 ± 3.75 and 16.64 ± 3.27) (p = .007). Net oxygen consumption was also found to be higher in PFPS group (15.12 ± 3.62 and 13.04 ± 3.24) (p = .005). The mean Borg scores were significantly higher in PFPS group at each walking trials (p < .001). No statistically significant difference was found between weight distribution (%) of symptomatic and nonsymptomatic extremity (50.45 ± 3.92% and 49.56 ± 3.93%, respectively) (p = .509). Dynamic pedobarography parameters were not different between 2 groups, and also between symptomatic and nonsymptomatic extremities (p > .05). ConclusionAlthough, rate of perceived exertion and energy expenditure during walking at 30% above PWS are affected negatively in young adults with PFPS, we may speculate that energy consumption and plantar pressure distribution can be compensated by a physiologic adaptation mechanism during walking at PWS. Level of evidenceLevel III, Therapeutic Study.

Breathing Hydrogen-Oxygen Mixture Decreases Inspiratory Effort in Patients with Tracheal Stenosis

Background: Hydrogen-oxygen mixture (H₂-O₂) may reduce airway resistance in patients with acute severe tracheal stenosis, yet data supporting the clinical use of H₂-O₂ are insufficient. Objectives: To evaluate the efficacy and safety of breathing H₂-O₂ in acute severe tracheal stenosis. Methods: Thirty-five consecutive patients with severe acute tracheal stenosis were recruited in this prospective self-control study. Air, H₂-O₂ and O₂ inhalation was given in 4 consecutive breathing steps: air for 15 min, H₂-O₂ (6 L per min, H₂:O₂ = 2: 1) for 15 min, oxygen (3 L per min) for 15 min, and H₂-O₂ for 120 min. The primary endpoint was inspiratory effort as assessed by diaphragm electromyography (EMGdi); the secondary endpoints were transdiaphragmatic pressure (Pdi), Borg score, vital signs, and impulse oscillometry (IOS). The concentration of H₂ in the ambient environment was obtained with 12 monitors. Adverse reactions during the inhalation were recorded. Results: The mean reduction in the EMGdi under H₂-O₂ was 10.53 ± 6.83%. The EMGdi significantly decreased during 2 H₂-O₂ inhalation steps (Steps 2 and 4) compared with air (Step 1) and O₂ (Step 3) (52.95 ± 15.00 vs. 42.46 ± 13.90 vs. 53.20 ± 14.74 vs. 42.50 ± 14.12% for Steps 1 through 4, p < 0.05). The mean reduction in the Pdi under H₂-O₂ was 4.77 ± 3.51 cmH₂O. Breathing H₂-O₂ significantly improved the Borg score and resistance parameters of IOS but not vital signs. No adverse reactions occurred. H₂ was undetectable in the environment throughout the procedure. Conclusions: Breathing H₂-O₂ may reduce the inspiratory effort in patients with acute severe tracheal stenosis and can be used for this purpose safely.