No description available.

Breathlessness during activity is increasingly recognized as a common symptom in the elderly, in older individuals with minor airway obstruction due to tobacco smoking, and in those with obesity. The underlying mechanisms of perceived respiratory difficulty in each of these populations remain unknown and are largely unstudied. Objective: The main purpose of this original research was to elucidate the alterations in central ventilatory drive and in dynamic ventilatory mechanics that might explain the origin of increased breathlessness during exercise in these three populations. General Hypothesis: In individuals with largely preserved resting pulmonary function, increased intensity of breathlessness during activity will arise as a result of measurable abnormalities of dynamic ventilatory mechanics, central respiratory drive, or both in combination. General Methods: We examined sensory-mechanical relationships during cardio-pulmonary exercise testing in each population (total n=146). We compared indices of ventilatory control (ventilation, pulmonary gas exchange and metabolic load), dynamic mechanics (breathing pattern and operating lung volumes) and ratings of dyspnea intensity in three well characterized cohorts: elderly versus younger; smokers with minor airway obstruction versus age-matched non-smokers, and obese versus lean participants. Results: Individuals across all three study populations had preserved resting pulmonary function. Compared with their respective control groups all three symptomatic groups demonstrated consistent abnormalities in dynamic airway function during exercise [expiratory flow limitation (EFL), dynamic increases in end expiratory lung volume, and restricted tidal volume response]; all had greater ventilatory requirements reflecting variable ventilation-perfusion and metabolic abnormalities. In all three groups, intensity of breathlessness increased as ventilatory demand approached capacity. In the elderly (with or without airway obstruction), breathlessness intensity ratings at a standardized ventilation during exercise correlated with indices of mechanical volume restriction secondary to EFL. In obese individuals, increased ventilatory drive secondary to increased metabolic loading (and not mechanical abnormalities) was the primary factor contributing to exertional breathlessness. Conclusion: Although the origin of breathlessness during physical exertion in the elderly (with or without minor airway obstruction) and in obese individuals is multi-factorial, we identified the central etiological importance of the combination of increased ventilatory drive and restrictive dynamic mechanical constraints to increasing ventilation. / Thesis (Ph.D, Physiology) -- Queen's University, 2008-07-02 14:17:41.602

The functional capacity of patients with coronary artery disease is often limited by breathlessness. The intensity of breathlessness is primarily determined by respiratory muscle effort, which increases as the pressures generated by the inspiratory muscles approach maximum capacity. Exercise training can potentially decrease breathlessness by inducing adaptations that reduce the ventilatory demand and increase the maximum capacity of the respiratory muscles. This study examines the extent to which the physiological adaptations occurring with exercise training contribute to reductions in breathlessness in patients with coronary artery disease. The pre- and post-training results were compared in 21 patients participating in the McMaster University Cardiac Rehabilitation program. Respiratory parameters were measured at rest and during a progressive maximal exercise test. The intensity of breathlessness was measured by psychophysical techniques using the Borg scale. Following training, the capacity to generate maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and maximum inspiratory flow (Vimax) improved by 22%, 18% and 5%, respectively, with no significant change in vital capacity, forced expiratory volume in one second and maximum expiratory flow. Exercise capacity improved by 14%, with an 11% decrease in the maximum intensity of breathlessness experienced. Although maximum ventilation (Ve) did not change significantly, Ve per unit workload decreased by 10% and breathlessness per unit Ve decreased by 13%. At the highest similar workload between the 2 tests (850 kpm), breathlessness decreased by 34%, with a 19% reduction in Ve. Breathing frequency, mean inspiratory flow (Vt/Ti), inspiratory flow generated during exercise in relation to maximum inspiratory flow (Vi%max), and time of inspiration in relation to total duty cycle (Ti%Ttot) decreased significantly by 20%, 15%, 20% and 4%, respectively. The decreases in breathlessness were significantly related to the reduction in ventilation associated with training. A significant decrease in breathlessness remained after removing the variance accounted for by Ve, reflecting the improvements in respiratory muscle performance. The decreases in breathlessness were better correlated with improvements in the dynamic measure of Vimax than the static measure of MIP. The decreases in breathlessness were best correlated to the changes in Vi%max, which accounts for decreases in ventilatory demand and increases in respiratory muscle performance. Decreases in breathlessness primarily occurred in patients who achieved a training effect. Exercise training decreases breathlessness in patients with coronary artery disease largely through decreases in Ve, with improvements in respiratory muscle performance contributing to a lesser degree. / Thesis / Master of Science (MSc)

Chronic obstructive pulmonary disease (COPD) patients are generally more sedentary and less physically active than healthy adults; putting them at increased risk of hospitalisation and death. For patients with mild-moderate COPD, physical activity appears to be reduced compared with apparently healthy adults but differences in time spent sedentary are less well established. Additionally, there is a need for a greater understanding of the correlates of behaviour in mild-moderate patients with much of the existing literature focusing on more severe or mixed stage patient samples and with many studies lacking objective behavioural monitoring, not adjusting for confounders and a paucity of data on correlates of sedentary time. Despite having mild-moderate airflow obstruction, these patients also report a range of symptom burdens with some individuals reporting severe symptoms. Subsequently, these patients represent a sub-set of individuals who may require lifestyle interventions. Therefore, factors associated with patients reporting more severe symptoms need to be identified to help understand how this phenomenon may manifest and be intervened upon. For patients with more advanced COPD who are admitted to hospital for an acute exacerbation behavioural intervention focussing on less intense movement may be a more suitable approach for reducing the risk of readmissions than more intense physical activity or exercise. To date no studies have specifically targeted reductions in sedentary behaviour in COPD. In addition, wearable self-monitoring technology may facilitate the provision of such interventions, removing important participation barriers such as travel and cost, but this has not been sufficiently examined in COPD. This thesis investigated: (i) objectively measured physical activity and sedentary time and the correlates of these behaviours for mild-moderate COPD patients and apparently healthy adults (Study One); (ii) factors associated with self-reported symptom severity and exacerbation history in mild-moderate COPD patients (Study Two) and (iii) the feasibility and acceptability of a home-based sedentary behaviour intervention using wearable self-monitoring technology for COPD patients following an acute exacerbation (Study Three). Methods: Study One: COPD patients were recruited from general practitioners and apparently healthy adults from community advertisements. Objectively measured moderate-to-vigorous physical activity (MVPA), light activity and sedentary time for 109 mild-moderate COPD patients and 135 apparently healthy adults were obtained by wrist-worn accelerometry. Patients with at least four valid days (≥10 waking hours) out of a possible seven were included in analysis. A range of demographic, social, symptom-based, general health and physical factors were examined in relation to physical activity and sedentary time using correlations and linear regressions controlling for confounders (age, gender, smoking status, employment status and accelerometer waking wear time). Study Two: In 107 patients recruited from general practitioners, symptoms were assessed using the COPD Assessment Test (CAT) and Modified Medical Research Council (mMRC) questionnaires. Twelve-month exacerbation history was self-reported. Exercise capacity was assessed via incremental shuttle walk test (ISWT) and self-reported usual walking speed. Physical activity and sedentary time were obtained from a wrist-worn accelerometer. Study Three: Patients were randomised in-hospital into a usual care (Control), Education or Education + Feedback group with the intervention lasting 14 days following discharge. The intervention groups received information about reducing prolonged sitting. The Education + Feedback group also received real-time feedback on their sitting time, number of stand-ups and step count at home through an inclinometer linked to a smart device app. The inclinometer also provided vibration prompts to encourage movement when the wearer had been sedentary for too long. Feasibility of recruitment (e.g. uptake and retention) and intervention delivery (e.g. fidelity) were assessed. Acceptability of the intervention technology (e.g. wear compliance, app usage and response to vibration prompts) was also examined. Results: Study One: COPD patients were more sedentary (592±90 versus 514±93 minutes per day, p < 0.05) and accrued less MVPA (12±18 versus 33±32 minutes per day, p < 0.05) than apparently healthy adults. For COPD patients, self-reported dyspnea and percentage body fat were independent correlates of sedentary time and light activity with exercise capacity (incremental shuttle walk test) an independent correlate of MVPA. For apparently healthy adults, percentage body fat and exercise capacity were independent correlates of sedentary time and light activity. Percentage body fat was an independent correlate of MVPA. Study Two: ISWT (B=-0.016±0.005, partial R2=0.117, p=0.004) and years living with COPD (B=0.319±0.122, R2=0.071, p=0.011) were independently associated with CAT score. ISWT (B=-0.002±0.001, R2=0.123, p < 0.001) and vector magnitude counts per minute (VMCPM) (B=0.0001±0.0000, R2=0.050, p=0.011) were independently associated with mMRC grade. MVPA was independently associated with previous exacerbations (B=-0.034±0.012, R2=0.081, p=0.005). Patients reporting a CAT score of > 20 or an mMRC score of ≥2 had lower VMCPM, were more sedentary and took part in less light activity than patients reporting a CAT score of 0-10 or mMRC of 0, respectively. Patients reporting ≥2 exacerbations took part in less MVPA than patients reporting zero exacerbations. Study Three: Study uptake was 31.5% providing a final sample of 33 COPD patients. Retention of patients at two-week follow-up was 51.5% (n=17). Reasons for drop-out were mostly related to being unable to cope with their COPD. Patients wore the inclinometer for 11.8±2.3 days (and charged it 8.4±3.9 times) with at least one vibration prompt occurring on 9.0±3.4 days over the 14 day study period. Overall, 325 vibration prompts occurred with patients responding 106 times (32.6%). 40.6% of responses occurred within 5 minutes of the prompt with patients spending 1.4±0.8 minutes standing and 0.4±0.3 minutes walking, taking 21.2±11.0 steps. Discussion: Study One: COPD patients were less active and more sedentary than apparently healthy adults; however, factors predicting behaviour were similar between groups. Correlates differed between sedentary time, light activity and MVPA for both groups. Interventions to boost physical activity levels and reduce sedentary time should be offered to patients with mild-moderate COPD, particularly those reporting more severe breathlessness. Study Two: Worse exercise capacity, low levels of physical activity and more time spent sedentary are some of the factors associated with patients of the same severity of airflow limitation reporting differing symptom severities. These patients may benefit from both lifestyle and exercise interventions. Study Three: Recruitment and retention rates suggest a trial targeting sedentary behaviour in hospitalised COPD patients is feasible. A revised intervention, building on the successful components of the present feasibility study is justified. Conclusion: The findings from this thesis have contributed a greater understanding of physical activity and sedentary behaviour in COPD and can inform the development of tailored physical activity and sedentary behaviour interventions for patients across the grades of COPD severity.

Bakgrund Kronisk obstruktiv lungsjukdom är en sjukdom som är irreversibel och påverkar andningen negativt hos dem som lider av den och visar sig genom ett stort antal symtom. Sjukdomen skapar stort lidande och försvårar förmågan att leva ett normalt liv med hög livskvalité. Det beräknas vara den tredje största dödsorsaken i världen 2030 enligt världshälsoorganisationen. Syfte Att beskriva personers erfarenheter av att leva med Kronisk obstruktiv lungsjukdom  Metod Studien utgörs av en litteraturstudie med fjorton artiklar. Artiklarnas resultat sammanfattades och gick från delarna till en ny helhet. En kvalitetsgranskning och analys utfördes för att skapa resultatet. Resultat Resultatet presenterades med fyra huvudkategorier: Att inte få luft, Förändrad livssituation, Beroende av stöd och Information och hantering. Till huvudkategorierna skapades följande tio underkategorier: Andnöd/andfåddhet, Ångest, Trötthet, Förluster, Skam, Miljöanpassning, Anhöriga, Hjälpmedel, Undervisning och information och Hantering och strategier. Konklusion Litteraturstudien visade att en stor dimension av symtom påverkar personer som lever med Kronisk obstruktiv lungsjukdom. Det behövs vidare forskning angående personers erfarenhet av sjukdomen men denna litteraturstudie har gett en inblick i några av de erfarenheter personerna lever med. / Background Chronic obstructive pulmonary disease is an irreversible disease and it’s effecting the breathing in a negative way for those suffering by the disease and it’s shown by many different symptoms. The disease creates big suffering and obstructs the ability to live a normal life with high quality of life. It is expected to be the third largest cause of death worldwide in 2030, according to the World Health Organization. Aim To describe people's experiences of living with chronic obstructive lung disease. Method The study is a literature study with fourteen articles. The result from the articles were summarized and went from parts into a new whole. An inspection of quality and analysis was performed to create the result. Result The result were presented with four main categories: Unable to breathe, Change of way of life, Depending on support, Information and management. To the main categories were ten under categories created:  Shortness of breath/breathlessness, Anxiety, Fatigue, Losses, Adaptation to environment, Relatives, Utilities, Education and information and Management and strategies. Conclusion The literature study showed that there’s a major dimension of symptoms affecting people living with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease. The literature review showed that a large dimension of symptoms are affecting people living with chronic obstructive pulmonary disease. We need further research on people's experience of the disease, but this study has provided an insight into some of the experiences people are living with.

Asthma is a chronic respiratory disease characterized by inflammation of the airway and the presence of recurrent attacks (exacerbations) of breathlessness, wheezing, cough, chest tightness, or some combination of these symptoms. In the US, about 53% of people with asthma had an asthma attack in 2008, and 57% of these, were children. One in ten children (10%) had asthma in 2009, and boys were more likely than girls to have asthma. Internationally, the prevalence of asthma varies widely in different countries, but the disparity is narrowing due to rising prevalence in low and middle income countries. Unfortunately, we do not have statistics for asthma in the Republic of Panama, neither epidemiological data nor costs, which is the reason why this research is needed. The Panamanian Social Security Fund (CSS) provides protection to workers, their immediate families and the pensioned. By the end of 2010, the total insured population was 2,862,202 (83% of the total population of Panama). Of the total insured population 58% were dependent. Of this, 1,205,607 (42%) were children. On the basis of this information, we decided to develop the research study using information from the CSS, specifically in the Hospital de Especialidades Pediatricas (HEPOTH). It is the only tertiary level of healthcare children's hospital of the CSS. A quantitative-descriptive design was used to develop this study. Data was collected from medical records of patients diagnosed with asthma in the HEPOTH from January to June 2012. We reviewed the medical records of each care area by month, and numbered each clinical record of children diagnosed with asthma in crisis and randomly selected 10% of the medical records from a minimum of 2000 records. Information on treatment costs was also obtained. Once all the information was collected, it was typed in the digital data log created for this study and the responses were code converted and the information was entered into a database. The data were exported to IBM SPSS Statistics 21. The average cost of asthma attacks in Panama is estimated at $205.52. We were able to confirm that there are variations in this average by gender, age, geographic area of residence, season, severity, whether treated in the emergency department or hospitalization, and the type of treatment received. It was also possible to obtain secondary information about the epidemiology of asthma that allowed us to confirm that our statistics matched international statistics.

No description available.

Human pregnancy is characterized by significant increases in central ventilatory drive and perceived respiratory discomfort (breathlessness). The physiological mechanisms of hyperventilation and breathlessness in pregnancy remain largely unknown and understudied. Objective: The main purpose of this research was to elucidate the mechanisms of maternal hyperventilation, and to systematically examine the contribution of alterations in central ventilatory drive, static/dynamic respiratory mechanics and their interaction with respect to the intensity of perceived breathlessness during exercise in pregnancy. General Methods: Experiments were conducted between 34-38 wks gestation and again 4-5 months post-partum in a total of 35 healthy, young women. A comprehensive mathematical model of ventilatory control was used to examine the role of alterations in wakefulness and central chemoreflex drives to breathe, acid-base balance and female sex hormones in maternal hyperventilation. The effects of pregnancy on detailed ventilatory (breathing pattern, airway function, operating lung volumes, esophageal pressure-derived indices of respiratory mechanics) and perceptual (breathing and leg discomfort) responses to incremental cycle exercise to the limits of tolerance were also examined. Results: Maternal hyperventilation resulted from a complex interaction between alterations in arterial and central acid-base balance and other factors that directly affect ventilation, including increased wakefulness and central chemoreflex drives to breathe, increased metabolism and decreased cerebral blood flow. Mechanical adaptations of the respiratory system, including recruitment of resting inspiratory capacity and reduced airway resistance, accommodated the increased demand for tidal volume expansion during exercise in pregnancy, while preserving effort-displacement and breathlessness-ventilation relationships. Variation in the severity of gestational breathlessness could not be explained by respiratory mechanical/muscular factors, but ultimately reflected variation in the amplitude of maternal hyperventilation and temporal desensitization to the sensory consequences of increased ventilation. Conclusion: Our results indicated that 1) the hyperventilation and attendant hypocapnia/alkalosis of pregnancy can be explained by alterations in wakefulness and central chemoreflex drives to breathe, acid-base balance, metabolic rate and cerebral blood flow; 2) mechanical adaptations of the respiratory system obviated the anticipated rise in perceived breathlessness for a given ventilation during exercise in pregnancy, and helped to ensure that peak aerobic working capacity was admirably preserved, even in late gestation; and 3) gestational breathlessness ultimately reflected the normal awareness of increased ventilation and contractile respiratory muscle effort. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2008-08-28 16:01:40.78

Andnöd är ett vanligt symtom på allvarliga sjukdomar som medför multidimensionella och komplexa upplevelser. Andnöd är kraftigt fysiskt och psykiskt begränsande dygnet runt för patienten. Syftet med studien var därför att belysa patientens upplevelse av andnöd. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Litteratursökningen genomfördes systematiskt. Resultat: Nio vetenskapliga artiklar låg till grund för resultatet. Med hjälp av meningsbärande enheter framkom sex underkategorier som resulterade i två huvudkategorier: Attack på livet och Hantera livet. Slutsats: Symtomet bidrog till kraftiga begränsningar i livet. Patienterna upplevde att hela deras livsvärld påverkades av andnöden även efter den akuta fasen. Rädsla eller okunskap skapade osäkerhet hos patienterna som upplevde sig själva som otillräckliga och hjälplösa. Detta tillsammans med brister inom vården bidrog till att patienterna upplevde skam på grund av andnöd. Genom att andnöden ständigt fanns med patienten i tankarna upplevdes också hopplöshet och negativ syn på framtiden. Resultatet visar även en positiv sida där patienterna kunde hantera livssituationen genom stöd av familj och anhöriga, ökad kunskap, kontroll samt träning. Fortsatt forskning om hur personcentrerad vård kan hjälpa patienter och lindra upplevelserna av andnöd behövs. Ny forskning som tydligare uppmärksammar patienternas upplevelser av andnöd även efter den akuta fasen är angeläget. / Shortness of breath is a common symptom of serious illnesses producing multidimensional and complex experiences. Breathlessness is very limiting - physically and psychologically - for patients around the clock. The purpose of the study was therefore to highlight the patient's experience of breathlessness. Method: The study was conducted as a general literature study with inductive approach. Literature was searched systematically. Result: Nine scientific articles formed the outcome. Using meaningful extracts six subcategories were formed in two main categories: Attack on life and Managing life. Conclusion: Breathlessness contributed to severe limitations in life. Patients felt their entire way of life was affected even beyond the acute phase. Fear or ignorance created uncertainty among patients who perceived themselves as inadequate and helpless. This, combined with shortcomings in health care, contributed to patients experiencing shame. Because breathlessness was always on the patient’s mind, hopelessness and despair were also experienced. The result also described a positive side where patients could handle life through supporting family and relatives, increased knowledge, control and training. Further research how person-centred care can relieve patients’ experiences of breathlessness is needed. New research clearly addressing patients' experiences of breathlessness outside the acute phase is required.

Andningsbesvär är en av de vanligaste sökorsakerna på Sveriges akutmottagningar. Det är ett komplext tillstånd som består i både fysiska och psykiska faktorer och kräver såväl farmakologisk som icke-farmakologisk vård. Okunskap inom den icke-farmakologiska vården leder till utebliven behandling, förlängt patientlidande och stor risk för vårdskador. Syftet med detta arbete var att belysa akutsjuksköterskans interventioner för att underlätta och förbättra tillståndet för patienter med andningsbesvär inom akutsjukvård. Studiedesignen som tillämpats var en litteraturöversikt med systematisk metod. Vetenskapliga artiklar som behandlat icke-farmakologisk behandlingsstrategi av all form av andningsbesvär som presentationssymtom eller huvudsymtom inom akutsjukvård har inkluderats. Totalt 15 vetenskapliga artiklar uppfyllde kriterierna för studien och genomgick kvalitetsgranskning samt integrerad analys. Resultaten visade att interventionerna kan delas in i fysiska (aktiv motståndsträning, bukläge och kontrollerad andning), såväl som psykologiska (trygg närvaro, kommunikation och utbildning samt vårdrelation). Motståndsträning kan göras med såväl sammandragna läppar som med apparat med god effekt. Bukläge visade sig effektivt på vakna patienter med omfattande andningsbesvär och syrgasbehov. Riktad och strukturerad kommunikation och patientutbildning ledde inte bara till signifikant förbättrade symtom utan även till att patienterna tolererade interventionerna bättre. Även en god vårdrelation med sjuksköterskan visade på lättare acceptans till givna behandlingar. Den slutsats som drogs var att akutsjuksköterskan har en stor roll i att förbättra tillståndet för patienter med andningsbesvär. Akutsjuksköterska kan ge lättillgängliga, men värdefulla ickefarmakologiska insatser för både de fysiska och psykologiska aspekterna av andningsbesvären. De kan även bidra med kunskap och utbildning för patienterna som resulterar i minskad ångest, förbättrad livskvalitet och minskade sjukhusbesök. De undersökta interventionerna kan troligen med fördel implementeras inom sluten- såväl som öppenvård för att förbättra tillståndet hos patienter med andningsbesvär. / Breathlessness is one of the most frequent causes of visit in Swedish emergency departments. It is a complex condition consisting of both physical and psychological factors, requiring both pharmacological and non-pharmacological treatment approaches. Inexperience in nonpharmacological treatment causes missed treatment, prolonged patient suffering and increased risk of care related injuries. The aim of this study was to illustrate the interventions of the emergency care nurse in facilitating and improving the condition for patients with breathlessness in emergency healthcare. The study design applied was a literature review with a systematic method. Scientific articles covering non-pharmacological treatment approaches of any breathlessness as presenting or main symptom within emergency healthcare was included. 15 articles in total met the criteria for the study and underwent a quality control and integrated analysis. The results indicated that the interventions could be divided into physical (active resistance training, prone position and controlled breathing techniques) and psychological (assuring presence, communication and education and care relationship). Resistance training can be achieved either through pursed lips or specific devices with good results. Prone position proved effective in patients with severe breathlessness requiring oxygen therapy. Aimed and structured communication and patient education did not only result in improved symptoms but enabled the patients to better endure the interventions. A good care relationship too facilitated better acceptance to given treatment. The conclusion drawn was that the emergency care nurse played an immense role in improving the condition of patients presenting with breathlessness. The emergency care nurse could provide easily available, although valuable non-pharmacological contributions to both the physical and psychological aspects of breathlessness. Furthermore, they could contribute with knowledge and education for the patients resulting in relieved anxiety, improved quality of life and reduced hospital visits. The analyzed interventions could presumably be successfully implemented within both inpatient and outpatient care improving conditions for patients suffering from breathlessness.