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dyspnoea approach

Christian Michael Horvath, Martin Horvath Brutsche, Otto Dagobert Schoch, Bernarde Schillig, Florent Baty, Dieter vonOw, Jochen Julius Rüdiger
Non-invasive ventilatory support is frequently used in patients with severe respiratory failure (SRF), but is often limited to intensive care units (ICU). We hypothesized that an instantaneous short course of NIV (up to 2 h), limited to regular working hours as an additional therapy on the emergency department (ED) would be feasible and could improve patient´s dyspnoea measured by respiratory rate and Borg visual dyspnea scale. NIV was set up by an interdisciplinary respiratory care team. Outside these predefined hours NIV was performed in the ICU...
October 8, 2016: Internal and Emergency Medicine
S E Roberts, F M Schreuder, T Watson, M Stern
OBJECTIVE: To investigate whether COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term and, if so, their experience of this. DESIGN: A mixed methodological approach using semi-structured telephone interviews, a focus group and observation of current PLB technique was used. Qualitative analysis was based on grounded theory. SETTING: Participants were recruited from the two inner city London (UK) boroughs...
May 27, 2016: Physiotherapy
Alberto Sandri, Francesco Guerrera, Matteo Roffinella, Stefania Olivetti, Lorena Costardi, Alberto Oliaro, Pier Luigi Filosso, Paolo Olivo Lausi, Enrico Ruffini
BACKGROUND: To assess the trend of our surgical patients affected by malignant pleural mesothelioma (MPM) and submitted to diagnostic/palliative or curative surgical procedures and to validate the European Organisation for Research and Treatment of Cancer (EORTC) prognostic score in our patient population. METHODS: This is a cohort study of patients submitted to surgery for MPM from January 2007 to December 2013. Primary outcome was overall survival (OS). Univariate and multivariate-adjusted comparisons by EORTC prognostic score for OS were accomplished using Cox method...
August 2016: Journal of Thoracic Disease
Deborah L Clarke, Lynne A Murray, Bruno Crestani, Matthew A Sleeman
Idiopathic pulmonary fibrosis (IPF) is a chronic fibrosing interstitial pneumonia of unknown cause, characterised by progressive worsening in lung function and dyspnoea with an associated prognosis similar to or worse than many cancers. As a better understanding emerges around the pathogenesis and mechanisms driving disease pathology, a host of novel agents are being tested both pre-clinically and clinically. However even with this deeper understanding and positive pre-clinical supportive data, negative trial outcomes are frequently reported, highlighting the problems faced in treating such a heterogeneous disease with a varied clinical course...
September 13, 2016: Pharmacology & Therapeutics
C Caviezel, D Franzen, I Inci, W Weder
In a number of large case series in the mid-1990s, lung volume reduction surgery (LVRS) was shown to reduce dyspnoea and improve pulmonary function and quality of life in patients with advanced pulmonary emphysema. The large randomised National Emphysema Treatment Trial (NETT) confirmed this in the early 2000s and also demonstrated that selected patients live longer after surgery. Patient selection is crucial to the success of the procedure and should be performed at a specialised experienced centre with a multidisciplinary team approach on emphysema treatment...
September 2016: Zentralblatt Für Chirurgie
Sara Roversi, Leonardo M Fabbri, Don D Sin, Nathaniel M Hawkins, Alvar Agusti
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely due to shared risk factors (e.g. ageing, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of COPD patients. The prevalence and incidence of cardiac comorbidities are higher in COPD patients than in matched control subjects, although estimates of prevalence vary widely...
September 2, 2016: American Journal of Respiratory and Critical Care Medicine
Richard B L Lim
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline...
October 2016: Therapeutic Advances in Respiratory Disease
Julian J Nesbitt, George Mori, Charlotte Mason-Apps, George Asimakopoulos
OBJECTIVE: Minimally invasive coronary artery bypass surgery performed through a left thoracotomy has potential benefits over conventional sternotomy, including reduced surgical trauma, faster recovery and potential improvement in quality of life. This study is a prospective assessment of quality of life in patients undergoing off-pump coronary bypass by median sternotomy and left anterior thoracotomy. METHODS: Quality of life was assessed by the EuroQoL questionnaire, with additional questions on dyspnoea, angina, wound pain and scar aesthetics...
July 20, 2016: Perfusion
Supriya Bajaj, Vijay Mahajan, Sumit Grover, Amit Mahajan, Nipun Mahajan
INTRODUCTION: Coronary Artery Disease (CAD) among women presents atypically with atypical chest pain, neck pain, nausea, fatigue and dyspnoea. Co-existing co-morbidities such as Diabetes Mellitus (DM) and hypertension along with difference in risk factor prevalence makes it necessary to have a gender specific approach. AIM: To study gender specific differences in diagnosing and treating Acute Myocardial Infarction (AMI) in North Indian population. MATERIALS AND METHODS: Fifty consecutive men and women presenting with AMI were studied...
May 2016: Journal of Clinical and Diagnostic Research: JCDR
Yu Liu, Tao Lu, Yongxing Zhang, Yulei Qiao, Junjie Xi, Qun Wang
OBJECTIVES: Artificial tracheas fabricated from collagen-conjugated mesh appear to overcome fatal postoperative complications, namely anastomotic dehiscence and prosthesis dislocation. Such prostheses are incorporated by host tissue, provided they are wrapped in omentum (necessitating an additional abdominal procedure) and a silicone tube is used as a stent (to be extracted several weeks postoperatively). To mitigate related host impact (i.e. injury, pain and distress), we investigated the feasibility of implanting this type of tracheal prosthesis (∼5 cm in length) alone, without omental wrapping and use of a silicone stent...
July 17, 2016: Interactive Cardiovascular and Thoracic Surgery
James M Smoliga, Zahra S Mohseni, Jeffrey D Berwager, Eric J Hegedus
KEY POINTS: "Dyspnoea" during exercise is a common complaint in seemingly otherwise healthy athletes, which may be associated with fatigue and underperformance.Because dyspnoea is an general term and may be caused by numerous factors, ranging from poor aerobic fitness to serious, potentially fatal respiratory and nonrespiratory pathologies, it is important for clinicians to obtain an appropriate case history and ask relevant exercise-specific questions to fully characterise the nature of the complaint so that a targeted diagnostic plan can be developed...
June 2016: Breathe
Julie Depiazzi, Mark L Everard
Excessive exercise-induced shortness of breath is a common complaint. For some, exercise-induced bronchoconstriction is the primary cause and for a small minority there may be an alternative organic pathology. However for many, the cause will be simply reaching their physiological limit or be due to a functional form of dysfunctional breathing, neither of which require drug therapy.The physiological limit category includes deconditioned individuals, such as those who have been through intensive care and require rehabilitation, as well as the unfit and the fit competitive athlete who has reached their limit with both of these latter groups requiring explanation and advice...
June 2016: Breathe
Natraj Setty Huliyurdurga Srinivasasetty, Raghu Thagachagere Ramegowda, Jayashree Kharge, Geetha Bachahalli Krishnanayak, Shivanand S Patil, Varada Raj, Nishanth Kandenahalli Ravindranath, Manjunath Cholenahalli Nanjappa
INTRODUCTION: Ascending aortic aneurysm is the second most common aortic aneurysm to abdominal aortic aneurysm. Most ascending aortic aneurysm is diagnosed in sixth or seventh decade of life. Majority of patients of ascending aortic aneurysm do not have any clinical manifestations. CASE PRESENTATION: 45year old female patient presented with Dyspnoea on exertion (NYHA class II-III), palpitation and vague chest pain since 2 years. Patient had worsening of symptoms NYHA IV dyspnoea since last 1 month and the patient managed with medications since the patient was not willing for surgery...
2016: International Journal of Surgery Case Reports
Maree Azzopardi, Rajesh Thomas, Sanjeevan Muruganandan, David C L Lam, Luke A Garske, Benjamin C H Kwan, Muhammad Redzwan S Rashid Ali, Phan T Nguyen, Elaine Yap, Fiona C Horwood, Alexander J Ritchie, Michael Bint, Claire L Tobin, Ranjan Shrestha, Francesco Piccolo, Christian C De Chaneet, Jenette Creaney, Robert U Newton, Delia Hendrie, Kevin Murray, Catherine A Read, David Feller-Kopman, Nick A Maskell, Y C Gary Lee
INTRODUCTION: Malignant pleural effusions (MPEs) can complicate most cancers, causing dyspnoea and impairing quality of life (QoL). Indwelling pleural catheters (IPCs) are a novel management approach allowing ambulatory fluid drainage and are increasingly used as an alternative to pleurodesis. IPC drainage approaches vary greatly between centres. Some advocate aggressive (usually daily) removal of fluid to provide best symptom control and chance of spontaneous pleurodesis. Daily drainages however demand considerably more resources and may increase risks of complications...
2016: BMJ Open
Mohini Pathria, Daniel Urbine, Marc Stuart Zumberg, Juan Guarderas
A 61-year-old woman presented with longstanding cough and progressive dyspnoea. She underwent an extensive evaluation and was diagnosed with common variable immunodeficiency (CVID) with granulomatous lymphocytic interstitial lung disease (GLILD). She was initially treated with subcutaneous immunoglobulin therapy, having declined intravenous immunoglobulin (IVIG) therapy. She also declined treatment with oral glucocorticoids. Over several months, she became increasingly symptomatic and developed increased pulmonary infiltrates, pleural effusions, mediastinal adenopathy, splenomegaly, pancytopenia and ascites...
2016: BMJ Case Reports
S M Mourad, R Mies, T Frenzel, S Willems, E van der Heijden, L J Schultze Kool
BACKGROUND: The incidence of hereditary haemorrhagic telangiectasia (HHT - Osler-Weber-Rendu disease) in the Netherlands is 1:5000 but approximately 1:1300 in people from the Antilles. The disease is characterised by the development of telangiectasia and arteriovenous malformations (AVMs) that may result in serious morbidity and mortality. CASE DESCRIPTION: A 31-year-old primigravid patient consulted her general practitioner at 31 1/7 weeks gestational age with dyspnoea...
2016: Nederlands Tijdschrift Voor Geneeskunde
Maria Victorina López Varela, Maria Montes de Oca, Alejandra Rey, Alejandro Casas, Roberto Stirbulov, Valentina Di Boscio
BACKGROUND AND OBJECTIVE: Opportunistic chronic obstructive pulmonary disease (COPD) case finding approaches for high-risk individuals with or without symptoms is a feasible option for disease identification. PUMA is an opportunistic case finding study conducted in primary care setting of Argentina, Colombia, Venezuela and Uruguay. The objectives were to measure COPD prevalence in an at-risk population visiting primary care for any reason, to assess the yield of this opportunistic approach and the accuracy of a score developed to detect COPD...
October 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Shirley P C Ngai, Alice Y M Jones, Wilson Wai San Tam
BACKGROUND: Tai Chi, a systematic callisthenic exercise first developed in ancient China, involves a series of slow and rhythmic circular motions. It emphasises use of 'mind' or concentration to control breathing and circular body motions to facilitate flow of internal energy (i.e. 'qi') within the body. Normal flow of 'qi' is believed to be essential to sustain body homeostasis, ultimately leading to longevity. The effect of Tai Chi on balance and muscle strength in the elderly population has been reported; however, the effect of Tai Chi on dyspnoea, exercise capacity, pulmonary function and psychosocial status among people with chronic obstructive pulmonary disease (COPD) remains unclear...
2016: Cochrane Database of Systematic Reviews
Lowie E G W Vanfleteren, Martijn A Spruit, Emiel F M Wouters, Frits M E Franssen
Chronic obstructive pulmonary disease (COPD) is an umbrella term that covers many clinical subtypes with clearly different pulmonary and extra-pulmonary characteristics, but with persistent airflow limitation in common. This insight has led to the development of a more personalised approach in bronchodilator therapy, prevention of exacerbations, and advanced treatments (such as non-invasive ventilation and lung volume reduction techniques). However, systemic manifestations and comorbidities of COPD also contribute to different clinical phenotypes and warrant an individualised approach as part of integrated disease management...
June 2, 2016: Lancet Respiratory Medicine
Toru Suzuki, Alexander Lyon, Rajeev Saggar, Liam M Heaney, Kenichi Aizawa, Antonio Cittadini, Ciro Mauro, Rodolfo Citro, Giuseppe Limongelli, Francesco Ferrara, Olga Vriz, Andrew Morley-Smith, Paolo Calabrò, Eduardo Bossone
Acute cardiothoracic and respiratory diseases frequently remain a challenge to diagnose and differentiate in the emergency setting. The main diseases that manifest with chest pain include ischaemic heart disease, myocarditis, acute pericarditis, aortic dissection/rupture and pulmonary embolism (PE). Diseases that primarily present with dyspnoea include heart failure (HF), acute respiratory distress syndrome (ARDS), pneumonia, asthma exacerbations and chronic obstructive pulmonary disease. Pre-test probabilities of clinical findings play a vital part in diagnostic decisions, and the use of a Bayesian approach to these greatly improves the ability to stratify patients more accurately...
September 2016: European Heart Journal. Acute Cardiovascular Care
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