Use of self-efficacy and dyspnea perceptions to predict functional performance in people with COPD.

This correlational and comparative study explored whether self-reports of self-efficacy and dyspnea perceptions predict the perceived level of functional performance in adults who have chronic obstructive pulmonary disease (COPD). The convenience sample included 97 Caucasian men (52) and women (45). Participants had to have a forced expiratory volume in 1 second (FEV1) of less than 70% predicted, and a FEV1/forced vital capacity (FVC) of less than 70%. Participants were recruited from pulmonary function laboratories and from better breather support groups in a Midwestern state. Three standardized, self-report instruments, COPD Self-Efficacy Scale (CSES), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and Functional Performance Inventory (FPI) were used to measure the participants' self-report of their perceptions of self-efficacy, dyspnea, and functional performance. Dyspnea predicted 38.1% of the variance in functional performance, with self-efficacy contributing an additional 6.5% to the variance in the total sample. Self-efficacy predicted 36.5% of the variance in functional performance in men, with dyspnea contributing an additional 7.2% to the variance. However, in women, only dyspnea was a significant predictor of functional performance, at 48.5% when both dyspnea and self-efficacy were entered as independent variables. To improve patients' perceptions of functional performance, nurses can use methods such as breathing techniques and upper- and lower-body exercises that increase optimal management of dyspnea. Nurses may increase the self-efficacy of managing dyspnea by helping patients master breathing techniques and exercise through coaching and providing vicarious experiences through patient support groups or pulmonary rehabilitation programs.     

Reliability and validity of dyspnea measures in patients with obstructive lung disease

Dyspnea, the clinical term for shortness of breath, is the primary symptom and an important outcome measure in evaluations of patients with lung disease. It is a subjective symptom that has proved difficult to quantify. Many dyspnea measures are available, yet it is difficult, based on the existing literature, to determine the most reliable and valid. In this study, we evaluated 6 measures of dyspnea for reliability and validity: (a) Baseline Dyspnea Index (BDI) and Transition Dyspnea Index, (b) UCSD Shortness of Breath Questionnaire (SOBQ), (c) American Thoracic Society Dyspnea Scale, (d) Oxygen Cost Diagram, (e) Visual Analog Scale, and (f) Borg Scale. Subjects were 143 patients (74 women and 69 men) with obstructive lung disease, ages 40 to 86, FEV., 0.36 to 3.53 L, FVC 1.07 to 5.74 L. Dyspnea measures were assessed for test-retest reliability, internal consistency, interrater reliability, and construct validity (i.e.. correlations among dyspnea measures and correlations of dyspnea measures with exercise tolerance, health-related quality of life, lung function, anxiety, and depression). Results suggest that the SOBQ and BDI demonstrated the highest levels of reliability and validity among the dyspnea measures examined. This research was supported by University of California Tobacco Related Disease Research Program Grant 2RT026S, National Heart. Lung, and Blood Institute Grant HL 34732 to Robert M. Kaplan, and National Institutes of Health NHLBI Preventive Pulmonary Academic Award No. HL02215 to Andrew L. Ries.     

脑钠肽与心力衰竭的研究进展

脑钠肽是心脏分泌的一种激素。多项研究显示,循环脑钠肽水平与心功能关系密切,对心源性呼吸困难诊断、心力衰竭的严重程度及预后的评估方面具有重要意义。另外,众多循证医学证据显示,重组的人脑钠肽在心力衰竭的治疗方面有较好的疗效及独特优势。脑钠肽在临床心衰的诊断和治疗中还存在一些问题,需要进一步研究。     

Pre and postoperative nurse-guided incentive spirometry versus physiotherapist-guided pre and postoperative breathing exercises in patients undergoing cardiac surgery: An evaluation of postoperative complications and length of hospital stay

Atelectasis is the most occurring postoperative complication after cardiac surgeries. Postoperative respiratory exercises and incentive spirometry led to decrease in postoperative complications, especially atelectasis and hospital stay. The objectives of the study were to evaluate postoperative complications and length of hospital stay of patients who received pre and postoperative nurse-guided incentive spirometry against those of patients who received pre and postoperative breathing exercises by the physiotherapist in patients who underwent cardiac surgery. Data of patients who received 2 days preoperative and 2 days postoperative nurse-guided incentive spirometry with a spirometer (PPN cohort, n = 102) or received 2 days preoperative and 2 days postoperative breathing exercises by physiotherapist without spirometer (PPP cohort, n = 105), or 2 days postoperative physiotherapist-guided breathing exercises only without spirometer (PPB cohort, n = 114) were collected and analyzed. The acute or chronic collapse of part or entire lung was defined as atelectasis. The length of stay in the hospital was from the day of admission to discharge. Patients of the PPN cohort had fewer numbers of incidences of atelectasis, dyspnea, and sweating >1 day after operations compared to those of the PPB and the PPP cohorts (P < .05 for all). The partial pressure of oxygen and oxygen saturation of arterial blood ≥6 hours after operations reported higher, the duration of ventilation was shorter, and numbers of re-intubation processes reported fewer for patients of the PPN cohort than those of the PPB and the PPP cohorts (P < .05 for all). The hospital length of the stay of patients in the PPN cohort was fewer than those of the PPB and the PPP (P < .0001 for both) cohorts. Pre and postoperative nurse-guided incentive spirometry with a spirometer following cardiac surgeries would have better postoperative pulmonary outcomes and fewer hospital stays than those of postoperative-only or pre and postoperative physiotherapist-guided breathing exercises (level of evidence: IV; technical efficacy stage: 5).     

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial

Abstract

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (T _lim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4?cm H₂O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30?days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved T _lim (Δ = 111?s) and lower minute-ventilation (Δ = 4?L^.min^?1) at exhaustion, when comparing the IMT effects within the PAV modality (p?=?0.001 and p?=?0.036, respectively) and improved T _lim for PAV vs. SHAM (PAV main-effect, p?=?0.001; IMT main-effect, p?=?0.006; PAV vs. IMT interaction, p?=?0.034). In addition, IMT?+?PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p?=?0.009; time main-effect, p?<?0.0001; IMT vs. time interaction, p?=?0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p?=?0.018; time main-effect, p?=?0.0001; IMT vs. time interaction, p?=?0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz).     

Is atrial fibrillation associated with pulmonary embolism?

Summary. Background: A pulmonary embolism (PE) is thought to be associated with atrial fibrillation (AF). Nevertheless, this association is based on weak data. Objectives: To assess whether the presence of AF influences the clinical probability of PE in a cohort of patients with suspected PE and to confirm the association between PE and AF. Patients/methods: We retrospectively analyzed the data from two trials that included 2449 consecutive patients admitted for a clinically suspected PE. An electrocardiography (ECG) was systematically performed and a PE was diagnosed by computer tomography (CT). The prevalence of AF among patients with or without a PE was compared in a multivariate logistic regression model. Results: The prevalence of PE was 22.8% (519/2272) in patients without AF and 18.8% (25/133) in patients with AF (P = 0.28). After adjustment for confounding factors, AF did not significantly modify the probability of PE (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.42–1.11). However, when PE suspicion was based on new‐onset dyspnea, AF significantly decreased the probability of PE (OR 0.47, 95% CI 0.26–0.84). If isolated chest pain without dyspnea was the presenting complaint, AF tended to increase the probability of PE (OR 2.42, 95% CI 0.97–6.07). Conclusions: Overall, the presence of AF does not increase the probability of PE when this diagnosis is suspected. Nevertheless, when PE suspicion is based on new‐onset dyspnea, AF significantly decreases the probability of PE, as AF may mimic its clinical presentation. However, in patients with chest pain alone, AF tends to increase PE probability.     

An Unusual Cause of Dyspnea

Background. Right-sided arcus aorta (RSAA) is a rare condition and usually asymptomatic. However, it may be symptomatic if it causes tracheal or esophageal compression. Methods. The authors evaluated clinical and radiological features of seven patients with RSAA who had the diagnosis between May 2006 and May 2009. Results. The authors found that the incidence of RSAA was 0.16% in patients who had applied to their clinic. The age of patients ranged from 17 to 55 years. The male to female ratio was 6/1. Four patients were symptomatic due to RSAA. Most common symptoms were dyspnea during exercise, which is similar to exercise-induced asthma and dysphagia. Two patients were misdiagnosed as asthma. The flow-volume curves on spirometry of the patients showed intrathoracic upper airway obstruction. Thorax magnetic resonance imaging (MRI) revealed marked narrowing of the tracheal air column due to external compression of RSAA in three patients. Conclusions. RSAA should be included in the differential diagnosis of asthma. Spirometry may help to suspect RSAA. Thorax computed tomography (CT) and/or MRI are the best imaging methods for the diagnosis of RSAA.     

Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype

Mantle cell lymphoma is an aggressive malignant B‐cell disorder that often presents with a leukemic picture. Circulating lymphoma cell morphology may vary from small round mature‐appearing lymphocytes resembling the lymphocytes of chronic lymphocytic leukemia to large prolymphocytoid or blastoid cells. Rare reports of hyperleukocytosis with leukostasis, treated with leukocytapheresis, are described in patients with prolymphocytoid or blastoid morphology. We report an 88 year old woman with mantle cell lymphoma, hyperleukocytosis (WBC > 400 × 10³/µL) with severe respiratory compromise but without interstitial or alveolar infiltrates on radiograph or computerized tomography of the chest. She was afebrile and had no central nervous system signs. Circulating lymphoma cell morphology was predominantly of the small lymphocyte type. A two‐whole‐blood‐volume leukocytapheresis reduced her WBC from 465 to 221 × 10³/µL in 150 min. Her respiratory rate decreased from 28/min to 18/min and her arterial oxygen saturation (SpO₂) rose from 91% to 97% on 6 L/min of oxygen by nasal cannula. Severe breathlessness before the procedure abated completely by the end of the procedure. Respiratory compromise may occur in mantle cell lymphoma with hyperleukocytosis with a mature lymphoma cell phenotype, even without a clear picture of leukostasis. Although the ultimate survival of the patient depends on treatment with chemotherapy, leukocytapheresis for alleviation of symptoms may be warranted and should be considered. Respiratory status and response to leukocytapheresis should be documented with physiological measurements. J. Clin. Apheresis 31:398–402, 2016. © 2015 Wiley Periodicals, Inc.