Severity Of Dyspnea Research Articles

Differences in clinical characteristics, angina, and quality of life among patients with microvascular vs vasospastic angina and no obstructive coronary artery disease (ANOCA)

Abstract Background In patients with angina and no obstructive coronary disease (ANOCA), the underlying pathophysiology includes microvascular angina (endothelial-dependent and independent coronary microvascular dysfunction (CMD)) and vasospastic angina (microvascular spasm and epicardial spasm) diagnosed with invasive coronary functional angiography (CFA). However, whether there are differences in demographics, clinical characteristics, and outcomes by underlying diagnosis is unknown. We hypothesize that microvascular angina patients will be older and have more cardiovascular risk factors and worse outcomes than the vasospastic angina group. Objective To explore the differences in demographics, risk factors, and outcomes in ANOCA patients with microvascular and vasospastic angina. Methods A prospective registry-based cohort study of consecutive CFA was performed in 156 ANOCA patients between 2020 and 2023 using the Doppler-tipped guide wire method. Patients were classified into microvascular angina, vasospastic angina, and mixed disease. Microvascular angina was defined as endothelial-independent CMD (coronary flow reserve [CFR] < 2.5 in response to adenosine) and/or endothelial-independent CMD (coronary blood flow [CBF] < 50% or no change in vessel diameter in response to 54 mcg intracoronary acetylcholine). Vasospastic angina as microvascular (<90% constriction) and epicardial spasm (>90% constriction) to 108 mcg intracoronary acetylcholine. The mixed disease group included microvascular and vasospastic angina. Validated questionnaires evaluated angina (SAQ-7), functional capacity (DASI), dyspnea severity (UCSD SOB), and perceived stress (PSS) were obtained from patients at office visits prior to undergoing CFA. Results Among 156 ANOCA patients, 114 had microvascular angina, 10 had vasospastic angina, and 32 had mixed disease. The average age was 58.5 (SD 11.2) years. Demographics and prevalence of risk factors, such as hypertension, hyperlipidemia, or diabetes, showed no significant differences among the microvascular, vasospastic, or mixed disease groups. The prevalence of heart failure with preserved ejection fraction (HFpEF) was high across the groups, and outcomes did not differ significantly among them. The SAQ-7 score average ranged from 16.9 to 40.3, consistent with moderate to severe angina, and the DASI score ranged from 32.2 to 34.9, consistent with moderate functional capacity. Dyspnea severity ranged from 30 to 41, consistent with low to moderate severity, and perceived stress ranged from 11.5 to 13, consistent with low to moderate stress among all participants. Conclusion In patients with ANOCA undergoing invasive CFA, demographics, cardiovascular risk factors, and outcomes were similar regardless of underlying diagnosis. We demonstrate a high prevalence of risk factors and HFpEF and evidence of moderate to severe symptoms and functional capacity in ANOCA patients across all diagnoses.Abbreviation explanation for table 1

Investigation of immunosuppressive treatment compliance, dyspnea, anxiety, and depression levels in lung transplant recipients: online interview

IntroductionFollowing lung transplantation (LTx), it is important for recipients to comply with immunosuppressive treatment and cope with related problems. In the post-LTx period, the course of dyspnea and psychological problems it causes in case of progression are not known. Depression and anxiety may develop in recipients after LTx. However, the relationship between this situation and treatment compliance and dyspnea is uncertain.ObjectiveThe aim of this study was to investigate dyspnea, anxiety, and depression levels of recipients following LTx and their immunosuppressive treatment compliance.MethodThe study was planned as a descriptive, correlational, and cross-sectional study. Data were collected on various social media platforms via an online interview, and 65 LTx recipients were included in the sample (n = 65). A Participant Information Form, the Modified Borg Scale, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Immunosuppressive Drug Compliance Scale were employed to collect data. The collected data were analyzed using descriptive statistics, the Mann–Whitney U test, and the Kruskal-Wallis test.ResultsThe mean age of the participants was found to be 52.60 ± 9.44 years, and 56.9% were male. Forty percent of the participants were dependent on oxygen support, and 32.2% had hypertension. Their dyspnea levels were mild, anxiety levels were moderate, depression levels were high, and immunosuppressive treatment compliance levels were slightly above-average. According to the correlation analysis results, dyspnea was associated with anxiety and depression (p < 0.05). As depression increased, immunosuppressive treatment compliance decreased, and the correlation between the two variables was statistically significant (p < 0.05).ConclusionIn this study, as the severity of dyspnea experienced by LTRs increased, the severity of their anxiety and depression also increased. Additionally, there was an inverse correlation between depression and immunosuppressive treatment compliance. LTRs demonstrated insufficient adherence to their immunosuppressive drug regimens, which is very significant in terms of graft survivability. These results suggest that LTRs should be closely monitored at home.

One-year trajectories of physical and mental health-related quality of life, fatigue and dyspnoea in COVID-19 survivors.

A substantial number of people experience a persisting impact on health-related quality of life (HRQoL) after COVID-19. The current study aims to identify different trajectories of physical and mental HRQoL, fatigue severity, and dyspnoea severity following hospitalisation with COVID-19, and associated factors of these trajectories. 500 patients with COVID-19 were followed for one year in a longitudinal cohort study. Self-reported outcomes were measured at 3, 6, 9, and 12 months after hospitalisation. Distinct trajectories were characterised using Growth Mixture Modelling. Sociodemographic and clinical correlates of trajectories were investigated using multivariable (multinomial) logistic regression analyses. Three trajectories ('stable high' (16%), 'improving' (40%), and 'stable low' (44%)) were found for physical HRQoL, and four ('stable high' (43%), 'improving' (14%), 'middle declining' (17%), and 'low' (26%)) for mental HRQoL. Older age, overweight and obesity, lower education, and comorbidities were associated with 'low' physical HRQoL. Younger age was associated with 'low' mental HRQoL. Four fatigue trajectories ('no fatigue' (15%), 'improving' (40%), 'low-severe' (27%), and 'high-severe' (18%)) were found. Participants either experienced almost never ('no dyspnoea', 75%) or almost always ('severe', 25%) dyspnoea. High co-occurrences between low HRQoL and severe fatigue and dyspnoea symptom trajectories were found. A substantial number of COVID-19 survivors continue to struggle with reduced HRQoL over time. However, large variations in these physical and mental HRQoL trajectories exist, and trajectories are associated with persisting COVID-19-related symptoms or pre-hospitalised health status. Regular measurement of HRQoL and post-COVID symptoms may help identify those that may benefit from timely interventions.

Dyspnea, respiratory muscle strength, cough capacity, and sleep quality in individuals with substance use disorder

There is evidence that substance use and smoking cause some adverse effects on the respiratory system. The aim of this study was to assess dyspnea severity, respiratory muscle strength, cough capacity, and sleep quality in people with substance use disorder (SUD). Forty eight individuals with SUD and 28 active cigarette smokers participated in the study. Participants’ dyspnea severity was assessed using the Modified Medical Research Council Scale, respiratory muscle strength was measured with a portable electronic mouth pressure device, peak cough flow was assessed with a Peak Flow Meter, and sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI). The amount of daily cigarette smoking and dyspnea severity were significantly higher in individuals with SUD (p < .001). Peak cough flow values, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), MIP (%predicted), and MEP (%predicted) were not significantly different between the SUD patients and the active cigarette smokers (p > .05). However, PSQI sub-parameters such as subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleeping medication, and total scores showed significant differences between the SUD patients and the active cigarette smokers (p < .05, p < .001, p = .03, p < .001, p < .001, respectively). Individuals with SUD were found to have higher dyspnea and poorer sleep quality than active smokers. However, respiratory muscle strength and cough capacities were similar.

Comorbid Diabetes Is Associated with Dyspnea Severity and Cardiometabolic Biomarkers in Black Adults with Heart Failure.

Comorbidities such as type 2 diabetes mellitus significantly and adversely influence heart failure outcomes, especially in Black adult populations. Likewise, heart failure has a negative effect on diabetes and cardiometabolic outcomes. Dyspnea, a common symptom of heart failure, often correlates with disease severity and prognosis. However, the relationship between comorbid diabetes, dyspnea severity, and cardiometabolic biomarkers in Black adults with heart failure remains understudied. The purpose of this pilot study was to examine differences in the distressing heart failure symptom of dyspnea and in cardiometabolic and inflammatory biomarkers in Black adults living with heart failure with and without diabetes. Black adults with heart failure were enrolled in this cross-sectional pilot study. Cardiometabolic and inflammatory biomarkers were measured via multiplex immunoassay. Univariate general liner models were used to identify group differences between persons with heart failure with comorbid diabetes and those without, controlling for age, sex, and comorbid burden. Participants were mostly female with a mean age of 55 years and mean left ventricular ejection fraction of 33%. Participants with diabetes exhibited higher dyspnea scores compared to those without diabetes, indicating greater symptom burden. Moreover, individuals with comorbid diabetes demonstrated higher levels of cardiometabolic and inflammatory markers. Comorbid diabetes was associated with higher dyspnea severity and adverse cardiometabolic profiles in Black adults with heart failure. These findings underscore the importance of targeted interventions addressing diabetes management and cardiometabolic risk factors to improve symptom control and outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and develop tailored therapeutic strategies for managing comorbidities in persons with heart failure, particularly in minoritized communities.

Endothelial function in patients after severe or critical acute phase of COVID-19 one year after the disease onset

BACKGROUND. The SARS-CoV-2 virus not only causes respiratory diseases but also significantly impacts endothelial function, which may be one of the mechanisms for developing long-term consequences of coronavirus disease (COVID-19). OBJECTIVE. To determine the levels of endothelial function markers (endothelin-1, thrombomodulin) in the peripheral blood of individuals who experienced non-hospital pneumonia on the background of COVID-19, in the early post-acute phase and one year after the onset of the disease, and to analyze the changes in individual levels of these markers. MATERIALS AND METHODS. The main group consisted of 16 individuals (age – 57.5 (43.8; 64.5) years, 8 (50.0 %) men, 7 (50.0 %) women), who were examined twice: at visit 1 – on day 60.0 (56.3; 62.5) from the onset of the disease; at visit 2 – on day 312.5 (300.0; 365.0) from the onset of the disease. The control group consisted of 10 individuals (age – 58.5 (39.5; 67.8) years, 4 (40.0 %) men, 6 (60.0 %) women). General clinical and laboratory methods were used, as well as an assessment of lung diffusion capacity (DLсо). RESULTS. At visit 1, the clinical status of 16 (100.0 %) individuals in the main group was impaired. At visit 2, the clinical status of 12 (75.0 %) individuals normalized, while 4 (25.0 %) individuals showed improvement; the severity of dyspnea according to the mMRC scale and heart rate decreased, and SpO2 and DLсо levels increased (p&lt;0.01, p&lt;0.01, p&lt;0.01, and p=0.03, respectively). The level of endothelin-1 in the control group was 14.6 (11.7; 17.0) pg/ml, and the thrombomodulin level was 451.7 (403.9; 652.4) pg/ml. The level of endothelin-1 at visit 1 in the main group was 11.1 (6.8; 15.9) pg/ml, and at visit 2 – 14.4 (11.2; 20.0) pg/ml (p=0.02), not differing from the control group (p=0.48 and p=0.61, respectively). The level of thrombomodulin at visit 1 in the main group was 723.1 (689.1; 1012.2) pg/ml, and at visit 2 – 811.5 (713.3; 911.7) pg/ml (p=0.40), which was higher than in the control group (p=0.01 and p=0.01, respectively). CONCLUSIONS. One year after COVID-19, most individuals show normalization of clinical status and improvement in lung diffusion capacity; however, elevated thrombomodulin levels persist, which requires further investigation. In some patients, the level of endothelin-1 also increases, which is why they should be monitored not only by a family doctor or a pulmonologist but also by a cardiologist.

The effect of yoga on dyspnea, sleep, and quality of life in patients with bronchiectasis: A randomized controlled trial

Background and purposeBronchiectasis is characterized by chronic cough, acute exacerbations, and excessive sputum production, along with symptoms such as shortness of breath and fatigue, which impair respiratory functions and quality of life. This study aims to investigate the effects of yoga on dyspnea, sleep quality, and overall quality of life in patients with bronchiectasis. Materials and methodsForty-eight participants with bronchiectasis were included in the study. The patients were randomly divided into two groups, the yoga group (n = 24) or control group (no placebo or sham intervention) (n = 24). The yoga group participated in a total of 24 sessions over 8 weeks, with three sessions per week. No intervention was performed on the patients in the control group. The Modified Medical Research Council (mMRC) questionnaire was used to assess patients' dyspnea level, and the Pittsburgh Sleep Quality Index (PSQI) and St. George's Respiratory Questionnaire (SGRQ) were used to assess sleep quality and health-related quality of life, respectively. ResultsIt was observed that the yoga intervention affected the intergroup change in dyspnea severity score over time (p < 0.05) (x̄yoga = 2.64-1.50 = 1.14; x̄control2.24-1.95 = 0.29). The decrease in the mean PSQI score of the yoga practice group (16.41-13.18 = 3.23) was significantly higher compared with the control group (14.90-14.57 = 0.33). Post-practice SGRQ activity scores were significantly different from pre-practice SGRQ activity scores. Similar to the change in SGRQ activity and symptom scores, the impact score also changed significantly over time (x̄yoga12.55-9.09 = 3.46; x̄control12–11.52 = 0.48). ConclusionThe results indicate that yoga may have a positive effect on dyspnea, sleep, and quality of life in patients with bronchiectasis.

Correlation Between Health-Related Life Quality and Dyspnea Severity in Aged COVID-19 Survivors in Indonesia

Introduction: COVID-19 is a disease that can severely reduce life quality, particularly in the aged population. The research aim was to establish the correlation between health-related life quality and dyspnea severity within aged COVID-19 survivors.Method: The cross-sectional study was conducted on older COVID-19 survivors at Persahabatan Hospital, Jakarta. The use of WhatsApp® video call and Zoom® video conference applications for audio and video evaluation in data collection. The European Quality of Life-5Dimensions-5L (EQ-5D-5L) and the European Quality of Life-Visual Analog Scale (EQ-VAS) were used to assess health-related quality of life. Modified Borg and modified Medical Research Council (mMRC) dyspnea scale were used to assess dyspnea severity. The data were analyzed using correlation test. Results: Based on 44 data collected, it was found that seven (15.9%) of the participants experienced mild breathlessness, while three patients (6.8%) had severe level of dyspnea on the modified Borg dyspnea scale assessment. The mMRC dyspnea scale assessment indicated that over nine patients (20.4%) had mMRC value greater than one. The study found a significant correlation (p less than 0.01) between the EQ-5D-5L and the modified Borg Dyspnea Scale, particularly in the areas of anxiety or depression (r=0.52), self-care (r=0.51), mobility (r=0.42), and EQ-VAS (r=-0.53). The EQ-5D-5L and the mMRC dyspnea scale showed a significant correlation (p less than 0.01), particularly in relation to usual activities (r=0.69), self-care (r=0.62), and mobility (r=0.65), as well as EQ VAS (r=-0.58).Conclusion: Moderate positive correlations existed between life quality issues including self-care, anxiety, depression and dyspnea severity .

Diaphragm Muscle Atrophy Contributes to Low Physical Capacity in COVID-19 Survivors.

Fatigue and dyspnea are the most commonly reported long-term complaints in individuals previously infected with SARS-CoV-2. This study aimed to comprehensively evaluate diaphragm muscle function in post-COVID-19 patients and investigate whether potential diaphragm dysfunction contributes to physical functioning impairment. A total of 46 patients who qualified for pulmonary rehabilitation were examined. Diaphragm muscle function parameters were evaluated using ultrasonography, while the severity of dyspnea, aerobic capacity, and the amount of energy used by the body during physical activity were assessed using the six-minute walk test, mMRC scale, and Metabolic Equivalent Task (MET), respectively. We identified that 69.5% of patients had diaphragm atrophy and 6.5% had diaphragm paralysis. The percentage of atrophy was not related to age, gender, BMI, oxygen therapy usage during the COVID-19 infection course, and disease severity. Patients who experienced cough, fever, and no loss of smell during the COVID-19 course had significantly greater diaphragm inspiratory thickness values, while patients with cough and no smell disorders had a significantly lower percentage of diaphragm atrophy. Diaphragm functional parameters were strongly associated with selected variables of exercise tolerance, such as distance in the six-minute walk test, oxygen saturation levels, fatigue, and exertion on the Borg scale. In conclusion, diaphragm muscle dysfunction is a serious long-term post-COVID-19 consequence and can be viewed as a major contributing factor to prolonged functional impairments.

Avoiding Treatment in Hospital With Subcutaneous Furosemide for Worsening Heart Failure: A Pilot Study (AT HOME-HF)

BackgroundTherapies are needed to address worsening congestion, without hospitalization, in patients with chronic heart failure (HF). ObjectivesThis pilot study assessed outcomes of a novel subcutaneous (SC) furosemide formulation compared to usual care in outpatients with worsening congestion. MethodsParticipants with chronic HF and worsening congestion were randomized open-label 2:1 to SC furosemide compared to usual care (UC). Decongestion was estimated by tracking body weight. The primary endpoint was a win ratio of a 30-day hierarchical composite of cardiovascular death, HF events, and change in N-terminal pro–B-type natriuretic peptide. Secondary endpoints included dyspnea severity, functional capacity, and quality of life. ResultsThirty-four participants were randomized to SC furosemide and 17 to UC. SC furosemide caused greater reduction in body weight: between-group difference in least square mean change was −2.02 kg at day 3 (95% CI: −3.9 to −0.14; P = 0.035). SC furosemide-to-UC win ratio was 1.11 (95% CI: 0.48-2.50; P = 0.806). Significant between-group least square mean differences favoring SC furosemide occurred in 7-point dyspnea score (P = 0.017) and 6-minute walk test (P = 0.032), with trend in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 Overall Summary Score of 9.15 (95% CI: 1.95-20.3; P = 0.106). The most common related adverse event with SC furosemide was mild infusion site pain (11.8%). ConclusionsSC furosemide augmented weight loss in patients with HF and worsening congestion. The composite primary endpoint was not statistically significant in this pilot investigation. However, findings of improved dyspnea scores and functional capacity, with favorable trend in KCCQ-12 score, warrant additional investigation to further document the clinical value of SC furosemide as an alternative to hospitalization (AT HOME-HF [Avoiding Treatment in the Hospital With Furoscix for the Management of Congestion in Heart Failure—A Pilot Study]; NCT04593823)

Implications of Global Lung Function Initiative Spirometry Reference Equations in Northeast Asian Patients With COPD

Accurate spirometry interpretation is critical in the diagnosis and management of chronic obstructive pulmonary disease (COPD). With increasing efforts for a unified approach by the Global Lung Function Initiative (GLI), this study evaluated the application of race-specific 2012-GLI and race-neutral 2022-GLI reference equations compared to Choi's reference equations, which is derived and widely used in South Korea, for spirometry interpretation in Northeast Asian patients with COPD. What are the effects of applying race-specific 2012-GLI, race-neutral 2022-GLI, and Choi's reference equations on the diagnosis, severity grade, and clinical outcome associations of COPD STUDY DESIGN AND METHODS: Serial spirometry data from the Korea COPD Subgroup Study (KOCOSS) consisting of 3,477 patients were utilized for re-analyses using 2012-GLI, 2022-GLI, and Choi's reference equations. The COPD diagnosis and severity categorization, associations with disease manifestations and health outcomes, and longitudinal trajectories of lung function were determined. Although there was strong concordance in COPD diagnosis comparing 2012-GLI, and 2022-GLI reference equations to Choi's reference equations, a notable portion of patients were reclassified to milder disease severity (17.0% and 23.4% for 2012-GLI and 2022-GLI reference equations, respectively). Relationships between FEV1 percent-predicted values calculated using 2012-GLI, 2022-GLI, and Choi's equations with clinical outcomes including dyspnea severity, exercise capacity, health-related quality of life, and frequency of exacerbations remain consistently significant. Similar annual decline rates of FEV1 and FVC percent-predicted were observed among the reference equations used, except for slower annual decline rate of FEV1 in Choi's equation compared to 2022-GLI race-neutral equation. Application of GLI reference equations for spirometry interpretation in Northeast Asian patients with COPD has potential implications on disease severity grade for clinical management and trial participation, and maintains consistent significant relationships with key disease outcomes.

Food-derived antioxidants intake association with serum oxidative stress markers and lung infection symptoms in COVID-19 infectious angina patients

PurposeResearch indicated that dietary antioxidants could improve immune system performance. This study aims to investigate the association of COVID-19 symptoms, total antioxidant capacity and serum inflammatory markers, with dietary antioxidants intake among angina patients.Design/methodology/approachA food frequency questionnaire was used in a cross-sectional study among 135 angina patients with COVID-19, to assess dietary antioxidants consumption. Serum levels of tumor necrosis factor, interleukin 1ß, malondialdehyde, high-sensitivity C-reactive protein and total antioxidant capacity were measured by enzyme-linked immunosorbent assay methods.FindingsAmong study angina patients, 76.67% followed unhealthy food patterns and 23.33% followed anti-inflammatory dietary patterns before hospitalization. The angina patients with anti-inflammatory food pattern had less fever (p = 0.021), cough (p = 0.018), dyspnea (p = 0.024), diarrhea (p = 0.014) and pneumonia severity index (p = 0.014) compared to patients with unhealthy food pattern. The serum levels of tumor necrosis factor, interleukin 1ß, high-sensitivity C-reactive protein and malondialdehyde, had a significantly negative association with dietary antioxidants intake (p < 0.05).Originality/valueThere are significant association between antioxidant intake with serum inflammation markers in COVID-19 patients. There is a need for more clinical trial studies for approval of these results.

Momentousness of integration of the high-resolution computed tomography scoring systems with pulmonary artery systolic pressure measurement for inference of idiopathic pulmonary fibrosis severity

BackgroundThe importance of high-resolution computed tomography (HRCT) in the diagnosis of idiopathic interstitial pneumonia (IIP) is being recognized more and more. Pulmonary arterial hypertension is common in patients with idiopathic pulmonary fibrosis, the presence of PAH is linked to higher mortality rates and might explain why some people who otherwise have normal pulmonary function are displaying symptoms of deterioration. The aim of this work was to find out the potency of integration of high-resolution computed tomography (HRCT) scoring system with pulmonary artery systolic pressure (PASP) for ascertaining the disease severity of patients with idiopathic pulmonary fibrosis and to predict the prognosis for proper management, along with incorporation of the key disparity of different HRCT scoring systems for the ILD.ResultsThis prospective study included 80 patients, who came with idiopathic pulmonary fibrosis. A strong positive correlation (r = 0.989) was noted between total lung zone HRCT score and PASP, pulmonary artery size, grades of dyspnea and PCO2. Nonetheless, total lung zone HRCT score proved to have good correlation and inversely proportional to (r = − 0.71) 6MWT, PO2, SPO2, FVC and FEV1/FVC. We utilized a ROC curve to identify the optimal cutoff value in HRCT scoring systems, for detecting pulmonary hypertension associated with the IPF. The sensitivity and specificity of Warrick score cutoff value was higher compared to that of the HRCT scoring system-based grading scale. Both HRCT scoring systems attained high correlation coefficient factors with various incorporated parameters in the study.ConclusionWe can safely say that in order to reveal the severity and prognosis of idiopathic pulmonary fibrosis, a high-resolution computed tomography scoring system should be incorporated with echocardiography measurement of pulmonary artery systolic pressure —which proved to be the most potent predictive factor; especially when measured after a specific HRCT score cutoff value—followed by (FEV1/FVC), the 6MWT and the severity of dyspnea. Their integration collectively will aid in precise management and follow-up of IPF cases. Both HRCT scoring systems proved to be potent and perfect for short-term interval follow-up, yet the Warrick score was easier and faster to use and attained relatively increased sensitivity and specificity for the cutoff value of the pulmonary hypertension detection compared to the HRCT scoring system-based grading scale.

The Sisyphean breath: role of anxiety sensitivity and distress tolerance in dyspnea among adults with asthma and COPD

Introduction Asthma and COPD are among the leading causes of morbidity and mortality, impacting over 260 million people and causing over 3 million deaths globally (Momtaz-Manesh, S. et al., 2023). Pulmonary symptoms can impair tolerance and increase the negative attribution of anxiety sensations. Reciprocally, anxiety associated with dyspnea can induce hyperventilation. This perpetuates a cycle of symptom exacerbation and poor treatment adherence. Managing labored breathing is challenging due to its subjective nature. Dyspnea is a sufferer’s endless pursuit to breathe, rendering its experience as truly, “Sisyphean.” Aim This study explored the role of anxiety sensitivity and distress tolerance in dyspnea among adults with asthma and COPD (N = 107). A single-group cross-sectional research design was used. Data from pulmonologist-diagnosed adults with asthma and COPD were collected across various clinics in Delhi-NCR. Results It was found that anxiety sensitivity, distress tolerance and dyspnea were strongly correlated. Also, an increase in anxiety sensitivity was strongly predictive of dyspnea severity. Further, distress tolerance acted as a partial mediator between anxiety sensitivity and dyspnea. Conclusions Improving distress tolerance can act as an adjuvant in effective dyspnea management.

Oxygen saturation recovery after 6-minute walk test in patients with idiopathic pulmonary fibrosis

BackgroundThe six-minute walk test (6MWT) is widely used to assess functional capacity and prognosis in patients with idiopathic pulmonary fibrosis (IPF). However, studies on oxygen saturation recovery after the 6MWT in patients with IPF are rare. In our study, we investigated the relationship between oxygen saturation recovery time and dyspnea, fatigue, quality of life, prognostic markers and pulmonary hypertension (PH).MethodsIn this cross-sectional study, IPF patients diagnosed according to current guidelines and followed up in our Interstitial Lung Disease Outpatient Clinic between 2021 and 2022 were included. Demographics, data from spirometry, diffusion capacity measurement, arterial blood gas analysis, transthoracic echocardiography and the 6MWT were recorded. The oxygen saturation recovery time, distance saturation product (DSP), gender-age-physiology (GAP) index and composite physiological index (CPI) scores were calculated. Dyspnea severity was assessed by the modified Medical Research Council (mMRC) and Dyspnoea-12 (D-12) scales, fatigue severity by the Multidimensional Fatigue Inventory (MFI-20) and quality of life by the St George’s Respiratory Questionnaire (SGRQ).ResultsFifty IPF patients (34 men, 16 women, age: 66.8 ± 7.3 years) were included in the study. The mean FVC was 77.8 ± 19.3%, the DLCO was 52.9 ± 17.1%, the 6-minute walk distance (6MWD) was 385.7 ± 90.6 m, the GAP index was 3.5 ± 1.5, and the CPI was 43.7 ± 14.1. Oxygen saturation after the 6MWT reached pretest values at an average of 135.6 ± 73.5 s. The oxygen saturation recovery time was longer in patients with higher GAP index scores (Rs = 0.870, p < 0.001), CPI scores (Rs = 0.906, p < 0.001), desaturation (Rs = 0.801, p < 0.001), FVC%/DLCO% (Rs = 0.432, p = 0.002), sPAP (Rs = 0.492, p = 0.001), TRV (Rs = 0.504, p = 0.001), mMRC (Rs = 0.913, p < 0.001), MFI-20 (Rs = 0.944, p < 0.001), D-12 scale (Rs = 0.915, p < 0.001) and SGRQ scores (Rs = 0.927, p < 0.001); lower FVC (%) (Rs=-0.627, p < 0.001), DLCO (%) (Rs=-0.892, p < 0.001), PaO2 (Rs=-0.779, p < 0.001), DSP (Rs=-0.835, p < 0.001), and 6MWD (Rs=-0.763, p < 0.001). A total of twenty patients (40%) exhibited an increased risk of PH. According to our multiple regression analysis, oxygen saturation recovery time was independently associated with the GAP index (p = 0.036), the lowest oxygen saturation occurring during the 6MWT (p = 0.011) and the SGRQ score (p < 0.001).ConclusionsOur results showed that oxygen saturation recovery time is associated with dyspnea, fatigue, quality of life, increased risk of PH and prognostic markers in IPF. Therefore, we recommend continuous measurement of oxygen saturation after 6MWT until pretest values are reached.

The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications.

Current management of COPD is predominantly focused on respiratory aspects. A multidimensional assessment including nutritional assessment, quality of life and disability provides a more reliable perspective of the true complexity of COPD patients. This was a prospective observational study of 120 elderly COPD patients at high risk of acute exacerbations. The Mini Nutritional Assessment (MNA) was administered in addition to the usual respiratory assessment. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. The median MNA Short Form (SF) score was 11 (8-12), 39 participants (32.50%) had a normal nutritional status, 57 (47.5%) were at risk of malnutrition and 24 (20%) were malnourished. Our multivariate linear regression models showed that the MNA score was associated with dyspnea and respiratory symptom severity, assessed by the Modified British Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) score, with spirometric variables, in particular with the severity of airflow limitation based on the value of FEV1, and with poorer QoL, as assessed by the EQ-5D-3 questionnaire. Competing risk analysis according to nutritional status based on the MNA Total Score showed that COPD participants "at risk of malnutrition" and "malnourished" had a higher risk of moderate to severe acute exacerbations with sub-hazard ratios of 3.08 (1.40-6.80), p = 0.015, and 4.64 (1.71-12.55), p = 0.0002, respectively. Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value.

Emotion Regulation Difficulties and Smoking Behavior among Adults with Chronic Obstructive Pulmonary Diseases

COPD is one of the leading causes of death in the United States and results in increased healthcare costs and disability. Smoking is the main determinant of COPD development and continued use increases mortality as compared to those who have stopped smoking. Research has indicated that cigarette smoking may play a role in attempts to regulate distressing emotional experiences and thus, may be an important transdiagnostic process underlying continued smoking behavior among adults with COPD. The current study investigated the role of ER difficulties in relation to smoking status and cigarettes smoked per day among adults with COPD. This cross-sectional study included a sample was adults with COPD (N = 320). Participants self-reported current smoking status, daily smoking, and the Difficulties in Emotion Regulation Scale. All analyses were adjusted for age, sex, probable depression, probable anxiety, and dyspnea severity. DERS total scores were associated with greater odds of current smoking. With the exception of impulsivity, all other dimensions of emotion regulation were significantly associated with current smoking. Greater difficulties in emotional awareness were associated with greater cigarettes smoked per day. However, neither the DERS total score nor any other dimensions of emotional regulation were significantly associated with cigarettes smoked per day. The present study provides preliminary data linking ER difficulties to smoking behavior among adults with COPD. If corroborated by future research, these findings suggest that ER might be a potential target for smoking cessation programs among adults with COPD.

Association between swallowing dynamics, tongue pressure and pulmonary function in patients with idiopathic pulmonary fibrosis

BackgroundSwallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF).MethodsPatients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax).ResultsThe sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea.ConclusionPatients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.

The Role of Cardiopulmonary Exercise Testing in Assessment of Patients with Interstitial Lung Disease

Abstract Background Cardiopulmonary exercise testing (CPET) is considered as the gold standard for evaluating the causes of exercise intolerance in patients with pulmonary and cardiac disease, and is based on the principle that system failure typically occurs while the system (e.g muscle-energetic, cardiovascular or pulmonary) is under stress. Objective To evaluate the role of cardiopulmonary exercise test in assessment of patients with interstitial lung disease. Patients and Methods This is observational study included 30 consecutive examined with the diagnosis of ILDs in Kobry El Kopa military hospital. The study was carried out over the period from February 2016 to August 2019. All patients with dyspnea to be investigated and ILDs diagnosed and assessed in rehabilitation department who undergo cardio pulmonary exercise test. Results Reduction on the compliance of the lung and/ or chest wall cause change in lung volumes and tachypnea during exercise. Also agreed with harris EzeAo Who showed that alterations on breathing pattern such as lower Vt, increased respiratory effort, rapid shallow breathing were reported in individual with interstitial lung diseases. Conclusion The pathophysiology of ILD has a negative impact on the ventilatory, cardiovascular, and skeletal muscle responses to exercise, thereby leading to exertional dyspnea and reduced exercise capacity. CPET is an excellent tool for assessing the severity of exertional dyspnea and mechanisms of exercise limitation in patients with various forms of cardiorespiratory disease; however, its application in ILD has remained limited. A growing body of evidence supports the use of CPET in patients with ILD. CPET is currently used to assess functional capacity, to inform exercise prescription, and to evaluate the effects of various interventions. Recent findings highlight that, in addition to its current uses, CPET-derived measures may help improve the management of patients with ILD. Despite these recent advances, additional research is required in order to confirm the utility of CPET in this population.

Effect of Educational Module on Severity of Dyspnea and Inhalation Therapy Adherence among Patients with Bronchial Asthma

Effect of Educational Module on Severity of Dyspnea and Inhalation Therapy Adherence among Patients with Bronchial Asthma