Dissertations / Theses: 'Dyspnea'

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Thomas, Loris A. "COPD dyspnea management by family caregivers." [Tampa, Fla.] : University of South Florida, 2004. http://purl.fcla.edu/fcla/etd/SFE0000541.

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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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Garske, Luke Albert. "Determinants of dyspnea associated with pleural effusion." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122900/1/Luke_Garske_Thesis.pdf.

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Fluid accumulation between the lung and rib-cage is commonly associated with shortness of breath, and frequently requires hospitalisation and invasive surgical procedures. This program of research has contributed new knowledge which has advanced our understanding of how fluid accumulation between the lung and rib cage causes shortness of breath. A technique was refined to measure the efficiency of the breathing muscles when fluid accumulates between the lung and rib cage. A novel non-invasive therapy to improve efficiency of the breathing muscles was trialled in a patient, and may improve shortness of breath.

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PELLEGRINO, GIULIA MICHELA. "LUNG FUNCTION AND DYSPNEA IN NEUROMUSCULAR DISEASES." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/842435.

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Dyspnea is a common source of suffering for patients affected by cardiorespiratory or neuromuscular diseases. The symptom is complex and encompasses different sensory qualities with distinct intensities. The Multidimensional Dyspnea Profile (MDP) is an instrument specifically developed to assess the multidimensional dimensions of the symptom, and it is applicable in both the research and clinical setting. In order to allow its use for Italian speaking populations, we aimed to provide a linguistically validated, Italian translation of the MDP. We conducted a structured translation and linguistic validation of the MDP questionnaire in accordance to the international guidelines and in cooperation with a specialized company (MAPI SAS, Language Services Unit, Lyon, France). Cognitive interviews on 8 patients were conducted in order to test clarity and understandability of the questionnaire. The multistep process was enriched by several quality checks which led to a translation conceptually equivalent to the original version (American English). A final certified copy linguistically validated Italian translation of the MDP is now available. It measures the intensity of the breathing discomforts in five sensory qualities and assess its intensity and potential reactions. W e here provide an Italian translation and linguistic validation of the MDP. This instrument, allows the assessment of dyspnea in both its sensory and emotional aspects, therefore representing a valuable method for research and therapy purposes.

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Burke, Susan P. (Susan Patricia). "Dyspnea and the mechanics of breathing during progressive exercise." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=57002.

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This study investigates dyspnea and the mechanics of breathing during progressive exercise. Three subject groups, athletes, normal sedentary subjects and chronic obstructive diseased patients were studied during progressive exercise testing to exhaustion on a cycle ergometer. Subjects rated dyspnea on a Borg Scale. Inspiratory flow, esophageal/gastric pressures and rib cage/abdominal displacements were measured.
Subjects demonstrated two patterns of dyspnea response to changes in esophageal (pleural) pressure. All athletes, two normals and five patients were termed "low dyspnea responders", (LDR), whereas the remaining subjects were termed "high dyspnea responders", (HDR).
LDR demonstrated large, rapid negative gastric pressure swings, coupled with outward abdominal displacement during early inspiration when compared to HDR, suggesting that LDR utilized abdominal muscle relaxation at the onset of inspiration. This mechanism appears to provide an extra inspiratory force, contributing to the increasing pleural pressures required. This breathing pattern appears to diminish the sensation of dyspnea at a given pleural pressure.

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Miura, Cinthya Tamie Passos 1983. "Adaptação cultural e validação do instrumento Modified Dyspnea Index." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308903.

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Orientador: Maria Cecilia Bueno Jayme Gallani
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-16T05:22:23Z (GMT). No. of bitstreams: 1 Miura_CinthyaTamiePassos_M.pdf: 2254405 bytes, checksum: 18a9c2640fe77f3688ab765ee00381d3 (MD5) Previous issue date: 2010
Resumo: A dispnéia é um dos sintomas cardeais das doenças cardiovasculares, as quais constituem importante causa de morbi e mortalidade no mundo. A subjetividade desse sintoma dificulta sua quantificação acurada, levando ao desenvolvimento de questionários, como o Modified Dyspnea Index (MDI), com o objetivo de avaliar mais especificamente o sintoma. Objetivos: Este estudo teve como objetivo realizar a adaptação cultural do instrumento Modified Dyspnea Index para a língua portuguesa do Brasil; testar sua confiabilidade e sua validade convergente por meio da correlação com o esforço percebido (aplicação da Escala Modificada de Borg), avaliação da força muscular respiratória e avaliação da qualidade de vida relacionada à saúde (aplicação do questionário Minnesota Living with Heart Failure). Metodologia: O processo de adaptação cultural seguiu metodologia recomendada internacionalmente, com as etapas de tradução-retrotradução e avaliação, por comitê de juízes, das equivalências: semântica, idiomática, cultural/experimental, conceitual e metabólica. O Índice de Validade de Conteúdo foi utilizado para avaliar a proporção de concordância entre os juízes. Como se trata de instrumento para uso do profissional de saúde, foi desenvolvido e validado um roteiro para nortear a aplicação do MDI. A confiabilidade foi avaliada segundo o critério da equivalência inter-observador, com aplicação simultânea do instrumento por dois profissionais de saúde (fisioterapeuta e enfermeiro) a pacientes portadores de doença cardiovascular com queixa de dispnéia. A validade foi testada segundo o critério da validade convergente, por meio da correlação entre MDI e: Escala Modificada de Borg, qualidade de vida relacionada à saúde (versão brasileira do Minnesota Living with Heart Failure - LHFQ) e valores de Pressão inspiratória máxima (Pi máx) e Pressão expiratória máxima (Pe máx). Os instrumentos foram aplicados por um único pesquisador, sob forma de entrevista; em seguida, os pacientes foram submetidos à mensuração da Pe máx e Pi máx. A concordância entre os avaliadores independentes, junto a 31 pacientes, foi avaliada por meio do coeficiente Kappa e para o teste das correlações entre o MDI e demais medidas (n=151) foi empregado coeficiente de correlação de Spearman. Foi adotado p? 0,05 como nível de significância. Resultados: O MDI sofreu alterações de acordo com a avaliação da validade de conteúdo. Foi constatado elevado coeficiente de concordância entre os observadores quanto ao escore total do MDI (k= 0,960). Foi observada correlação negativa significativa, embora de pequena magnitude entre MDI e Escala de Borg Modificada (r= -0,29, p=0,0003) e entre MDI e Pi máx e Pe máx (r= 0,26, p=0,0001; e r= 0,28, p=0,0006; respectivamente). A correlação entre o MDI e a medida de qualidade de vida, entretanto, foi de forte magnitude, considerando-se o escore total do LHFQ e sua dimensão física (r= -0,53, p=<0,0001; r= -0,59, p=<0,0001, respectivamente); e de moderada magnitude com a dimensão emocional (r= -0,30, p=<0,0001). A adaptação do MDI para a cultura brasilleira foi realizada com rigor e a análise de sua confiabilidade e validade aponta fortes evidências de ser uma ferramenta útil para avaliação da dispnéia em pesquisa e na prática clínica.
Abstract: Dyspnea is an important symptom in cardiovascular diseases, which are important cause of morbidity and mortality worldwide. The subjectiveness of the symptom hampers its accurate quantification. Thus, questionnaires, as the Modified Dyspnea Index (MDI), have been developed in order to provide a more specific evaluation of the symptom. Objectives: The aim of this study were to cross-culturally adapt the instrument Modified Dyspnea Index for the Portuguese language of Brazil, to test its reliability and convergent validity by correlation of its scores with perceived exertion (Modified Borg Scale), respiratory muscle strength evaluation and assessment of health-related quality of life (Minnesota Living with Heart Failure). Methodology: The process of cultural adaptation followed rigorous methodology and included the steps of translation, back translation and evaluation of semantic, idiomatic, cultural and metabolic equivalence by a committee of experts. The Index of Content Validity was used to estimate the proportion of agreement among the judges. As the MDI is designed to be answered by health professionals based on an the evaluation of the patient, a User's Guide for administering the Brazilian-MDI in Portuguese was prepared, with purpose of standardizing its administration and rating. Reliability was assessed according to the criterion of inter-observer equivalence, evaluating the agreement between two health care providers (one nurse and one physiotherapist) regarding individual and total scores of patients with cardiovascular disease with dyspnea. Validity was tested according to the criterion of convergent validity, by the correlation between Brazilian-MDI and: Modified Borg Scale, health-related quality of life (Brazilian version of the Minnesota Living with Heart Failure - LHFQ) and maximal inspiratory (MIP) and maximal expiratory pressure (MEP). The instruments were interviewer- administered by a single researcher, due to the low educational level of the target population. Afterwards, the patients were submitted to the measurement of MIP and MEP. The agreement between the independent observers in 31 patients was evaluated with Kappa's coefficient; Spearman coefficients were used to test the correlations between Brazilian-MDI and the other measures (n=151). The significance level used was p <0.05. Results: Evaluation of the content validity resulted in the rewording of some sentences of the MDI. The coefficient of agreement between the independent observers was k = 0.960.The Brazilian-MDI was negatively and significant but weakly correlated to the Modified Borg Scale (r= -0.29; p=0.0003) and to the Brazilian-MDI and MIP and MEP measures (r= 0.26; p=0.0001 and r= 0.28; p=0.0006; respectively). However, the Brazilian-MDI was highly correlated to the scores of health-related quality of life, considering the LHFQ total score and the physical subscale, (r= -0.53, p=<0.0001; r= -0.59, p=<0.0001, respectively); and the emotional domain (r= -0.30; p=<0,0001). The adaptation of the MDI for use in a Brazilian population has been undertaken with rigor and the tests of its reliability and validity points to strong evidences of being a useful tool for use in research and clinical settings in evaluating dyspnea.
Mestrado
Enfermagem e Trabalho
Mestre em Farmacologia

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Park, Soo Kyung. "The dyspnea experience in Korean immigrants with asthma and COPD." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3378502.

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Grant, Christina L. "Anxiety sensitivity and subjective feelings of dyspnea in asthmatic children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq20829.pdf.

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Balen, Frédéric. "Evaluation précoce de la dyspnée aiguë de l'adulte en médecine d'urgence." Electronic Thesis or Diss., Université de Toulouse (2023-....), 2024. http://www.theses.fr/2024TLSES060.

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La dyspnée aiguë est un symptôme subjectif perçu par le patient comme une "sensation de gêne respiratoire" évoluant depuis moins de deux semaines. La dyspnée est un symptôme de défaillance du système cardio-respiratoire. Le champ des diagnostics à envisager est vaste. Les pathologies les plus graves et fréquentes en médecine d'urgence sont la pneumopathie bactérienne (18 à 25%), l'insuffisance cardiaque aiguë (18 à 24 %), l'exacerbation de Bronchopneumopathie Chronique obstructive (BPCO) (16 à 18 %), l'asthme aigu (10 à 11 %) et l'embolie pulmonaire (1 %). La dyspnée un motif de recours important à bien des égards pour la Médecine d'Urgence dans tous ses aspects (en régulation téléphonique et lors de sa prise en charge extra et intra-hospitalière). En effet, il s'agit d'un motif fréquent de recours aux urgences extra et intra-hospitalières, la démarche diagnostique est complexe et source d'erreurs et sa mortalité intra-hospitalière est élevée (5 à 15 %). Les objectifs de ce travail sont d'identifier les patients les plus sévères dès l'appel aux secours, puis identifier les patients à risque de traitement inapproprié du diagnostic de leur dyspnée et proposer des outils afin de réduire ce taux de traitements inappropriés. Afin d'identifier les patients les plus graves dès l'appel téléphonique, nous avons constitué une cohorte rétrospective de 1387 patients âgés de plus de 15 ans ayant contacté les secours (appel au SAMU) pour dyspnée du 1er juillet 2019 au 31 décembre 2019 et ayant été admis aux urgences ou décédés avant leur admission. Deux cent huit (15 %) nécessitaient la mise en place d'un support respiratoire précoce. Les facteurs prédictifs d'un recours à un support respiratoire précoce identifiables à l'appel étaient : avoir un traitement de fond par ß2-mimétique, la polypnée, une incapacité à finir ses phrases, la cyanose, les sueurs et les troubles de la vigilance. Il semble pertinent de rechercher ses éléments en régulation médicale afin d'adapter les moyens de secours à engager. Afin d'identifier les patients a risque de traitement inapproprié du diagnostic de leur dyspnée, nous avons constitué une cohorte rétrospective de 2123 patients âgés de plus de 15 ans admis en service d'urgence pour dyspnée du 1er juillet 2019 au 31 décembre 2019. Huit cent neuf (38 %) avaient un traitement inapproprié au diagnostic final de leur dyspnée, comparé aux traitements recommandés internationalement. Les facteurs de risque de traitement inapproprié étaient : un âge de plus de 75 ans, des antécédents cardiaque ou respiratoires, une SpO2 < 90 %, une auscultation pulmonaire retrouvant des crépitants bilatéraux, un foyer de crépitants ou des sibilants. Cette population doit faire l'objet d'études ultérieures afin de diminuer le taux de traitements inappropriés. Nous avons également étudié les performances diagnostique de l'échographie pleuropulmonaire (EPP) dans le diagnostic précoce de patients âgés (plus de 65 ans) admis en service d'urgence pour dyspnée. La cohorte, prospective, était composée de 116 patients. Les performances de l'EPP, disponible immédiatement au lit du patient, étaient comparables à la stratégie habituelle (comportant examen clinique et résultats biologiques) disponible à 2 heures, pour le diagnostic d'insuffisance cardiaque et de pneumopathie. L'utilisation de l'EPP devrait permettre d'approcher le diagnostic final de façon précoce et peut être diminuer le traitement inapproprié. Nous proposons un protocole de recherche à venir sur cette thématique. La dyspnée représente un défi de prise en charge pour la Médecine d'Urgence. Les travaux menés et à venir devraient nous permettre d'optimiser les prises en charge pré et intra-hospitalières
Acute dyspnea is a subjective symptom perceived by the patient as a "sensation of respiratory discomfort" that has been evolving for less than two weeks. Dyspnea is a symptom of cardiorespiratory failure. The range of diagnoses to be considered is vast. The most serious pathologies frequently encountered in emergency medicine are bacterial pneumoniae (18 to 25%), acute heart failure (18 to 24%), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) (16 to 18%), acute asthma (10 to 11%) and pulmonary embolism (1%). Dyspnea is an important symptom for emergency medicine, in all its aspects (telephone regulation and out-of-hospital and in-hospital management). In fact, it is a frequent reason for referral to out-of-hospital and in-hospital emergency services, the diagnostic process is complex and error-prone, and in-hospital mortality is high (5 to 15%). The objectives of this study are to identify the most severe patients as soon as they call for help, then to identify patients at risk of inappropriate treatment for the diagnosis of their dyspnea, and to propose tools to reduce the rate of inappropriate treatment. In order to identify the most severe patients from the time of the telephone call, we set up a retrospective cohort of 1387 patients aged over 15 years who contacted emergency services (call to the "112"/"911") for dyspnea from July 1, 2019 to December 31, 2019 and were admitted to the emergency department or died before admission. Two hundred and eight (15%) required early respiratory support. Factors predictive of the need for early respiratory support that could be identified on call were: having background ß2-mimetic therapy, polypnoea, inability to speak, cyanosis, sweating and altered consciousness. It seems relevant to investigate these elements during first call for help, in order to adapt the rescue resources to be engaged. In order to identify patients at risk of inappropriate treatment for the diagnosis of their dyspnea, we set up a retrospective cohort of 2123 patients aged over 15 admitted to an emergency department for dyspnea from July 1, 2019 to December 31, 2019. Eight hundred and nine (38%) had inappropriate treatment of the final diagnosis of their dyspnea, compared with internationally recommended treatments. Risk factors for inappropriate treatment were: age over 75, cardiac or respiratory history, SpO2 < 90%, pulmonary auscultation finding bilateral crackles, a crackle focus or wheezing. This population should be the subject of further studies to reduce the rate of inappropriate treatment. We also studied the diagnostic performance of lung ultrasound (LUS) in the early diagnosis of elderly patients (over 65) admitted to the emergency department for dyspnea. The prospective cohort recruited 116 patients. The performance of LUS, available immediately at the patient's bedside, was comparable to the usual strategy (including clinical examination and laboratory results) available at 2 hours, for the diagnosis of heart failure and pneumopathy. The use of LUS should make it possible to approach the final diagnosis at an early stage, and perhaps reduce inappropriate treatment. We propose a future research protocol on this topic. Dyspnea represents an important challenge for emergency medicine. Our current and future work should enable us to optimize pre-hospital and in-hospital management

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Steele, Bonnie Gail. "Dimensions of dyspnea in chronic obstructive pulmonary disease : a nociceptive model /." Thesis, Connect to this title online; UW restricted, 1991. http://hdl.handle.net/1773/7347.

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Webel, Allison R. "Thirty-day analysis of dyspnea and edema in heart failure subjects." Connect to this title online, 2004. https://kb.osu.edu/dspace/handle/1811/176.

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Thesis (Honors)--Ohio State University, 2004.
Title from first page of PDF file. Document formatted into pages; contains 31 p.; also includes graphics. Includes bibliographical references (p. 22-23). Available online via Ohio State University's Knowledge Bank.

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Decavèle, Maxens César. "Caractérisation de la réponse émotionnelle à la dyspnée : des corrélats observationnels physio-cliniques à la reconnaissance des expressions faciales." Electronic Thesis or Diss., Sorbonne université, 2024. http://www.theses.fr/2024SORUS026.

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Bien pire que la douleur, la dyspnée chez les patients de réanimation placés sous ventilation mécanique est à l'origine d'une souffrance majeure, d'une sensation terrifiante d'asphyxier (mourir asphyxié) sans pouvoir ni la contrôler (powerlessness), ni lui échapper, ni même la signaler aux soignants (helplessness). Elle participe à la survenue du syndrome de stress post-traumatique des patients. L'absence d'attention portée par les soignants à la dyspnée des patients et les difficultés des patients à communiquer avec les soignants leurs symptômes sont à l'origine d'un enjeu de soins crucial, conceptualisé sous le terme « d'invisibilité » de la dyspnée, qui demeure au quotidien une souffrance non-évaluée et non traitée. Cette thèse de science, propose une approche transversale de l'observation de la souffrance respiratoire d'une « autre personne » afin d'apporter des éléments de réponses à la problématique de l'invisibilité de la dyspnée des patients. Une approche pédagogique suggère que le niveau d‘empathie des soignants influence leur capacité à ressentir ce qu'éprouvent les patients et à estimer l'intensité de la dyspnée des patients. Une approche clinique a permis le développement et la validation d'une échelle observationnelle de dyspnée la MV-RDOS permettant de fortement suspecter la dyspnée chez les patients placés sous ventilation mécanique et non-communicant. Enfin, dans une approche fondamentale, ces investigations proposent pour la première fois une description des expressions faciales associées à la dyspnée induite en laboratoire (sujets sains) ainsi qu'une méthode intelligente de reconnaissance faciale automatique des principales expressions faciales de dyspnée. Ces travaux de thèse ouvrent des pistes de développement d'outils de surveillance continue de la souffrance respiratoire des patients de réanimation afin de restaurer la « visibilité » de la dyspnée et mieux la soulager
Much worse than pain, dyspnea in intensive care unit (ICU) patients receiving mechanical ventilation is a major cause of suffering, conveying a terrifying sensation of an asphyxial threat, without being able to control it (powerlessness), or escape it, or even report it to caregivers (helplessness). It participates independently in the onset of post-traumatic stress syndrome in survivors of ICU stay. The lack of attention paid by caregivers to patients' dyspnea and the difficulty patients have in communicating their symptoms with caregivers are at the origin of a crucial care issue, conceptualized under the term "invisibility" of dyspnea, which remains an under-assessed and an under-treated suffering in daily practice. This science thesis proposes a transversal approach to observing the respiratory suffering of “another person” in order to provide elements of response to the problem of the invisibility of patients' dyspnea. An educational approach suggests that caregivers' level of empathy influences their ability to feel what patients are experiencing and to estimate the intensity of patients' dyspnea. A clinical approach allowed the development and validation of an observational dyspnea scale, the MV-RDOS, making it possible to strongly suspect dyspnea in noncommunicative, mechanically ventilated patients. Finally, in a fundamental approach, these investigations provide an original description of the facial expressions associated with dyspnea as well as an intelligent method for automatic facial recognition of the main facial expressions of dyspnea. This thesis work opens avenues for developing tools for continuous monitoring of respiratory suffering in the ICU in order to restore the “visibility” of dyspnea and better relieve it

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Rossi, Stephanie. "COPD patients responding to Tiotropium with dyspnea relief: a proof of efficacy?" Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66898.

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Characteristics of COPD patients who respond to Tiotropium with dyspnea relief Rossi, S., Glady, C., Baril, J., Perrault, H. and Bourbeau, J., RECRU, Montréal Chest Institute, McGill University, Montréal, Québec, Canada. Introduction: Our prescription practice is based essentially on patient self-reporting dyspnea relief. Objective: To assess whether COPD patients (pts) who reported dyspnea relief "tiotropium responders" provide similar response on repeated treatment attempt, and examine the potential underlying physiological determinants of the response. Method: A randomized (TIO or placebo), two-treatment period (2-weeks each), double-blind, cross-over design was conducted using pts characterised as "responder" based on self-reported dyspnea relief and a 1-point decrease on the TDI after the initial 2-week washout period. Each treatment period was preceded by a 2-week washout. Pts were taking Atrovent® and continue their regular medication except for TIO. Total lung capacity (TLC) and inspiratory capacity (IC) were obtained at rest (static hyperinflation) while IC, breathing frequency (BF), tidal volume (VT) and ventilation (VE) and Borg dyspnea scores were obtained at the end of steady-state cycling at 40% and 75% of peak power under both treatment. Paired t-test and a non-parametric analysis were done on all physiological outcomes versus dyspnea scores, as assessed by the TDI and CRQ at each visit. Results: Of the 21 pts recruited, 7 pts (69 ± 7 yrs; FEV1 33 ± 15% pred) drop out due to worsening of respiratory symptoms during washout (n=4) and during placebo treatment period (n=3). In the remaining 14 pts (67 ± 9 yrs; FEV1 55 ± 14%pred), 11 and 10 pts reported decreases in dyspnea on the TDI and CRQ respectively, under TIO. Decreases in dyspnea corresponded to increases in exercise IC and BF in 7 pts and decreases in TLC rest in 7 pts as compared to placebo. Improvements in Borg scores during
Les caractéristics des patients MPOC qui répondent au tiotropium par un soulagement de dyspnée Rossi, S., Baril, J., Gladis, C., Perrault, H. et Bourbeau, J., Épidémiologie respiratoire et Unité de recherches cliniques, Institut thoracique de Montréal, Université McGill, Montréal, Québec, Canada. Introduction : Notre pratique en matière de prescription est basée essentiellement sur le soulagement de dyspnée exprimé par le patient. Objectif : Évaluer si les patients MPOC qui ont rapporté un soulagement de dyspnée, « répondeur tiotropium », fournissent une réponse semblable sur la tentative répétée du traitement, et examiner les causes déterminantes physiologiques de la réponse. Méthode : La période de deux traitements (deux semaines chacun) randomisés (TIO ou placebo) à double anonymat croisé, en utilisant des patients caractérisés en tant que « répondeur » basé sur leurs rapports individuels de soulagement dyspnée et de la diminution d'un point sur le TDI après la période initiale d'élimination de deux semaines. Les patients prenaient Atrovent® et continuaient leur médicament habituel excepté le TIO. La capacité pulmonaire totale (TLC) et la capacité inspiratoire (IC) ont été obtenues au repos (hyperinflation statique) tandis que l'IC, la fréquence de respiration (BF), le volume courant (VT), la ventilation (VE), et les pointages de dyspnée de Borg ont été obtenus pendant effort constant à 40 % et à 75 % de puissance maximale pour les deux traitements. Le test t pour échantillons appariés et une analyse non-paramétrique ont été faites sur tous les résultats physiologiques contre les pointages de dyspnée évaluée par le TDI et le CRQ à chaque visite. Résultats : Des 21 patients recrutés, 7 patients (± 69 7 ans; FEV1 33 que le ± 15 % pred) ont lâché en raison de la détérioration des symptômes respiratoires pendant la période d'élimin

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Halank, Michael, Christiane Jakob, Martin Kolditz, Gerd Höffken, Utz Kappert, Gerhard Ehninger, and Matthias Weise. "Intimal Pulmonary Artery Sarcoma Presenting as Severe Dyspnea and Right Heart Insufficiency." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-134918.

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Background: Pulmonary artery sarcoma is a rare tumor with a poor prognosis. Case Report: We report the case of a 64-year-old man with an intimal pulmonary artery sarcoma presenting with severe high oxygen flow-demanding dyspnea and weight loss of 12 kg in the last 6 months. On echocardiography, right heart insufficiency, markedly elevated right ventricular pressure, a pressure gradient along the right outflow tract, and a tumor mass adherent to the wall of the truncus pulmonalis were detected. The tentative diagnosis by echocardiographic findings was pulmonary artery sarcoma. Computed tomography of the thorax and 18-fluorodeoxyglucose positron emission tomography showed an advanced local tumor manifestation. Surgical resection of the tumor to improve hemodynamics confirmed the diagnosis. Conclusions: Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients with dyspnea due to right heart failure, particular in the case of additional weight loss, and echocardiographic examination is a useful first diagnostic approach in establishing the diagnosis
Hintergrund: Das Pulmonalarteriensarkom ist eine seltene Erkrankung mit einer schlechten Prognose. Fallbericht: Wir berichten über einen 64-jährigen Mann mit einem intimalen Pulmonalarteriensarkom, der sich mit starker Luftnot trotz hoher Sauerstoffsubstitution und einem Gewichtsverlust von 12 kg in den letzten 6 Monaten vorstellte. Echokardiographisch fielen eine Rechtsherzinsuffizienz, ein deutlich erhöhter rechtsventrikulärer Druck, ein Druckgradient über dem rechten Ausflusstrakt und eine Tumormasse im Bereich des Trunkus pulmonalis mit Kontakt zur Gefäßwand auf. Die mittels Echokardiographie erhobene Verdachtsdiagnose lautete Pulmonalarteriensarkom. Die Computertomographie des Thorax und die 18-Flur-Desoxyglukose-Positron-Emissionstomographie erbrachten den Befund eines lokal fortgeschrittenen Tumors. Die chirurgische Resektion des Tumors, die zur Verbesserung der Hämodynamik durchgeführt wurde, bestätigte die Diagnose. Schlussfolgerungen: Das Pulmonalarteriensarkom sollte differenzialdiagnostisch als eine seltene Ursache der Luftnot im Rahmen einer Rechtsherzinsuffizienz, insbesondere bei zusätzlichem Gewichtsverlust, in Erwägung gezogen werden. Die Echokardiographie stellt eine wertvolle initiale Untersuchungsmethode bei der Diagnosestellung dar
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

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15

Marines-Price, Rubria. "Sensory and Affective Dimensions of Dyspnea on Exertion in Young Obese Women." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/595631.

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Introduction: Dyspnea on exertion (DOE) is a common symptom experienced by 40% of healthy obese women. Dyspnea has at least two dimensions: a sensory (intensity) and an affective dimension. The affective dimension was measured in this study by unpleasantness and negative emotions (i.e., depression, anxiety, frustration, anger, and fear) related to DOE, measured as rating of perceived breathlessness (RPB). Purpose: To examine whether RPB during exercise was associated with unpleasantness and negative emotions and the relative exercise intensity and to examine whether 12-week exercise training can reduce unpleasantness and negative emotions related to breathlessness in healthy obese women. Methods: A secondary analysis was conducted from data collected from an interventional study. Volunteers underwent body measurements, underwater weighing, pulmonary function testing, and a constant-load cycle test (60 watts). RPB, unpleasantness, and negative emotions related to DOE were obtained. Results: There was a positive relationship (n = 74) between RPB and unpleasantness (r = .61) and RPB and anxiety (r = .50). There was a relationship (n = 52) between unpleasantness and %VO₂max, r = .28 as well as %HRmax r = .38; anxiety and %HRmax, r = .28 (p < .05). Unpleasantness and anxiety were different between groups (n=55). Unpleasantness was higher in the +DOE group (M = 3.91, SD = 2.29) than the–DOE group (M = 1.37, SD = 2.01), t(53) = 4.27, p = < .0001; Anxiety was higher in the +DOE group (M = 2.76, SD = 2.99) than in–DOE group (M = 0.72, SD = 1.23), t(41.95) = 3.45, p = < .001. Within group analysis (n = 13) showed that participants in +DOE experienced a decrease in unpleasantness after 12-week exercise training (p = .013; paired t test). There was a main effect of exercise on unpleasantness (p = .0307) and a group x training interaction (p = .0285) indicating that persons with DOE prior to the exercise intervention experienced less unpleasantness after the intervention. Conclusion: Unpleasantness and anxiety have been identified as the most common symptoms associated with RPB. Healthy obese women who engage in physical activity may experience higher rates of unpleasantness and anxiety based on their relative intensity of exercise. In addition, women with DOE who experience unpleasantness as an associated symptom could possibly decrease the level of unpleasantness if they engage in an exercise-training program.

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PEARSON, SHERIDAN LEIGH. "SPEAKING DYSPNEA: EFFECT OF BREATHING DISCOMFORT ON SPEAKING IN PEOPLE WITH COPD." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/613387.

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Dyspnea (breathing discomfort) in people with COPD is an issue that impacts quality of life. Breathing discomfort can have negative emotional, physical, and mental effects due to chest/lung tightness, anxiety, and fear. By analyzing data of breathing perceptions and breathing patterns of participants, this study aims to determine the effects of breathing discomfort on speaking in people with COPD. The study also looks at which speaking tasks cause the most amount of breathing discomfort and why that may be.

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Halank, Michael, Christiane Jakob, Martin Kolditz, Gerd Höffken, Utz Kappert, Gerhard Ehninger, and Matthias Weise. "Intimal Pulmonary Artery Sarcoma Presenting as Severe Dyspnea and Right Heart Insufficiency." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A27604.

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Background: Pulmonary artery sarcoma is a rare tumor with a poor prognosis. Case Report: We report the case of a 64-year-old man with an intimal pulmonary artery sarcoma presenting with severe high oxygen flow-demanding dyspnea and weight loss of 12 kg in the last 6 months. On echocardiography, right heart insufficiency, markedly elevated right ventricular pressure, a pressure gradient along the right outflow tract, and a tumor mass adherent to the wall of the truncus pulmonalis were detected. The tentative diagnosis by echocardiographic findings was pulmonary artery sarcoma. Computed tomography of the thorax and 18-fluorodeoxyglucose positron emission tomography showed an advanced local tumor manifestation. Surgical resection of the tumor to improve hemodynamics confirmed the diagnosis. Conclusions: Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients with dyspnea due to right heart failure, particular in the case of additional weight loss, and echocardiographic examination is a useful first diagnostic approach in establishing the diagnosis.
Hintergrund: Das Pulmonalarteriensarkom ist eine seltene Erkrankung mit einer schlechten Prognose. Fallbericht: Wir berichten über einen 64-jährigen Mann mit einem intimalen Pulmonalarteriensarkom, der sich mit starker Luftnot trotz hoher Sauerstoffsubstitution und einem Gewichtsverlust von 12 kg in den letzten 6 Monaten vorstellte. Echokardiographisch fielen eine Rechtsherzinsuffizienz, ein deutlich erhöhter rechtsventrikulärer Druck, ein Druckgradient über dem rechten Ausflusstrakt und eine Tumormasse im Bereich des Trunkus pulmonalis mit Kontakt zur Gefäßwand auf. Die mittels Echokardiographie erhobene Verdachtsdiagnose lautete Pulmonalarteriensarkom. Die Computertomographie des Thorax und die 18-Flur-Desoxyglukose-Positron-Emissionstomographie erbrachten den Befund eines lokal fortgeschrittenen Tumors. Die chirurgische Resektion des Tumors, die zur Verbesserung der Hämodynamik durchgeführt wurde, bestätigte die Diagnose. Schlussfolgerungen: Das Pulmonalarteriensarkom sollte differenzialdiagnostisch als eine seltene Ursache der Luftnot im Rahmen einer Rechtsherzinsuffizienz, insbesondere bei zusätzlichem Gewichtsverlust, in Erwägung gezogen werden. Die Echokardiographie stellt eine wertvolle initiale Untersuchungsmethode bei der Diagnosestellung dar.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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Harper, Megan. "Mechanisms of exertional dyspnea in postsurgical patients with non-small cell lung cancer." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/55676.

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Background: Dyspnea is a debilitating symptom reported by patients with non-small cell lung cancer (NSCLC) after pulmonary resection. Reduced ventilatory capacity and respiratory muscle weakness associated with surgery could lead to an imbalance between ventilatory effort and output (a phenomenon known as neuromechanical uncoupling [NMU]) and result in dyspnea. Additionally, augmented pulmonary vascular resistance may impair left ventricular (LV) stroke volume (SV), and contribute to dyspnea and exercise intolerance. It was therefore hypothesized that greater NMU would be associated with dyspnea and exercise intolerance in NSCLC. It was also hypothesized that reduced diastolic filling and decreased LV SV would be associated with dyspnea and exercise intolerance in NSCLC. Methods: Using a cross-sectional design, thirteen post-surgical NSCLC patients performed a pulmonary function test and an incremental cardiopulmonary exercise test, followed by constant-load cycling exercise at 25%, 50%, and 75% Wmax. At 75% Wmax, patients exercised until symptom limitation. The sensory intensity, unpleasantness and sensory qualities of dyspnea were measured during exercise using the modified Borg scale and the multidimensional dyspnea profile. Ventilatory parameters, esophageal pressures, and operational lung volumes were measured continuously; echocardiography was employed during the constant-load trials. Healthy, sedentary age and sex-matched individuals were selected from our database for comparison to the NSCLC group. Results: Patients with NSCLC reported greater intensity of dyspnea for a given power output when compared to controls, particularly during higher intensity exercise. NMU was unchanged throughout exercise despite significant reductions in ventilatory capacity (p<0.05). There was a significant correlation between the resting E/A and exercise tolerance (r² = 0.58; p = 0.035); however, there were no significant correlations observed between ventilatory or cardiovascular parameters and dyspnea or exercise tolerance. Conclusion: In contrast to our hypothesis, we observed no evidence of NMU during exercise in NSCLC. The lack of association between ventilatory parameters and dyspnea suggests that the mechanisms of dyspnea are different from those previously identified in other respiratory diseases. The primary constraint to exercise appeared to be ventilatory limitation secondary to reduced ventilatory capacity and increased ventilatory demand due to peripheral deconditioning. Therapeutic interventions that improve aerobic capacity and reduce ventilatory drive are now warranted with the ultimate aim of reducing dyspnea in this population.
Graduate Studies, College of (Okanagan)
Graduate

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19

Rycroft, Ashley McLean. "Development of a constant rate step test to assess exertional dyspnea in the primary care setting in patients with chronic obstructive pulmonary disease (COPD)." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112359.

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Rationale. There is a need for the development of a field test to evaluate exertional dyspnea in the primary care setting. This study examined the applicability of a 3-minute constant rate step test in patients with COPD.
Methods. This test involved 4 stepping rates (18, 22, 26, 32 steps.min-1) equivalent to approximately 4.5, 5.3, 6.0, and 7.2 MET with the ultimate goal that in its final development, the assessment will be made a single stepping rate based on disease severity. Stable COPD patients (N = 43; 65 +/- 6.5 years; FEV1 = 49 +/- 16% pred.; SpO2 (%) rest: 95 +/- 2) were equipped with a portable Jaeger Oxycon MobileRTM metabolic system and followed an audio signal for stepping up and down a single 20 cm step for 3 minutes. Borg dyspnea scores were obtained at the end each stepping bout. A 10-min rest was given between each stepping bout.
Results. Of the 43 patients, 80% completed stages 1 and 2, 74 and 37% stages 3 and 4 while no patient of MRC class 4 or 5 (N = 8) completed stage 1. Breathing frequency (breaths.min-1) spanned from 26.5 +/- 4.1 to 39.0 +/- 6.4 but VT (L) remained unchanged (1.4 +/- 0.3 vs. 1.5 +/- 0.4) from stage 1 to 4 while Borg scores were 3 +/- 1, 4 +/- 1, 5 +/- 2, 6 +/- 3 respectively and SpO2 (%) were 92 +/- 5, 91 +/- 4, 91 +/- 4 and 90 +/- 4.
Conclusions. Preliminary findings indicate that a 3-minute constant rate step test may present a feasible alternative to laboratory testing to assess exertional dyspnea in moderately severe COPD. In this population, a stepping rate of 26 steps.min-1 could be sustained by the majority of patients while producing a level of dyspnea potentially amenable to therapy.
This study was supported by an unrestricted grant from Boehringer-Ingelheim/Pfizer.

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20

Henophy, Sara Catherine 1983. "Test-re-test reproducibility of constant rate step and shuttle walking tests for the assessment of exertional dyspnea in patients with chronic obstructive pulmonary disease (COPD)." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=116085.

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Purpose: Exercise testing modalities to assess the effects of a given intervention should prove to be reliable and reproducible. This study reports on test-retest reproducibility of the 3-min shuttle walking and step testing exercise protocols to assess exertional dyspnea and exercise physiology in COPD patients.
Methods: Stable COPD patients (N=43; 65 +/- 6.5 years; FEV1 = 49 +/- 16% pred.) equipped with a portable Jaeger Oxycon MobileRTM metabolic system repeated the walking or stepping tests on two occasions separated by 7 to 14 days. At each visit, participants performed, in a randomized order, four externally paced 3-min bouts of shuttle walking at speeds of 1.5, 2.5, 4.0 and 6.0 km·h-1 or of stepping at a constant rate of 18, 22, 26 and 32 steps·min-1, respectively. Each exercise bout was separated by a 10-min rest period. Ventilation, heart rate, gas exchange parameters and Borg dyspnea score were obtained for each bout during the last 30-seconds of exercise.
Results: The majority of patients completed stepping or walking at the slowest cadence but only 33% completed walking at 6.0 km·h -1 and 40% completed stepping at 32 steps·min-1. Test-retest Pearson correlation coefficients for ventilation, heart rate, gas exchange parameters and dyspnea scores over the four exercise bouts, all exceeded 0.80 with the highest coefficient found for ventilation (r≥.95). Intra-class correlation coefficients were similar to Pearson. Bland & Altman representation showed that a similar proportion of dyspnea data points (92 vs. 96%) lied within 2 SD of the mean difference between test-retest values for dyspnea Borg scores during walking and stepping.
Conclusion: Results show very good reproducibility for both 3-min shuttle walking and stepping exercise protocols in patients with COPD.
This study was supported by an unrestricted grant from Boehringer-Ingelheim/Pfizer.

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Henoch, Ingela. "Dyspnea experience and quality of life : among persons with lung cancer in palliative care /." Göteborg : Institute of Health and Care Sciences, Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/887.

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22

Takeda, Tomoshi. "Relationship between Small Airway Function and Health Status, Dyspnea and Disease Control in Asthma." Kyoto University, 2010. http://hdl.handle.net/2433/120545.

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Hajiro, Takashi. "Analysis of clinical methods used to evaluate dyspnea in patients with chronic obstructive pulmonarydisease." Kyoto University, 2001. http://hdl.handle.net/2433/150187.

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Schaeffer, Michele. "Physiological mechanisms of sex differences in exertional dyspnea: role of neural respiratory motor drive." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=119732.

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Dyspnea, the awareness of an increase in breathing discomfort, is commonly experienced during physical activity in healthy individuals and in patients with cardiopulmonary disease. It is well established that the intensity of perceived dyspnea is consistently higher during exercise in healthy women compared to men, regardless of age, height, and weight. However, the mechanism(s) of this sex-related difference in activity-related dyspnea is/are poorly understood and represented the primary focus of this thesis.Compared to men, women have smaller lungs, narrower airways, and weaker breathing muscles. These anatomical differences manifest as greater mechanical constraints on ventilation, particularly during the stress of exercise when ventilatory requirements are high. In addition, the amount of work the breathing muscles must perform in order to move a given volume of air into and out of the lungs during exercise is considerably higher in women than men. It is reasonable to predict that, because of these differences, the central nervous system must activate the respiratory muscles (particularly the diaphragm) to a greater extent during exercise in women compared to men to achieve the same level of ventilation and that this higher respiratory muscle activation may account for the increased perception of activity-related dyspnea in women. While it is not feasible to directly measure the neural output of the brains' respiratory control center at rest or during exercise in humans, central neural respiratory motor drive can be assessed indirectly by quantifying the electromyogram of the crural diaphragm (EMGdi) using a special electrode catheter positioned in an individual's esophagus. To date, no previous study, in health or disease, has examined whether the combination of relatively greater dynamic mechanical ventilatory constraints and a higher EMGdi (i.e., neuromechanical uncoupling of the respiratory system) during exercise in women is responsible, at least in part, for sex differences in activity-related dyspnea. To address this important question we compared detailed assessments of EMGdi, respiratory muscle function, ventilation, breathing pattern, operating lung volumes, cardio-metabolic function, and dyspnea intensity and unpleasantness ratings during symptom-limited incremental bicycle exercise testing in 25 healthy, young (20-40 yrs) women and 25 age-matched men. Our results demonstrated relatively greater mechanical constraints on tidal volume expansion at any given ventilation during exercise in women compared to men. The present study was the first to demonstrate that esophageal electrode catheter-derived measures of EMGdi were consistently higher at any given ventilation during exercise in women compared with men and that these differences reflected, in large part, the presence of relatively greater dynamic mechanical ventilatory constraints in women. In keeping with the results of previous studies, sensory intensity and unpleasantness ratings of dyspnea were higher at any given ventilation during submaximal exercise in women compared to men. However, in contrast to our a priori hypothesis, these perceptual differences could not be readily explained by greater neuromechanical uncoupling of the respiratory system, but primarily reflected the awareness of a relatively higher EMGdi (or central neural respiratory motor drive) needed to achieve any given ventilation during exercise in the setting of greater dynamic mechanical ventilatory constraints in women. These findings may have implications for our understanding of the physiological mechanisms of sex differences in activity-related dyspnea in variants of health (e.g., aging) and in patients with cardiopulmonary disease.
La dyspnée, définie comme la conscience d'une augmentation de gêne respiratoire, est souvent connu pendant l'activité physique chez les sujets sains ainsi que chez les patients ayant une maladie cardio-pulmonaire. Il est bien établi que l'intensité de la dyspnée perçue est systématiquement plus élevée au cours de l'exercice chez les femmes en bonne santé par rapport aux hommes, indépendamment de l'âge, de la taille et du poids. Cependant le/les mécanisme(s) de cette différence sont mal compris et la clarification de ceux-ci comportent l'objet principal de la thèse en question.Comparativement aux hommes, les femmes ont de plus petits poumons, des voies respiratoires plus étroites et des muscles respiratoires plus faibles. Ces différences anatomiques se manifestent par de plus grandes contraintes mécaniques sur la ventilation, en particulier pendant le stress de l'exercice lorsque les besoins ventilatoires sont élevés. Par conséquent, le travail que les muscles respiratoires doivent effectuer afin de déplacer un volume défini d'air dans les poumons pendant l'exercice est considérablement plus élevé chez les femmes que chez les hommes. En raison de ces différences, nous prévoyons que le système nerveux central doit activer les muscles respiratoires (notamment le diaphragme) dans une plus grande mesure chez les femmes pour atteindre le même niveau de ventilation et que cette activation supérieure peut expliquer la perception accrue de la dyspnée liée à l'activité chez les femmes. Même s'il n'est pas possible de mesurer directement les signaux envoyés par le centre de contrôle respiratoire chez l'homme, le contrôle moteur de la respiration peut être évalué indirectement en quantifiant l'électromyogramme du diaphragme crural (EMGdi) en utilisant un cathéter à électrode spécialisée placée dans l'oesophage d'un individu. À ce jour, aucune étude n'a examiné si la combinaison de contraintes ventilatoires mécaniques plus grandes et d'un EMGdi plus élevé pendant l'exercice chez les femmes est responsable des différences de sexe dans la dyspnée liée à l'activité. Nous avons donc comparé des évaluations détaillées de EMGdi, de fonction musculaire respiratoire, de ventilation, de modèle de respiration, de volumes pulmonaires opérationnels, de fonction cardio-métabolique, et d'intensité de la dyspnée et des cotes de désagréments lors de tests d'exercice incrémental de vélo dans 25 jeunes (20-40 yrs) femmes saines et 25 hommes sains du même âge. Nos résultats démontrent des contraintes mécaniques sur l'expansion du volume courant pendant l'exercice plus fortes chez les femmes par rapport aux hommes. La présente étude est la première à démontrer que les mesures de cathéter à électrodes œsophagiennes dérivés de EMGdi étaient systématiquement plus élevés peu importe le niveau de ventilation au cours de l'exercice chez les femmes par rapport aux hommes et que ces différences reflètent, en grande partie, la présence de contraintes ventilatoires mécaniques dynamiques relativement plus grande chez les femmes. En accord avec les résultats d'études antérieures, l'intensité sensorielle et le désagrément de dyspnée ont été supérieurs à n'importe quelle ventilation donnée au cours de l'exercice sous-maximal chez les femmes par rapport aux hommes. Cependant, contrairement à notre hypothèse a priori, ces différences de perception ne peuvent être facilement expliquées par un plus grand découplage neuromécanique du système respiratoire et reflètent la conscience d'une EMGdi relativement élevée (ou moteur d'entraînement respiratoire neural central) nécessaire pour atteindre une ventilation donnée pendant l'exercice dans le cadre de contraintes ventilatoires mécaniques dynamiques plus grande chez les femmes. Ces résultats pourraient avoir des implications dans notre compréhension des mécanismes de différences de sexe dans la dyspnée liée à l'activité dans les variantes de la santé et chez les patients ayant une maladie cardio-pulmonaire.

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Sundström, Robert, and Jesper Forsell. "Sjuksköterskans omvårdnadsåtgärder för patienter med andningssvikt i slutenvården : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3607.

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Bakgrund Andningssvikt är ett tillstånd som uppkommer till följd av problem med gasutbytet i kroppen. Ett flertal respiratoriska sjukdomar som till exempel astma och kroniskt obstruktiv lungsjukdom leder till andningssvikt. Patienter med andningssvikt upplever ofta ett lidande i samband med deras tillstånd och behöver ofta vård inom slutenvården. Sjuksköterskans professionella ansvar inkluderar därför omvårdnad av tillståndets symptom såsom dyspné, samt ett arbete mot att lindra patienters lidande. Syfte Syftet med denna litteraturöversikt var att belysa sjuksköterskors omvårdnad hos vuxna patienter med identifierad andningssvikt inom sluten sjukhusvård. Metod Litteraturöversikt användes som metod. Det inkluderades 15 artiklar i denna litteraturöversikt, dessa söktes fram i databaserna CINAHL och PubMed. Artiklarna granskades av författarna separat och tillsammans. Kvalitativa och kvantitativa artiklar har inkluderats i detta arbete, och analyserats utifrån metoden integrerad analys enligt Kristensson (2014). Resultat Dataanalysen gav upphov till tre kategorier. Dessa var “Sjuksköterskans förutsättning för god identifiering och bedömning av andningssvikt”, “dokumentation av andningssvikt” och “omvårdnadsåtgärder vid andningssvikt”. Det framgick att sjuksköterskor besitter bristande kunskaper om andningssvikt, använder inte evidensbaserade omvårdnadsåtgärder och undervärderar nivån av dyspné hos patienten. Sjuksköterskors vård av patienter med andningssvikt förbättrades vid krav på dokumentation, regelbundna bedömningar, samt användning av instrument och protokoll. Slutsats Bedömning är en viktig aspekt inom omvårdnaden av andningssvikt, och bör utföras regelbundet och i samband med omvårdnad. Det finns en stor variation av bedömningsinstrument och protokoll, och användning av dessa förbättrar sjuksköterskans omvårdnad av patienter med andningssvikt. Dessa verktyg är billiga och enkla att använda, samt kan leda till en hållbar miljö inom vården.
Background Respiratory insufficiency is a condition that is caused by problems related to the gas exchange that occurs in the body. Respiratory insufficiency is caused by numerous respiratory diseases like asthma and chronic obstructive pulmonary disease. Patients with respiratory insufficiency often experience an accompanied suffering and may need incare hospital care. Nurses’ professional responsibility therefore includes nursing care for the symptom of the condition such as dyspnea, and a work towards alleviating the patients suffering. Aim The aim of this literature review was to highlight nursing care towards adult patients with identified respiratory insufficiency within incare hospital setting. Method The applied method was a literature review. A search was performed in the bibliographic databases PubMed and CINAHL, and 15 articles was included in the literature review. These articles were reviewed by the authors separately and together. Quantitative and qualitative articles were included, both kinds were analyzed with the method integrated analysis according to Kristensson (2014). Results The data analysis resulted in three categories. These were “Nurses’ condition for good identification and assessment of respiratory insufficiency”, “Documentation of respiratory insufficiency” and “nursing interventions in respiratory insufficiency”. The results showed that nurses have inadequate knowledge about respiratory insufficiency, don’t use evidence-based interventions and underestimate the level of dyspnea among patients. Nursing care was improved with assessments in regularity, documentation requirements, or with the use of measuring instruments or protocols. Conclusions Assessment is an important aspect in nursing care for respiratory insufficiency and should be performed regularly and in liaison with care. There is a broad variety of assessment tools and protocols, and they improve nursing care for patients with respiratory insufficiency. These tools are cheap, easy to use and can lead to a sustainable environment in healthcare.

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Woo, Kevin Y. "The relationships between dyspnea, physical activity, and fatigue in patients with chronic obstructive pulmonary disease." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq28794.pdf.

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Aloush, Sami Mohammad. "Predictors of Exercise Tolerance, Severity of Dyspnea and Quality of Life in Pulmonary Rehabilitation Patients." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1372853967.

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Liou, Chiou-Fang. "The Role of Anxiety in the Relationship between Breathing Effort and Cancer-Related Dyspnea Sensation." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1196435748.

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Morris, Jason. "Non‐invasive testing to determine cardiac or non‐cardiac etiology of dyspnea in the ED." Thesis, The University of Arizona, 2014. http://hdl.handle.net/10150/315906.

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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Objectives: There were two main objectives of this study. The first was to determine the diagnostic threshold of hemodynamic values derived from impedance cardiography (ICG) and whether these thresholds are sex specific in determining the etiology of shortness of breath (dyspnea) in patients presenting to the emergency department (ED). The second was to compare ICG hemodynamic values with the results of bedside cardiothoracic ultrasonography and B-type natriuretic peptide (BNP) levels in patients with dyspnea in the ED. Methods: A prospective cohort of 50 adult patients presenting to the Maricopa Medical Center ED with dyspnea were evaluated using ICG, bedside cardiothoracic ultrasound, and BNP to determine the etiology of their complaint. The final etiology was determined through review of the treating practitioner’s final diagnosis and evaluation of the data available from the patient’s ED visit. Cardiac and non-cardiac groups were then compared to determine the accuracy, sensitivity, and specificity of ICG, bedside cardiothoracic ultrasound and BNP in identifying the etiology of their complaint. Results: BNP at a threshold of 164 pg/mL proved to be the most accurate with a sensitivity of 84.21%, a specificity of 79.17% and an area under the curve (AUC) of 0.8684 when plotted on a receiver operating characteristics (ROC) curve. Right ventricle diameter during systole was the most accurate bedside ultrasound parameter; at a threshold of 1.71 cm it showed a sensitivity of 77.78%, a specificity of 60.00% and an AUC of 0.7489. Heather index (HI) was the most accurate ICG parameter; at a threshold of 9.2 Ohm/sec2 it showed a sensitivity of 72.41%, a specificity of 85.00%, and an AUC of 0.8405. Only HI showed a significant difference between male and female patients. HI in females at a threshold of 10.4 Ohm/sec2 was 87.50% sensitive and 87.50% specific with an AUC of 0.9297. In males a HI threshold of 6.9 Ohm/sec2 was 69.23% sensitive and 66.67% specific with an AUC of 0.7564. Conclusion: Bedside cardiac ultrasound was technically challenging and the least accurate modality. ICG demonstrated some sex specific thresholds and while an easy to use modality, it was slightly less accurate than BNP which proved to be a simple and accurate modality for determining a cardiac or non-cardiac etiology of dyspnea.

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Newton, Phillip J. "The management of dyspnoea in advanced heart failure." Thesis, View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/35551.

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Heart failure is a cause of significant burden to both individuals and society. Individuals live with a disease where there is a decline in physical functioning, the experience of a range of symptoms including breathlessness and pain, frequent hospitalisations and death. The frequent hospital admissions that are usually precipitated by shortness of breath places an economic burden on the current health system. This burden of heart failure is expected to increase in the coming years due to factors such as the ageing population and improved survival from acute cardiac events. This current and predicted continuing burden has been recognised by the health system and has resulted in significant improvement in the pharmacotherapy and nonpharmacotherapy treatment of heart failure. Despite this improvement and with the exception of those few who receive cardiac transplantation, there is no cure for heart failure. Whist the advances in therapy have promoted significant improvements in heart failure management, symptoms including breathlessness (dyspnoea) remain a major issue. The Management of Dyspnoea in Advanced Heart Failure project explored and assessed the current therapeutic management of dyspnoea in advanced heart failure and examined two potential therapeutic options namely nebulised frusemide and long-term oxygen therapy. Following a comprehensive review of the nebulised frusemide literature, The Haemodynamic Effects of Nebulised Frusemide in Heart Failure study showed that nebulised frusemide did have an impact on the haemodynamic parameters of participants. Whilst many consider oxygen therapy as a common sense approach for breathlessness, the lack of scientific evidence for its use in chronic breathlessness with people who have normal or mildly low oxygen levels has prevented funding to supply oxygen therapy to this group of patients. The O2 Breathe Study is a palliative care study that is testing long-term home oxygen therapy versus medical air in patients who do meet the current funding arrangements. The analysis of the screening data showed that the symptom burden as a result of dyspnoea is similar to that seen in cancer and respiratory patients, and heart failure patients had lower levels of physical functioning than the respiratory group. Whilst the design of the studies in this thesis will not allow conclusions to be made regarding their efficacy for dyspnoea management in heart failure, they have provided preliminary data and hypotheses to be tested in the future.

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Beaumont, Marc. "Effet de l'entraînement des muscles inspiratoires sur la dyspnée chez des patients atteints de BPCO, en réhabilitation respiratoire." Thesis, Brest, 2017. http://www.theses.fr/2017BRES0044/document.

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Dans le cadre d’un programme de réhabilitation respiratoire (PRR) chez les patients atteints de BPCO, les sociétés savantes recommandent d’inclure un entrainement des muscles inspiratoires (EMI) chez les patients présentant une diminution objective de la force des muscles inspiratoires. Cette recommandation fait suite à une méta-analyse qui suggère qu’un EMI serait bénéfique lorsque la pression inspiratoire (PI) maximale est inferieure a 60 cm H2O.L’entraînement des muscles améliore la force et l’endurance des muscles inspiratoires, la capacité d’exercice et la dyspnée. Dans la dernière méta-analyse, les auteurs précisent que, dans le cadre d’un PRR, il n’est pas certain que l’EMI améliore davantage la dyspnée par rapport à un PRR seul.La question de départ est la suivante : est-ce que l’EMI au cours d’un PRR permet de diminuer davantage la dyspnée qu’un PRR seul ?Dans la première étude contrôlée randomisée, nous montrons que dans le cadre d’un PRR, l’EMI n’améliore pas davantage la dyspnée, chez des patients avec une force des muscles inspiratoires normale. Cependant, une analyse en sous-groupe tend à montrer que chez les patients plus sévèrement atteints (VEMS<50% théorique), l’EMI permettrait une amélioration plus importante de la dyspnée.La deuxième étude est le plus important essai contrôle randomise à propos de l’effet de l’EMI sur la dyspnée dans le cadre d’un PRR. Dans cette étude trois outils différents sont utilisés afin d’évaluer la dyspnée des patients, dont le questionnaire multidimensionnel MDP. Nous montrons que l’EMI ajoute a un PRR n’apporte pas une amélioration significativement plus importante de la dyspnée en comparaison a un PRR seul. Ainsi l’intérêt clinique de l’EMI dans le cadre d’un PRR semble remis en cause
During a pulmonary rehabilitation program (PRP) in COPD patients, French and international respiratory societies recommend to include inspiratory muscles training (IMT) in patients with an objective inspiratory muscles weakness. This recommendation follows upon a meta-analysis which suggests that IMT would be beneficial when the maximal Inspiratory pressure (PImax) is lower than 60 cm H2O. IMT improves the strength and the endurance of the inspiratory muscles, the exercise capacity and the dyspnea. In the last meta-analysis, the authors specifies that, when IMT is associated to a PRP, it is not certain that IMT improves more the dyspnea compared with a PRP alone.The initial question of this work is: does IMT during a PRP allow decreasing more the dyspnea than a PRP alone?In the first randomized controlled trial, we show that during a PRP, IMT in COPD patients with normal inspiratory muscles strength does not improve more the dyspnea, compared to a PRP alone. However, an analysis in sub-groups tends to show that in severe or very severe COPD patients (VEMS < 50 % of predictive value), IMT would allow a higher improvement of the dyspnea.The second study is the most important randomized controlled trial about the effect of IMT on the dyspnea during pulmonary rehabilitation. In this study we used three different tools to estimate the dyspnea of the patients, of which the multidimensional Dyspnea Profile questionnaire (MDP). We show that IMT added to a PRP does not improve significantly more dyspnea compared to a PRP alone. So the clinical interest of IMT during a PRP seems questionnable

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Nelson, Christy L. "Branched-chain amino acid nutrition and respiratory stability in premature infants." free to MU campus, others may purchase free online, 2002. http://wwwlib.umi.com/cr/mo/preview?3074432.

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Newton, Phillip J. "The management of dyspnoea in advanced heart failure." View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/35551.

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Thesis (Ph.D.)--University of Western Sydney, 2008.
A thesis submitted to the University of Western Sydney, College of Health and Science, School of Nursing in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographical references.

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Luketic, Jamie Eileen. "THE EFFECT OF INSPIRATORY MUSCLE STRENGTH TRAINING ON VENTILATION AND DYSPNEA DURING SIMULTANEOUS EXERCISE AND SPEECH." Miami University / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=miami1177035858.

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Dangers, Laurence. "Application du principe de contre-irritation à l'étude des mécanismes neurophysiologiques de la dyspnée : de la physiologie à la thérapeutique." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066132/document.

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L'existence d'une contre-irritation dyspnée-douleur, c'est-à-dire l'inhibition d'une sensation douloureuse par une sensation de dyspnée, permet d'établie une analogie forte dyspnée - douleur. La dyspnée de type " effort inspiratoire excessif " inhibe le réflexe spinal de flexion, ce qui indique qu'elle est au moins en partie médiée par des fibres C. Cette thèse approfondit les connaissances dans ce domaine. Elle montre que la dyspnée de type soif d'air possède des propriétés analgésiques procédant de mécanismes centraux puisqu'elle interagit avec les potentiels évoqués laser qui sont le reflet des mécanismes corticaux mis en jeu au cours de stimulation douloureuse. Elle évalue l'effet d'un antalgique non opioïde de pallier 1, le nefopam, sur une dyspnée expérimentale de type " effort inspiratoire excessif " sans mettre en évidence d'interaction du nefopam avec la contre-irritation dyspnée douleur
Dyspnea – pain counter – irritation, namely the inhibition of nociceptive sensation by dyspneic sensation, indicates that dyspnea and pain share some mechanisms. Dyspnea of the work/effort type inhibits the spinal flexion reflex, meaning that it involves C-Fibers. This thesis aims at improving knowledge in this field. It shows that dyspnea of the air hunger type has analgesics properties proceeding from central mechanisms: “air hunger” indeed inhibits laser evoked potentials that depends on the pain-related activation of cortical networks. It also evaluates the effect of a non-opioid first step analgesic, nefopam, on an experimental dyspnea of the “work-effort” type, and shows that although nefopam acts on C-fibers, it does not attenuate dyspnea and does not modify dyspnea-pain counter-irritation as evaluated by laser-evoked potentials. Finally, the thesis brings the first evidence of dyspnea-pain interactions in the clinical setting, by showing that ALS patients treated by non-invasive ventilation exhibit heightened pain sensitivity concomitant to the relief of dyspnea. These data advance the current understanding of dyspnea mechanisms and open new perspectives for treatment evaluation

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Suzuki, Masao. "A Randomized, Placebo-Controlled Trial of Acupuncture in Patients With Chronic Obstructive Pulmonary Disease (COPD): the COPD-Acupuncture Trial (CAT)." Kyoto University, 2015. http://hdl.handle.net/2433/202643.

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Chouihed, Tahar. "Identification des profils congestifs de l'insuffisance cardiaque aiguë pour guider les stratégies diagnostiques et thérapeutiques de prise en charge en urgence." Thesis, Université de Lorraine, 2018. http://www.theses.fr/2018LORR0065/document.

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La dyspnée aigue due à une congestion pulmonaire dans le cadre d’une insuffisance cardiaque aiguë (ICA) est un motif d’admission fréquent aux Urgences. Actuellement, l’ICA est deux fois plus fréquente et est associée à un risque deux fois plus élevé de décès (8%) que les syndromes coronariens aigus (SCA). La prise en charge en pré hospitalier et aux urgences est devenue une étape clé du parcours de soin de ces patients. Ces dernières années ont vu émerger de nouveaux paradigmes autour de la prise en charge de l’ICA mettant en perspective la complexité de cette pathologie. On parle désormais de syndrome d’insuffisance cardiaque aiguë (SICA), terminologie qui souligne la pluralité des situations cliniques et la diversité des profils congestifs. Cependant, l’évaluation de la répartition de la congestion au cours d’un SICA, même s’il existe peu de données sur ce sujet, est actuellement principalement faite sur des arguments cliniques ; l’échographie pulmonaire et l’estimation du volume plasmatique (ePVS, basé sur un calcul intégrant hémoglobine et hématocrite) pourraient permettre de mieux préciser les profils congestifs. Plusieurs études rapportent que la rapidité et l’exactitude du diagnostic étiologique de dyspnée aigue sont associées au pronostic des patients. Malgré l’existence d’outils diagnostiques (biomarqueurs, examens de radiologie), l’incertitude quant au diagnostic étiologique reste importante dans le contexte d’un service d’urgence, ce qui rend difficile la diminution du « Time to therapy » promue par les recommandations de la société européenne de cardiologie 2016. Les objectifs de notre travail étaient d’identifier des profils de congestion distincts d’insuffisance cardiaque aigue, de préciser la valeur diagnostique et pronostique de ces profils dans le contexte d’une dyspnée aigue, et de déterminer si l’effet thérapeutique des modalités de prise en charge initiale en urgence est dépendant de ces profils congestifs. Dans le cadre de notre travail, nous avons pu montrer sur la base des analyses réalisées dans la cohorte DeFSSICA que les outils permettant de mieux préciser le profil congestif des patients (notamment l’échographie pulmonaire et l’ePVS) sont peu utilisés aux urgences. Dans un deuxième travail, nous avons montré sur la cohorte PARADISE (NCT02800122) – conçue dans le cadre de ce doctorat, que l’altération de fonction rénale, l’hyponatrémie et la dysglycémie sont associée de façon significative au pronostic des patients atteints de dyspnée aigue. Dans un troisième travail, nous avons montré que le volume plasmatique estimé est un outil diagnostique performant de SICA et qu’un niveau plus important de congestion évaluée par l’ePVS est associé à une mortalité intra-hospitalière des patients admis pour dyspnée aigue plus élevée. Notre travail a aussi permis de concevoir et démarrer l’étude PURPLE (Pathway and Urgent caRe of dyspneic Patient at the emergency department in LorrainE district – NCT NCT03194243) qui collecte les données cliniques et paracliniques des patients admis pour dyspnée aigue aux urgences de façon prospective dans la région Lorraine. Par ailleurs, ce travail de thèse a aussi permis de concevoir et faire financer le projet EMERALD-US (Evaluation de la faisabilité de la Mise en œuvre et de la performance d’un algorithme d’EchogRraphie Aux urgences pour Le diagnostic de Dyspnée aigue-UltraSound) qui vise à valider un algorithme spécifique aux urgences utilisant l’échographie pulmonaire, cardiaque et vasculaire pour le diagnostic étiologique de dyspnée aigue
Acute dyspnea due to pulmonary congestion in acute heart failure (AHF) is a common reason for admission to the ER. Currently, AHF is twice as common and associated with a twofold higher risk of death (8%) than acute coronary syndromes (ACS). Pre-hospital and emergency care has become the cornerstone of care of these patients. In recent years, new paradigms have emerged surrounding AHF management, highlighting the complexity of this disease. Hence the use of the term acute heart failure syndrome (AHFS), a terminology underscoring the plurality of clinical situations and the diversity of congestive profiles. However, the assessment of congestion distribution during an AHFS is currently predominantly based on clinical arguments in spite of limited data. Alternatively, lung ultrasound (LUS) and estimation of plasma volume (ePVS, based on hemoglobin and hematocrit) could allow for a better assessment of congestive profiles. Several studies report that the rapid and accurate etiological diagnosis of acute dyspnea is associated with prognosis. Despite the availability of diagnostic tools including clinical exam, biomarkers and radiology, there is still considerable uncertainty regarding etiological diagnosis in the emergency department (ED) setting, hence rendering it difficult in reducing the « Time to therapy » advocated by the recommendations of the European Cardiology Society 2016 for AHF. The objectives of the present work were to identify distinct congestion profiles of AHF, to clarify the diagnostic and prognostic value of these profiles in the context of acute dyspnea, and to determine whether the therapeutic effect of initial emergency management modalities is dependent on these congestive profiles. In the course of our work, we were able to demonstrate in the DeFSSICA cohort that the tools allowing a better assessment of the patient's congestive profile (particularly LUS and ePVS) are rarely used in ED. In a second study, we showed in the PARADISE cohort (NCT02800122) - designed as part of this PhD research project - that impaired renal function, hyponatremia and dysglycemia are significantly associated with prognosis in patients with acute dyspnea. In a third study, we showed that the ePVS is an effective AHF diagnostic tool and that a higher congestion level assessed by ePVS is associated with higher in-hospital mortality of patients admitted for acute dyspnea. Our work also enabled us to design and initiate the PURPLE (Pathway and Urgent caRe of dyspneic Patients at the emergency department in LorrainE district - NCT03194243) study, which collects clinical and paraclinical data of patients admitted for acute dyspnea on a prospective basis. Lastly, this PhD research project enabled designing and obtain funding for the EMERALD-US project (Evaluation of the feasibility of implementing and performance of an Emergency Echography algorithm for the diagnosis of Acute Dyspnea-UltraSound) which aims to validate an original algorithm specific to emergency situations using lung, cardiac and vascular ultrasound for the etiological diagnosis of acute dyspnea

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Simsic, Aline Aparecida. "Tradução e validação da escala Dyspnoea-12 para o português falado no Brasil em pacientes com DPOC e hipertensão pulmonar." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17138/tde-30032017-135743/.

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Objetivo: Traduzir e adaptar para o português falado no Brasil a escala Dyspnoea-12. Fornecer dados de validação da escala para pacientes com DPOC e hipertensão pulmonar (HP). Métodos: A versão em inglês da escala Dyspnoea-12 sofreu processo clássico de tradução, até obtenção de versão definitiva em português denominada Dispneia-12-Pt. A escala Dispneia-12-Pt foi aplicada a 51 pacientes com DPOC (33 homens; idade: 66,4±8,1 anos; VEF1: 48,7±17,2%) e 15 com HP de diferentes etiologias (12 mulheres; idade: 45,8±12,7 anos; pressão sistólica da artéria pulmonar: 88±33,2 mmHg). Os voluntários responderam a escala de dispneia do Medical Research Council(MRC), o índice de dispneia basal (IDB), a escala hospitalar de ansiedade e depressão, questionário respiratório de Saint George (QRSG), avaliação funcional respiratória e teste da caminhada dos seis minutos (TC6min). Sessenta voluntários responderam a escala uma segunda vez, duas semanas após a primeira avaliação. Resultados: No grupo DPOC a escala Dispneia-12-Pt apresentou correlações significantes com as escalas MRC (r=0,4641; p=0,0006), IDB (r=0,515; p <0,0001), QRSG (r=0,8113; p<0,0001), ansiedade (r=0,4714; p=0,0005), depressão (0,4139; p=0,0025) e distância percorrida no TC6min (r=0,3293; p=0,0255). No grupo com HP a escala mostrou correlações significantes com as escalas MRC (r=0,5774; p=0,0242), QRSG (r=0,6907; p=0,0044), distância percorrida no TC6min (r=0,7193; p=0,0025) e difusão do monóxido de carbono (r=0,564; p=0,0447). O alfa de Cronbach para os voluntários analisados em um único grupo foi 0,927 e o coeficiente de correlação intraclasse 0,8456. Conclusões: A escala Dispneia-12-Pt apresenta propriedades biométricas aceitáveis e pode ser empregada em pacientes brasileiros com dispneia de diferentes etiologias.
Objective: To translate and to adapt for the Portuguese spoken in Brazil the scale Dyspnoea-12. To obtain validation data, regarding the use of this scale in patients with COPD and pulmonary hypertension (PH). Methods: The English version of the scale Dyspnoea-12 received a formal translation process and the final version was called Dispneia-12-Pt. The latter was applied to 51 COPD patients (33 men; age: 66.4±8.1 years; FEV1: 48.7±17.2 % pred) and 15 subjects with PH from different etiologies (12 women; age: 45.8±12.7 years; systolic pulmonary arterial pressure: 88±33.2 mmHg). The volunteers also answered the Medical Research Council dyspnea scale (MRC), the basal dyspnea index (DBI), the hospital scale of anxiety and depression, the Saint George Respiratory Questionnaire (SGRQ), respiratory functional evaluation and the six minute walk test (6 MWT). Sixty volunteers also answered the Dispneia-12-Pt scale about two weeks after the first evaluation. Results: In the COPD group the Dispneia-12-Br showed significant correlations with the scales MRC (r=0.4641; p=0.0006), BDI (0.515; p<0.0001), SGRQ (r=0.8113; p<0.0001), anxiety (r=0.4714; p=0.0005), depression (0.4139; p=0.0025) and walked distance in the 6 MWT (r=0.3293; p= 0.0255). In the HP group the scale showed significant correlations with the scales MRC (r=0.5774; p=0.0005), SGRQ (r=0.6907; p=0.0044), walked distance in the 6 MWT (0.7193; p=0.0025) and carbon dioxide diffusion capacity (r=0.564; p=0.0447). Cronbach´s alpha calculated for all volunteers evaluated as a whole was 0.927 while the intraclass correlation coefficient was 0.8456. Conclusions: The Dispneia-12-Pt exhibits acceptable biometric properties and may be used as a tool in Brazilian patients with dyspnea of different etiologies.

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Schwietering, Laura Ann. "Speech and Breathing Characteristics in Patients with Upper Airway Disorders: A Comparative Study." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1367278513.

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Sharma, Pramod. "The Effect of Experimental Changes in Physiological and Psychological Factors on Perception of Exertional Dyspnea in Healthy Individuals." Thesis, Griffith University, 2015. http://hdl.handle.net/10072/365245.

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Dyspnea is a clinical term for the sensation of shortness of breath. It is a subjective experience perceived and reported by an affected person when referring to a feeling of the unpleasantness and discomfort related to breathing (Epstein, Manning, and Schwartzstein, 1995; Mukerji, 1990). Both healthy subjects and patients with heart and lung disease can experience this sensation, but a key difference is the level of activity at which this sensation becomes particularly troublesome (West et al., 2010). Typically, healthy subjects experience substantial dyspnea during heavy to severe exertion when demands on the cardiorespiratory system are high, e.g. during running, stair climbing or at high altitude (Mukerji, 1990). By contrast, patients with heart and lung disease are likely to experience this sensation during their day to day activities (Hajiro et al., 1999; Simon et al., 1990; Vivodtzev et al., 2006) which may, as a consequence, become more limited as their condition progresses. So, dyspnea becomes an issue of clinical concern, likely indicative of disease, when it occurs at a level of activity in an individual that would not usually cause any difficulty (Mukerji, 1990). Although dyspnea is associated with a wide range of clinical conditions, it is a particularly significant symptom in Chronic Obstructive Pulmonary Disease (COPD) where it has a major impact on exercise capacity and quality of life
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Allied Health
Griffith Health
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Baille, Guillaume. "Atteinte ventilatoire dans la maladie de Parkinson : du symptôme à l’atteinte objective." Thesis, Lille 2, 2019. http://www.theses.fr/2019LIL2S023.

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La maladie de Parkinson (MP) est la deuxième maladie neurodégénérative la plus fréquente. Parmi les nombreux signes cliniques rapportés par les patients et observés par les médecins, les manifestations respiratoires sont encore très peu étudiées.Premièrement, la dyspnée, signe fonctionnel invalidant et altérant la qualité de vie, semble fréquente dans la MP mais sa prévalence et ses caractéristiques (dimension perceptive et réponse émotionnelle notamment) doivent être précisées. L'objectif de l'étude DYSPARK était de mieux définir le profil des patients dyspnéiques, le retentissement de la plainte respiratoire et de corréler ses caractéristiques avec des éléments cliniques de la MP afin de mieux appréhender sa physiopathologie.Deuxièmement, les anomalies ventilatoires objectives (explorations fonctionnelles respiratoires - EFR) sont encore mal connues dans la MP, de même que leur évolution. Une altération des volumes pulmonaires ou une atteinte de la musculature respiratoire pourraient avoir un retentissement sur le cours évolutif de la maladie. L'objectif de l'analyse d'une sous-population de la cohorte PRODIGY-PARK était de déterminer de façon prospective, sur 5 ans, le cours évolutif des données en EFR et leur impact pronostique potentiel
Parkinson’s disease (PD) is the second most common neurodegenerative disease. Among the numerous signs reported by the patients and observed by the physicians, respiratory manifestations are one the least explored.Firstly, dyspnea, debilitating symptom that can impair the quality of life, seems to be frequent in PD, but its prevalence and its clinical characteristics (perceptive aspect and emotional response) need to be determined. The objective of the DYSPARK project was to define the clinical profile of dyspneic PD patients, the consequence of the shortness of breath and to correlate its clinical features with the motor and non-motor aspects of the disease.Secondly, objective ventilatory abnormalities (pulmonary function testings – PFT) and the change over time are not well defined in PD. A diminution of lung volumes or impaired respiratory muscles could influence the outcome of the disease. The aim of the analysis of a group of patients from the PRODIGY-PARK cohort was to prospectively assess (5 years follow-up) the PFT data and their possible prognostic impact

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Koblick, Heather. "EFFECTS OF SIMULTANEOUS EXERCISE AND SPEECH TASKS ON THE PERCEPTION OF." Master's thesis, University of Central Florida, 2004. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2965.

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The purpose of this study was to investigate the effects of voice production and perception of dyspnea in aerobic instructors during simultaneous tasks of exercise and speech production. The study aimed to document changes that occur during four conditions: 1) voice production without exercise and no use of amplification; 2) voice production without exercise and the use of amplification; 3) voice production during exercise without the use of amplification; 4) voice production during exercise with the use of amplification. Participants included ten aerobic instructors (two male and eight female). The dependent variables included vocal intensity, average fundamental frequency (F0), noise-to-harmonic ratio (NHR), jitter percent (jitt %), shimmer percent (shim %), and participants' self-perception of dyspnea. The results indicated that speech alone, whether it was with or without amplification, had no effect on the sensation of dyspnea. However, when combining speech with exercise, the speech task became increasingly difficult, even more so without the use of amplification. Exercise was observed to inhibit vocal loudness levels as vocal intensity measures were lowest in the conditions with exercise with the use of amplification. Increases in F0 occurred in conditions involving exercise without the use of amplification. Moreover, four participants in various conditions exhibited frequencies that diverged from their gender's normal range. Participants' NHR increased during periods of exercise, however no participants were found to have NHR measures outside the normal range. Four participants were found to have moderate laryngeal pathology that was hemorrhagic in nature. Findings suggest that traditional treatment protocols may need to be modified beyond hygienic approaches in order to address both the respiratory and laryngeal work-loads that are encountered in this population and others involving similar occupational tasks.
M.A.
Department of Communicative Disorders
Health and Public Affairs
Communicative Disorders

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Ezeani, Nkiru Ezeani. "Guideline Use in Asthma Management in Primary Care Setting: A Systematic Review." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2813.

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Asthma is a chronic airway inflammatory disease that is characterized by reversible airway obstruction due to hyper-responsiveness of the tracheobronchial tree. The condition disproportionately affects male children, females, and the aged globally, and its prevalence keeps rising despite being a preventable condition in terms of relapse. Most asthmatic patients receive care in primary care settings. Various health agencies have developed asthma management guidelines to improve the quality of asthma care; however, in some cases, adherence to these guidelines is substandard. The overarching aim of this study was to determine whether primary care providers manage asthma in line with the available guidelines. A qualitative systematic review was conducted by searching for journal articles published between 2005 and 2016 relating to guideline use in primary care management of asthma. Twenty-nine primary studies evaluating adherence to asthma management guidelines were included. The collected data were analyzed through thematic data analysis techniques, and various themes emerged with regard to the research questions. Generally, the findings suggest that there is a mismatch between what is needed by patients/caregivers and what is currently provided by primary care providers (PCPs) in primary care settings and that asthma management guidelines are only partially followed or not used. Emerging themes were classified into 3 main categories: physician-, patient-, and institution-related barriers. The study provides recommendations on how adherence to asthma management can be improved.

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Nicot, Frédéric. "Contributions à l’exploration fonctionnelle respiratoire de l’enfant : mesure de la force des muscles respiratoires et étude de la perception d’une charge respiratoire par les potentiels évoqués respiratoires." Thesis, Paris Est, 2010. http://www.theses.fr/2010PEST0047.

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Certains enfants souffrant de maladies bronchopulmonaires et de maladies neuromusculaires présentent lors de l'évaluation de la force des muscles respiratoires des valeurs anormales et évaluent mal leur état dyspnéique. Le peu de gène respiratoire ressenti par ces patients permet d'émettre l'hypothèse qu'une anomalie de l'intégration corticale des afférences somesthésiques d'origines respiratoires serait responsable. Une nouvelle technique d'exploration neurophysiologique, les potentiels évoqués respiratoires (PER) provoqués par l'occlusion des voies aériennes permet d'investiguer cette voie.Des manoeuvres volitionnelles d'évaluation de la force des muscles respiratoires (Sniffs et SNIP) et non volitionnels (stimulation magnétique) ainsi que les PER ont été enregistrés chez des enfants sains et atteints de pathologies respiratoires et neuromusculaires.Les valeurs de force des muscles respiratoires enregistrées dans les différents groupes étaient semblables. Les composantes des PER enregistrées au sommet de la pariétale ascendante (C3-Cz ; C4-Cz) ont toutes été retrouvées chez les enfants sains et les enfants malades. Seules N1 et P2 ont été plus souvent recueillies chez les patients atteints de maladies neuromusculaires que chez les enfants souffrant de pathologies bronchopulmonaires (p < 0,005).Ces études ont montré que la force des muscles respiratoires peut être évaluée par différentes manœuvres chez les enfants atteints de maladies pulmonaires chroniques et de maladies neuromusculaires et que ces enfants présentent des altérations des PER
Some children with chronic lung and neuromuscular diseases showed abnormal values of respiratory muscle strength and misjudge their dyspneic state. These breathing difficulties allow us to hypothesize an abnormal integration of cortical somatosensory afferents. A new neurophysiological approach, Respiratory Related Evoked Potentials (RREPs) caused by upper airways occlusion allows to investigate this pathway.Volitional manoeuvres assessment of the strength of respiratory muscles (Sniff and SNIP) and non-volitional (Magnetic stimulation) and RREPs were recorded in healthy and children suffering from respiratory and neuromuscular diseases.Respiratory muscle strength values recorded in different groups by these techniques were similar. The components of RREPs recorded at C3-Cz and C4-Cz have all been found in healthy children and patients. Only N1 and P2 were more often collected from patients with neuromuscular diseases than in children with lung disease (p <0.005).These studies have shown that muscle strength breathing can be assessed by different manoeuvres in children with chronic lung diseases, neuromuscular diseases and thatChildren show alterations of RREPs

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Perry, Sarah Elizabeth. "The effect of different interventions on the sensory and affective dimensions of dyspnea in patients with COPD during exercise." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/43187.

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Background: Dyspnea is a complex sensation that has been recognized as a similar entity to the sensation of pain. Research has shown that dyspnea can be caused by a variety of diverse mechanisms and can be interpreted differently by each individual. Hyperoxia, heliox, and BiPAP are able to reduce dyspnea in patients with COPD but it is unknown how they specifically influence the affective (A1) and sensory (SI) dimensions of dyspnea during exercise. The aim of this study was to examine the extent to which hyperoxia, heliox and BiPAP alter A1 and SI scores and if changes in these dimensions of dyspnea are associated with improvements in exercise capacity. Methods: 10 patients with moderate to severe COPD (post-bronchodilator FEV1/FVC <0.7, 30%< FEV1 < 80% pred, >10 pack year history of smoking) who were exacerbation-free for at least six weeks prior to the study performed constant-load cycling at 75% of maximal work rate breathing air, hyperoxia (40% O₂, 60% N₂), heliox (21% O₂, 79% He), or BiPAP (pressure optimized for each individual). Results: At an isotime during exercise, hyperoxia reduced the sensory intensity of dyspnea (p=0.033). The change in A1 and SI were also significantly reduced compared to air with both hyperoxia (p=0.033, p=0.025, respectively) and heliox (p=0.047, p=0.041, respectively) but not with BiPAP. The A1/SI ratio was unchanged with all interventions compared to air. There were no significant changes in the sensory qualities of dyspnea with any intervention, except for the sensation of breathing a lot (rapidly, deeply, or heavily), which was significantly reduced with heliox at isotime. There were no significant differences in dyspnea measures or ventilatory parameters at end exercise. Conclusions: Hyperoxia and heliox altered the affective and sensory dimensions of dyspnea during exercise, leading to improvements in exercise time with hyperoxia. There were considerable individual differences in the reported quality of dyspnea scores, as well as exercise time. These findings suggest that phenotyping patients based on their specific type of dyspnea to a particular therapy before an exercise intervention may be warranted to enhance the known benefits of exercise for patients with COPD.

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Laches, Lisa A. "The Relationships Among Pain, Dyspnea, Constipation and Quality of Life in Lung Cancer Patients Enrolled in a Hospice Program." Scholar Commons, 2007. http://scholarcommons.usf.edu/etd/3926.

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There is evidence of a relationship between pain and associated symptoms, specifically constipation and dyspnea, and quality of life. Literature supports that endstage lung cancer patients suffer more symptoms than those with other types of cancers, and the course of treatment is primarily palliative, as many of these diagnosed patients cannot be cured. The purpose of this secondary analysis of data was to evaluate the relationships between pain and other common symptoms in end stage lung cancer patients in hospice care, and the relationships among pain, dyspnea, constipation and quality of life. The study sample included fifty lung cancer patients admitted to a hospice program, reporting pain. A series of Pearson’s correlations were used to analyze relationships between the variables pain intensity, pain distress, dyspnea intensity, dyspnea distress, constipation intensity and the relationships of these variables with quality of life. The results showed positive significant correlations between pain intensity and pain distress (r = .44, p = .002), dyspnea intensity and dyspnea distress (r = .47, p = .001), and constipation intensity and quality of life (r = -.57, p = .013). Pain and the relief of pain have been studied extensively in cancer patients, yet little research has been done in the way of side effects of opioid use, specifically constipation. This study reinforces to vi nursing the importance of a thorough assessment upon admission to hospice, and at each subsequent nursing visit, which includes a bowel habit history, current medications in use, potential risk for developing constipation and management of constipation once it is present. Hospice patients with lung cancer are reporting a decrease in quality of life secondary to constipation. Prevention or rapid alleviation of this symptom will provide comfort and allow the patient to focus on important end of life tasks.

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Miura, Cinthya Tamie Passos 1983. "Avaliação da dispneia : validação da versão brasileira do Modified Dyspnea Index em pacientes portadores de doença pulmonar obstrutiva crônica." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/283896.

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Orientadores: Maria Cecília Bueno Jayme Gallani, Roberta Cunha Matheus Rodrigues
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem
Made available in DSpace on 2018-08-26T06:01:11Z (GMT). No. of bitstreams: 1 Miura_CinthyaTamiePassos_D.pdf: 2054944 bytes, checksum: 19f9ca970b1a426cbe265606f08a42d1 (MD5) Previous issue date: 2014
Resumo: Este estudo teve como objetivo evidenciar a aplicabilidade clínica da versão brasileira do Modified Dyspnea Index (MDI), junto a pacientes portadores de Doença Pulmonar Obstrutiva Crônica (DPOC), a partir da análise de sua validade convergente. Foi verificada a validade convergente do instrumento por meio da correlação com dados da função pulmonar, da capacidade física submáxima, qualidade de vida relacionada à saúde (QVRS) e outra medida de dispneia. Métodos: A coleta de dados foi realizada no período de agosto de 2012 a outubro de 2013, de forma individual, em ambiente privativo, em uma única etapa, por meio de consulta ao prontuário e entrevista individualizada, com aplicação do MDI a seguir dos demais questionários, em sequência aleatória. Posteriormente os pacientes foram submetidos à avaliação da força muscular respiratória, da capacidade funcional e da função pulmonar. A função pulmonar foi analisada por meio da espirometria e da força muscular respiratória. Os seguintes dados foram obtidos a partir da espirometria: volume expiratório forçado no primeiro segundo (VEF1); capacidade vital forçada (CVF) e relação VEF1/CVF. Todos os dados da espirometria foram expressos como valores obtidos e porcentagem do predito. A força muscular respiratória foi avaliada por meio da manovacuometria, sendo mensuradas as pressões inspiratória e expiratória máximas (PI máx e PE máx). A capacidade física submáxima foi avaliada objetivamente por meio do teste de caminhada de 6 minutos (TC6M) e pelo autorrelato, com emprego do instrumento Veterans Specific Activity Questionnaire (VSAQ). A QVRS foi avaliada por meio de uma medida genérica - Medical Outcomes Study Short Form-36 (SF-36), e outra específica para doença pulmonar - versão modificada do Questionário do Hospital Saint George na Doença Respiratória- SGRQm. A Escala Modificada de Borg foi utilizada como outra medida de dispneia. Análise de Dados: Os dados foram submetidos inicialmente à análise descritiva. O teste de correlação parcial, com controle das variáveis: sexo, idade e IMC, foi utilizado para verificar a correlação da versão brasileira do MDI com os valores obtidos na avaliação da função pulmonar, da capacidade física submáxima, da qualidade de vida e da outra medida de dispneia. A análise de outliers uni e multivariados descartou a presença de valores extremos das variáveis de interesse. A correção de Bonferrroni foi adotada com finalidade de evitar os erros do tipo I. Resultados: Correlações positivas, de magnitude modesta a moderada, foram observadas entre o MDI e a capacidade respiratória: VEF1 (r = 0,25, p<0,01) e PI máx (r = 0,36, p<0,01). Correlações positivas, de moderada a forte magnitude, foram observadas com a capacidade física: TC6M ¿ distância (r = 0,34, p<0,01); e VSAQ (r =0,63, p<0,01). Correlação negativa foi observada com a Escala modificada de Borg (dispneia) (r=-0,46, p<0,01). Além disso, fortes correlações positivas foram observadas entre a pontuação total do MDI e medidas de QVRS, especificamente com os domínios de avaliação da capacidade física: SF-36 (r = 0,72, p<0,01) e o SGRQm (r = 0,63, p<0,01). Conclusão: Nossos dados demonstraram evidências de validade convergente da versão brasileira do MDI entre os pacientes com DPOC no Brasil. As correlações observadas apontam para sua utilidade na prática clínica, como avaliação mais abrangente da dispneia
Abstract: This study was aimed at evidencing the clinical applicability of the Brazilian version of the Modified Dyspnea Index (MDI), among Chronic Obstructive Pulmonary Disease (COPD) outpatients by the analyses of its correlations with data regarding pulmonary function; submaximal physical capacity, generic as well as specific measures of health-related quality of life (HRQoL) and another measure of dyspnea. Methods: In this cross-sectional study, data collection was gathred from August 2012 to October 2013, individually, in a private room. Patient records were reviewed and individual interviews were conducted with application of the MDI and then of the other questionnaires, in a random order. Subsequently, patients underwent the assessment of respiratory muscle strength, functional capacity and pulmonary function. Pulmonary function was assessed by spirometry obtaining the following data: forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC. All data were expressed as absolute (obtained) values and percentage of predicted. Respiratory muscle strength was assessed through the measures of maximal inspiratory and expiratory pressures (PIM and PEM). The submaximal physical capacity was objectively evaluated by the 6-minute walk test (6MWT) and by the self-reported measure, the Veterans Specific Activity Questionnaire (VSAQ). HRQoL was assessed by a generic measure ¿ the Medical Outcomes Study Short Form-36 (SF-36), and another specific for lung diseases ¿ the Modified Saint George's Respiratory Questionnaire- SGRQm. The Modified Borg Scale was used as another measure of dyspnea. Data Analysis: Data were initially submitted to the descriptive analysis. The partial correlation, adjusted by age, gender and BMI, was used to verify the correlation of the Brazilian version of the MDI with data concerning pulmonary function, submaximal exercise capacity, quality of life and other as dyspnea. Outlier¿s analysis (single or multivariate) discarded the presence of extreme values of the interest variables. The Bonferrroni correction was adopted to control type I errors. Results: Modest to moderate positive correlations were observed between the MDI and respiratory capacity (%): VEF1 (r = .25, p<.01); PIM (r = .36, p<.01). Moderate to strong positive correlations were observed with functional capacity: 6MWT-distance (%) r = .34, p<.01); VSAQ (r = .63, p<.01) and negative correlations with Borg scale (dyspnea) (r = -.46, p<.01). Moreover, strong positive correlations were found between total score of the MDI and HRQoL measures, specifically with the domains concerned to physical capacity: SF-36 (r =.72, p<.01) and SGRQm (r =.63, p<.01). Conclusion: Our data demonstrated evidence of convergent validity of the MDI among Brazilian COPD outpatients. The correlations observed point to the usefulness of the MDI in the clinical practice, as more comprehensive assessment of dyspnea
Doutorado
Enfermagem e Trabalho
Doutora em Enfermagem

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Mendonca, Cassandra. "Physiological mechanisms of dyspnea during exercise in the presence of external thoracic restriction: role of increased neural respiratory motor drive." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121504.

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Background & rationale. "Dyspnea" refers to the awareness of breathing discomfort that accompanies an increase in physical activity in health and across various diseases. It is arguably the most severe and burdensome symptom experienced by patients with chronic pulmonary disorders and is an important contributor to physical activity-limitation and adverse health outcomes, including hospitalization and death. Nevertheless, the mechanisms of dyspnea on exertion in health and disease remain partially understood. Accumulating evidence implicates neuromechanical uncoupling of the respiratory system as a likely mechanism of activity-related dyspnea, particularly in patients with chronic pulmonary diseases. According to this hypothesis, sensory intensity and unpleasantness ratings of dyspnea increase as a function of the widening disparity (as exercise progresses) between neural respiratory drive and the simultaneous response of the respiratory system, particularly as it relates to tidal volume (VT) expansion. An alternative and largely untested hypothesis states that the increased perception of dyspnea during exercise may reflect the awareness of increased neural respiratory drive needed achieve any given ventilation (V· E) in the presence of "abnormal" restrictive constraints on VT expansion. To date, the contribution of pathophysiological abnormalities in neural respiratory drive, dynamic respiratory mechanics and their interaction to the symptom of dyspnea during exercise in patients with chronic pulmonary disorders has proved difficult to study (beyond correlation) due to the presence of multiple co-morbidities that may independently contribute to the perception of dyspnea. Research Objectives. In light of the information cited above, the objectives of this research project were to better understand the physiological mechanisms of exertional dyspnea. Methods. This randomized cross-over study examined the acute effects of external thoracic restriction by chest wall strapping (CWS) – an accepted model of the "abnormal" restrictive constraints on VT expansion typical of patients with chronic pulmonary disorders - on detailed assessments of V· E, breathing pattern, dynamic respiratory mechanics, neural respiratory drive (as assessed by changes in the diaphragm electromyogram; EMGdi), and sensory intensity and unpleasantness ratings of dyspnea during symptom-limited incremental cycle exercise testing in 20 healthy, young men with normal lung function and cardiorespiratory fitness. Results. The key findings of this study include: [1] relatively greater dynamic mechanical constraints on VT expansion were evident during exercise with vs. without CWS; [2] EMGdi was consistently higher during exercise with vs. without CWS; [3] CWS had no effect on neuromechanical coupling of the respiratory system, as evidenced by relative preservation of the relationship between increasing EMGdi and VT expansion (adjusted for CWS-induced reductions in vital capacity) during exercise; [4] sensory intensity and unpleasantness ratings of dyspnea were significantly higher during exercise with vs. without CWS; and [5] CWS had no effect on the relationship between increasing EMGdi and each of the intensity and unpleasantness of dyspnea during progressive exercise. Conclusions & implications. We concluded that the increased perception of dyspnea during exercise with CWS could not be readily explained by increased neuromechanical uncoupling of the respiratory system, but that it likely reflected the awareness of increased neural respiratory drive needed to overcome the "abnormal" restrictive constraints on VT expansion. These findings may have implications for our understanding of the pathophysiological mechanisms of exertional dyspnea causation in patients with chronic restrictive lung disorders. This information, in turn, may aid in the development of more effective dyspnea relieving interventions for use in these patients.
Contexte et raisonnement. La «dyspnée» désigne une prise de conscience de gêne respiratoire se manifestant généralement à l'effort autant chez ceux en santé que ceux atteints de diverses maladies. Sans doute, il est symptôme le plus lourdement ressenti par patients atteints de maladies pulmonaires chroniques (MPC) pour son effet limitant sur l'activité physique et effet nocif sur la santé, y compris l'hospitalisation et la mort. Néanmoins, les mécanismes de la dyspnée d'effort en temps de santé et maladie restent que partiellement comprises. Des étudies ultérieurs suggèrent le découplage neuromécanique du système respiratoire comme mécanisme de dyspnée d'effort, en particulier chez patients atteints de MPC. Selon cette hypothèse, l'intensité sensorielle et le sentiment de malaise augmentent en fonction d'une disparité croissante entre pulsion respiratoire neuronale et réaction simultanée du système respiratoire, concernant notamment le volume courant (VT) d'extension. Une hypothèse alternative et largement non vérifiée suggère qu'une perception de la dyspnée élevée durant exercice reflète une prise de conscience d'une pulsion respiratoire neuronale nécessaire pour atteindre une ventilation (V· E) donnée lors de contraintes "anormales" sur l'expansion VT. À ce jour, la contribution des anomalies physiopathologiques sur la pulsion respiratoire neural, mécanique respiratoire dynamique et symptôme de la dyspnée au cours de l'exercice chez patients atteints de MPC s'est révélée difficile à étudier (au-delà de corrélation) en raison de présence de multiples comorbidités contribuant indépendamment à la perception de la dyspnée. Objectif. En guise de l'information présentée précédemment, nous tentons de mieux comprendre les mécanismes physiologiques de dyspnée d'effort. Méthode. Cette étude randomisée, contrôlée et croisée a permis d'examiner les effets aigus de la restriction thoracique externe par le cerclage de paroi thoracique (chest wall strapping, CWS),- un modèle accepté qui assimile les contraintes restrictives "anormales" sur l'expansion du VT de patients avec troubles pulmonaires chroniques - sur la V· E, mode de respiration, mécanique respiratoire dynamique, pulsion respiratoire neural (évaluée par changements dans l'électromyogramme du diaphragme; EMGdi), cotes d'intensité sensorielle et malaise accompagnant la dyspnée au cours d'épreuve incrémental d'effort limitée par symptômes, dans 20 jeunes hommes en santé et à fonctions pulmonaire et cardiorespiratoire normaux. Résultats. Les résultats principaux furent : [1] Les contraintes mécaniques dynamiques sur l'expansion du VT étaient relativement plus grandes durant effort avec CWS que sans; [2] L'EMGdi était systématiquement plus élevé lors de l'effort avec CWS que sans; [3] Le CWS n'avait aucun effet sur le découplage neuromécanique du système respiratoire, comme la relation entre EMGdi et expansion du VT (normalisée selon la réduction de la capacité vitale causée par le CWS) durant effort a été maintenue. [4] L'intensité sensorielle et le sentiment de malaise accompagnant la dyspnée étaient sensiblement plus élevés durant effort avec CWS que sans; et [5] Le CWS n'a eut aucun effet sur la relation entre une l'EMGdi augmentée, et l'intensité sensorielle et malaise ressentie, pris séparément durant l'effort progressif. Conclusions. Nous concluons que la perception accrue de la dyspnée durant effort avec CWS n'est pas aisément expliquée par découplage neuromécanique du système respiratoire élevé, mais qu'elle reflète plutôt la prise de conscience de la pulsion respiratoire neural supplémentaire nécessaire pour surmonter les contraintes restrictives « anormales » sur l'expansion du VT. Nos résultants permettent d'approfondir notre compréhension des mécanismes physiopathologiques causant la dyspnée d'effort chez patients à troubles pulmonaires chroniques, et s'avère important pour le développement de modalités soulageant la dyspnée chez ces patients dans le futur.

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Ferreira, José Filipe Miranda. "Dispneia: vivências do cuidador informal." Bachelor's thesis, [s.n.], 2018. http://hdl.handle.net/10284/7081.

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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Enfermagem
A presente investigação é do tipo descritivo-exploratório, de cariz fenomenológico inserido no paradigma qualitativo e realizado em meio natural, onde se incluíram 14 cuidadores informais de pessoas com dispneia, realizando-se a colheita de dados individualmente, através de um questionário presencial, na visita do doente numa instituição de saúde do Porto. Assim, importa conhecer quais as vivências do cuidador informal de pessoas com dispneia, em contexto domiciliário, visto ser um tema ainda pouco estudado em Portugal, considerando-o primordial para o instruir a cuidar de um doente com dispneia. Dos resultados obtidos o cuidar regista 57,14% na figura do feminino, 42,85% da população da amostra têm mais de 63 anos de idade e 28,56% com idade inferior a 39 anos, sendo 78,57% casados, tendo 28,57% completado o 1º ensino básico e 21,43% completou o 2º ensino básico. A respeito da situação profissional a taxa de 42,86% iguala a situação quer de empregado quer de reformado. No prestar cuidados à pessoa com dispneia os CI´s adjetivam-no, em reconfortante (n=5) e em tristeza (n=4). Assumir o papel de CI teve implicações na vida social (n=9). A família é o apoio no cuidar (n=9), sendo que para os CI´s (n=14) não têm qualquer apoio para além das instituições de saúde. Os CI´s (n=10) não tiveram qualquer ensino formal. Num episódio agudo e súbito de dispneia os CI’s caracterizam a reação, como não tendo reação (n=6), com desespero (n=3) sendo que (n=2) ainda não vivenciaram tal episódio. Como estratégias de coping no alívio da dispneia num episódio agudo a maioria dos CI´s assumem “sentar” (n=7). Nas AVD a gestão de esforço e tempo (n=6) é a estratégia assumida pelos CI´s, para diminuir e/ou evitar períodos agudos de dispneia, sendo que (n=5) assumem “nada” fazerem. Relativamente ao controlo sintomático da dispneia através de medidas não farmacológicas a maioria dos CI´s (n=10) dizem desconhecer.
The present descriptive-exploratory research, with a phenomenological nature inserted in the qualitative paradigm and carried out in the natural environment, where 14 informal caregivers of people with dyspnea were included, and individual data were collected through a face-to-face questionnaire at the visit of the patient in a Porto health institution. Thus, it is important to know the experiences of the informal caregiver of people with dyspnea, in a home context, since it is a subject that has not yet been studied in Portugal, considering it to be the primary instruction for caring for a patient with dyspnea. Of the results obtained, caregiving registered 57,14% in the female figure, 42,85% of the population of the sample were over 63 years of age and 28,57% under the age 39, 78,57% being married, with 28,57% having completed elementary education and 21,43% completed 2nd grade. Regarding the professional situation, the rate of 42,86% equals the situation of both employed and retired. In caring for the person with dyspnea, the ICs adjectival, comforting (n=5) and sadness (n=4). Assuming the role of IC had implications in social life (n=9). The family is caring support (n=9), and for ICs (n=14) they have no support beyond health institutions. The ICs (n=10) did not have any formal education. In an acute and sudden episode of dyspnea, ICs characterize the reaction, not having a reaction (n=6), with despair (n=3) and (n=2) not yet experienced this episode. How coping strategies in relieving dyspnea in an acute episode most ICs assume "sit" (n=7). In ADL, effort and time management (n=6) is the strategy adopted by ICs to decrease and/or avoid acute periods of dyspnea, and (n=5) assume "nothing" to do. Regarding the symptomatic control of dyspnea through non-pharmacological measures most ICs (n=10) say they do not know.
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Hedin, Kajsa. "Samband mellan gångsträcka, dyspné och desaturation i 6 minuters gångtest hos en grupp individer med pulmonell arteriell hypertension (PAH) - en registerbaserad pilotstudie." Thesis, Uppsala universitet, Åsenlöf: Fysioterapi, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-407329.

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Background: Pulmonary arterial hypertension (PAH) is a rare but serious disease with symptoms as dyspnea, fatigue and intolerance to exercise. The treatment is mainly pharmacological with physical exercise as an important complement. The 6 minutes walking test (6MWT) is used today worldwide for assessment and follow-up of the PAH patient. Objective: The aim of this study was to, among a PAH-population in Norrland, examine the 6-minutes walking test variables walking distance, ∆dyspnea and Δsaturation according to change over time and correlation between the variables. A further objectice was to examine any differences between four different PAH risk groups according to ∆dyspné och Δsat. Method: This study is a retrospective register study based on the Umeå/Sundsvall part of the Swedish patient registry SPAHR. A total of 69 patients were examined at the time of diagnosis and at follow-up after 12 ± 3 months regarding 6MWT. Results: A significantly longer walkning distance was measured at follow-up comepared to baseline (284 m (IQR 187-410) vs 322 m (IQR 240 - 435), p < 0,001). A negative but weak correlation existed at baseline between walking distance and Δsat (r = -0.23, p= 0.022) and at follow-up (r = -0.27, p= 0.033). No significant difference regarding Δsaturation and Δdyspnea could be seen between the risk groups. Conclusion: Also this study demonstrates that the walking distance is the measure that is seen to vary over time, while Δsaturation and Δdyspnea have not been shown to do so. The weak correlation that could be detected between walking distance and Δsaturation raises the idea that it may be a factor that strengthens or weakens the result measured in meters and could thus possibly increase the informational value of the 6MWT. However, the results of this study indicate that desaturation and estimated dyspnea are not factors that correlate with the walking distance (and thus the patient's functional working capacity). Other variables such as quality of life and fear of movement may need to be estimated by the patient group to be able to evaluate and plan both pharmacological treatment and physical exercise, and to see if it can predict the outcome of the treatment. This should be studied scientifically.

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