Improvement In Dyspnea Research Articles

Effects of Multidisciplinary Rehabilitation Program in Patients with Long COVID-19: Post-COVID-19 Rehabilitation (PCR SIRIO 8) Study.

Up to 80% of COVID-19 survivors experience prolonged symptoms known as long COVID-19. The aim of this study was to evaluate the effects of a multidisciplinary rehabilitation program in patients with long COVID-19. The rehabilitation program was composed of physical training (aerobic, resistance, and breathing exercises), education, and group psychotherapy. After 6 weeks of rehabilitation in 97 patients with long COVID-19, body composition analysis revealed a significant decrease of abdominal fatty tissue (from 2.75 kg to 2.5 kg; p = 0.0086) with concomitant increase in skeletal muscle mass (from 23.2 kg to 24.2 kg; p = 0.0104). Almost 80% of participants reported dyspnea improvement assessed with the modified Medical Research Council scale. Patients' physical capacity assessed with the 6 Minute Walking Test increased from 320 to 382.5 m (p < 0.0001), the number of repetitions in the 30 s Chair Stand Test improved from 13 to 16 (p < 0.0001), as well as physical fitness in the Short Physical Performance Battery Test from 14 to 16 (p < 0.0001). The impact of fatigue on everyday functioning was reduced in the Modified Fatigue Impact Scale from 37 to 27 (p < 0.0001). Cardiopulmonary exercise test did not show any change. The multidisciplinary rehabilitation program has improved body composition, dyspnea, fatigue and physical capacity in long COVID-19 patients.

Effect of Long-Term Oxygen Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Clinical Study

Introduction: Long-Term Oxygen Therapy (LTOT) has the potential to improve the mortality and morbidity in Chronic Obstructive Pulmonary Disease (COPD) patients. Aim: To assess the effect of LTOT on the Quality of Life (QoL) in stable COPD patients with severe resting hypoxemia. Materials and Methods: This was a prospective observational study conducted in a tertiary care teaching hospital in Kozhikode, Kerala, on stable COPD patients with severe hypoxemia who were newly initiated on home LTOT for ≥15 hours per day. Health Related Quality of Life (HRQoL), modified Medical Research Council (mMRC) grade of dyspnoea, frequency of exacerbations and adherence to treatment on LTOT were studied. Total of 60 patients were followed-up for one year. Significance of mean was tested using paired t-test and association between qualitative variables was tested using Chi-square test. The p-value <0.05 was considered statistically significant. Results: Out of all, 7 patients died during the study period and 53 patients were included in the final analysis. The mean total St.George’s Respiratory Questionnaire (SGRQ) scores at 3, 6 and 12 months improved to 53.73±13.2, 53.97±13.22 and 54.63±13.16, respectively, from a baseline score of 72.51±8.88. At the end of 12 months of LTOT, 22 (41.51%) patients did not have exacerbations and 31 (58.49%) patients had exacerbations. There was no statistically significant improvement in dyspnoea after one year of LTOT. Among the 53 patients, who completed one year follow-up, 36 (67.92%) participants were adherent and remaining 17 (32.07%) participants were non adherent to LTOT. Conclusion: LTOT improves the HRQoL in stable COPD patients with severe hypoxemia. Use of domiciliary oxygen for at least 15 hours per day can reduce the number of COPD exacerbations.

Long-term results of patients implanted with CRT: Single centre experience

Cardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients. Data on its pronounced long-term outcome are scarce. To assess clinical outcomes of CRT and cardiac events over the long term. We conducted a retrospective study of all CRT device implantations from March 2009 to March 2021 at university heart center Algiers. Baseline characteristics, improvement in NYHA class, changes in left ventricular ejection fraction (LVEF), CRT procedural complications and post CRT device implantations cardiac events were assessed. A total of 198 patients with a median age of 60 years were included, sixty four percent were male, 84.85% had non ischemic cardiomyopathy whose 18.18% had post-surgical valvular cardiomyopathy, and 71.72% were in sinus rhythm whereas 26.77% were in atrial fibrillation. 89.39% had a bundle branch block, 12.63% had an atrio-ventricular block and 5.55% had a pacemaker. The mean LVEF was 28.2% ± 5.886. Mostly of the patients (60.61%) had received a CRTP. Procedural complications occurred in 32 pts (16%) (8 coronary sinus dissections, 14 lead dislodgements, 3 phrenic stimulation and 7 infections). During a mean follow up of 4 years, 45 pts died (22.73%), 31 pts were hospitalized for acute decompensated heart failure (15.66%). An improvement in dyspnea was reported in 81.31%. An improvement of LVEF was reported in 76.26% and 21.72% had normalized their LVEF. The ischemic cardiomyopathy was independent predictor of non-response to CRT (OR, 5.95; 95% CI, 2.16–16.37; P = 0.0005). Selected patients who survive for at least 4 years experience sustained improvement in LVEF and NYHA-class.

Using Cytoprotective Features of Succinic Acid During the Rehabilitation of the Patients with Previous Acute Myocardial Infarction Complicated with Decompensated Heart Failure

Aim: To improve treatment effectiveness for patients with previous myocardial infarction (MI) while studying clinical pathogenetic features of decompensated heart failure (HF) in the postinfarction period with the focus of using succinic acid. Materials and Methods: The work is based on the results of an examination of 60 patients with previous MI, who got registered decompensated II А-B CHF. The patients with previous STEMI complicated by decompensated HF were divided into groups: the I group included the patients with previous STEMI, who were getting standard treatment according to the guidelines of the MoH of Ukraine (beta-blockers, ACE inhibitors, dual antiplatelet therapy (acetylsalicylic acid+clopidogrel), nitrates, statins) (n=30); the II group included the patients with previous STEMI, who were getting succinic acid into the therapy complex beside the standard treatment. Results: We determined insignificant improvements in such symptoms, as angina, dyspnea, dizziness, and tiredness in the group of patients receiving standard treatment. Herewith using succinic acid reduced clinical signs of inadequate response to physical exercise significantly. Disregarding the one-sidedness of the probable dynamics of the aforementioned 6MWD characteristics, the positive dynamic was less significant in the case of standard treatment. all examined groups presented positive dynamics concerning decreasing the number of points in the patients with decompensated HF after STEMI during the therapy according to Borg’s scale. Conclusions: The use of succinic acid for patients with decompensated heart failure that occurred after STEMI is accompanied by positive clinical effects, and antiischemic and cytoprotective influence.

Neuromuscular Electrical Stimulation (NMES) as an Add-on Therapy for the Improvement of Dyspnea in Patients with Post-Covid Syndrome: a Protocol for a Phase II Randomized, Non-Pharmacological Intervention-Controlled, Double-Blind Study.

Introduction: To date, 501 million people have been infected with SARS-CoV-2, and the incidence of COVID-19 is still increasing as new variants develop. Beyond the well-known short-term consequences of morbimortality of the COVID-19 disease, multiple long-term sequelae have been identi-fied, which are referred to as Post COVID Syndrome (PCS). Dyspnea beyond three weeks from in-fection is the most common long-term symptom, and physical therapy is the standard care for those patients. Neuromuscular Electrical Stimulation (NMES) has been previously used to improve muscle weakness in different pulmonary diseases with promising results. Therefore, given the expected burden of disease, additional tools that seek to optimize patient care, which are easy to use and cost-effective, are a promising approach to PCS recovery. Objective: To compare the efficacy of NMES plus physical therapy against sham procedure and physical therapy in improving dyspnea among patients who developed PCS. Methods: This trial will be a multicentric randomized sham-controlled, double-blinded parallel phase 2 superiority trial. Patients admitted to the hospital with moderate to severe COVID-19, who develop PCS, will be allocated to intervention and sham groups in a 1:1 ratio. They will be assessed for dyspnea through the 6-minute walk test (6MWT) for three months. Conclusion: To our knowledge, no previous published literature tested the same intervention array as this study. Thus, the study assesses the possible impact of the proposed intervention to improve dyspnea among patients with PCS. Keywords: COVID-19, Post-COVID Syndrome, Post-acute COVID, Long COVID, Neuromuscular Electrical Stimulation, Dyspnea.

Effectiveness of an Inpatient Virtual Reality-Based Pulmonary Rehabilitation Program among COVID-19 Patients on Symptoms of Anxiety, Depression and Quality of Life: Preliminary Results from a Randomized Controlled Trial.

Forms of rehabilitation for patients after COVID-19 are gaining interest. The purpose of this study was to investigate and compare an innovative in-hospital pulmonary rehabilitation programs augmented with training elements performed in virtual reality. This randomized controlled study included 32 patients enrolled in post-COVID-19 rehabilitation at a Public Hospital in Poland. The rehabilitation models included exercise capacity training on a cycle ergometer, breathing and general fitness workout, resistance training, and relaxation. The forms of training and relaxation differed between the groups: the experimental group employed virtual reality, and the control group used a traditional form of therapy. Exercise tolerance was assessed using a 6 min walk test (6 MWT), while psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS) and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). The analysis of the post-rehabilitation results showed a statistically significant improvement in both groups regarding depression (VR: 6.9 (3.9) vs. 4.7 (3.5), p = 0.008; CG: 7.64 (4.5) vs. 6.6 (4.8), p = 0.017) and anxiety (VR: 8.6 (4.6) vs. 5.6 (3.3), p < 0.001; CG: 9.57 (6.0) vs. 8 (4.8), p = 0.003). No statistically significant improvements in quality of life were noted in both groups. Moreover, the analysis showed a statistically significant improvement in the exercise capacity in both groups after completion of the rehabilitation program, expressed as a distance in the 6 MWT, as well as a statistically significant improvement in dyspnea in the VR group. To conclude, the analysis of the preliminary data revealed that a 3-week hospital-based pulmonary rehabilitation program for COVID-19 patients led to an improvement in exercise tolerance as well as a reduction in the symptoms of anxiety and depression. The virtual reality-based form of training delivery, despite its attractiveness, did not significantly affect patients' performance.

Case Report: The first reported case of pulmonary alveolar proteinosis with myasthenia gravis in a 27-year-old patient

Background: Pulmonary alveolar proteinosis is a very rare diffuse lung disease characterized by the accumulation of amorphous and periodic acid Schiff-positive lipoproteinaceous material in the alveolar spaces due to impaired surfactant clearance by alveolar macrophages. Three main types were identified: Autoimmune, secondary and congenital. Pulmonary alveolar proteinosis has been previously reported to be associated with several systemic auto-immune diseases. Accordingly, we present the first case report of pulmonary alveolar proteinosis associated with myasthenia gravis. Case: A 27-year-old female patient, ex-smoker, developed a dyspnea on exertion in 2020. The chest X-ray detected diffuse symmetric alveolar opacities. Pulmonary infection was ruled out, particularly COVID-19 infection. The chest scan revealed the “crazy paving” pattern. The bronchoalveolar lavage showed a rosy liquid with granular acellular eosinophilic material Periodic acid-Schiff positive. According to the lung biopsy results, she was diagnosed with pulmonary alveolar proteinosis. The granulocyte macrophage colony-stimulating factor autoantibodies were negative. Nine months later, she was diagnosed with bulbar seronegative myasthenia gravis, confirmed with the electroneuromyography with repetitive nerve stimulation showing significant amplitude decrement of the trapezius and spinal muscles. She was treated with pyridostigmine, oral corticosteroids and azathioprine. Given the worsening respiratory condition of the patient, a bilateral whole lung lavage was performed with a partial resolution of symptoms. Thus, this previously unreported association was treated successfully with rituximab, including improvement of dyspnea, diplopia and muscle fatigability at six months of follow-up. Conclusions: This case emphasizes on the possible association of auto-immune disease to PAP, which could worsen the disease course, as the specific treatment does not exist yet. Hence, further studies are needed to establish clear-cut guidelines for PAP management, particularly when associated to auto-immune diseases.

A Case of Posterior Glottic Stenosis Caused by Treatment of COVID-19 with Long-term Intubation

Posterior glottic stenosis (PGS), of which the most common cause is tracheal intubation, is often misdiagnosed as bilateral vocal cord paralysis. We herein report a case of PGS that occurred after treatment with COVID-19 with long-term intubation. The patient underwent tracheostomy and endoscopic resection and showed improvement in dyspnea. The COVID-19 epidemic is expected to increase long-term intubation cases and cases of severe laryngeal injury, including PGS. We need tracheostomy in long-term intubated COVID-19 patients, just like other diseases, and an appropriate diagnosis and surgical treatment for PGS should be performed. When otolaryngologists encounter cases of bilateral vocal cord paralysis, it is necessary to keep in mind the possibility of PGS and laryngeal stenosis and pay attention to the history of COVID-19.

Assessment of diaphragmatic role in dyspneic patients with pleural effusion

BackgroundDyspnea that is caused by pleural effusion and affects patients’ quality of life may not be resolved after lung expansion following pleural tapping. This study aims to investigate the role that changes in the diaphragmatic shape and movement play in the development of dyspnea in those patients.MethodsThirty patients with pleural effusions and dyspnea were evaluated before and at 24 h after therapeutic thoracentesis. The primary outcomes are to investigate changes in diaphragmatic shape and movement before and after thoracentesis by chest ultrasound to evaluate factors causing effusion-related dyspnoea, while the secondary outcomes are firstly to investigate the effect of pleural effusion on the cardiorespiratory, functional, and diaphragmatic variables in causing dyspnea and secondly to detect the percentages and demographics of patients who experience post-drainage dyspnea improvement.ResultsThirty patients with age >18 years old who had moderate to massive pleural effusion (either of benign or malignant etiology), with breathlessness were recruited from the Chest Department, Ultrasonography Unit, Ain-Shams University Hospitals. Almost all (96.7%) of the studied patients experienced shortness of breath with a mean modified Borg Score of 5.13 ± 1.78, tapping of varying amounts of pleural fluid ranging from 1000 to 2000 ml.There is a highly significant improvement in the diaphragmatic excursion, with non-significant improvement in diaphragmatic shape, although nonsignificant correlation between diaphragmatic excursion and functional parameters (M. Borg score, spirometry, and 6MWD: 6-min walk distance), but a significant negative correlation between diaphragmatic excursion and amount of drained effusion (P value 0.045 and 95% CI for OR 1.041–36.779). 63.3% of patients experienced dyspnea improvement after thoracocentesis, and they showed highly significant improvements in M. Borg dyspnea score, spirometry, pulse rate, respiratory rate, 6MWD, and blood oxygen saturation.ConclusionIn this study, we conclude that the improvement of the diaphragmatic excursion was negatively correlated with the amount of drained effusion, but no significant correlation was detected with the functional parameters and effusion-related indices that may be caused by the small sample size of the study.

Effectiveness and safety of opioids for dyspnea in patients with lung cancer: secondary analysis of multicenter prospective observational study

Patients with lung cancer are more likely to have comorbidities [e.g., interstitial lung disease (ILD)], chronic obstructive pulmonary disease) and metastases that may affect dyspnea and the effectiveness and safety of opioids for dyspnea than other cancer types. Therefore, this study examined the effectiveness and safety of opioids for dyspnea, among the patients with lung cancer. The present study is a secondary analysis of a multicenter prospective observational study examining the effectiveness and safety of opioids for dyspnea in patients with cancer in Japan. For this secondary analysis, patients with lung cancer with a documented dyspnea Numerical Rating Scale (NRS) at baseline were included. The primary outcome was dyspnea NRS, and Integrated Palliative care Outcome Scale/Support Team Assessment Schedule (IPOS/STAS) scores change between baseline and 24 hours after baseline. As secondary outcomes, we investigated the predictors of opioid effectiveness for dyspnea improvement and adverse events (nausea, somnolence, and delirium). This study analyzed 124 patients with lung cancer with known dyspnea NRS at baseline. The median age was 74, and the Eastern Cooperative Oncology Group performance status of 107 patients were 3-4. Both NRS and IPOS/STAS score of dyspnea significantly improved 24 hours after opioid initiation [-1.64, 95% confidence interval (CI): -2.12 to -1.17, P<0.001; -1.03; 95% CI: -1.21 to -0.85, P<0.001; respectively]. Moreover, the improvement of NRS score was greater than the minimal clinically important difference of 1 point. In the multivariate logistic regression analysis, ILD was significantly associated with a better improvement [(hazard ratio (HR): 3.39, 95% CI: 1.34-11.09, P=0.043]. Somnolence was the most common grade 3-4 adverse event (n=16), followed by delirium (n=9). Opioids were effective and safe for treating dyspnea in patients with lung cancer. Furthermore, lung cancer patients with ILD may benefit more from opioids.

Bilateral Pleural Effusion: A Rare Case Report

A 24-year-old female presented with complaints of distension of abdomen, lower limb swelling and shortness of breath. On examination, she had bilateral pedal oedema, tender mild hepatomegaly, bilateral pleural effusion and ascites. She had received treatment on lines of chronic liver disease, congestive heart failure but did not manifest any improvement. Laboratory investigations including haemogram, echocardiography and liver function testing were inconclusive. Ultrasonography and computed tomography of abdomen revealed obstruction at the junction of inferior vena cava and hepatic vein with pre-stenotic dilatation confirming the diagnosis of Budd-Chiari syndrome. She was treated with balloon dilatation from right femoral vein and the patient showed marked recovery with decrease in ascites and bilateral pleural effusion and improvement in dyspnoea and leg swelling.

The Efficacy and Safety of Tolvaptan in Heart Failure Patients with Congestive Signs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: The aim of this study was to investigate the efficacy and safety of tolvaptan, as well as the impact of its treatment dose and duration in heart failure patients with congestive signs. Methods: The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched to collect data from all randomized controlled trials (RCT) examining the efficacy and safety of tolvaptan in heart failure patients with congestive signs compared with placebo or blank control until March 4, 2021. Urine volume, change in body weight, improvement in dyspnea, and reduction of edema were evaluated as efficacy indicators. All-cause mortality, worsening heart failure, and adverse events were considered safety indicators. The quality of eligible publications was assessed using the Cochrane risk of bias for RCTs. Results: Ten RCTs with 5,980 patients were included in this analysis. Compared with control, tolvaptan significantly reduced weight in the short term (day 1, 7 RCTs, weighted mean difference (WMD): –1.09, 95% confidence interval (CI): –1.27 to –0.91; day 2, 2 RCTs, WMD: –1.67, 95% CI: –3.00 to –0.33; day 7, 4 RCTs, WMD: –0.95, 95% CI: –1.25 to –0.66), increased urine volume (WMD: 1,825.72, 95% CI: 1,438.38–2,213.07), and relieved dyspnea (risk ratio (RR): 1.12, 95% CI: 1.05–1.19) without increasing the mortality rate (RR: 0.96, 95% CI: 0.87–1.06). Furthermore, the weight loss and increase in urine volume were not dose-dependent effects, and prolonged medication did not lead to sustained weight loss. In addition, there seemed to be more adverse events (RR: 1.17, 95% CI: 1.03–1.32) after treatment with tolvaptan. Further analysis revealed that patients treated with tolvaptan were more likely to report thirst (RR: 6.09, 95% CI: 3.37–11.00) and dry mouth (RR: 6.36, 95% CI: 4.09–9.90), as well as develop hypernatremia (RR: 12.76, 95% CI: 3.52–46.32). Conclusions: The meta-analysis shows that tolvaptan can improve congestion with no increase in mortality rate, but should be used to guard against adverse events. Deserve to be mentioned, the number of RCTs included was limited, suggesting that the observed results should be interpreted with caution. Additional robust clinical studies are warranted to validate the present findings.

Acupuncture or cupping plus standard care versus standard care in moderate to severe COVID-19 patients: An assessor-blinded, randomized, controlled trial

BackgroundNon-pharmacological strategies that have been proposed by complementary medical systems, can be effective in management of COVID-19. MethodsThis study was designed as a three-arm, assessor-blinded, randomized controlled trial. A total of 139 hospitalized COVID-19 patients were randomly assigned into three groups: (1) acupuncture (ACUG), (2) cupping (CUPG), and (3) control (CTRG). All participants received conventional treatment. The primary study endpoint included changes in respiratory signs including oxygen saturation (SpO2) and respiratory rate (RR). The secondary endpoints were COVID-19-related hospitalization duration and serious adverse events such as intensive care unit (ICU) admission, intubation or death, all up to day 30. Also, improvements in cough, dyspnea, chest tightness, oxygen demand, anorexia, headache, weakness, sore throat, and myalgia were evaluated. ResultsForty-two patients in ACUG, 44 patients in CUPG, and 42 patients in CTRG completed the trial. After 3 days, SpO2 and RR improved significantly in CUPG and ACUG compared with CTRG (effect size: 8.49 (6.4 to 10.57) and 8.51 (6.67 to 10.34), respectively: p<0.001). Compared with CTRG, patients in CUPG and ACUG recovered faster (mean difference: 6.58 (4.8 to 8.35) and 9.16 (7.16 to 11.15), respectively) and except for two patients in ACUG who were admitted to ICU, none of patients in ACUG or CUPG needed ICU or intubation (p<0.001 in comparison to CTRG). Amelioration of clinical COVID-19 related symptoms reached a high level of statistical significance in CUPG and ACUG in comparison with CTRG (p<0.01). ConclusionCupping and acupuncture are promising safe and effective therapies in management of COVID-19. Trial registration: This study was registered at Iranian Registry of Clinical Trials: IRCT20201127049504N1 (https://en.irct.ir/trial/52621).

An observational study of the effects of smoking cessation earlier on the clinical characteristics and course of acute exacerbations of chronic obstructive pulmonary disease

BackgroundPrevious studies have focused on the negative effects of continued smoking on chronic obstructive pulmonary disease (COPD). However, few studies have investigated the positive effects of long-term smoking cessation on patients suffering from acute exacerbations of COPD.MethodsThe study recruited and followed current or former smokers who had been hospitalized and diagnosed with AECOPD. An in-depth analysis of clinical and laboratory indicators was conducted.Results125 patients were covered, including 72 short-term quitters and 53 long-term quitters. The results showed that long-term smoking cessation may result in milder dyspnea and cough, a higher oxygenation index, a lower arterial partial pressure of carbon dioxide, and milder pulmonary hypertension, airflow restriction, and gas retention in patients with AECOPD. However, despite the lower treatment intensity for long-term quitters, improvement in dyspnea and an increase in oxygenation index were comparable to those achieved by short-term quitters. Furthermore, patients with mild phlegm, which accounted for 84% of all subjects, showed greater improvement in phlegm in AECOPD patients with long-term cessation of smoking.ConclusionIt was found that in patients with AECOPD who quit smoking for a long period of time, there was a reduction in symptoms, improvement in lung function, reduction in treatment intensity, and better improvement in phlegm symptoms after therapy. It is beneficial and necessary to quit smoking early, even if you smoke a small amount of cigarettes.

Effects of inhaled furosemide on dyspnea and pulmonary function in people with COPD: A literature review.

To determine whether inhaled furosemide can be effectively used in patients with chronic obstructive pulmonary disease (COPD) to improve feelings of dyspnea and improve pulmonary function values. This literature review was conducted using randomized control trials and a literature review in which the participants consisted of or included patients with COPD receiving inhaled furosemide as a potential treatment option for their dyspnea and low pulmonary function values. Searches in four databases and secondary sources using five key terms yielded 83 unduplicated articles. Ultimately, four studies, one of which was a literature review, were included which studied the short-term result of inhaled furosemide on dyspnea and pulmonary function values. All studies measured dyspnea as an outcome and three found a statistically significant improvement in patient reported symptoms. Pulmonary function values were measured in all studies which all found improvements. The effect of inhaled furosemide on the dyspnea and pulmonary function values in people with COPD remains uncertain, and questions have emerged regarding the long-term impact on these patients. While this therapy is promising for dyspnea relief and improvement of pulmonary function values in people with COPD, further consideration and additional data still need to be gathered.

Long-Term Patient-Reported Symptom Improvement and Quality of Life after Transthoracic Diaphragm Plication in Adults

INTRODUCTION: Open and robotic-assisted transthoracic approaches for diaphragm plication are accepted surgical interventions for diaphragm paralysis and eventration. However, long-term patient-reported symptom improvement and quality of life (QOL) remains unclear. METHODS: A telephone-based survey was developed focusing on postoperative symptom improvement and QOL. Patients who underwent open or robotic-assisted transthoracic diaphragm plication (2008−2020) across three institutions were invited to participate. A telephone survey was conducted with patients who responded and provided consent. Likert responses on symptom severity were dichotomized and rates before and after surgery were compared using McNemar’s test. RESULTS: 41% of patients participated (43/105, mean age 61.0 years, 67.4% male, 37.2% robotic-assisted surgery), with an average time between surgery and survey of 4.1 ± 3.2 years. Patients reported significant improvement in dyspnea while lying flat (67.4% preop vs 27.9% postop, p < 0.001), dyspnea at rest (55.8% preop vs 11.6% postop, p < 0.001), dyspnea with activity (90.7% preop vs 55.8% postop, p < 0.001), dyspnea while bending over (79.1% preop vs 34.9% postop, p < 0.001), and fatigue (67.4% preop vs 41.9% postop, p = 0.008). Chronic cough did not improve (Figure). 86% of patients reported improved overall QOL, 79% had increased exercise capacity, and 86% would recommend surgery to a friend with a similar problem. Analysis comparing open and robotic-assisted approaches found no statistically significant differences in symptom improvement or QOL responses between the groups.FigureCONCLUSION: Patients report significantly improved dyspneic and fatigue symptoms following transthoracic diaphragm plication, regardless of open or robotic-assisted approach. A high number of patients report improved QOL and exercise capacity.

Challenges in pulmonary rehabilitation: COVID-19 and beyond.

Pulmonary rehabilitation is a comprehensive multidisciplinary intervention requiring a team involving an expert chest physician, an exercise training specialist, a nutritional expert, a psychologist, a social worker, and an occupational therapist, who together aim at improving respiratory functional capacity in patients with chronic obstructive pulmonary disease (COPD). We aimed at evaluating the effectiveness of pulmonary rehabilitation in a large number of trials, systematic reviews, and meta‑analyses in pre-COVID-19 conditions, and the impact of pulmonary rehabilitation during the COVID‑19 pandemic was estimated based on results of abundant available studies. As many as 34 studies were selected to assess the global results of pulmonary rehabilitation in COPD patients before the pandemic, and 40 studies were selected from the literature concerning pulmonary rehabilitation during the COVID‑19 pandemic.A large number of systematic reviews and meta‑analyses reported on the efficacy of rehabilitation in COPD patients, based on the improvement in inspiratory muscle strength, exercise capacity, dyspnea, and quality of life. The response to rehabilitation in patients with COVID‑19 is also satisfactory. The effectiveness of pulmonary rehabilitation in COPD patients shows an evolving need for health care professionals to design an individually tailored pulmonary rehabilitation program for patients with COVID-19 to alleviate the chronic symptoms and reduce complications.

EFFICACY OF PIRFENIDONE ON DYSPNEA IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS (IPF): RESULTS FROM A POST HOC RESPONDER ANALYSIS

EFFICACY OF PIRFENIDONE ON DYSPNEA IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS (IPF): RESULTS FROM A POST HOC RESPONDER ANALYSIS

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

A CASE OF PULMONARY HYPERTENSION AS A POSSIBLE EXTRACRANIAL MANIFESTATION OF MOYAMOYA DISEASE

A CASE OF PULMONARY HYPERTENSION AS A POSSIBLE EXTRACRANIAL MANIFESTATION OF MOYAMOYA DISEASE