The majority of patients with chronic obstructive pulmonary disease (COPD) have milder airway obstruction and are not diagnosed in a timely fashion. Nevertheless, these patients are largely under-studied; this, despite new evidence of increased morbidity and mortality in this sub-population. Recent studies have highlighted the increased ventilatory requirements and abnormalities in respiratory mechanics as important features to explain the relatively reduced exercise tolerance and greater exertional dyspnea in these patients. However, it remains uncertain whether such abnormal mechanical factors actually limit exercise capacity in mild COPD. Accordingly, the objective of this study was to determine whether ventilatory constraints represent a primary factor in exercise limitation and increased dyspnea in this patient group. To determine the role of mechanical factors in exercise limitation in mild COPD, we selectively loaded the respiratory system by adding dead space (DS) to the breathing circuit. We compared ventilation, breathing pattern, operating lung volumes, and dyspnea intensity during incremental cycle exercise in 20 patients with GOLD stage I COPD (post-bronchodilator FEV1/FVC=61±5%, and FEV1=95±11% predicted; mean±SD) and 20 healthy age-, sex- and BMI-matched subjects under two conditions, in randomized order: unloaded control (CTRL) or ventilatory stimulation by 600mL of an added DS. Compared to the CTRL condition, both healthy and COPD participants had small decreases in peak work rate and no significant increase in peak ventilation with the added DS. At the highest equivalent work rate of 60 watts, DS caused a smaller increase in tidal volume (VT) in COPD compared with healthy subjects (+0.26±0.29 vs. +0.56±0.22 L respectively, p<0.01) with a correspondingly greater increase in dyspnea intensity (+1.8±1.8 vs. +0.2±0.6 Borg units, respectively, p<0.0001). At peak exercise, COPD patients failed to significantly increase VT, reflecting the fact that end-inspiratory lung volume (EILV) could not increase with DS vs. CTRL (5.25±0.91 vs. 5.16±0.84 L, respectively, p=0.41). This contrasts the results in health where EILV increased with DS vs. CTRL (5.40±1.01 vs. 5.13±0.90 L, respectively, p<0.05). We conclude that the lower exercise performance in mild COPD, compared with health, is explained by critical respiratory mechanical constraints which limit further increases in ventilation to support a higher metabolic load. / Thesis (Master, Physiology) -- Queen's University, 2012-09-28 12:04:50.507

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.

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by increasedresistance in the airways which in turn leads to dyspnea, especially during physical activity. Dyspneamay subsequently cause anxiety. Music has, according to previous studies, been seen to reduce theperception of dyspnea and anxiety during physical activity amongst patients suffering from COPD.The results are promising but however inconclusive. Aim: The primary aim was to evaluate the impact of music therapy (MT) on physical endurance, andon respiratory and psychological symptoms during physical activity in patients clinically diagnosedwith COPD. Secondly, to explore the meaning of music on life quality for these individuals. Methods: This study is a randomized cross-over pilot study of 10 patients with clinically diagnosedCOPD. Mixed methods, which is a combination of qualitative and quantitative design methods, wereutilized during data collection. Patient’s physical endurance was measured by a 6- minute walkingtest. Patients were randomly selected to listen to music throughout one of 2 walking tests. Basicphysiological parameters such as heart rate and oxygen saturation was measured before and after eachwalking test. In addition, questionnaires were used to measure perceived exertion, dyspnea andanxiety. Quantitative data was analyzed using paired Student´s T-test. Qualitative data was gainedthrough semi-structured interviews with patients concerning the influence of music. Results: 10 patients were recruited for the study. Preliminary results suggest that MT waseffective in reducing perceived anxiety and dyspnea during physical exercise amongst 70 % and40 % of the patients respectively. MT has however not demonstrated an effect on physicalendurance where results proved statistically insignificant. A common factor among the studyparticipants was that music is very important in improving their life quality. Conclusion: The study has indicated positive trends in MT being effective in reducing perceivedanxiety and dyspnea during physical exercise amongst some patients with COPD. Our findingsdo not support that music affects the tolerance for physical exercise. An important finding of thisstudy is that music plays an important role in the lives of the participants, and thus improve their lifequality. If future research confirms the effectiveness of music, the aspiration is for musicrehabilitation to be implemented in the COPD treatment program to further improve the life qualityof these patients, which is of great importance.

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.

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 &lt; 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.

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.

No description available.

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 202-211). Also available on the Internet.

SYMPTOM CLUSTERS IN LUNG CANCER PATIENTS By Debra Rattican, PhD, RN A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2012 Major Director: Debra E. Lyon, PhD. Professor and Chair Family and Community Health Nursing The purpose of the study was to examine selected relationships among symptoms common to individuals with lung cancer. The specific aims were: 1) To examine the relationship between the symptoms of dyspnea and anxiety in patients with lung cancer. 2) To examine the relationships among the symptoms of dyspnea, anxiety, and symptom cluster components (depressive symptoms, fatigue, pain) in patients with lung cancer. 3) To examine the correlation between functional ability and quality of life in patients with lung cancer. 4) To explore the relationships among the symptoms of dyspnea, anxiety, and symptom cluster components (depressive symptoms, fatigue, pain) in patients with lung cancer and patients’ functional ability. 5) To explore the relationships among the symptoms of dyspnea, anxiety, and symptom cluster components (depressive symptoms, fatigue, pain) in patients with lung cancer and patients’ quality of life. Data were gathered through online survey and analyzed using descriptive, correlation, principal component analysis, exploratory factor analysis, and forward stepwise regression techniques. A strong positive correlation was found between dyspnea and anxiety (both anxiety in general and anxiety at the time the survey was completed. While results of this study cannot provide conclusive evidence of the existence of a symptom cluster composed of depressive symptoms, fatigue, and pain, the results are consistent with other studies in this area. Significant positive correlations among these three symptoms indicate that this is a possible symptom cluster experienced by lung cancer patients in general. This study provides preliminary data on how these symptoms are related and how they affect functional ability, or the ability to perform routine activities of daily living (ADLS) and instrumental activities of daily living (IADLS), and quality of life in patients with lung cancer. Further study is needed on to better understand the symptom experience of these individuals in order to develop robust interventions targeting effective symptom management.

INTRODUÇÃO: A insuficiência cardíaca (IC) constitui hoje um dos maiores problemas de saúde pública em todo o mundo, com números crescentes em qualquer análise epidemiológica. Além de representar grande demanda aos serviços de saúde, é responsável por prejuízo na qualidade de vida das pessoas. Alterações do sono têm sido descritas como freqüentes e comuns entre os pacientes com IC, e também é um dos sintomas de mais incômodo para esta população. OBJETIVO: Descrever o padrão de sono em pacientes com IC e analisar associações do padrão de sono com as seguintes variáveis: sexo, idade, fadiga, fadiga ao esforço, atividade física, classe funcional, terapia medicamentosa, dispnéia e índice de massa corporal. MÉTODO: Estudo transversal descritivo, com uma amostra não probabilística de 400 pacientes ambulatoriais (idade média 57,8 anos, DP=11,6; 64,8% eram homens; escolaridade média de 6,1 anos, DP=3,9; 82,5% em classe funcional II ou III) em tratamento de insuficiência cardíaca em um hospital de ensino. Os dados foram coletados por meio de entrevista em que os participantes responderam a um conjunto de instrumentos contendo: dados de demográficos e da insuficiência cardíaca; e avaliação do padrão de sono (Pittsburg Sleep Quality Index PSQI); de fadiga (Dutch Fatigue Scale DUFS), fadiga ao esforço (Dutch Exertion Fatigue Scale), atividade física (International Physical Activity Questionnaire) e dados sobre dispnéia, tabagismo e terapia medicamentosa. Os instrumentos mostraram boa consistência interna na amostra deste estudo (no PSQI = 0,73; na DUFS = 0,90 e na DEFS = 0,92). Testes não paramétricos foram aplicados para analisar a associação do padrão de sono com variáveis selecionadas e um modelo de regressão logística foi ajustado para investigar os preditores de maus dormidores. RESULTADOS: O escore total médio no PSQI foi 8,70 (DP = 4,39); a prevalência de maus dormidores (PSQI > 5) foi de 68,5%; e 46,5% classificou o sono como ruim ou muito ruim. Escores mais elevados no PSQI ou categoria de mau dormidor foram associados com: sexo feminino (p=0,009); não empregados (p=0,013), fadiga (p=0,000), fadiga ao esforço (p=0,000), dispnéia (p=0,000) e classes funcionais mais elevadas da IC (p=0,000). Dispnéia (OR = 3,23; IC95%1,72 6,07) e fadiga (OR = 3,45; IC95%1,82 6,49) associaram-se independentemente à categoria de mau dormidor. CONCLUSÕES: A proporção de maus dormidores entre os pacientes com IC está entre as mais altas nas doenças crônicas. Dispnéia e fadiga, sintomas comuns nessa enfermidade, aumentam significativamente a chance de ser mau dormidor. Portanto, o padrão do sono dos pacientes com IC deve ser rotineiramente avaliado. / INTRODUCTION: Heart failure (HF) is one of the largest public health problems worldwide, with increasing numbers in any epidemiological analysis. Besides representing a large demand for health services, it is responsible for poor quality of life. Sleep disorders have been described as frequent and common among patients with HF, as well as one of the most troublesome symptoms for this population. OBJECTIVE: To describe sleep patterns in patients with HF and examine associations of sleep pattern with the following variables: gender, age, fatigue, fatigue on exertion, physical activity, functional class, drug therapy, dyspnea, body mass index, and smoking habits. METHODS: A cross sectional study, with a non-probability sample of 400 outpatients (mean age 57.8 years (SD = 11.6), 64.8% men, mean schooling = 6.1 years (SD = 3.9); 82.5% in functional class II or III) under treatment of HF in an academic hospital. Data were collected by interviews in which participants answered a set of tools including: demographic and heart failure data; and assessment of the sleep pattern (PSQI Pittsburgh Sleep Quality Index), fatigue ( Dutch Fatigue Scale - DUFS), fatigue on exertion (Dutch Exertion Fatigue Scale), physical activity (International Physical Activity Questionnaire), and data on dyspnea, smoking habits and drug treatment. Reliability coefficients of the tools in this study were adequate ( PSQI = 0.73; DUFS = 0.90; DEFS = 0.92). Nonparametric tests were applied to analyze the association of sleep patterns with selected variables, and a logistic regression model was adjusted to investigate predictors of poor sleepers. RESULTS: The mean PSQI total score was 8.70 (SD 4.39), the prevalence of poor sleepers (PSQI> 5) was 68.5% and 46.5% rated sleep as poor or very poor. Higher PSQI scores or poor sleeper category was associated with: female gender (p = 0.009), unemployement (p = 0.013), fatigue (p = 0.000), fatigue on exertion (p = 0.000), dyspnea (p = 0.000) and higher HF functional class (p = 0.000). Dyspnea (OR=3.23; CI 95% 1.72 to 6.07) and fatigue (OR= 3.45; CI 95% 1.82 to 6.49) were independently associated with the poor sleeper category. CONCLUSIONS: The proportion of poor sleepers among patients with HF is among the highest rates in chronic diseases. Dyspnea and fatigue, commom symptoms in this illness, increase significantly the likelihood of being a poor sleeper. Therefore, the sleep pattern of HF patients has to be routinely assessed.