Perception Of Dyspnea Research Articles

Impact of pulmonary rehabilitation training on Chronic Obstructive Pulmonary Disease (COPD) and asthma patients

The objective of this study is to assess the impact of pulmonary rehabilitation training in the management of asthma and chronic obstructive pulmonary disease patients. A 6-month prospective interventional study was conducted in a tertiary care hospital that included participants above 18 to less than 70 years of age admitted to the general medicine ward with the diagnosis of mild-moderate chronic obstructive pulmonary disease and asthma without any other comorbidity or concurrent illness. The rehabilitation procedure consisted of breathing exercises and endurance training. Parameters like FEV1, FVC, modified medical research council scale, modified BORG grade, 6-minute walk test, and questionnaire like SF-36 were measured and compared with post-training results. A total of 80 patients were enrolled in the study. The pre and post-rehabilitation comparison in both COPD and asthma patients showed significant results in terms of improved dyspnea (FEV1, FVC, FEV1/FVC ratio; p=0.001) evident with modified Medical Research Council scores and modified BORG grades followed by significant differences in distance covered during 6-minute walk test (p=0.001) and health-related quality of life (SF-36 scores; p=0.001). Conclusion: Pulmonary rehabilitation significantly improved exercise tolerance, perception of dyspnea, health-related quality of life, and psychosocial behavior. Inclusion of pulmonary rehabilitation in COPD and asthma patients is essential to palliate the disease burden, reduce the rate of hospitalizations and improves the quality of life of a patients.

Perceived exertion and dyspnea while cycling during a hypoxic and hyperoxic placebo.

Rating of perceived exertion (RPE) is used to subjectively quantify the perception of physical activity, breathlessness or dyspnea, and leg discomfort (RPElegs) during exercise. However, it is unknown how dyspnea or RPElegs can be influenced by expectations. Thirty healthy, active participants (19males, 11females) completed five, 5-minute submaximal cycling trials at 60% peak work rate. We deceived participants by telling them they were inspiring different hypoxic and hyperoxic gases, when in fact they breathed room air. Cardiorespiratory variables were similar between the trials, however, dyspnea and RPElegs evaluated with a Borg scale changed in a dose-response manner. When participants believed they were breathing 15% O2, they significantly increased dyspnea+0.70±0.2 units (p=0.03) compared to room air, whereas RPElegs was unchanged+0.35±0.1 units (p=0.70). When participants believed they were breathing 15% O2, they significantly increased dyspnea+1.05 ± 0.4 units (p=0.003) compared to 23% hyperoxic condition, whereas RPElegs was unchanged+0.35±0.1 units (p=0.70). We found that dyspnea during exercise is susceptible to expectancy, without any accompanying physiological changes. Given coaches and clinicians use perceived exertion to prescribe exercise intensity and evaluate treatments, our findings show that the effect of expectations must be considered when interpreting sensations of breathlessness.

Factors affecting the success of pulmonary rehabilitation in asthma

Objective The majority of patients with asthma limit their physical activity due to the fear of exercise dyspnea. Regular exercise, on the other hand, is currently suggested as one of the non-pharmaceutical treatment alternatives for patients with asthma since it improves their quality of life and symptom control. This study aimed to investigate the indicators of success in patients with asthma receiving pulmonary rehabilitation (PR). Methods A total of 131 patients with the diagnosis of asthma were included in the study. All patients attended an 8-week comprehensive, multidisciplinary, outpatient and individualized PR program. Results The factors related to the gains in dyspnea perception, exercise capacity, peripheral muscle strength, respiratory muscle strength and quality of life were evaluated. In the multivariate linear regression analysis, the gain in dyspnea perception is related to baseline dyspnea. The gain in exercise capacity is related to baseline exercise capacity and the amount of smoking. The gain in peripheral muscle strength is related to gender. The gain in respiratory muscle strength is related to age, and finally the gain in quality of life is related to baseline dyspnea and anxiety levels. Conclusions Especially men, young people, heavy smokers, and those with low initial exercise capacity, high perception of dyspnea, and high anxiety are more likely to benefit from PR.

Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study

Background/Aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic. Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March–12 June 2020 and 2 November 2020–9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge. Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 ± 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH2O, and the maximal expiratory pressure was 59.1 cmH2O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH2O; and maximal expiratory pressure by 9.5 cmH2O. Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting.

Consistency Evaluation of Two Loading Devices in Measuring the Perception of Dyspnea.

PurposeThis study aimed to assess the consistency of hand-held electronic incremental threshold loading device (I-TLD) and traditional constant threshold loading device (C-TLD) in measuring the perception of dyspnea (POD) in humans.Patients and methodsThirty-eight patients with stable chronic obstructive pulmonary disease (COPD) and 41 non-COPD subjects were recruited for the study, all of whom were subjected to an external loading breathing test by gradually increasing the inspiratory load starting from 0 to 5, 10, 20, and 30 cmH2O oral pressure using I-TLD and C-TLD. The Borg score measurement was performed immediately after the loading breath of each level. The linear regression slope a of Borg scores vs percentage of oral pressure from the patients’ maximum represented patients’ POD. The consistency of POD measured by the two devices was analyzed by two Related Samples Wilcoxon test, Spearman correlation analysis, and Bland-Altman analysis.ResultsThere was no significant difference in slope a measured by the two devices in all subjects. The Spearman correlation analysis revealed that the slope a measured by the two devices in the inspiratory loading breath test had a significant correlation: in COPD patients, r = 0.678, (p < 0.001) and in non-COPD subjects, r = 0.603, (p < 0.001). For the results of the Bland-Altman analysis of the whole subjects, 3.8% (3/79) points were outside of the 95% LoA confidence interval (CI) (−10.380, 9.457), and the LoA CI was acceptable, which depicted that the two devices were consistent in their estimation.ConclusionI-TLD was consistent with C-TLD in measuring POD in COPD patients and non-COPD subjects. I-TLD may be used as an alternative method to replace C-TLD to measure POD in COPD patients and non-COPD subjects.

Effect of modified Total Body Recumbent Stepper training on exercise capacity and thioredoxin in COPD: a randomized clinical trial

Exercise intolerance is one of the major symptoms of chronic obstructive pulmonary disease (COPD). Exercise training can benefit COPD patients, but the underlying mechanism remains unclear. The modified Total Body Recumbent Stepper (TBRS, Nustep-T4) can benefit patients with stroke, spinal cord injury and amyotrophic lateral sclerosis. Nevertheless, the effect of TBRS training alone on pulmonary rehabilitation (PR) in COPD patients remains largely unknown. We aimed to explore the effect of TBRS training on exercise capacity and the thioredoxin system (TRXS) in COPD patients to provide a novel rehabilitation modality and new theoretical basis for PR of COPD patients. Ninety stable COPD patients were randomly divided into a control group (NC group) and a TBRS training group (TBRS group), with 45 cases in each group. Subjects in the TBRS training group were scheduled to undergo TBRS endurance training triweekly for 12 weeks under the guidance of a rehabilitation therapist. We assessed the primary outcome: exercise capacity (6-min walking distance, 6MWD); and secondary outcomes: perception of dyspnoea (mMRC, Borg), the COPD assessment test (CAT), the BODE index, pulmonary function, the number of acute exacerbations of COPD and oxidative stress (TRXS) at one-year follow-up. Compared with before the intervention and the control group, after the intervention, the TBRS training group, exhibited an increase in the 6MWD (from 366.92 ± 85.81 to 484.10 ± 71.90, 484.10 ± 71.90 vs 370.63 ± 79.87, P < 0.01), while the scores on the BORG, mMRC, BODE index, CAT, and the number of acute exacerbations of COPD were reduced, and the protein and mRNA expression levels of TRXS was significantly increased (P < 0.01). However, no differences were found in PF parameters in the comparison with before the intervention or between groups. TBRS training can effectively increase exercise capacity, while there are indications that it can alleviate COPD-related dyspnoea and reduce the number of acute exacerbations of COPD. Interestingly, long-term regular TBRS training may reduce oxidative stress associated with COPD to increase exercise capacity.

Is the repeated pulmonary rehabilitation program as effective as the first one in COPD patients?

Although it is known that the effects of pulmonary rehabilitation (PR) programs in patients with chronic obstructive pulmonary disease (COPD) decrease over time, the results of the repeat PR programs are contradictory. Our study aimed to compare the effectiveness of the initial and the repeat PR programs on functional outcomes in COPD patients.Thirty two COPD patients who completed a second PR program were included in our retrospective cohort study. Eight-week PR program was applied to the patients twice with at least a one-year interval in between. mMRC Dyspnea Scale, Six-Minute Walk Test, Hospital Anxiety and Depression Scale, 36 Item Short Form Survey (SF-36), and St. George's Respiratory Questionnaire (SGRQ) were performed before and after both programs. The gains from the initial and the repeated programs were compared.Six-minute walk distance, dyspnea, and quality of life improved following both programs (p<0.05). Improvements in six-minute walk distance (p= 0.009), dyspnea (p= 0.003), and SGRQ quality of life (p= 0.037 for activity score, p= 0.050 for total score) were found to be significantly higher in the initial PR program.Although many of the gains obtained from the repeated PR programs were similar to the initial PR program, the improvements in walk distance, perception of dyspnea, and quality of life obtained in the initial PR program were higher compared to the repeated PR program.

Increased airway resistance can be related to the decrease in the functional capacity in obese women.

Background and objectiveObesity can increase the airways resistance, mainly in the periphery, leading to dyspnea perception that can impair the functional capacity. This study aimed to analyze if airways resistance could be related to the walking capacity of women with morbid obesity.MethodsThirty-seven women with grade III obesity in preoperative bariatric surgery were evaluated using the spirometry test, impulse oscillometry system (IOS), and six-minute walk test (6MWT). Additionally, data about their daily dyspnea perception and physical activity level were collected.ResultsVariables of the spirometry test did not detect ventilator disorders. Compared to the predicted values, the IOS identified significant increase in airways resistance (kPa/L/s) (R5: 0.36 (0.34; 0.36) and 0.53 (0.47; 0.61); R20: 0.30 (0.28; 0.30) and 0.41 (0.35; 0.45); R5-20: 0.06 (0.06; 0.06) and 0.14 (0.10; 0.15); X5: -0.03 (-0.04; -0.01) and -0.20 (-0.27; -0.18), respectively). The distance walked in the 6MWT, 491.4±60.4m was significantly correlated to R5 (rho = -0.41, p = 0.01), R5-20 (rho = -0.52, p = 0.001), and X5 (rho = 0.54, p = 0.0006).ConclusionThe IOS is able to identify changes in airway resistance even before the onset of symptoms. When evaluated by IOS women with severe obesity and normal spirometry exhibited central and peripheral airways obstruction. The correlations between the IOS and six-minute walk distance suggest that increased peripheral airways resistance could be related to worsening functional capacity.

Changes in Respiratory Function in Asthma Patients using Respiratory Inspiration Muscle Exercise: Literature Review

Asthma is characterized by narrowing and inflammation of the bronchi, with symptoms of dyspnea, fatigue, and limited activity. This study aims to explain the effect of respiratory inspiratory muscle training on changes in respiratory function based on the results of previous studies. This study was compiled based on a literature review that came from the databases: PubMed, springer link, and google scholar which were selected based on the inclusion criteria that have been set. From 272 articles found, only 6 articles deserve to be reviewed. The results of the review stated that respiratory inspiratory muscle exercise had an effect on changes in respiratory function in asthmatic patients with a very significant significance value. Changes provided by inspiratory muscle training are related to respiratory muscle strengthening which reduces respiratory stimulus and ventilation requirements for a given workload, contributing to more efficient breathing patterns and decreased perception of dyspnea. Inspiratory respiratory muscle exercise, either done alone or in combination with other respiratory rehabilitation programs, can increase the strength of the respiratory muscles so as to have an improved impact on the respiratory function of children with asthma from children to adults.

INFLUENCE OF THE SURGICAL MASK ON THE PERCEPTION OF EFFORT AND SOME PHYSIOLOGICAL PARAMETERS IN THE PERFORMANCE OF AN INCREMENTAL TEST

TYPE: Late Breaking Abstract TOPIC: Pulmonary Rehabilitation PURPOSE: To compare the influence of the surgical mask on the perception of effort and some physiological parameters during an incremental test in healthy subjects. METHODS: Case series with 5 healthy subjects. An incremental exercise test was executed with Bruce protocol, divided into two phases, the first execution in a conventional manner and a second using a surgical mask. Vital signs, perception of exertion and dyspnea with the Borg Scale were measured at the beginning and at the end of each test. At the end of each test, blood gasses, distance walked in the stress test and METS achieved were registered. Data analysis with descriptive statistics: ranges and measures of central tendency. RESULTS: 3 men and 2 women, aged between 19 and 22 years (p50:20), BMI between 20.6 and 26.4 (p50:23.4). With the use of a mask, systolic blood pressure, respiratory rate, and perceived exertion increase while peripheral oxygen saturation decreases. In 4 participants, decrease in the distance and METS achieved. Metabolic acidosis was observed, associated with hyperlactatemia and an increase in PaCO2 in 3 participants. PaO2 decreased in all participants during the test without a mask. CONCLUSIONS: Apparently the use of a surgical mask during exercise increases the perception of effort and decreases the distance walked in an incremental aerobic test. Likewise, a decrease in PaO2 compared to the test without a mask. CLINICAL IMPLICATIONS: These findings on physiological variables and the perception of effort in healthy subjects should be considered for the prescription of exercise in pulmonary rehabilitation programs. DISCLOSURE: No significant relationships. KEYWORD: surgical mask, prescription of exercise

Constant-Load Exercise Versus High-Intensity Interval Training on Aerobic Fitness in Moderate-to-Severe Asthma: A Randomized Controlled Trial

The effects of high-intensity interval training (HIIT) on dyspnea and aerobic fitness in adults with asthma are poorly understood. To compare constant-load exercise (CLE) versus HIIT for improvements in dyspnea symptoms and clinical control in adults with moderate-to-severe asthma. Participants were randomized into 2 groups: CLE (n= 27; started with 70% of maximal watts [Wmax] obtained during cardiopulmonary exercise testing [CPET]) and HIIT (n= 28; started with 80% and increased until 140% Wmax). Exercise training lasted 12 weeks (twice/week, 40 minutes/session on a cycle ergometer), and the intensity was based on CPET. Clinical asthma control (Asthma Control Questionnaire), aerobic fitness (the peak of oxygen uptake), health-related quality of life (Asthma Quality of Life Questionnaire), physical activity levels (PAL; accelerometer), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), and dyspnea were evaluated before and after the intervention. Systemic and airway inflammation were also assessed. Two-way analysis of variance and χ2 tests were used for comparisons. Sixteen participants dropped out during the interventions and returned for the final evaluations. The CLE and HIIT groups showed similar improvements in aerobic fitness. The HIIT group had lower dyspnea and fatigue perception scores and higher PAL than the CLE group (P < .05) and clinical improvements in the psychosocial distress. In addition, only the HIIT group achieved a minimal clinically important difference in asthma symptoms. There was no change in the systemic and airway inflammation (P > .05). Both interventions promoted similar improvements in aerobic fitness; however, HIIT induced a greater reduction in dyspnea and fatigue perception. Similar responses were observed for other variables.

Exercise Physiology at “Conversational Level” Is Not Impaired in Healthy Young Subjects Wearing Masks or Respirators

Objective: The aim of this study was to evaluate the effects of the use of both surgical masks and FFP2 respirators on the inspiratory muscle strength, metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception, before and during 30 min stable load exercise at “conversational level”. Methods: A randomized cross-over study was carried out. Nineteen healthy adults completed 3 conditions (without a mask, with a surgical mask or an FFP2 respirator) during a 30-min steady-state test at the lactate threshold intensity. Inspiratory muscle strength was measured before and after the test, and metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception were collected at baseline, during, and after the test. Results: There was a significant reduction in inspiratory muscle strength after the 30-min test in all conditions (control: 6.26 mm Hg, p < 0.5; surgical mask: 8.55 mm Hg, p < 0.01; FFP2 respirator: 12.42 mm Hg, p < 0.001), but without significant differences between them (p = 0.283). Data showed a statistically significant effect for time, but did not show a statistically significant interaction between condition and time for heart rate (p = 0.674), oxygen saturation (p = 0.297), blood lactate level (p = 0.991), rating perceived exertion (p = 0.734) and dyspnea (p = 0.532) comparisons. Conclusions: The present study findings suggested that inspiratory muscle strength and physiological parameters during “conversational level” exercise were not impaired under wearing masks in healthy, nonsmoking young adults.

Contribution of Peripheral Chemoreceptors to Exercise Intolerance in Heart Failure.

Peripheral chemoreceptors (PChRs), because of their strategic localization at the bifurcation of the common carotid artery and along the aortic arch, play an important protective role against hypoxia. Stimulation of PChRs evokes hyperventilation and hypertension to maintain adequate oxygenation of critical organs. A relationship between increased sensitivity of PChRs (hyperreflexia) and exercise intolerance (ExIn) in patients with heart failure (HF) has been previously reported. Moreover, some studies employing an acute blockade of PChRs (e.g., using oxygen or opioids) demonstrated improvement in exercise capacity, suggesting that hypertonicity is also involved in the development of ExIn in HF. Nonetheless, the precise mechanisms linking dysfunctional PChRs to ExIn remain unclear. From the clinical perspective, there are two main factors limiting exercise capacity in HF patients: subjective perception of dyspnoea and muscle fatigue. Both have many determinants that might be influenced by abnormal signalling from PChRs, including: exertional hyperventilation, oscillatory ventilation, ergoreceptor oversensitivity, and augmented sympathetic tone. The latter results in reduced muscle perfusion and altered muscle structure. In this review, we intend to present the milieu of abnormalities tied to malfunctioning PChRs and discuss their role in the complex relationships leading, ultimately, to ExIn.

Outcomes of pulmonary rehabilitation after lung resection in patients with lung cancer.

Background In this study, we aimed to examine the effectiveness of pulmonary rehabilitation applied after resection in patients with lung cancer. Methods Between October 2017 and December 2019, a total of 66 patients (53 males, 13 females; median age: 65 years; range, 58 to 70 years) who underwent lung resection for non-small cell lung cancer and who were not administered any chemotherapy or radiotherapy regimen were included in the study. An eight-week comprehensive outpatient pulmonary rehabilitation program was applied to half of the patients, while the other half received respiratory exercise training. After the intervention, the results of both groups were compared. Results In the pulmonary rehabilitation group, forced vital capacity value (p=0.011), six-minute walking distance (p<0.001), and Short Form-36 physical function, mental health, vitality scores increased significantly, while all scores of St. George's Respiratory Questionnaire, dyspnea (p<0.001) and anxiety score (p=0.041) significantly decreased. In the group given breathing exercise training, only dyspnea (p=0.046) and St. George's Respiratory Questionnaire symptom scores (p=0.038) were decreased. When the changes in the groups after pulmonary rehabilitation were compared, the decrease in dyspnea perception was significantly higher in the pulmonary rehabilitation group (p<0.001). Conclusion Pulmonary rehabilitation program applied after lung resection in patients with non-small cell lung cancer reduces dyspnea and psychological symptoms, increases exercise capacity, and improves quality of life. It should be ensured that patients with lung cancer who have undergone lung resection are directed to the pulmonary rehabilitation program and benefit from this program.

The Comparison of the Effectiveness of Respiratory Physiotherapy Plus Myofascial Release Therapy Versus Respiratory Physiotherapy Alone on Cardiorespiratory Parameters in Patients With COVID-19.

BackgroundRespiratory involvement is a common consequence of COVID-19; changes in cardiorespiratory parameters of these patients during respiratory rehabilitation program are very important. Previous studies showed that myofascial release therapy (MFRT) could affect the respiratory muscle and adjunct fascia.PurposeThe aim of this study was to evaluate the effects of MFRT techniques and respiratory physiotherapy, in comparison with respiratory physiotherapy alone, on improving cardiorespiratory parameter in patients with COVID-19.SettingA hospital affiliated to Tehran University of Medical Sciences in Tehran, Iran, from February to July 2021.ParticipantsFifty patients with COVID-19 participated in this study.Research DesignA single-blind, randomized control design.InterventionThe patients with COVID-19 randomly assigned to an intervention group who received respiratory physiotherapy combined with MFRT or a control group receiving respiratory physiotherapy alone.Main Outcome Measure(s)Heart rate, systolic and diastolic blood pressure, respiration rate, oxygen saturation, chest expansion, and ease of breathing were assessed at baseline and after the first and third session of treatment. Dyspnea and fatigue perception and 6-minute walking were assessed at baseline and at the end of treatment. Patient’s thoughts about the treatment were examined through the 4-point Likert scale.ResultsThe ANOVAs found significant time effect for ease of breathing, dyspnea perception (F = 32.33, p < .01 and F = 11.72, p < .01, respectively). Also significant time by group interaction was found for chest expansion at xiphoid level (F = 4.02, p = .02).ConclusionsThe present study provided evidence that both programs could result in improving ease of breathing and dyspnea perception, although the inclusion of MFR techniques into a respiratory physiotherapy program did not result in better outcomes in cardiorespiratory function of patients with COVID-19.

Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea.

Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.

Evaluation of the change in pain, dyspnea perception, and pulmonary function values with pain tape application in patients undergoing thoracotomy

Evaluation of the change in pain, dyspnea perception, and pulmonary function values with pain tape application in patients undergoing thoracotomy

The effect of comprehensive multidisciplinary pulmonary rehabilitation on 5-year survival in COPD: does maintaining a home exercise program improve survival?

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common causes of death worldwide. Therefore, optimizing medical therapy in the comprehensive management of the disease, as well as including pulmonary rehabilitation (PR) in the treatment, is essential. The goal of our study was to determine the impact of PR on the survival of COPD patients. Between 2007-2015, 509 COPD patients who completed the PR constituted the PR group, while 167 patients who applied but could not complete it after the initial evaluations formed the control group. In the PR group, dyspnea perception, exercise capacity, muscle strength, body composition, quality of life, psychosocial status, and i-BODE scores were assessed at the beginning and end of the program, whereas in the control group, these assessments could only be conducted at the beginning. Also, after PR, our PR participants have prescribed a home exercise program, and they were recalled to the hospital at the 3rd, 6th, 12th, 18th, and 24th months for follow-up visits. A statistically significant improvement was found in almost all the data (except FEV1/FVC, BORG after exercise, and FFMI) after PR. There was a statistically significant difference in 5-year survival in favor of the PR group (p = 0.006), and in PR patients who accompanied the home exercise program vs. those who did not (p = 0.000). Also the gains in MRC (p = 0.003; OR: 2.20; CI: 1.319- 3.682), MEP (p = 0.041; OR: 1.02; CI: 1.001-1.035), and i-BODE (p = 0.006; OR: 0.914; CI: 0.857-0.974) increased the survival. Apart from incorporating PR into treatment in the comprehensive management of COPD, we demonstrated that maintaining a home exercise program for at least two years following PR increased 5-year survival significantly.

Relationship between thoracic kyphosis angle, dyspnea perception, and disease-specific health status in patients with COPD

Purpose: This study was carried out to examine the relationship between thoracic kyphosis angle, dyspnea perception, and disease-specific health status in patients with COPD and thus to reveal the postural effect.Methods: A total of 105 patients (68.10±8.59 years, FEV1:47.59±21.50%) diagnosed with COPD were included in the study. The thoracic kyphosis angle was evaluated using the Spinal Mouse® device and the dyspnea perception with the Modified Medical Research Council (MMRC) Dyspnea Scale. For the disease-specific health status, the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) were used. The patients were separated into three groups according to the thoracic kyphosis angle as Group 1: 20°-50°, Group 2: 51°-60°, and Group 3: 61°-90° and groups were compared.Results: While a significant positive relationship at a low level was observed between the thoracic kyphosis angle and the dyspnea perception (rho=0.23, p=0.02), no relationship was determined with the disease-specific health status (rho&amp;lt;0.20, p&amp;gt;0.05). CAT and CCQ scores were similar between groups (p&amp;gt;0.05). In group 3 with thoracic kyphosis angle&amp;gt;60°, the dyspnea perception was significantly higher (p=0.03).Conclusion: As the thoracic kyphosis angle increase in patients with COPD, the dyspnea perception increases, but the disease-specific health status remains stable. The postures of patients with COPD should be evaluated in detail in physiotherapy and rehabilitation practices due to increased dyspnea caused by thoracic kyphosis. Also, preventive measures such as exercise and ergonomic arrangements should be taken for thoracic kyphosis in the early period.

Cardiovascular Risk in Patients with COPD: Cardiovascular Comorbidities in Patients with COPD Increase CAT and mMRC Dyspnea Scores

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a number of different comorbidities. Cardiovascular diseases (CVD) are the most frequent comorbidities in COPD. The economic burden associated with cardiovascular comorbidity (CVC) in this population of patients is considerable. The COPD patients are related to the increased systemic inflammation, reduced capacity for physical activity, and airflow obstruction. AIM: The aim of our investigation was to evaluate the dyspnea as a disabling symptom in COPD patients with cardiovascular comorbidity (CVC) especially heart failure. The main aim of this study is to evaluate its intensity in patients with COPD in stages II according to GOLD. METHODS: The investigation was conducted from December 2019 to January 2020, on pulmonology and allergology clinic and cardiology clinic of medical faculty in Skopje. We investigated 65 outpatients with COPD, 44 with different type of CVD, Group I, and 21 without CVD, Group II. All patients were with partial chronic respiratory failure (In type 1 respiratory failure hypoxemic). Patients, according GOLD initiative, were in COPD stadium II, 70% &lt; forced expiratory volume in 1 s (FEV1)&gt;50%. Heart condition was diagnosed on the basis of clinical examination, electrocardiography, and echocardiography of the heart. Included patients with CVD were with ejection fraction (EF) &lt;65%. Dyspnea was measured with modified MRC (mMRC) dyspnea scale. RESULTS: The forced vital capacity and forced expiratory volume in 1 s were statically significantly higher in Group II with CVD. Dyspnea measured with Modified Medical Research Council (MRC) dyspnea scale showed statistically significantly higher values in Group I COPD patients with CVC (2.9 ± 1.4) versus Group II without CVC (1.7 ± 1.4), (p &lt; 0.05). The perception of the higher dyspnea in Group I was associated with increased COPD assessment test-scores, in Group I: Group I (19.8 ± 9.1) versus Group II: (9.8 ± 9.1), (p &lt; 0.001). The number of exacerbations and what is more important the number of severe exacerbation leading to hospitalizations was statistically higher in patients of Group I with CVC than in Group II without CVC (3.0 ± 1.1 vs. 1.0 ± 2.1), (p &lt; 0.001) and the number of hospitalizations (1.0 ± 1.1 vs. 0.3 ± 2.1) (p &lt; 0.001). CONCLUSION: We can conclude that patients with COPD who have CVC have an increased risk of high symptoms, which mean poor quality of life and increased morbidity.