No / Harold Shipman, a general practitioner (GP) working near Manchester in England, is thought to have killed 250 of his patients by diamorphine overdose between 1975 and 1998. Opiates are recommended for relieving dyspnoea in end stage chronic obstructive pulmonary disease (COPD). Little is known about the effect of the Shipman case on clinician attitudes to prescribing of opiates in advanced COPD. Subjects and methods: Focus groups were held with a total of 39 health professionals in primary (n = 3) and secondary care settings (n = 2) in two sociodemographically contrasting areas of England. Results: Participants identified that the experience of dyspnoea in end-stage COPD was often distressing for patients, their families and their professional carers. Whilst opiates were recognised to be effective in relieving dyspnoea, the Shipman case, and associated fears of litigation, was identified as the key barrier to prescribing. Whilst this was seen as a particular problem within primary care settings leading, for example, GPs to admit patients to hospital rather than prescribe opiates, it was also considered an issue within acute hospital settings. Of particular concern to participants was recognising when an exacerbation was 'terminal' and hence opiate prescribing appropriate. Conclusions: There is evidence to show that opiates are effective in managing end-stage dyspnoea in COPD without hastening death. However, participants did not perceive this to be the case and expressed considerable anxiety about appropriate prescribing in this situation. Given the significant burden of dyspnoea on patients with advanced COPD, there is an urgent need for appropriate training to increase clinician confidence regarding opiate use in this patient group which is sensitive to the concerns raised by the Shipman murders.

Dyspnoea (breathlessness) is a debilitating, often poorly controlled, symptom of cardiopulmonary, neurovascular and psychological disorders. This thesis develops the necessary methodology to dissociate aspects of the acute dyspnoea experience using functional magnetic resonance imaging (FMRI) in healthy volunteers. The neuronal mechanisms underlying dyspnoea anticipation, its perceived intensity and unpleasantness and the modulation of these mechanisms by the opioid remifentanil were explored. We investigated the subjective perception of respiratory loading, a commonly used dyspnoea stimulus, and its potential systematic confounds on FMRI due to cerebral blood flow changes. Investigation of the perception of respiratory loading at different levels of hypercapnia (increased end-tidal CO₂) showed that hypercapnia should be kept to a minimum to avoid increased baseline respiratory unpleasantness whilst maintaining the stable arterial CO₂ (isocapnia) beneficial for FMRI analysis. Investigation of the effects of respiratory loading (± 9 cmH₂O) on cerebral blood flow showed that systematic confounds of respiratory loading on perfusion-based neuroimaging data were small (~5%) and did not significantly alter neural activation in response to visual stimulation. Isocapnic respiratory loading during a classical fear-conditioning paradigm during FMRI was used to investigate dyspnoea anticipation, and dissociate the intensity and unpleasantness of acute dyspnoea by modulating unpleasantness with remifentanil. Differential neural networks were found to be involved in perceived intensity (thalamus, insula, somatosensory cortex) and unpleasantness (hippocampus, medial prefrontal cortex). Remifentanil reduced respiratory unpleasantness without affecting the perceived intensity and differentially reduced brain activity during both dyspnoea anticipation and perception. This thesis showed the potential of isocapnic respiratory loading for the study of dyspnoea with FMRI. This stimulus revealed, for the first time, brain activation for dyspnoea anticipation, perceived intensity and unpleasantness. The opioid-sensitive nature of the anticipation and unpleasantness of dyspnoea provides brain targets for future research and might facilitate more effective dyspnoea palliation.

No description available.

This thesis consists of 3 studies: 1. Determination of the minimal important difference (MID) of the visual analogue scale for dyspnoea (VASD): Determining the MID of the VASD is essential to interpret the results of trials in patients with malignant pleural effusions (MPEs). Patients undergoing a pleural procedure assessed the change in their VASD and the degree of change in their symptoms on a Likert scale. The mean VASD in patients experiencing a ‘small but just worthwhile’ decrease in their symptoms is the MID for the VASD and was found to be 22mm (95% CI 16 - 27mm). 2. Development of a thoracic ultrasound septation score (TUSS): A TUSS is important for objectively assessing the degree of septation within a pleural effusion. An iterative process was used to demonstrate that degree of septation predicts clinical outcome, to identify candidate factors for inclusion in a TUSS and to determine which factors predicted the degree of septation. The final TUSS consisted of an assessment of the degree of homogeneity of septation distribution and number of septations at the most septated area. 3. Effect of an indwelling pleural catheter (IPC) versus standard care for relieving dyspnoea in patients with MPEs: the TIME2 randomised controlled trial (RCT). The objective of this unblinded RCT was to determine whether IPCs are more effective than chest drains and talc pleurodesis at relieving dyspnoea in patients with MPEs. 106 patients were randomised to either IPC or standard care in a 1:1 ratio. The primary outcome was daily VASD over 42 days post intervention. Dyspnoea improved in both groups with no significant difference in mean dyspnoea in the first 42 days (mean score: IPC 25mm (95% CI 19 – 30), standard care 24mm (95% CI 19 – 29)).

Experiencing respiratory symptoms in conjunction with exercise is common in children and adolescents and can have a negative impact on daily life. The aim of the thesis was to estimate the prevalence of exercise-induced dyspnoea, exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (E-ILO) in a general adolescent population, and to explore factors associated with EIB. Methods: All 12-13-year-old adolescents in the city of Uppsala (n=3,838) participated in a survey on exercise-induced dyspnoea. A subsample of adolescents who answered the survey, 103 randomly selected adolescents reporting exercise-induced dyspnoea and 47 random adolescents who did not report exercise-induced dyspnoea underwent standardised treadmill exercise tests for EIB and E-ILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease ≥10% in FEV1 from baseline. E-ILO was investigated using continuous laryngoscopy during exercise. Health related quality of life (HRQoL), and objectively measured daily physical activity were investigated in those with (n=49) and without (n=91) a positive EIB-test. Results: The prevalence of exercise-induced dyspnoea was 14%, and the estimated prevalence of EIB and E-ILO in the total population was 19.2% and of 5.7%, respectively, with no gender differences. In adolescents with exercise-induced dyspnoea 40% had EIB, 6% had E-ILO, and 5% had both conditions. An increased baseline level of fraction of nitric oxide in exhaled air (FeNO), female gender, and exercise-induced dyspnoea were associated with a positive EIB test. Female adolescents with EIB had lower HRQoL and lower baseline lung function compared to females without EIB. These differences were not observed in male adolescents. There was no difference in time spent in moderate- to vigorous daily physical activity between adolescents with and without EIB.

No description available.

Aim of the research. To determine influence of yoga exercises applied in physical therapy to aspiration functions of 10-15 years-old children. Tasks: 1. To determine influence of yoga exercises to dyspnoea and lung ventilation in research group for children ill with bronchial asthma. 2. To evaluate changes in rate of dyspnoea and lung ventilation in research group for children ill with bronchial asthma. 3. To compare changes received in research and control group. Hypothesis of research: application of yoga asans and respiration in treatment of children ill with bronchial asthma should positively affect their respiration functions. Methods and organizing of research. 28 children ill with bronchial asthma voluntary agreed to participate in the research were investigated. 2 groups of 14 children each, homogeneous according gender, age, duration and severity of illness were formed. The research group was applied yoga exercises, and control group – not. The research took three months. At the beginning and at the end of research both groups were applied objective spirometry examination: the greatest speed of exhalation jet, forced vital capacity, forced expiratory volume in liters per first second. Subjective sensations reflecting change of dyspnoea and tolerance to physical strain (Valsalvijus sample and scale of change of dyspnoea) were evaluated. Results received were compared by using statistical methods Results of research. Changes in forced vital capacity in the research... [to full text]

Magister Artium (Sport, Recreation and Exercise Science) - MA(SRES) / Obesity is recognised as a risk factor for non-communicable diseases which has reached epidemic proportions globally. South Africa is one of the developing countries with significant statistical representation reported for these conditions. Obesity is associated with other conditions such as type 2 diabetes, hypertension and dyslipidaemia which are all part of what is called metabolic syndrome. As a strategy to reduce the levels of obesity, physical activity has been introduced to compliment clients who are on medication for diabetes.

Bakgrund: Vid idiopatisk lungfibros (IPF) är dyspné det dominerande symtomet, vilket påverkar gångsträckan. Andra patientkategorier har ökat gångsträckan och minskat dyspnén efter inspirationsmuskelträning (IMT). Endast två studier angående IMT för personer med IPF har hittats och ingen av dessa studier har IMT som enda studieintervention.   Syfte: Syftet var att undersöka om IMT ökar andningsmuskelstyrkan (MIP), om gångsträcka och dyspné förändras efter träningen samt om det finns ett samband mellan MIP och gångsträcka, MIP och dyspné samt gångsträcka och dyspné.   Metod: Single-subject experimentell design användes. Sex personer med IPF deltog. IMT genomfördes under åtta veckor. Under baslinje, intervention och cirka sex veckor efter interventionsslutet mättes MIP med Micro RPM® och gångsträcka med sex-minuters gångtest. Dyspnén skattades med Borg CR-10-skala och University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ).   Resultat: Resultatet varierade mellan studiedeltagarna. Fyra deltagare ökade MIP. Fem studiedeltagare hade en kliniskt relevant ökning av gångsträcka. Fyra deltagare hade en kliniskt relevant minskad dyspné vid skattning med Borg CR-10 i vila eller UCSD SOBQ. Korrelationen mellan MIP och gångsträcka var signifikant för två studiedeltagare med rs 0,88 respektive 0,99.   Konklusion: IMT kan öka MIP och ge kliniskt relevanta förbättringar av gångsträcka och dyspné. Alla studiedeltagare drar ej nytta av träningen. Fortsatta studier behövs för att undersöka vilka som har nytta av IMT och vilken träningsmängd som behövs för att uppnå förbättring. / Introduction: In idiopathic pulmonary fibrosis (IPF), dyspnoea is the predominant symptom that affects walking distance. In other patient categories, walking distance has been increased and dyspnoea has been reduced after inspiratory muscle training (IMT). Only two studies on IMT for people with IPF have been found and none of these studies have IMT as the sole study intervention. Purpose: The purpose was to investigate whether IMT increases respiratory muscle strength (MIP), if walking distance and dyspnoea alter after practice, and if there is a relation between MIP and walking distance, MIP and dyspnoea and walking distance and dyspnoea. Method: Single-subject experimental design was used. Six people with IPF participated. IMT was carried out in eight weeks. During baseline, intervention and about six weeks after the intervention, MIP was measured with Micro RPM® and walking distance with a six-minute walk test. Dyspnoea was estimated with Borg CR 10-scale and the University of California, San Diego Shortness of Breath Questionnaire (UCSD SOBQ). Results: The results varied among the study participants. For four participants, the MIP increased. Five study participants had a clinically relevant increase in walking distance. Four participants had a clinically relevant reduction in dyspnoea on measuring with Borg CR 10 at rest or UCSD SOBQ. The correlation between MIP and walking distance was significant for two study participants with rs 0.88 and 0.99, respectively. Conclusion: IMT can increase MIP and provide clinically relevant improvements in walking distance and dyspnoea. All study participants do not benefit from exercise. Further studies are needed to determine which ones have the advantage of IMT and the amount of exercise needed to achieve improvement.

No description available.