Dissertations / Theses on the topic 'Breathlessness'
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Coates, James C. "Mechansims of breathlessness." Thesis, University of Newcastle Upon Tyne, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.399148.
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Meek, Paula M. "The cognitive dimension of breathlessness." Diss., The University of Arizona, 1993. http://hdl.handle.net/10150/186540.
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The investigation focused on differences in judgments of individuals experienced with breathlessness (due to chronic pulmonary disease, n = 30) and those without chronic experience (normal lung function, n = 30). The research had three major aims. The first tested whether symptomatic individuals made decisions based in logic and probability or some other means, such as natural assessment strategies. Participants were asked to judge the probability that certain symptom and activity descriptions would be associated with an episode of breathlessness. The results indicated symptomatic judgments based on individualized descriptors are subject to errors in logic and probability. Additionally, the results support the premise that experience with a symptom alters an individual's judgments concerning it. The second aim focused on cognitive representations and their associated influence on the perceptual analysis of breathlessness intensity by testing if the use of a typical cognitive symptom pattern (prototype) or specific remembered symptom instance (exemplar) of breathlessness influenced the determination of symptom intensity or response sensitivity (RS). Magnitude estimation techniques were used to evaluate judgments based on different (prototypes and exemplars) cognitive representations of intensity, using airflow resistance as a stimulus for breathlessness. The results demonstrated a decrease in sensitivity with a prototype and increased RS with an exemplar. This supports that judgments of breathlessness RS vary according to the cognitive representation used. The final aim tested whether cognitive prototypes of symptoms are present with breathlessness and whether these produce different patterns of response. Assuming the existence of a symptom prototype for breathlessness, the study tested whether the responses to two different but symmetrical statements about breathing status differed based on amount of experience with the symptom. The results demonstrated asymmetrical differences between groups and stimuli used supporting the existence and influence of a symptom prototype. Taken together the results suggest individuals make rational (experience-based judgments) versus logical (probability based) decisions concerning their symptoms. Cognitive representations of the symptomatic experience were found to influence judgments of intensity. Cognitive information about symptoms exists in the form of a symptom prototype.
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Oxberry, Stephen Grantley. "Opioids for breathlessness in heart failure." Thesis, University of York, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.550494.
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Breathlessness is a common and problematic symptom in heart failure. Opioids have traditionally been considered as analgesics, but a potential role for their use in breathlessness is beginning to emerge. This thesis commences with a review of the existing literature in support of a possible role for opioids in the management of breathless in heart failure. A systematic review of existing human symptom control studies in this thesis suggests that opioid administration may have a small but significant benefit in chronic heart failure. However, only six studies were included in the review and most were either small or of poor methodological quality. This presents a relative gap in the knowledge on this topic. A randomised controlled trial was therefore performed to assess the effect of opioids on breathlessness in chronic heart failure. This crossover trial involved the comparison of two oral opioids with placebo. Thirty-five participants completed the trial, making it the largest trial of its type in this area. Opioid administration was shown to be safe in this patient cohort. No statistically significant differences were demonstrated for breathlessness severity between treatments. Participants were subsequently invited to participate in a three month open label extension. Thirty three participants in total were followed up with thirteen remaining on active therapy. This is the first trial of its type in breathlessness in heart failure and represents the longest participant follow-up in this area. Whilst not as robust as the initial trial, this extension period revealed that opioid continuers rated a statistically significant improvement in breathlessness severity from baseline compared to non-continuers. Finally, a semi-structured interview study in ten participants with heart failure revealed for the first time that opioids are acceptable in this population and they describe troublesome symptoms that might respond to opioid treatment.
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Binks, Andrew Paul. "Breathlessness and the pattern of breathing." Thesis, University of Newcastle Upon Tyne, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263019.
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Worden, Jessica. "The performance of breathlessness on the page." Thesis, Brunel University, 2017. http://bura.brunel.ac.uk/handle/2438/14908.
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This thesis formulates a practice-based approach to performances of breathlessness on the page. It investigates breathlessness as a subject of creative practice through performance writing, creating different works that function as material object, site as well as score for future performance permutations. These works each examine different aspects of breathlessness, with a focus on the corporeal, affect and between-ness. The relationship of these performance works to the body, affect, time and duration establish the performative possibilities of writing and how this specific form of artistic practice contributes to discourse surrounding live work. My research does not distinguish between the contributions of practice and critical analysis. The outcome of the research is three works, one of which is embedded within this document, and a critical analysis that explores the different ways breathlessness performs on the page. Key to my research is a negotiation of understandings of lessness. Breathless performance writing posits a concept of lessness as other than absence. The ability of the practice-based work to initiate experiences that engage with the body, time and duration also demonstrate forms through which writing can generate as well as directly participate in performance. This research contributes to the field of contemporary performance and theatre practice by defining the live in relation to writing as well as developing a concept of lessness. The distinction between writing and performance leads to unnecessary schisms between the two disciplines. This body of research demonstrates the ways in which performance writing bridges these disciplines to initiate live work. This research disrupts conventional and binary definitions of breathlessness, performance and writing. Performance writing initiates live experiences for audiences of one or many, unbound to any one point in time, capable of generating multiple but unique live encounters with performance.
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Yorke, Janelle. "Quantification of breathlessness using descriptors in cardiopulmonary disease." Thesis, University of Salford, 2009. http://usir.salford.ac.uk/26979/.
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Rationale: Breathlessness is a multidimensional construct reflected in different verbal descriptors. It is a perceptual experience that is complex and highly subjective. In cardiopulmonary disease breathlessness can be extremely debilitating and distressing. It is usually measured using scales such as visual analogue and Borg scales; or indirectly through report of activity limitation or quality of life. This thesis presents the development and validation of an instrument that measures overall breathlessness magnitude using descriptors that reflect its different aspects. Methods: Eighty-one breathlessness descriptors were administered to 123 patients with chronic obstructive pulmonary disease (COPD), 129 with interstitial lung disease (ILD) and 106 with chronic heart failure. These were reduced to 34 items using hierarchical methods. Rasch analysis was then applied to inform decisions regarding further item removal and overall fit to the Rasch unidimensional model. Principal components analysis (PCA) tested whether items separated into discrete components. Validity and reliability of the new instrument was further assessed in a separate group of 53 patients with COPD, 46 with ILD and 65 with asthma. Results: After removal of items with hierarchical methods (n=47) and items that failed to fit the Rasch model (n=22), 12 items were retained. The 12-item set had good internal-reliability (Cronbach's alpha=0.9) and fit to the model (x2 p=0.08). PCA identified two sub-components: 'physical' (n=7) and 'affective' (n=5). 'Affective' items represented more severe breathlessness. In the separate validation study, Dyspnoea-12 correlated with six-minute walk distance, St George's Respiratory Questionnaire, MRC dyspnea grade, and had good stability over time (ICCC=0.9, p<0.001). Conclusion: Dyspnoea-12 fulfills modern psychometric requirements for measurement. It provides a global score of breathlessness that incorporates both 'physical' and 'affective' aspects. It addresses the need for a comprehensive breathlessness instrument and is based on the language used by patients. It can measure breathlessness across several disease groups.
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Booth, Sara. "Improving the palliative care of patients with intractable breathlessness." Thesis, Imperial College London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542942.
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Subhan, M. M. Feisal Beg. "The effects of volitional breathing on breathlessness during exercise." Thesis, University of Newcastle Upon Tyne, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.320393.
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Wainwright, Megan Julie. "Breathing and breathlessness : chronic obstructive pulmonary disease in Uruguay." Thesis, Durham University, 2013. http://etheses.dur.ac.uk/7270/.
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An increasingly common part of being human is living with chronic health problems for which management over time, and not cure, is the goal of medical treatment. One such chronic condition is chronic obstructive pulmonary disease (COPD), a lung disease caused by breathing-in smoke, dusts and chemicals, including tobacco smoke. This ethnographic study set out to explore how COPD is lived with and cared for in Uruguay, where rates of COPD are amongst the highest in South America and where most cases go undiagnosed. The aims of the research were to explore the following questions: a) what does it feel like to be breathless and how is COPD experienced within family and healthcare relationships? b) how is the lived-experience of COPD shaped by cultural, social, economic and political contexts? And, c) what are some of the challenges and opportunities for preventing and treating COPD? The objective of this ethnography is to contribute a unique case study to the anthropological literature on chronic illness both in terms of the disease under investigation and the cultural context. The thesis responds to a call in the literature for more sophisticated phenomenological approaches. By incorporating a multitude of field methods into ethnographic fieldwork I combine a sensorial medical anthropology approach and a political-economy of health perspective. The ethnography begins with a cultural and sensorial analysis of breathing and breathlessness in Uruguay in order to situate the expressions of this disease across a diverse group of participants. I argue that the experience of COPD is shaped by healthcare systems and inequalities and highlight two healthcare contexts where space is made for people to socially interpret sensations in the body. The thesis culminates in the critical assessment of public health goals and makes recommendations for improving COPD prevention and care in Uruguay.
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Craik, Marie Clare. "Physiological and clinical aspects of breathlessness assessed using the visual analogue scale." Thesis, University of Newcastle Upon Tyne, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.346418.
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Pearce, Linda. "Randomised controlled trial of nurse-led breathlessness intervention to improve the management of breathlessness in patients with chronic obstructive pulmonary disease : a pilot study." Thesis, University of Essex, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446548.
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Malik, Farida. "Breathlessness in patients with advanced disease : the experiences of caregivers." Thesis, King's College London (University of London), 2011. https://kclpure.kcl.ac.uk/portal/en/theses/breathlessness-in-patients-with-advanced-disease-the-experiences-of-caregivers(ee9b3c51-313a-4d08-9d0e-c04527d73c78).html.
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Ofir, Dror. "Ventilatory constraints and breathlessness during exercise in the elderly, in the obese, and in those with mild airflow limitation." Thesis, Kingston, Ont. : [s.n.], 2008. http://hdl.handle.net/1974/1301.
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Faull, Olivia. "The role of the periaqueductal gray in respiratory control and breathlessness." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:8be9a788-57c7-4323-8052-c849bc9a8eb6.
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Understanding respiratory control is crucial for improving the management of respiratory disease, and the accompanying breathlessness endured by its sufferers. A body of animal evidence supports the role of the midbrain periaqueductal gray (PAG) in modulating ascending and descending respiratory information, with the PAG subdivisions acting within a network that may contribute to the threatening perception of breathlessness. In this Thesis we used ultra high field magnetic resonance imaging (MRI) at 7 Tesla to firstly identify activity within the columns of the PAG during the simple respiratory task of breath holding in humans, matching those previously reported in animals for slowed ventilatory responses. Extending this investigation to the perception of breathlessness, we then used a classical fear-conditioning paradigm to investigate anticipation and response to an aversive inspiratory resistive loading stimulus. We found activity in the lateral PAG (lPAG) during slowed breathing against an inspiratory resistance, and activity in the ventrolateral PAG (vlPAG) during anticipation of resistive loading. These results align with the proposed threat perception model in animals; with the vlPAG involved in passive responses to inescapable stress, while the lPAG is involved in active responses to threat. Lastly, we investigated the role and connections of the PAG columns within the wider cortical breathlessness network, and any plastic changes evoked by exercise. Functional and connectivity results suggest the PAG column activities in breathlessness are influenced by top-down cortical networks, with the vlPAG involved in the affective emotional dimension of breathlessness, while the lPAG is involved in the sensory component. In a comparison between athlete and sedentary subjects, athletes displayed increased functional activity in the vlPAG and prefrontal cortex during anticipation of breathlessness, indicating possible affective changes in perception rather than a global 'de-sensitisation' to breathlessness. Therefore, in this Thesis we have identified the columns of the PAG to be intricately involved with respiratory control and perception of breathlessness. It appears the PAG may be a critical point of distinction between aspects of breathlessness perception, with the vlPAG a possible area of adaptation of affective breathlessness in athletes, or conversely (mal)adaptation and a target for treatment in patients with chronic respiratory disease.
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Lane, Roderick John Tudor. "Investigations into the physiological basis of the sensation of breathlessness in man." Thesis, Imperial College London, 1991. http://hdl.handle.net/10044/1/46879.
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Hyman, James Dorset. "The role of perceived control in the perception of breathlessness severity in heart failure." Thesis, University of Hull, 2011. http://hydra.hull.ac.uk/resources/hull:4926.
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Coping is acknowledged to be an important factor in the process of adjustment to illness, and which has consistently been related to outcomes in chronic health conditions such as heart failure (HF). Despite this, to date coping has been poorly conceptualised which has limited the clarity and usefulness of research findings. A systematic review was conducted to examine the relationship between ways of coping, and dimensions of psychological wellbeing as important health outcomes in the HF population. Electronic databases (CINAHL, Medline, PsychINFO, Scopus and Web of Science) were searched and articles selected based on systematic search, inclusion and exclusion criteria. Sixteen studies were included in the review utilising a variety of designs and measures. Study findings suggested that coping by ignoring, minimising or denying HF is related to poorer outcomes of psychological wellbeing. However, more illness focused ways of coping did not consistently relate to better outcomes. Consistent with research in other populations, the conceptualisation of coping in the reviewed studies was inconsistent. It is argued that coping should be considered within a wider framework of transition and adjustment to more meaningfully examine HF patients‟ experience following diagnosis and inform more appropriate psychological support strategies.
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Copestake, Andrew J. "The influence of inspiratory muscle training upon exertional breathlessness in healthy elderly men and women." Thesis, Loughborough University, 1995. https://dspace.lboro.ac.uk/2134/7996.
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Breathlessness is a common complaint amongst seemingly, healthy, elderly people, mild exertion being sufficient to illicit extremely debilitating sensations. This places an unacceptable physical limitation on the individual and reduces their quality of life. Previous investigators have suggested that the strength and condition of the respiratory muscles are contributing factors in the sensation of breathlessness on exertion (Aldrich, 1990; Killian, 1990). Therefore, the aim of the research contained within the thesis, was firstly; to characterise the respiratory muscle function of a group of healthy elderly subjects, and secondly; to assess the influence of inspiratory muscle training upon the genesis of exertional breathlessness in healthy, elderly men and women. The respiratory muscle strength of a group of healthy, elderly people was determined by measuring the maximum static and dynamic respiratory pressures on two occasions separated by approximately one week. The results suggested the maximum (or minimum) mouth pressure averaged over a one second period, measured using a hand-held mouth pressure meter (Precision Medical Ltd, U.K.), represents a reliable and reproducible index of respiratory muscle function in healthy, elderly subjects. In addition, the data was used to establish a contemporary set of prediction equations, and normal values were derived to facilitate the estimation of respiratory muscle strength in healthy, elderly subjects. Finally, the data suggested that the respiratory muscle function of healthy, elderly people declines with advancing age. However, the strength of the respiratory muscles does not correlate significantly with indices of body size, but is strongly influenced by customary levels of physical activity. Breathlessness during both cycle ergometry and treadmill walking was measured using both the visual analogue scale and the modified Borg scale. For healthy, elderly subjects, poor correlations existed between exertional breathlessness and the prevailing level of ventilation. Mean breathlessness scores were therefore used as an alternative index of breathlessness. The use of this parameter was validated by examining its reproducibility during both cycle and treadmill exercise. During cycle ergometry, the modified Borg scale provided more reproducible ratings of breathlessness than the visual analogue scale. However, a treadmill walking protocol was developed, which induces breathlessnesss afely, and during which, elderly people rated their breathlessnessr eproducibly using both the VAS and modified Borg scale. In general, elderly subjects preferred using the modified Borg scale. Finally, the role of the respiratory muscles in the genesis of exertional breathlessness was examined by determining the influence of inspiratory muscle training upon the sensation of breathlessness during treadmill exercise. Respiratory muscle training, using an inspiratory muscle training device, increased the inspiratory muscle strength of healthy, elderly men and women by approximately 20% and ameliorated the sensation of exertional breathlessness by 21.4%. Inspiratory muscle training was also associated with improvements in elderly people's subjective perception of their breathing, their ability to perform daily routine activities and their "well-being". Together, these results suggest that inspiratory muscle training may improve the quality of life of healthy, elderly people.
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Bausewein, Claudia. "Course and non-pharmacological management of breathlessness in advanced disease : a comparison between cancer and COPD." Thesis, King's College London (University of London), 2009. https://kclpure.kcl.ac.uk/portal/en/theses/course-and-nonpharmacological-management-of-breathlessness-in-advanced-disease(3b9d3c03-ba6d-40b0-8756-f65a6ea71288).html.
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Genberg, Jenny. "Prescription of opioids and benzodiazepines for breathlessness in interstitial lung disease : A national population-based study." Thesis, Umeå universitet, Institutionen för integrativ medicinsk biologi (IMB), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-170027.
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Roberts, Suzanne Emily. "The effectiveness of pursed lips breathing in the management of breathlessness in stable chronic obstructive pulmonary disease." Thesis, University of Hertfordshire, 2011. http://hdl.handle.net/2299/6453.
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Introduction: This dissertation aims to explore, in a clinical setting, the effectiveness of pursed lips breathing (PLB), in the management of dyspnoea in stable COPD. Methodology: A mixed methodology that comprised a randomised controlled trial (RCT), a predominantly qualitative follow-up (FU) study and two measurement studies was used. The RCT intervention group was taught PLB at home over 8 weeks. Primary outcome measures were the Self Report Chronic Respiratory Disease Questionnaire (CRQ-SR) dyspnoea and mastery domains and Endurance Shuttle Walk Test (ESWT). The FU study investigated the long-term experience of PLB in a subset of RCT participants through telephone interview, focus group and observation of PLB technique at home visit. Prior to the RCT a study using limits of agreement (LoA) methodology was conducted to investigate reliability of hand-held spirometric measurement of inspiratory capacity (IC) with a view to using it as an outcome measure. Following the RCT a retrospective analysis of data collected from the ESWT was performed comparing a 1-walk protocol with the published 2-walk protocol. Results: Forty-one patients with COPD were recruited to the RCT (PLB n = 22, control n =19); mean age 68 years (SD 11), mean FEV1% predicted 47% (SD 15.80) and 13 were approached to participate in the FU; 11 of 13 agreed to telephone interview, 5 to attend the focus group and 6 to home visit. The median time since learning PLB was 17 months (6 - 23). The RCT found no statistically significant difference between groups in the primary outcome measures and in retrospect was insufficiently powered. Post hoc analysis found effect sizes for primary outcome measures were: CRQ-SR dyspnoea 0.05, CRQ-SR mastery 0.48 and ESWT 0.44. For secondary outcome measures the PLB group showed a significant (p = 0.02) improvement in oxygen saturation on ESWT. Long-term follow-up found 9 of 11 still used PLB, 8 reported definite benefit. Those using PLB used it for breathlessness with four themes identified: use of PLB with physical activity (8/11), to increase confidence and reduce panic (4/11), as an exercise (3/11), at night (3/11). Discontinuation of PLB (2/11) was due to no benefit. Hand-held spirometric measurement of IC found LoA for same-day IC measurement in healthy volunteers (n = 20) ± 0.630L (95%CI ± 0.255) and over 3 weeks (n = 11) ± 0.560L (95%CI ± 0.326). In COPD, same day LoA (n = 26) were ± 0.582L (95%CI ± 0.169) and over 6 weeks (n = 8) ± 0.486L (95%CI ± 0.302). Retrospective analysis of ESWT data identified that completion rates improved by 17% for the 1-walk protocol but that the ceiling-effect was 12.2% compared to 7.3% for the 2-walk protocol. LoA between protocols when measuring change over time (n = 31) was ±80% (95%CI 25.56); less than the difference described as "somewhat better" (113%) following pulmonary rehabilitation (PR) but greater than the m.c.i.d. of 68%. Conclusions: LoA for IC exceeded the clinically significant reported 0.3L; the protocol tested here was not sufficiently reliable for use as an outcome measure. Analysis of ESWT data showed the 1-walk protocol was adequate for identify change in clinical practice but, for research purposes the 2-walk protocol should be retained. From the RCT learning PLB resulted in reduced physiological stress with respect to oxygen desaturation when performing ESWT compared to the control group. Long-term follow-up showed that, in severe COPD perceived benefits persisted in 62% of patients.
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Hutchinson, Ann. "What influences the presentation of patients with chronic breathlessness to the Emergency Department? : a mixed methods study." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:15187.
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Background: Chronic breathlessness is a common and distressing symptom of many long-term cardiorespiratory conditions and cancers which are highly prevalent in both the UK and worldwide. It is associated with presentation to the emergency department (ED) and admission to hospital. Aim: The aim of this research is to improve our understanding of the role of chronic breathlessness in ED presentations by people with advanced cardiorespiratory disease and to identify potential targets for interventions to prevent or avoid emergency presentations. Methods: Mixed methods study with integration of findings at analysis. A systematic review and qualitative synthesis were performed to examine the literature on the experience of breathlessness. A prospective survey and case note review were conducted to establish the prevalence of presentations due to acute-on-chronic breathlessness at the ED and to identify the demographic and clinical characteristics of those patients. The perceptions of patients with chronic breathlessness, their carer and healthcare professionals regarding presentation to the ED due to acute-on-chronic breathlessness were explored by semi-structured interview. Findings: Living with chronic breathlessness involves widespread effects on the lives of both the patient and those caring for them, yet this impact may remain largely invisible to others. Quality of life with chronic breathlessness is maximised by a patient’s engaged coping style and a clinician’s responsiveness to breathlessness as well as to the underlying disease. This is described by the Breathing Space concept. Presentation to the ED sits within this context and occurs as a result of a breathlessness crisis. There are a proportion of patients who may have avoidable attendances and could be more optimally managed in the community. Conclusions: Greater public and professional understanding of the widespread effects of breathlessness, combined with appropriate assessment and management of the symptom, including planning for crisis may reduce the need to present to the ED.
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Orme, Mark W. "Physical activity and sedentary behaviour across the spectrum of chronic obstructive pulmonary disease." Thesis, Loughborough University, 2017. https://dspace.lboro.ac.uk/2134/25248.
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Chronic obstructive pulmonary disease (COPD) patients are generally more sedentary and less physically active than healthy adults; putting them at increased risk of hospitalisation and death. For patients with mild-moderate COPD, physical activity appears to be reduced compared with apparently healthy adults but differences in time spent sedentary are less well established. Additionally, there is a need for a greater understanding of the correlates of behaviour in mild-moderate patients with much of the existing literature focusing on more severe or mixed stage patient samples and with many studies lacking objective behavioural monitoring, not adjusting for confounders and a paucity of data on correlates of sedentary time. Despite having mild-moderate airflow obstruction, these patients also report a range of symptom burdens with some individuals reporting severe symptoms. Subsequently, these patients represent a sub-set of individuals who may require lifestyle interventions. Therefore, factors associated with patients reporting more severe symptoms need to be identified to help understand how this phenomenon may manifest and be intervened upon. For patients with more advanced COPD who are admitted to hospital for an acute exacerbation behavioural intervention focussing on less intense movement may be a more suitable approach for reducing the risk of readmissions than more intense physical activity or exercise. To date no studies have specifically targeted reductions in sedentary behaviour in COPD. In addition, wearable self-monitoring technology may facilitate the provision of such interventions, removing important participation barriers such as travel and cost, but this has not been sufficiently examined in COPD. This thesis investigated: (i) objectively measured physical activity and sedentary time and the correlates of these behaviours for mild-moderate COPD patients and apparently healthy adults (Study One); (ii) factors associated with self-reported symptom severity and exacerbation history in mild-moderate COPD patients (Study Two) and (iii) the feasibility and acceptability of a home-based sedentary behaviour intervention using wearable self-monitoring technology for COPD patients following an acute exacerbation (Study Three). Methods: Study One: COPD patients were recruited from general practitioners and apparently healthy adults from community advertisements. Objectively measured moderate-to-vigorous physical activity (MVPA), light activity and sedentary time for 109 mild-moderate COPD patients and 135 apparently healthy adults were obtained by wrist-worn accelerometry. Patients with at least four valid days (≥10 waking hours) out of a possible seven were included in analysis. A range of demographic, social, symptom-based, general health and physical factors were examined in relation to physical activity and sedentary time using correlations and linear regressions controlling for confounders (age, gender, smoking status, employment status and accelerometer waking wear time). Study Two: In 107 patients recruited from general practitioners, symptoms were assessed using the COPD Assessment Test (CAT) and Modified Medical Research Council (mMRC) questionnaires. Twelve-month exacerbation history was self-reported. Exercise capacity was assessed via incremental shuttle walk test (ISWT) and self-reported usual walking speed. Physical activity and sedentary time were obtained from a wrist-worn accelerometer. Study Three: Patients were randomised in-hospital into a usual care (Control), Education or Education + Feedback group with the intervention lasting 14 days following discharge. The intervention groups received information about reducing prolonged sitting. The Education + Feedback group also received real-time feedback on their sitting time, number of stand-ups and step count at home through an inclinometer linked to a smart device app. The inclinometer also provided vibration prompts to encourage movement when the wearer had been sedentary for too long. Feasibility of recruitment (e.g. uptake and retention) and intervention delivery (e.g. fidelity) were assessed. Acceptability of the intervention technology (e.g. wear compliance, app usage and response to vibration prompts) was also examined. Results: Study One: COPD patients were more sedentary (592±90 versus 514±93 minutes per day, p < 0.05) and accrued less MVPA (12±18 versus 33±32 minutes per day, p < 0.05) than apparently healthy adults. For COPD patients, self-reported dyspnea and percentage body fat were independent correlates of sedentary time and light activity with exercise capacity (incremental shuttle walk test) an independent correlate of MVPA. For apparently healthy adults, percentage body fat and exercise capacity were independent correlates of sedentary time and light activity. Percentage body fat was an independent correlate of MVPA. Study Two: ISWT (B=-0.016±0.005, partial R2=0.117, p=0.004) and years living with COPD (B=0.319±0.122, R2=0.071, p=0.011) were independently associated with CAT score. ISWT (B=-0.002±0.001, R2=0.123, p < 0.001) and vector magnitude counts per minute (VMCPM) (B=0.0001±0.0000, R2=0.050, p=0.011) were independently associated with mMRC grade. MVPA was independently associated with previous exacerbations (B=-0.034±0.012, R2=0.081, p=0.005). Patients reporting a CAT score of > 20 or an mMRC score of ≥2 had lower VMCPM, were more sedentary and took part in less light activity than patients reporting a CAT score of 0-10 or mMRC of 0, respectively. Patients reporting ≥2 exacerbations took part in less MVPA than patients reporting zero exacerbations. Study Three: Study uptake was 31.5% providing a final sample of 33 COPD patients. Retention of patients at two-week follow-up was 51.5% (n=17). Reasons for drop-out were mostly related to being unable to cope with their COPD. Patients wore the inclinometer for 11.8±2.3 days (and charged it 8.4±3.9 times) with at least one vibration prompt occurring on 9.0±3.4 days over the 14 day study period. Overall, 325 vibration prompts occurred with patients responding 106 times (32.6%). 40.6% of responses occurred within 5 minutes of the prompt with patients spending 1.4±0.8 minutes standing and 0.4±0.3 minutes walking, taking 21.2±11.0 steps. Discussion: Study One: COPD patients were less active and more sedentary than apparently healthy adults; however, factors predicting behaviour were similar between groups. Correlates differed between sedentary time, light activity and MVPA for both groups. Interventions to boost physical activity levels and reduce sedentary time should be offered to patients with mild-moderate COPD, particularly those reporting more severe breathlessness. Study Two: Worse exercise capacity, low levels of physical activity and more time spent sedentary are some of the factors associated with patients of the same severity of airflow limitation reporting differing symptom severities. These patients may benefit from both lifestyle and exercise interventions. Study Three: Recruitment and retention rates suggest a trial targeting sedentary behaviour in hospitalised COPD patients is feasible. A revised intervention, building on the successful components of the present feasibility study is justified. Conclusion: The findings from this thesis have contributed a greater understanding of physical activity and sedentary behaviour in COPD and can inform the development of tailored physical activity and sedentary behaviour interventions for patients across the grades of COPD severity.
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Donovan, Kerry J. "An investigation into the influence of self-contained breathing apparatus (SCBA) upon lung function, inspiratory muscle strength and breathlessness in fire-fighters." Thesis, University of Birmingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368144.
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Gustafsson, Simon. "Att leva med KOL : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119235.
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Bakgrund Kronisk obstruktiv lungsjukdom är en sjukdom som är irreversibel och påverkar andningen negativt hos dem som lider av den och visar sig genom ett stort antal symtom. Sjukdomen skapar stort lidande och försvårar förmågan att leva ett normalt liv med hög livskvalité. Det beräknas vara den tredje största dödsorsaken i världen 2030 enligt världshälsoorganisationen. Syfte Att beskriva personers erfarenheter av att leva med Kronisk obstruktiv lungsjukdom Metod Studien utgörs av en litteraturstudie med fjorton artiklar. Artiklarnas resultat sammanfattades och gick från delarna till en ny helhet. En kvalitetsgranskning och analys utfördes för att skapa resultatet. Resultat Resultatet presenterades med fyra huvudkategorier: Att inte få luft, Förändrad livssituation, Beroende av stöd och Information och hantering. Till huvudkategorierna skapades följande tio underkategorier: Andnöd/andfåddhet, Ångest, Trötthet, Förluster, Skam, Miljöanpassning, Anhöriga, Hjälpmedel, Undervisning och information och Hantering och strategier. Konklusion Litteraturstudien visade att en stor dimension av symtom påverkar personer som lever med Kronisk obstruktiv lungsjukdom. Det behövs vidare forskning angående personers erfarenhet av sjukdomen men denna litteraturstudie har gett en inblick i några av de erfarenheter personerna lever med.Background Chronic obstructive pulmonary disease is an irreversible disease and it’s effecting the breathing in a negative way for those suffering by the disease and it’s shown by many different symptoms. The disease creates big suffering and obstructs the ability to live a normal life with high quality of life. It is expected to be the third largest cause of death worldwide in 2030, according to the World Health Organization. Aim To describe people's experiences of living with chronic obstructive lung disease. Method The study is a literature study with fourteen articles. The result from the articles were summarized and went from parts into a new whole. An inspection of quality and analysis was performed to create the result. Result The result were presented with four main categories: Unable to breathe, Change of way of life, Depending on support, Information and management. To the main categories were ten under categories created: Shortness of breath/breathlessness, Anxiety, Fatigue, Losses, Adaptation to environment, Relatives, Utilities, Education and information and Management and strategies. Conclusion The literature study showed that there’s a major dimension of symptoms affecting people living with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease. The literature review showed that a large dimension of symptoms are affecting people living with chronic obstructive pulmonary disease. We need further research on people's experience of the disease, but this study has provided an insight into some of the experiences people are living with.
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Chan, Carmen Wing Han. "A randomised controlled trial of the effectiveness of a psychoeducational intervention on breathlessness, fatigue and anxiety in patients with advanced lung cancer undergoing radiotherapy." Thesis, King's College London (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429685.
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Eliasson, Karl, and Rickard Tingemar. "Patientens upplevelse av andnöd : När luften tar slut." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-35845.
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Andnöd är ett vanligt symtom på allvarliga sjukdomar som medför multidimensionella och komplexa upplevelser. Andnöd är kraftigt fysiskt och psykiskt begränsande dygnet runt för patienten. Syftet med studien var därför att belysa patientens upplevelse av andnöd. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Litteratursökningen genomfördes systematiskt. Resultat: Nio vetenskapliga artiklar låg till grund för resultatet. Med hjälp av meningsbärande enheter framkom sex underkategorier som resulterade i två huvudkategorier: Attack på livet och Hantera livet. Slutsats: Symtomet bidrog till kraftiga begränsningar i livet. Patienterna upplevde att hela deras livsvärld påverkades av andnöden även efter den akuta fasen. Rädsla eller okunskap skapade osäkerhet hos patienterna som upplevde sig själva som otillräckliga och hjälplösa. Detta tillsammans med brister inom vården bidrog till att patienterna upplevde skam på grund av andnöd. Genom att andnöden ständigt fanns med patienten i tankarna upplevdes också hopplöshet och negativ syn på framtiden. Resultatet visar även en positiv sida där patienterna kunde hantera livssituationen genom stöd av familj och anhöriga, ökad kunskap, kontroll samt träning. Fortsatt forskning om hur personcentrerad vård kan hjälpa patienter och lindra upplevelserna av andnöd behövs. Ny forskning som tydligare uppmärksammar patienternas upplevelser av andnöd även efter den akuta fasen är angeläget.Shortness of breath is a common symptom of serious illnesses producing multidimensional and complex experiences. Breathlessness is very limiting - physically and psychologically - for patients around the clock. The purpose of the study was therefore to highlight the patient's experience of breathlessness. Method: The study was conducted as a general literature study with inductive approach. Literature was searched systematically. Result: Nine scientific articles formed the outcome. Using meaningful extracts six subcategories were formed in two main categories: Attack on life and Managing life. Conclusion: Breathlessness contributed to severe limitations in life. Patients felt their entire way of life was affected even beyond the acute phase. Fear or ignorance created uncertainty among patients who perceived themselves as inadequate and helpless. This, combined with shortcomings in health care, contributed to patients experiencing shame. Because breathlessness was always on the patient’s mind, hopelessness and despair were also experienced. The result also described a positive side where patients could handle life through supporting family and relatives, increased knowledge, control and training. Further research how person-centred care can relieve patients’ experiences of breathlessness is needed. New research clearly addressing patients' experiences of breathlessness outside the acute phase is required.
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Flores, Chiari Nydia. "Cost of Treatment of Asthma Attacks in a Tertiary Level Healthcare Hospital in Panama." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4671.
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Asthma is a chronic respiratory disease characterized by inflammation of the airway and the presence of recurrent attacks (exacerbations) of breathlessness, wheezing, cough, chest tightness, or some combination of these symptoms. In the US, about 53% of people with asthma had an asthma attack in 2008, and 57% of these, were children. One in ten children (10%) had asthma in 2009, and boys were more likely than girls to have asthma. Internationally, the prevalence of asthma varies widely in different countries, but the disparity is narrowing due to rising prevalence in low and middle income countries. Unfortunately, we do not have statistics for asthma in the Republic of Panama, neither epidemiological data nor costs, which is the reason why this research is needed.
The Panamanian Social Security Fund (CSS) provides protection to workers, their immediate families and the pensioned. By the end of 2010, the total insured population was 2,862,202 (83% of the total population of Panama). Of the total insured population 58% were dependent. Of this, 1,205,607 (42%) were children. On the basis of this information, we decided to develop the research study using information from the CSS, specifically in the Hospital de Especialidades Pediatricas (HEPOTH). It is the only tertiary level of healthcare children's hospital of the CSS.
A quantitative-descriptive design was used to develop this study. Data was collected from medical records of patients diagnosed with asthma in the HEPOTH from January to June 2012. We reviewed the medical records of each care area by month, and numbered each clinical record of children diagnosed with asthma in crisis and randomly selected 10% of the medical records from a minimum of 2000 records. Information on treatment costs was also obtained. Once all the information was collected, it was typed in the digital data log created for this study and the responses were code converted and the information was entered into a database. The data were exported to IBM SPSS Statistics 21.
The average cost of asthma attacks in Panama is estimated at $205.52. We were able to confirm that there are variations in this average by gender, age, geographic area of residence, season, severity, whether treated in the emergency department or hospitalization, and the type of treatment received. It was also possible to obtain secondary information about the epidemiology of asthma that allowed us to confirm that our statistics matched international statistics.
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Arrato, Nicole Andrea. "Improving Biobehavioral Outcomes with Progressive Muscle Relaxation in Patients with Advanced Lung Cancer." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1556728922855059.
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Swan, Flavia Eirwen Serena. "A preliminary investigation of the hand-held fan and the Calming Hand for the management of chronic refractory breathlessness in patients with advanced malignant and non-malignant diseases." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:15139.
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Background Chronic breathlessness is a devastating symptom of advanced cardio-respiratory diseases, with extensive consequences for patients and their family carers. Despite optimal management of the underlying disease, problems may persist. Non-pharmacological interventions such as the hand-held fan and the Calming Hand may offer benefits, however there is little supportive evidence. Aim To gain preliminary data about the effectiveness of the hand-held fan and the Calming Hand for the management of exertion-induced breathlessness in people with chronic breathlessness. Methods Mixed method study with integrated findings; Systematic literature review and meta-analyses of airflow; feasibility 2x2 factorial, randomised controlled trial of the handheld fan and/or Calming Hand for the relief of exertion-induced acute-on-chronic breathlessness. Qualitative interviews of patients and carers. Findings Review findings indicate that airflow delivered from the hand-held fan at rest provides discernible breathlessness relief. The “2x2 factorial, pragmatic phase II trial of the Calming Hand and hand-held fan was feasible in terms of recruitment, data completion and trial acceptability. These preliminary results supported use of the fan for exertion-induced breathlessness including for time and rate of recovery after exertion-induced breathlessness. Qualitative data indicated that faster recovery improved patient self-efficacy and confidence. Patients identified the fan as a helpful “medical” device that played a useful role as part of a complex intervention for breathlessness. Conversely, there was little indication from quantitative or qualitative data to signal worthwhile benefit from the Calming Hand. The best candidate primary outcome measure was judged to be recovery rate or recovery time from exertion-induced breathlessness. Conclusion A future definitive trial is feasible to assess the benefits of the hand-held fan with exertion induced breathlessness. Breathlessness recovery rate and the recovery time are novel outcomes that may potentially reflect important patient improvements with exercise. The hand-held fan represents a tool that helps to promote patient self-mastery of breathlessness. These data do not support the use of the Calming Hand.
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Sabapathy, Surendran, and n/a. "Acute and Chronic Adaptations To Intermittent and Continuous Exercise in Chronic Obstructive Pulmonary Disease Patients." Griffith University. School of Physiotherapy and Exercise Science, 2006. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20070115.170236.
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The primary aim of this thesis was to develop a better understanding of the physiology and perceptual responses associated with the performance of continuous (CE) and intermittent exercise (IE) in patients with moderate chronic obstructive pulmonary disease (COPD). A secondary aim was to examine factors that could potentially limit exercise tolerance in COPD patients, particularly in relation to the dynamics of the cardiovascular system and muscle metabolism. The results of the four studies conducted to achieve these aims are presented in this thesis. In Study 1, the physiological, metabolic and perceptual responses to an acute bout of IE and CE were examined in 10 individuals with moderate COPD. Each subject completed an incremental exercise test to exhaustion on a cycle ergometer. Subjects then performed IE (1 min exercise: 1 min rest ratio) and CE tests at 70% of peak power in random order on separate days. Gas exchange, heart rate, plasma lactate concentration, ratings of breathlessness, inspiratory capacity and the total amount of work completed were measured during each exercise test. Subjects were able to complete a significantly greater amount of work during IE (71 ± 32 kJ) compared with CE (31 ± 24 kJ). Intermittent exercise was associated with significantly lower values for oxygen uptake, expired ventilation and plasma lactate concentration when compared with CE. Subjects also reported a significantly lower rating of breathlessness during IE compared to CE. The degree of dynamic lung hyperinflation (change in end-expiratory lung volume) was lower during IE (0.23 ± 0.07 L) than during CE (0.52 ± 0.13 L). The results suggest that IE may be superior to CE as a mode of training for patients with COPD. The greater amount of total work performed and the lower measured physiological responses attained with intermittent exercise could potentially allow greater training adaptations to be achieved in individuals with more limited lung function. The purpose of Study 2 was to compare the adaptations to 8 wk of supervised intermittent and continuous cycle ergometry training, performed at the same relative intensity and matched for total work completed, in patients with COPD. Nineteen subjects with moderate COPD were stratified according to age, gender, and pulmonary function, and then randomly assigned to either an IE (1 min exercise: 1 min rest ratio) or CE training group. Subjects trained 3 d per week for 8 wk and completed 30 min of exercise. Initial training intensity, i.e., the power output applied during the CE bouts and during the exercise interval of the IE bouts, was determined as 50% of the peak power output achieved during incremental exercise and was increased by 5% each week after 2 wk of training. The total amount of work performed was not significantly different (P=0.74) between the CE (750 ± 90 kJ) and IE (707 ± 92 kJ) groups. The subjects who performed IE (N=9) experienced significantly lower levels of perceived breathlessness and lower limb fatigue during the exercise-training bouts than the group who performed CE (N=10). However, exercise capacity (peak oxygen uptake) and exercise tolerance (peak power output and 6-min walk distance) improved to a similar extent in both training groups. During submaximal constant-load exercise, the improved (faster) phase II oxygen uptake kinetic response with training was independent of exercise mode. Furthermore, training-induced reductions in submaximal exercise heart rate, carbon dioxide output, expired ventilation and blood lactate concentrations were not different between the two training modes. Exercise training also resulted in an equivalent reduction for both training modes in the degree of dynamic hyperinflation observed during incremental exercise. Thus, when total work performed and relative intensity were the same for both training modes, 8 wk of CE or IE training resulted in similar functional improvements and physiological adaptations in patients with moderate COPD. Study 3 examined the relationship between exercise capacity (peak oxygen uptake) and lower limb vasodilatory capacity in 9 patients with moderate COPD and 9 healthy age-matched control subjects. While peak oxygen uptake was significantly lower in the COPD patients (15.8 ± 3.5 mL·min-1·kg-1) compared to the control subjects (25.2 ± 3.5 mL·kg-1·min-1), there were no significant differences between groups in peak calf blood flow or peak calf conductance measured 7 s post-ischemia. Peak oxygen uptake was significantly correlated with peak calf blood flow and peak conductance in the control group, whereas there was no significant relationship found between these variables in the COPD group. However, the rate of decay in blood flow following ischemia was significantly slower (p less than 0.05) for the COPD group (-0.036 ± 0.005 mL·100 mL-1·min-1·s-1) when compared to the control group (-0.048 ± 0.015 mL·100 mL-1·min-1·s-1). The results of this study suggest that the lower peak exercise capacity in patients with moderate COPD is not related to a loss in leg vasodilatory capacity. Study 4 examined the dynamics of oxygen uptake kinetics during high-intensity constant-load cycling performed at 70% of the peak power attained during an incremental exercise test in 7 patients with moderate COPD and 7 healthy age-matched controls. The time constant of the primary component (phase II) of oxygen uptake was significantly slower in the COPD patients (82 ± 8 s) when compared to healthy control subjects (44 ± 4 s). Moreover, the oxygen cost per unit increment in power output for the primary component and the overall response were significantly higher in patients with COPD than in healthy control subjects. A slow component was observed in 5 of the 7 patients with COPD (49 ± 11 mL·min-1), whereas all of the control subjects demonstrated a slow component of oxygen uptake (213 ± 35 mL·min-1). The slow component comprised a significantly greater proportion of the total oxygen uptake response in the healthy control group (18 ± 2%) than in the COPD group (10 ± 2%). In the COPD patients, the slow component amplitude was significantly correlated with the decrease in inspiratory capacity (r = -0.88, P less than 0.05; N=5), indicating that the magnitude of the slow component was larger in individuals who experienced a greater degree of dynamic hyperinflation. This study demonstrated that most patients with moderate COPD are able to exercise at intensities high enough to elicit a slow component of oxygen uptake during constant-load exercise. The significant correlation observed between the slow component amplitude and the degree of dynamic hyperinflation suggests that the work of breathing may contribute to the slow component in patients with COPD.
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Sabapathy, Surendran. "Acute and Chronic Adaptations To Intermittent and Continuous Exercise in Chronic Obstructive Pulmonary Disease Patients." Thesis, Griffith University, 2006. http://hdl.handle.net/10072/366117.
Full textAbstract:
The primary aim of this thesis was to develop a better understanding of the physiology and perceptual responses associated with the performance of continuous (CE) and intermittent exercise (IE) in patients with moderate chronic obstructive pulmonary disease (COPD). A secondary aim was to examine factors that could potentially limit exercise tolerance in COPD patients, particularly in relation to the dynamics of the cardiovascular system and muscle metabolism. The results of the four studies conducted to achieve these aims are presented in this thesis. In Study 1, the physiological, metabolic and perceptual responses to an acute bout of IE and CE were examined in 10 individuals with moderate COPD. Each subject completed an incremental exercise test to exhaustion on a cycle ergometer. Subjects then performed IE (1 min exercise: 1 min rest ratio) and CE tests at 70% of peak power in random order on separate days. Gas exchange, heart rate, plasma lactate concentration, ratings of breathlessness, inspiratory capacity and the total amount of work completed were measured during each exercise test. Subjects were able to complete a significantly greater amount of work during IE (71 ± 32 kJ) compared with CE (31 ± 24 kJ). Intermittent exercise was associated with significantly lower values for oxygen uptake, expired ventilation and plasma lactate concentration when compared with CE. Subjects also reported a significantly lower rating of breathlessness during IE compared to CE. The degree of dynamic lung hyperinflation (change in end-expiratory lung volume) was lower during IE (0.23 ± 0.07 L) than during CE (0.52 ± 0.13 L). The results suggest that IE may be superior to CE as a mode of training for patients with COPD. The greater amount of total work performed and the lower measured physiological responses attained with intermittent exercise could potentially allow greater training adaptations to be achieved in individuals with more limited lung function. The purpose of Study 2 was to compare the adaptations to 8 wk of supervised intermittent and continuous cycle ergometry training, performed at the same relative intensity and matched for total work completed, in patients with COPD. Nineteen subjects with moderate COPD were stratified according to age, gender, and pulmonary function, and then randomly assigned to either an IE (1 min exercise: 1 min rest ratio) or CE training group. Subjects trained 3 d per week for 8 wk and completed 30 min of exercise. Initial training intensity, i.e., the power output applied during the CE bouts and during the exercise interval of the IE bouts, was determined as 50% of the peak power output achieved during incremental exercise and was increased by 5% each week after 2 wk of training. The total amount of work performed was not significantly different (P=0.74) between the CE (750 ± 90 kJ) and IE (707 ± 92 kJ) groups. The subjects who performed IE (N=9) experienced significantly lower levels of perceived breathlessness and lower limb fatigue during the exercise-training bouts than the group who performed CE (N=10). However, exercise capacity (peak oxygen uptake) and exercise tolerance (peak power output and 6-min walk distance) improved to a similar extent in both training groups. During submaximal constant-load exercise, the improved (faster) phase II oxygen uptake kinetic response with training was independent of exercise mode. Furthermore, training-induced reductions in submaximal exercise heart rate, carbon dioxide output, expired ventilation and blood lactate concentrations were not different between the two training modes. Exercise training also resulted in an equivalent reduction for both training modes in the degree of dynamic hyperinflation observed during incremental exercise. Thus, when total work performed and relative intensity were the same for both training modes, 8 wk of CE or IE training resulted in similar functional improvements and physiological adaptations in patients with moderate COPD. Study 3 examined the relationship between exercise capacity (peak oxygen uptake) and lower limb vasodilatory capacity in 9 patients with moderate COPD and 9 healthy age-matched control subjects. While peak oxygen uptake was significantly lower in the COPD patients (15.8 ± 3.5 mL·min-1·kg-1) compared to the control subjects (25.2 ± 3.5 mL·kg-1·min-1), there were no significant differences between groups in peak calf blood flow or peak calf conductance measured 7 s post-ischemia. Peak oxygen uptake was significantly correlated with peak calf blood flow and peak conductance in the control group, whereas there was no significant relationship found between these variables in the COPD group. However, the rate of decay in blood flow following ischemia was significantly slower (p less than 0.05) for the COPD group (-0.036 ± 0.005 mL·100 mL-1·min-1·s-1) when compared to the control group (-0.048 ± 0.015 mL·100 mL-1·min-1·s-1). The results of this study suggest that the lower peak exercise capacity in patients with moderate COPD is not related to a loss in leg vasodilatory capacity. Study 4 examined the dynamics of oxygen uptake kinetics during high-intensity constant-load cycling performed at 70% of the peak power attained during an incremental exercise test in 7 patients with moderate COPD and 7 healthy age-matched controls. The time constant of the primary component (phase II) of oxygen uptake was significantly slower in the COPD patients (82 ± 8 s) when compared to healthy control subjects (44 ± 4 s). Moreover, the oxygen cost per unit increment in power output for the primary component and the overall response were significantly higher in patients with COPD than in healthy control subjects. A slow component was observed in 5 of the 7 patients with COPD (49 ± 11 mL·min-1), whereas all of the control subjects demonstrated a slow component of oxygen uptake (213 ± 35 mL·min-1). The slow component comprised a significantly greater proportion of the total oxygen uptake response in the healthy control group (18 ± 2%) than in the COPD group (10 ± 2%). In the COPD patients, the slow component amplitude was significantly correlated with the decrease in inspiratory capacity (r = -0.88, P less than 0.05; N=5), indicating that the magnitude of the slow component was larger in individuals who experienced a greater degree of dynamic hyperinflation. This study demonstrated that most patients with moderate COPD are able to exercise at intensities high enough to elicit a slow component of oxygen uptake during constant-load exercise. The significant correlation observed between the slow component amplitude and the degree of dynamic hyperinflation suggests that the work of breathing may contribute to the slow component in patients with COPD.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Physiotherapy and Exercise Science
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Aleflod, Ebba, and Sandra Hellgren. "Är det här mitt sista andetag - patienters upplevelser av andnöd : En litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-6537.
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Bakgrund: Andnöd är ett vanligt symtom som upplevs av patienter med sjukdom i avancerat stadium och beskrivs som svårighet att få luft eller känsla av tung andning vilket kan ge ångest och rädsla. Flera sjukdomstillstånd såsom KOL, lungcancer och hjärtsvikt kan ge upphov till andnöd under den palliativa fasen vars vård syftar till att lindra lidande genom att behandla och förebygga symtom. Sjuksköterskor behöver känna till patienters upplevelser av andnöd för att kunna tillhandahålla samt individanpassa symtomlindring. Syfte: Beskriva upplevelser av andnöd hos personer som erhåller palliativt syftande vård eller vård vid avancerad sjukdom samt deras strategier för att hantera andnöd. Metod: En litteraturöversikt har genomförts med datainsamling från fem databaser som resulterade i 12 vetenskapliga artiklar där 11 var kvalitativa och en kvantitativ. Analysen utfördes utifrån Friberg (2017) och resulterade i två teman. Resultat: De två huvudteman som framkom var Upplevelser av andnöd samt Strategier för hantering av andnöd. Resultatet visade att andnöd gav upphov till ångest och rädsla samt fysisk trötthet och besvärande hosta. Dessutom innebar andnöd inskränkningar av patienters vardag och kunde leda till att de blev socialt isolerade. För att hantera andnöd var en vanlig strategi att anpassa livet efter sina förutsättningar. Diskussion: Metoddiskussionen tar upp författarnas gemensamma arbete, utmaningar och överväganden. Resultatdiskussionen tar bland annat upp hur upplevelsen av andnöd skapar ångest och inskränker patienters vardag. Detta kopplades till Roys adaptionsmodell.Background: Breathlessness is a symptom that makes breathing difficult which can lead to experiences of anxiety and fear. It is one of the most common symptoms experienced by patients with advanced stage disease. Several diseases such as COPD, cancer and heart failure can cause breathlessness. Palliative care aims to alleviate suffering by treating and preventing symptoms, such as breathlessness. Nurses need to be aware of patients´ experiences in order to provide and individually adjust symptomatic relief. Aim: Describe patients´ experiences of breathlessness, while receiving palliative care or receiving care for an advanced disease, including their strategies for managing breathlessness. Method: A literature review was carried out with data collection from five databases that resulted in 12 scientific articles of which 11 were qualitative and one was quantitative. The data analysis was made with Friberg (2017) method and resulted in two themes. Results: The two main themes that emerged were Experiences of breathlessness and Strategies for managing breathlessness. The result showed that breathlessness can cause anxiety and fear, physical fatigue and severe coughing. In addition, breathlessness implied limitations of patients´ daily life and could lead to patients being isolated in their homes, intended or unintended. Different strategies for managing breathlessness are presented. Discussion: In the discussion the pros and cons regarding the authors' joint work, challenges and considerations were addressed. The main findings of the result were discussed using Sister Callista Roy’s adaptation model.
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Wagner, Marlén, and Erica Larsson. "HUR INDIVIDER MED KRONISK OBSTRUKTIV LUNGSJUKDOM UPPLEVER LIVSKVALITET I DET DALIGA LIVET." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24766.
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Individer med kronisk obstruktiv lungsjukdom (KOL) kämpar varje dag att undvika andfåddhet och andnöd. Syftet med denna litteraturstudie är att undersöka kroniskt obstruktiva lungsjuka patienters upplevelse av livskvalitet, med särskilt fokus på andfåddhet och social isolering. Metodavsnittet beskrivs genom Goodmans sju steg (1996). Resultatet presenteras i fyra huvudteman: Andfåddhet och andnöd, livskvalitet och det dagliga livet, social isolering och miljön och stigmatisering och samhället. I resultatet framkommer det att andfåddhet är det mest besvärande symtomen, vädret och miljön påverkar individernas förmåga att röra sig utomhus. Slutsats Individer med KOL är tvungna att strukturera upp sin vardag för att kunna fungera i det dagliga livet.Individuals suffering from chronic obstructive pulmonary disease (COPD) struggle every day to avoid breathlessness and becoming out of breath. The aim with this literature review is to examine chronic obstructive pulmonary disease patient’s experiences of quality of life, focusing on breathlessness and social isolation. The method guidance is described through Goodman’s seven steps (1996). The result is presented in four themes: out of breath and breathlessness, quality of life and the daily living, social isolation and the environment, and stigma and society. The result that emerged was that breathlessness is the most troublesome symptoms and the weather and the environment affected the individual’s ability to move about outdoors. The conclusion was that individuals suffering from COPD had to organise their daily life to be able to make it through the day.
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Ferreira, Ana Filipa Basílio. "Validação do Breathlessness Beliefs Questionnaire e a sua relação com a atividade física e sintomas respiratórios na DPOC." Master's thesis, 2019. http://hdl.handle.net/10773/27969.
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Enquadramento: A dispneia, um dos principais sintomas da DPOC é uma das principais causas de incapacidade e ansiedade. Este sintoma torna a prática de
atividade física (AF) desagradável, levando a evitar a prática da mesma. A inatividade física é um preditor de mortalidade, morbilidade e hospitalizações na
Doença Pulmonar Obstrutiva Crónica (DPOC). Por este motivo, torna-se fundamental avaliar o impacto da dispneia e das crenças disfuncionais associadas à mesma, nos níveis de AF de pessoas com DPOC. Objetivos: Avaliar a validade e fiabilidade do instrumento Breathlessness Beliefs Questionnaire em pessoas com DPOC. Avaliar a relação entre crenças disfuncionais sobre a sensação de dispneia e a atividade física em pessoas com DPOC. Métodos: Realizou-se um estudo prospetivo, transversal, não experimental. Os dados para a caracterização da amostra (dados sociodemográficos, antropométricos, clínicos) foram recolhidos através de um protocolo de dados estruturado. A função pulmonar foi avaliada com espirometria. O Breathlessness Beliefs Questionnaire (BBQ) avaliou as crenças disfuncionais associadas à dispneia, instrumento composto por 2 subescalas: “foco somático” e “evitamento da atividade”, score final obtido na soma total de itens das subescalas. A validade de construto (validade convergente) foi avaliada através da correlação (coeficiente de Spearman) entre o BBQ e a dispneia, avaliada com a Modified Medical Research Council Dyspnea Questionnaire (mMRC), fadiga com o questionário The Checklist of Individual Strength (CIS20-P), e a qualidade de vida relacionada com a saúde através do Saint George’s Respiratory Questionnaire (SGRQ). Para avaliar a fiabilidade teste-reteste, foi calculado o Intraclass Correlation Coefficient (ICC), sendo que o instrumento BBQ foi preenchido novamente 2 semanas após o primeiro contacto. A AF foi medida através de acelerómetros ActiGraph GT3X+, usados durante 7 dias consecutivos. A análise dos dados foi realizada recorrendo à estatística descritiva e inferencial. Resultados: Foram recrutados 20 participantes com diagnóstico clínico de DPOC. Eram na sua maioria do género masculino (n=14), média de idades de 65,5±10,9anos, em relação à função pulmonar verifica-se um padrão respiratório obstrutivo (49,51±19,85) sendo que, de acordo com a classificação da DPOC (n=5) encontravam-se num estadio muito severo, e (n= 6) num estadio moderado. Na análise das propriedades psicométricas do BBQ, a correlação dos itens sugere boa fiabilidade e consistência interna, no total da escala BBQ (α=0,871) e na dimensão foco somático (α=0,766). Os valores de ICC foram elevados (ICC=0.965 vs ICC=0.981). Nos coeficientes de correlação entre os valores obtidos no BBQ e os valores de dispneia, fadiga, qualidade de vida e atividade física, estes não foram estatisticamente significativos (p<0.05). Os valores da AF nos participantes apresentaram níveis inferiores às recomendações internacionais, número de passos/dia, 5020,33 ±3163,08. Conclusões: O instrumento BBQ é fiável para a avaliação de pacientes com
doenças respiratórias com crenças disfuncionais relativas à dispneia e atividade física na DPOC. Mais investigação será necessária para validar o BBQ na população portuguesa.Background: Dyspnea, one of the main symptoms of COPD is one of the main causes of disability and anxiety. This symptom makes the practice of physical activity unpleasant, leading to avoiding the practice of it. Physical inactivity is a predictor of mortality, morbidity and hospitalizations in Chronic Obstructive Pulmonary Disease (COPD). For this reason, it is essential to evaluate the impact of dyspnea and dysfunctional beliefs associated with dyspnea, on the PA levels of people with COPD Aims: Evaluation of the validity and reliability of the Breathlessness Beliefs Questionnaire instrument and evaluation of the psychometric properties of the same in people with COPD. Evaluate the relationship between dysfunctional beliefs about the sensation of dyspnea/other respiratory symptoms and physical activity in people with COPD. Methods: A prospective, cross-sectional, non-experimental study was conducted. Data for sample characterization (sociodemographic, anthropometric, clinical data) were collected through a structured data protocol. Pulmonary function was evaluated with spirometry. The Breathlessness Beliefs Questionnaire (BBQ) evaluated dysfunctional beliefs associated with dyspnea, an instrument with 2 subscales: “somatic focus” and “activity avoidance”, the final score obtained on the total sum of subscale items. Construct validity (convergent validity) was assessed by correlation (Spearman coefficient) between BBQ and dyspnea, assessed with Modified Medical Research Council Dyspnea Questionnaire (mMRC), fatigue with The Checklist of Individual Strength questionnaire (CIS20-P), and health-related quality of life through the Saint George's Respiratory Questionnaire (SGRQ). To assess test-retest reliability, the Intraclass Correlation Coefficient (ICC) was calculated and the BBQ instrument was refilled 2 weeks after the first contact. PA was measured by ActiGraph GT3X + accelerometers, used for 7 consecutive days. Data analysis was performed using descriptive and inferential statistics. Results: Twenty participants with clinical diagnosis of COPD were recruited. They were mostly male (n=14), an average age of 65.5±10,9 years, regarding pulmonary function, there is an obstructive respiratory pattern (49.51±19.85) and according to the COPD classification (n=5) were at a very severe stage, and (n= 6) in a moderate stage. In the analysis of the psychometric properties of the instrument, the correlation of the items suggests good reliability and internal consistency, in the total BBQ scale (α=, .871) and in the somatic focus dimension (α=.766). The ICC values are very high and similar to those obtained by Wu et all (2017) (ICC = 0.965 vs ICC = 0.981). In the correlation coefficients between the values obtained in the BBQ and the values of dyspnea, fatigue, quality of life and physical activity, these were not statistically significant (p <0.05). PA values in the participants presented levels below the international recommendations, number of steps/day, 5020.33 ± 3163.08. Conclusions: The BBQ instrument is reliable and good instrument for evaluating patients with respiratory diseases with dysfunctional beliefs related to their dyspnea and physical activity in COPD. More research will be needed to validate BBQ in the Portuguese population.
Esta dissertação foi desenvolvida no âmbito do projeto “OnTRACK - On Time to Rethink ACtivity Knowledge: a personalized mHealth coaching platform to tackle physical inactivity in COPD” , financiado pelo Fundo Europeu de Desenvolvimento Regional (FEDER) através do COMPETE2020 - Programa Operacional Competitividade e Internacionalização (ref. POCI-01-0145-FEDER-028446), no âmbito do Programa PORTUGAL 2020, e por fundos nacionais através da FCT/MCTES (PTDC/SAU-SER/28446/2017).
Mestrado em Fisioterapia
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Jensen, DENNIS. "CHEMICAL AND MECHANICAL ADAPTATIONS OF THE RESPIRATORY SYSTEM AT REST AND DURING EXERCISE IN HEALTHY HUMAN PREGNANCY: IMPLICATIONS FOR RESPIRATORY SENSATION." Thesis, 2008. http://hdl.handle.net/1974/1386.
Full textAbstract:
Human pregnancy is characterized by significant increases in central ventilatory drive and perceived respiratory discomfort (breathlessness). The physiological mechanisms of hyperventilation and breathlessness in pregnancy remain largely unknown and understudied.
Objective: The main purpose of this research was to elucidate the mechanisms of maternal hyperventilation, and to systematically examine the contribution of alterations in central ventilatory drive, static/dynamic respiratory mechanics and their interaction with respect to the intensity of perceived breathlessness during exercise in pregnancy.
General Methods: Experiments were conducted between 34-38 wks gestation and again 4-5 months post-partum in a total of 35 healthy, young women. A comprehensive mathematical model of ventilatory control was used to examine the role of alterations in wakefulness and central chemoreflex drives to breathe, acid-base balance and female sex hormones in maternal hyperventilation. The effects of pregnancy on detailed ventilatory (breathing pattern, airway function, operating lung volumes, esophageal pressure-derived indices of respiratory mechanics) and perceptual (breathing and leg discomfort) responses to incremental cycle exercise to the limits of tolerance were also examined.
Results: Maternal hyperventilation resulted from a complex interaction between alterations in arterial and central acid-base balance and other factors that directly affect ventilation, including increased wakefulness and central chemoreflex drives to breathe, increased metabolism and decreased cerebral blood flow. Mechanical adaptations of the respiratory system, including recruitment of resting inspiratory capacity and reduced airway resistance, accommodated the increased demand for tidal volume expansion during exercise in pregnancy, while preserving effort-displacement and breathlessness-ventilation relationships. Variation in the severity of gestational breathlessness could not be explained by respiratory mechanical/muscular factors, but ultimately reflected variation in the amplitude of maternal hyperventilation and temporal desensitization to the sensory consequences of increased ventilation.
Conclusion: Our results indicated that 1) the hyperventilation and attendant hypocapnia/alkalosis of pregnancy can be explained by alterations in wakefulness and central chemoreflex drives to breathe, acid-base balance, metabolic rate and cerebral blood flow; 2) mechanical adaptations of the respiratory system obviated the anticipated rise in perceived breathlessness for a given ventilation during exercise in pregnancy, and helped to ensure that peak aerobic working capacity was admirably preserved, even in late gestation; and 3) gestational breathlessness ultimately reflected the normal awareness of increased ventilation and contractile respiratory muscle effort.Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2008-08-28 16:01:40.78
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Altfelder, Nadine. "Charakteristika von Palliativpatienten mit Atemnot - Ergebnisse der Hospiz- und Palliativerhebungen (HOPE) von 2006 bis 2008." Doctoral thesis, 2012. http://hdl.handle.net/11858/00-1735-0000-000D-EFF0-3.
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Ferreira, Diana Marques Barroso Honório. "Report on internship in palliative care South Adelaide palliative services : South Australia." Master's thesis, 2015. http://hdl.handle.net/10400.14/19734.
Full textAbstract:
Having acquired some knowledge in the palliative-care field over the last year, I felt the urgency for developing some practical skills. As such, contacts have been made and I enrolled in a 9-week internship in the South Adelaide Palliative Services (SAPS), in Adelaide, South Australia, from July to September 2014. I got to know a high-quality palliative-care service and develop activities like inpatients’ and outpatients’ assistance, consultancy and a research project. In my last week in Australia, I visited another palliative-care service at the Royal Melbourne Hospital, in order to compare different perspectives and ways of working.
My main goal was to get the full experience of a highly specialised palliative-care service and because of that my schedule was rather flexible. I also wanted to develop skills in symptom management, communication, psychosocial approaches and research. All the activities developed were extremely productive and helped me to build some solid knowledge and ideas to apply in my daily work. Additionally, it helped me to see changes that can be made to improve the quality of care we provide to our patients.
The research project concerning the issue of chronic refractory breathlessness has resulted in an article which is currently submitted for peer review to the “The Journal of Pain and Symptom Management”.Dado ter adquirido algum conhecimento teórico na área dos cuidados paliativos no ano precedente, senti uma necessidade urgente de desenvolver algumas competências práticas neste campo. Neste contexto, estabeleci alguns contactos e realizei um estágio prático de 9 semanas nos South Adelaide Palliative Services (SAPS), em Adelaide, Austrália, de Julho a Setembro de 2014. Durante o período que passei no SAPS pude observar um serviço de cuidados paliativos de elevada qualidade e desenvolver actividades no serviço de internamento, consulta externa, consultoria hospitalar e um projecto de investigação. Na minha última semana na Austrália visitei um segundo serviço de cuidados paliativos no Royal Melbourne Hospital, em Melbourne com o intuito de comparar diferente perspectivas e modos de trabalho. O principal objectivo era captar toda a experiência de um serviço de cuidados paliativos altamente especializado e portanto a minha rotação pelos diferentes serviços disponíveis era particularmente flexível. Outros objectivos eram desenvolver competências nas áreas do controlo sintomático, comunicação, abordagem psicossocial e investigação. Todas as actividades desenvolvidas foram extremamente produtivas e ajudaram-me a construir conhecimento sólido e ideias para aplicação no meu trabalho diário. Adicionalmente, permitiu-me identificar as mudanças que podem ser feitas para melhorar a qualidade dos cuidados que prestamos aos doentes. O projecto de investigação desenvolvido sobre dispneia crónica refractária resultou num artigo científico que foi submetido para revisão no “The Journal of Pain and Symptom Management”.