Uncomfortable Breathing Research Articles

Effect of face masks on dyspnea perception, cardiopulmonary parameters, and facial temperature in healthy adults.

Respiratory droplets, naturally produced during expiration, can transmit pathogens from infected individuals. Wearing a face mask is crucial to prevent such transmission, yet the perception of dyspnea and uncomfortable breathing remains a common concern, particularly during epidemics. The aim of this study was to investigate the impact of face mask use on the perception of dyspnea, cardiopulmonary parameters, and facial temperature during physical activity. A randomized crossover study was conducted on healthy adults at a physiology laboratory located in the Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, in November 2022. Participants underwent five stages of physical exercise tests based on the Bruce Protocol under three conditions: without any face mask (control), wearing a surgical mask, and an N95 mask, forming the study's main groups. Dyspnea perception (measured by the Modified Borg Dyspnea Scale), cardiopulmonary parameters (heart rate, oxygen saturation, respiratory rate, blood pressure, and mean arterial pressure) and facial temperature were measured before the exercise test (pre-workout), at the end of stage 1, 2, 3, 4, 5, and after the whole exercise test (post-workout). A two-way repeated measures ANOVA was conducted, considering two factors: the type of mask (control, surgical mask, N95 mask) and the various stages of the exercise test. A total of 36 healthy adults were included in the study. We found that dyspnea perception was much worse in the N95 mask group, particularly during vigorous exercise. There was no significant difference between groups in cardiopulmonary parameters. However, participants wearing N95 had a greater supralabial temperature than those wearing surgical masks or no mask at all. It is recommended to undertake a more in-depth evaluation of cardiopulmonary physiological measures.

Psychological Behavior and Compliance of the General Population with Facemasks during the COVID-19 Pandemic: Implications for the Future

Background: Globally people have succumbed to viral infections that posed a stupendous threat. Community wearing of facemask helped lowering the incidence of COVID-19. The objective was to determine the public opinion regarding prolonged mask-wearing practice, and to find out the behavioral differences as pertinent compensations for not wearing that may help combat pandemics because of emerging infections.
 Methodology: This cross-sectional study carried out in the outpatient departments of Military Hospital (MH) Rawalpindi, Pakistan from January to June 2021 after ethical approval. Participants selected by non-probability convenience sampling technique of different residential, economic and educational backgrounds, above 16 years of age, from both genders to give their opinion on a validated questionnaire, “Multidimensional face mask perceptions scale” with eight domains.
 Results: Among 175 participants, almost 81.7% participants were of the view that when they do not wear mask it is because facemasks get overheated and disrupt the breathing, 60.6% adopted compensation ways by avoiding people and 45.7% considered its wearing a hassle. Female participants felt more uncomfortable by disrupted breathing (p =0.029), male participants reflected about value of independence (p<0.001), and participants from rural area thought a difficult access to get facemasks (p =0.003).
 Conclusion: The most likely reason for not wearing mask among participants was uncomfortable breathing. The other reasons includes adopting social distancing guidelines as a compensatory measure, finding facemask wearing practice a hassle, interference with freedom and access issues by rural population. Designing and implementing awareness sessions may halt such spread of pandemics because of emerging infections.

Vocal cord disorders: uncommon causes of dyspnea

Dyspnea is a subjective sensation of difficult or uncomfortable breathing experienced by the patient. The etiology includes myriad causes starting from cardiopulmonary to psychogenic. The evaluation of dyspnea needs to be thorough so as to take into account all possible causes. Vocal cord disorders are a group of conditions uncommonly leading to dyspnea. These patients are usually wrongly labelled as difficult-to-treat asthma and consequently experience significant morbidity. Two cases of vocal cord disorders were presented with dyspnea and initially attributed to pulmonary causes and will be discussed in the present study.

Dyspnoea: Pathophysiology and a clinical approach.

Dyspnoea, also known as shortness of breath or breathlessness, is a subjective awareness of the sensation of uncomfortable breathing. It may be of physiological, pathological or social origin. The pathophysiology of dyspnoea is complex, and involves the activation of several pathways that lead to increased work of breathing, stimulation of the receptors of the upper or lower airway, lung parenchyma, or chest wall, and excessive stimulation of the respiratory centre by central and peripheral chemoreceptors. Activation of these pathways is relayed to the central nervous system via respiratory muscle and vagal afferents, which are consequently interpreted by the individual in the context of the affective state, attention, and prior experience, resulting in the awareness of breathing. The clinical evaluation and approach to the management of dyspnoea are directed by the clinical presentation and underlying cause. The causes of dyspnoea are manifold, and include a spectrum of disorders, from benign to serious and life-threatening entities. The pathophysiology, aetiology, clinical presentation and management of dyspnoea are reviewed.

Dyspnea Management in Early-Stage Lung Cancer

Virtually unheard of before the last decade, ES-NSCLC survivors have become part of a growing population. Currently comprising 15% of the 221,000 newly diagnosed lung cancers in 2011, the National Cancer Institute (NCI) cites improved screening and increased public consciousness in allowing the medical community to offer this group a chance of curative intervention; something practically nonexistent in lung cancer 5,6. Approximately 32% of these individuals have a stage I or II disease, the focus population for this article. Amounting to an approximately 50% five-year survival rate at stage IA–B, and averaging 30% for stages IIA–B 7–9, newly diagnosed patients with ES-NSCLC warrant treatment methods that employ an interdisciplinary approach. It is only through comprehensive assessment, interdisciplinary management and surveillance, that the palliative team will demonstrate sound clinical strategies, enhancing the QOL for these patients and their families 10. Often referred to as the 6th vital sign by leading authorities, dyspnea is defined as respiratory demand exceeding the body’s ability to meet that need 6,7,11. It is a subjective or perceived, sensory, varied, and yet common experience in lung cancer patients. It is associated with a conscious sensation of uncomfortable breathing, smothering or suffocating, difficult or labored breathing, inability to get enough air, or tightness in the chest 1,11. It differs from tachypnea (increased respirations) or breathlessness, which can be a normal physiological response as seen in exercise or a state of excitement 11. Dyspnea varies in intensity, consisting of an interface among physiological, psychological, social, and environmental factors, inducing secondary responses 11,12. In the clinical presentation chronic, labored breathing is one of the most difficult symptoms to identify or manage, and once acquired, it promises to remain an ever-present condition. Dyspnea possesses unique characteristics in that acute episodes, such as asthma or bronchitis, are manageable, and tend to subside and resolve with uncomplicated or minimal intervention of the underlying cause. Chronic cases are persistent, linger, and have varied intensity, regardless of intervention. In chronic dyspnea, 85% of the etiologies stem from cardiopulmonary and psychogenic causes 13. The American Thoracic Society (ATS) suggests the prevalence ranges from 55% – 87% in all stages of lung cancer. The sensation of breathlessness is frightening to patients and their caregivers (CGs) lending to a feeling of suffocation and possible death. Not only is dyspnea an alarming, multidimensional symptom, the impact on a patient’s QOL is undeniable and often incessant 4,11,14. Cognizant of the needs of these individuals, it is the palliative care nurse, possessing a specialized skill set, who is poised as the point person in coordinating care, and is a critical component of the interdisciplinary healthcare team. Along with the diagnosis of ES-NSCLC, 60% of these patients suffer co-morbid conditions and symptoms, such as COPD and dyspnea15. The plan of care should encompass pharmacological and non-pharmacological interventions for pre-existing medical concerns, along with those issues imposed by lung cancer or cancer treatments. Supportive and palliative care is an essential ingredient in ES-NSCLC patients with dyspnea. The following discussion addresses the etiology, assessment, management, and follow up for the symptom of dyspnea in ES-NSCLC patients.

Disnea causada por Coxiella burnetii

Dyspnea is a subjective sensation of difficult or uncomfortable breathing caused by increased excitation of brain respiratory centres,1 and is usually secondary to pulmonary or cardiac disease.2Heart failure is a serious public health problem in industrialised countries, with an increasing prevalence and incidence. It is more common in the elderly, and is usually caused by a defect in myocardial contraction, coronary atherosclerosis, or less frequently, valvular disease.3 Aortic insufficiency (AI) is one of them. It may originate from infective endocarditis, congenital or valvular heart disease, or rheumatic fever. It may lead to a medical emergency due to the inability of the left ventricle to adapt to the rapid increase in the end-diastolic volume caused by regurgitation of blood from aorta to left ventricle. If not corrected, the AI can lead to acute cardiogenic shock.4

La dyspnée dans le cancer du poumon

Dyspnea is a subjective symptom defined as an experience of uncomfortable and difficult breathing which strongly affects the quality of life. It is the most common symptom in lung cancer but its physiopathology remains unclear. Dyspnea is due to cancer itself, specific therapies or comorbidities. To evaluate intensity of dyspnea, analogue visual and verbal rating scales need to be preferred. Diagnosis of underlying cause, based on rational and non invasive strategy is needed to perform effective treatment if possible. Despite its frequency, few therapies are really effective, except nonpharmacologic measures: only morphine can be actually recommend, especially with naive patients. In palliative cases, if dyspnea is uncontrolled, benzodiazepine can be used and may represent ethic approach.

Determining the cause of dyspnoea: linguistic and biological descriptors

Dyspnoea is the most common symptom of patients with cardio-respiratory diseases. It is a generic term related to different pathophysiological abnormalities that may result in different qualities of respiratory discomfort, defined by specific verbal descriptors for a specific diagnosis. Often it is difficult to distinguish the underlying pathology of dyspnoea, eg, either from chronic heart failure (CHF) or from other respiratory causes. The discovery of the endocrine function of the heart, as well as the development of accurate and feasible assay methods allow the use of cardiac natriuretic hormones in the assessment of cardiovascular diseases, namely acute coronary syndromes and heart failure. It is advisable to measure cardiac natriuretic hormones in order to exclude or suggest the diagnosis of CHF in patients with a suspicious diagnosis, but with ambiguous signs and symptoms or manifestations that can be confused with other pathologies (like chronic obstructive pulmonary disease). The most common symptom of patients with cardio-respiratory diseases is dyspnoea, a 'difficult, laboured, uncomfortable breathing'. Dyspnoea has been defined as 'a term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social and environmental factors, and may induce secondary physiological and behavioural responses'. Breathlessness is characterized by measurable intensity and qualitative dimensions, which may vary depending on the individual, the underlying disease, and other circumstances.3 The neurophysiological basis of dyspnoea relies on receptors in the airways lung parenchyma, respiratory muscles together with chemoreceptors providing sensory feedback via vagal, phrenic and intercostal nerves to the spinal cord, medulla and higher centres. Breathlessness is based on different pathophysiolagical abnormalities that may result in different qualities of respiratory discomfort, which are defined by specific verbal descriptors related to a specific diagnosis. Nevertheless different diseases may share the same descriptors. There is no clear relationship between the qualitative descriptors of dyspnoea and the quantitative intensity among the patient groups: different diseases may be distinguished by quality but not intensity of the sensation. Differences in languages, in races, cultures, gender, and in the manner in which concepts or symptoms are held can all influence the idea, quality and intensity of dyspnoea.

Oxygen or air for palliation of breathlessness in advanced cancer

Breathlessness—difficult laboured or uncomfortable breathing, dyspnoea—is a complex experience of the body and the mind. It is the most common and distressing symptom of advanced lung cancer1 and also frequently affects those whose cancer originates outside the thorax. Unlike cancer pain, breathlessness is difficult to treat successfully; a survey of patients treated by a community palliative care team demonstrated that its prevalence rose as death approached and that treatment was ineffective.2 Although clinicians and patients alike tend to associate cancer with pain, breathlessness has a comparable incidence: in one recent study 85% patients with cancer experienced pain and 78% breathlessness in the last year of life.3 The neural pathways serving the sensation of breathlessness are poorly understood, but dyspnoea is not simply an abnormality of the heart and lungs; it is a multisystem disorder with many accompanying subtle neurohormonal abnormalities and alterations in skeletal and respiratory muscle structure and function. The higher centres responsible for thinking and feeling can strongly influence the severity of the symptom. The ‘nervous system is not hard-wired’:4 it is characterized by plasticity and, just as with pain, the experience of breathlessness is likely to be modified both by previous experience of the sensation and by pathways from different areas in the central nervous system. Patients with apparently similar disease can have breathlessness of widely different severity. In this review we outline the causes of breathlessness in advanced cancer and the use of air and oxygen in management of the symptom.

Do steroids interfere in dyspnoea sensation?

Dyspnoea remains a remarkable clinical problem and a therapeutic challenge, mainly in chronic respiratory conditions. This study investigated the potential effects of steroids on dyspnoea sensation regardless of their pulmonary anti-inflammatory actions. Sixteen healthy men (mean age ± SD = 22.5±1.6 years) developed uncomfortable breathing by the use of inspiratory resistors (loads of 0, 7, 14 and 21 cm H2O/l/s) and breathholding 6 h after taking 40 mg of prednisone (Pred) or placebo (Plac). Respiratory discomfort during breathing with loads was evaluated with a 100 mm visual analog scale. The maximum voluntary apnoea time did not differ between the prednisone and placebo days (Plac= 96±11.8 s×Pred=105±12.2 s) and prednisone did not influence the dyspnoea sensation induced by different inspiratory loads (0 cm H2O/l/s: Pred=2.8 mm×Plac=1.9 mm; 7 cm H2O/l/s: Pred=18.3 mm×Plac=18.6 mm; 14 cm H2O/l/s; Pred=33.0 mm×Plac=34.1 mm; 21 cm H2O/l/s: Pred=48.1 mm×Plac=49.6 mm). Prednisone intake was associated with a significant increase in minute ventilation during breathing with no inspiratory loads (Pred=11.91±1.28 l/min×Plac=9.95±0.86 l/min). Although steroids certainly may improve respiratory conditions due to anti-inflammatory actions, available evidence does not support any specific beneficial effect of these drugs on the perception of dyspnoea itself.

Perceptual contributions to optimization of breathing.

Besides regulating the energetic cost of breathing, optimization of breathing may involve the alleviation of an uncomfortable breathing sensation. In this article, we consider perceptual contributions to the optimization of breathing. Just as the cost function proposed by Poon depends on ventilation and arterial PCO2 so does the sense of dyspnea. Consequently, we examined the relationship between breathing discomfort and Poon's cost function. Based on our model and psychophysical studies, it appears that breathing discomfort, which can integrate chemical and mechanical inputs to the respiratory controller, may not operate simply as an estimate of a cost function. We explain how our reflex control model can dynamically minimize a cost function such as Poon's. Also, we consider the influence of willful adjustments of ventilation on breathing discomfort. From this we infer that ventilatory optimization may emerge from automatic reflexes and behavioral responses that involve excitatory chemical and inhibitory neuromechanical feedbacks.

Dyspnea-limited response in chronic obstructive pulmonary disease: reduced unsupported arm activities.

Dyspnea, the sensation of uncomfortable breathing, is the primary activity-limiting symptom leading to reduced functional ability in chronic obstructive pulmonary disease (COPD). Patients with severe COPD report a marked increase in the sensation of dyspnea with routine tasks that require arm use, especially activities necessitating unsupported arm elevation. Dyspnea is associated with alterations in respiratory muscle function, such as an increase in muscle force requirement, a reduction in respiratory muscle strength and endurance, and an increase in the recruitment of the rib cage and accessory muscles. Unsupported arm exercise (UAE) further compromises respiratory muscle capacity for ventilation because it requires the muscles' concomitant recruitment in the maintenance of chest wall stabilization. This article presents respiratory muscle mechanisms leading to reduced UAE, methods of measuring unsupported arm endurance, and treatment strategies to improve unsupported arm activity endurance in patients with COPD.

Dyspnea in the Weaning Patient: Assessment and Intervention

Dyspnea, the subjective sensation of uncomfortable breathing, is frequently experienced by patients during weaning from mechanical ventilation. As the clinical manifestation of increased work of breathing, dyspnea can be a valuable predictor and indicator of changes in patient respiratory status during the weaning process. The importance of measuring dyspnea is emphasized and the numerical rating and visual analog scales as direct measures of dyspnea are described. The most reliable physiologic variables that can be used to indirectly estimate dyspnea are discussed. Strategies such as positioning, coaching, "bagging," inspiratory muscle training, pressure support ventilation, oxygen, and relaxation/biofeedback techniques that can be used by the critical care nurse to decrease dyspnea are suggested.

Dyspnea

There is no universally accepted definition of dyspnea, but everybody has experienced the sensation and thus has an intuitive understanding of the phenomenon. At a symposium on breathlessness in 1965, Julius H. Comroe¹outlined his concept of dyspnea. It "is difficult, labored, uncomfortable breathing; it is an unpleasant type of breathing, though it is not painful in the usual sense of the word. It is subjective and, like pain, it involves both perception of the sensation by the patient and his reaction to the sensation." In his closing remarks²at the end of the symposium, he returned to this issue. We have learned here that there are five or six different grades or types of this sensation. One is an awareness that there is a little increase in ventilation. Another is a little shortness of breath ('harder to get one's breath') and this may be slightly unpleasant. Another is an