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Robert B Banzett - One of the best experts on this subject based on the ideXlab platform.
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A Multidimensional Profile of Dyspnea in Hospitalized Patients
Chest, 2019Co-Authors: Jennifer P. Stevens, Richard M Schwartzstein, Robert W Lansing, Andrew R. Sheridan, Heather B. Bernstein, Kathy Baker, Robert B BanzettAbstract:Background Dyspnea is prevalent among hospitalized patients but little is known about the experience of Dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of Dyspnea in patients admitted with Dyspnea to a tertiary care hospital. Methods We selected patients who reported breathing discomfort of at least 4/10 on admission (10 = unbearable). Research staff recruited 156 patients within 24 hours of admission and evaluated daily patients' current and worst Dyspnea with the Multidimensional Dyspnea Profile; patients participated in the study 2.6 days on average. The Multidimensional Dyspnea Profile assesses overall breathing discomfort (A1), intensity of five sensory qualities of Dyspnea, and 5 negative emotional responses to Dyspnea. Patients were also asked to rate whether current levels of Dyspnea were "acceptable." Results At the time of the first research interview, patients reported slight to moderate Dyspnea (A1 median 4); however, most patients reported experiencing severe Dyspnea in the 24 hours before the interview (A1 mean 7.8). A total of 54% of patients with Dyspnea ≥4 on day 1 found the symptom unacceptable. The worst Dyspnea each day in the prior 24 hours usually occurred at rest. Dyspnea declined but persisted through hospitalization for most patients. "Air hunger" was the dominant sensation, especially when Dyspnea was strong (>4). Anxiety and frustration were the dominant emotions associated with Dyspnea. Conclusions This first multidimensional portrait of Dyspnea in a general inpatient population characterizes the sensations and emotions dyspneic patients endure. The finding that air hunger is the dominant sensation of severe Dyspnea has implications for design of laboratory models of these sensations and may have implications for targets of palliation of symptoms.
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prevalence of Dyspnea among hospitalized patients at the time of admission
Journal of Pain and Symptom Management, 2018Co-Authors: Jennifer P. Stevens, Carl R Odonnell, Richard M Schwartzstein, Robert B Banzett, Kathy Baker, Tenzin Dechen, Michael D HowellAbstract:Abstract Context Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. Objectives There is no large-scale study of the prevalence and intensity of patient-reported Dyspnea at the time of admission to the hospital. Methods Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's 1) current level of Dyspnea on a 0–10 scale with 10 anchored at "unbearable," 2) worst Dyspnea in the past 24 hours before arrival at the hospital on the same 0–10 scale, and 3) activities that were associated with Dyspnea before admission. The prevalence of Dyspnea was identified, and tests of difference were performed across patient characteristics. Results We analyzed 67,362 patients, 12% of whom were obstetric patients. Fifty percent of patients were admitted to a medical-surgical unit after treatment in the emergency department. Among all noncritically ill inpatients, 16% of patients experienced Dyspnea in the 24 hours before the admission. Twenty-three percent of patients admitted through the emergency department reported any Dyspnea in the past 24 hours. Eleven percent experienced some current Dyspnea when interviewed within 12 hours of admission with 4% of patients experiencing Dyspnea that was rated 4 or greater. Dyspnea of 4 or more was present in 43% of patients admitted with respiratory diagnoses and 25% of patients with cardiovascular diagnoses. After multivariable adjustment for severity of illness and patient comorbidities, patients admitted on the weekend or during the overnight nursing shift were more likely to report Dyspnea on admission. Conclusion Dyspnea is a common symptom among all hospitalized patients. Routine documentation of Dyspnea is feasible in a large tertiary care center.
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Routine Dyspnea assessment and documentation: Nurses’ experience yields wide acceptance
BMC Nursing, 2017Co-Authors: Kathy M. Baker, Susan Desanto-madeya, Robert B BanzettAbstract:Background Dyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine Dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document Dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after Dyspnea measurement was implemented we explored nurses’ approach to Dyspnea assessment, their perception of patient response, and their perception of the utility and burden of Dyspnea measurement. Methods We obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine Dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups. Results Ninety-four percent of the nurses surveyed reported administering the Dyspnea assessment is “easy” or “very easy”. None of the nurses reported that assessing Dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed Dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their Dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient’s condition. Conclusions In this study, we have demonstrated that routine Dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine Dyspnea assessment and documentation into their practice and felt that it improved patient-centered care.
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multidimensional Dyspnea profile an instrument for clinical and laboratory research
European Respiratory Journal, 2015Co-Authors: Robert B Banzett, Carl R Odonnell, Richard M Schwartzstein, Tegan Guilfoyle, Mark B Parshall, Paula Meek, Richard H Gracely, Robert W LansingAbstract:There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea Profile (MDP) assesses overall breathing discomfort, sensory qualities, and emotional responses in laboratory and clinical settings. Here we provide the MDP, review published evidence regarding its measurement properties and discuss its use and interpretation. The MDP assesses dyspnoea during a specific time or a particular activity (focus period) and is designed to examine individual items that are theoretically aligned with separate mechanisms. In contrast, other multidimensional dyspnoea scales assess recalled recent dyspnoea over a period of days using aggregate scores. Previous psychophysical and psychometric studies using the MDP show that: 1) subjects exposed to different laboratory stimuli could discriminate between air hunger and work/effort sensation, and found air hunger more unpleasant; 2) the MDP immediate unpleasantness scale (A1) was convergent with common dyspnoea scales; 3) in emergency department patients, two domains were distinguished (immediate perception, emotional response); 4) test–retest reliability over hours was high; 5) the instrument responded to opioid treatment of experimental dyspnoea and to clinical improvement; 6) convergent validity with common instruments was good; and 7) items responded differently from one another as predicted for multiple dimensions.
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Dyspnea affective response comparing copd patients with healthy volunteers and laboratory model with activities of daily living
BMC Pulmonary Medicine, 2013Co-Authors: Carl R Odonnell, Richard M Schwartzstein, Robert W Lansing, Tegan Guilfoyle, Daniel Elkin, Robert B BanzettAbstract:Laboratory-induced Dyspnea (breathing discomfort) in healthy subjects is widely used to study perceptual mechanisms, yet the relationship between laboratory-induced Dyspnea in healthy volunteers and spontaneous Dyspnea in patients with chronic lung disease is not well established. We compared affective responses to Dyspnea 1) in COPD patients vs. healthy volunteers (HV) undergoing the same laboratory stimulus; 2) in COPD during laboratory Dyspnea vs. during activities of daily living (ADL). We induced moderate and high Dyspnea levels in 13 COPD patients and 12 HV by increasing end-tidal CO2 (PETCO2) during restricted ventilation, evoking air hunger. We used the multidimensional Dyspnea profile (MDP) to measure intensity of sensory qualities (e.g., air hunger (AH) and work/effort (W/E)) as well as immediate discomfort (A1) and secondary emotions (A2). Ten of the COPD subjects also completed the MDP outside the laboratory following Dyspnea evoked by ADL. COPD patients and HV reported similar levels of immediate discomfort relative to sensory intensity. COPD patients and HV reported anxiety and frustration during laboratory-induced Dyspnea; variation among individuals far outweighed the small differences between subject groups. COPD patients reported similar intensities of sensory qualities, discomfort, and emotions during ADL vs. during moderate laboratory Dyspnea. Patients with COPD described limiting ADL to avoid greater Dyspnea. In this pilot study, we found no evidence that a history of COPD alters the affective response to laboratory-induced Dyspnea, and no difference in affective response between Dyspnea evoked by this laboratory model and Dyspnea evoked by ADL.
Giorgio Scano - One of the best experts on this subject based on the ideXlab platform.
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Dyspnea: an update:
Multidisciplinary respiratory medicine, 2010Co-Authors: Giorgio ScanoAbstract:Our understanding of the nature and mechanisms of Dyspnea has greatly evolved over the last two centuries. Although the relationship was never formally specified, discomfort was always assumed to accompany respiratory muscle activity. Hypotheses and theories of Dyspnea thus became synonymous with the factors controlling the extremes of respiratory muscle activity, with expiratory muscle activity and discomfort now being known to be controlled by the same factors. In his introduction to the "Breathlessness symposium" held in Manchester (1966), Julius H. Comroe [1] predicted that none of the speakers would deal directly with Dyspnea: instead they would present only what they understood - the control of breathing, a circumstance in which Dyspnea may occur. In the event Comroe was largely right. Few contributors dealt with sensory aspects of the subjects, and what sensory physiology there was, was naive. In the 25 years following that symposium, things changed greatly, as the contributions to the Moran Campbell Symposium held in Hamilton (1991) [2] testified. Both investigators and clinicians had by then adopted the approach of sensory physiology and the methods of psychophysics. Also, the main related topic concerned the respiratory muscles rather than breathing control. The influence of both these two changes on the Moran Campbell Symposium was central. Dyspnea is a very common symptom in patients with respiratory disorders. It presents major challenges to the medical community, so that clinicians and scientists need to keep a constant focus on the advances being made to overcome this problem. While a full account of the major challenges is not possible in this single issue, we wish to contribute to keeping pneumologists abreast of at least part of the considerable progress that has been made in recent years in the understanding of the pathophysiology, diagnosis, and therapeutic management of patients with both obstructive and restrictive pulmonary disease. This Multidisciplinary Focus reviews some recent progress in the field of Dyspnea. Four distinguished experts present the best of their own work and review the present knowledge regarding health and disease. The integrated approach present in this collection of reviews "is designed to explain and inform and in fact to inspire those who wish to serve dyspneic patients better than ever before". I wish to thank the authors for their willingness to contribute to this update on Dyspnea. Their expertise has allowed the publication of this focus on current concepts related to the evaluation and treatment of Dyspnea. A final word of cordial thanks to Multidisciplinary Respiratory Medicine for publishing this special Focus devoted to Dyspnea. I am confident that the readers will appreciate the efforts of those involved in this undertaking.
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Dyspnea and asthma.
Current opinion in pulmonary medicine, 2006Co-Authors: Giorgio Scano, Loredana StendardiAbstract:Purpose of review Dyspnea – the perception of respiratory discomfort – is a primary symptom of asthma. This review examines possible ways to link mechanisms, measurement and treatment that will increase our understanding of this condition. Recent findings Functional neuroimaging methods have proven to be powerful tools that serve as advanced models of sensor motor brain function. Studies examining functional neuroimaging methods have revealed activation of distinct brain areas associated with increased Dyspnea. Pulmonary hyperinflation has been proposed to influence the perception of Dyspnea. The association of hyperinflation with minor levels of bronchoconstriction reflects the partition of the sensory effect of airway narrowing per se from that of the attendant elastic loading of the inspiratory muscles. There is evidence to suggest, however, that hyperinflation does not play an important role in the pathogenesis of exercise Dyspnea as it does during induced bronchoconstriction. Decreased levels of perception of airway obstruction may be a risk factor associated with life-threatening asthma. A poor perceiver may be vulnerable to further hypoxia-induced suppression of respiratory sensation. Monitoring the response to bronchodilator therapy with formoterol and salbutamol in patients with acute or chronic asthma has resulted in significantly faster improvement in Dyspnea, within 2 min. Summary Regardless of the factors involved, much variability in Dyspnea scores remains unexplained. Quantitative and qualitative assessment of the perception of Dyspnea, symptom measurement and quality of life complement physiological measurements and contribute to our understanding of Dyspnea in asthma.
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breathing retraining and exercise conditioning in patients with chronic obstructive pulmonary disease copd a physiological approach
Respiratory Medicine, 2003Co-Authors: Francesco Gigliotti, Isabella Romagnoli, Giorgio ScanoAbstract:Abstract In this review we shall consider the commonest techniques to reduce Dyspnea that are being applied to patients with chronic obstructive pulmonary disease (COPD) subjected to a pulmonary rehabilitation program (PRP). Pursed lip breathing (PLB) and diaphragmatic breathing (DB) are breathing retraining strategies employed by COPD patients in order to relieve and control Dyspnea. However, the effectiveness of PLB in reducing dyspnoea is controversial. Moreover, DB may be associated with asynchronous and paradoxical breathing movements, reflecting a decrease in the efficiency of the diaphragm. Exercise training (EXT) is a mandatory component of PRP. EXT has been shown to improve exercise performances and peripheral muscle strength. Recent studies have focused on the effect of EXT on breathlessness. However, concerns persist as to whether the decreased sensation of Dyspnea for a given exercise stimulus is principally due to psychological benefits of rehabilitation or to improved physiological ability to perform exercise. The effect of EXT on breathlessness may be reinforced by inhaling oxygen. However, two studies have recently shown that breathing supplemental oxygen during training has either a marginal effect or no advantage over training. In a comprehensive PRP, strength training (ST) and arm endurance training (AET) could have a role in decreasing peripheral muscle weakness and metabolic and ventilatory requirements for AET. The role of unloading the respiratory muscles during EXT has to be clarified.
Omer Van Den Bergh - One of the best experts on this subject based on the ideXlab platform.
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The impact of Dyspnea and threat of Dyspnea on error processing.
Psychophysiology, 2018Co-Authors: Josef Sucec, Ilse Van Diest, Michaela Herzog, Omer Van Den Bergh, Andreas Von LeupoldtAbstract:Dyspnea (breathlessness) is a threatening and aversive bodily sensation and a major symptom of various diseases. It has been suggested to impair several aspects of functioning in affected patients, but experimental proof for this assumption is widely absent. Error processing is an important domain of functioning and has intensively been studied using electrophysiological measures. Specifically, the error-related negativity (ERN) has been suggested to reflect early performance monitoring and error detection, while the error positivity (Pe) has been linked to subsequent error awareness. So far, little is known about the effects of anticipated or perceived Dyspnea on error processing. Therefore, in 49 healthy participants, we studied the effects of experimentally induced Dyspnea and threat of Dyspnea on the ERN/Pe and behavioral task performance. Participants performed the arrowhead version of the flanker task during three experimental conditions: an unloaded baseline condition, a Dyspnea condition, and a threat of Dyspnea condition. Dyspnea was induced by breathing through inspiratory resistive loads, while high-density EEG was continuously measured. No differences in task performance (reaction times, error rates) and ERN mean amplitudes were found between conditions. However, mean amplitudes for the Pe differed between conditions with smaller Pe amplitudes during threat of Dyspnea compared to baseline and Dyspnea conditions, with the latter two conditions showing no difference. These results may suggest that threat of Dyspnea, but not Dyspnea itself, reduces error awareness, while both seem to have no impact on early error processing and related behavioral performance.
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Association Between Anxiety, Dyspnea-Related Fear, and Dyspnea in a Pulmonary Rehabilitation Program
2015Co-Authors: Thomas Janssens, Steven De Peuter, Linda Stans, Geert Verleden, Thierry Troosters, Marc Decramer, Omer Van Den BerghAbstract:Background: A growing body of research connects anxiety with poorer outcomes in COPD. However, more specifi c measures of Dyspnea-related fear may be more closely related to critical processes involved in pulmonary rehabilitation (perception of Dyspnea and avoidance of physical activity) and may have a predictive value for COPD outcome beyond general anxiety measures. Methods: In this naturalistic outcome study, we investigated the effects of baseline anxiety and Dyspnea-related fear on perceived Dyspnea and other outcomes of a well-established pulmonary rehabilitation program for COPD. Results: Seventy-three patients participated in the study. At baseline, higher Dyspnea-related fear was associated with higher levels of Dyspnea during ergometer exercise, but also with a steeper decrease of exercise Dyspnea during the course of pulmonary rehabilitation, whereas lower Dyspnearelated fear was associated with an increase in exercise Dyspnea, even when controlling for anxiety, lung function, and exercise intensity. Furthermore, higher Dyspnea-related fear was associated with reduced quality of life (mastery subscale) and maximal exercise capacity at baseline, but also with a steeper increase in quality of life (emotions and mastery subscale) and exercise capacity during rehabilitation. However, the association of Dyspnea-related fear with worse 6-min walking distance and impairment in daily activities persisted throughout rehabilitation. Conclusions: Results indicate a mediating effect of Dyspnea-related fear on the association between anxiety and exercise-related Dyspnea. Exercise in pulmonary rehabilitation in people with higher baseline Dyspnea-related fear may act as a correction of excessive symptom reports through exposure to dyspneic situations.
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Dyspnea Perception in COPD: Association Between Anxiety, Dyspnea-Related Fear, and Dyspnea in a Pulmonary Rehabilitation Program
Chest, 2011Co-Authors: Thomas Janssens, Steven De Peuter, Linda Stans, Geert Verleden, Thierry Troosters, Marc Decramer, Omer Van Den BerghAbstract:Background A growing body of research connects anxiety with poorer outcomes in COPD. However, more specific measures of Dyspnea-related fear may be more closely related to critical processes involved in pulmonary rehabilitation (perception of Dyspnea and avoidance of physical activity) and may have a predictive value for COPD outcome beyond general anxiety measures. Methods In this naturalistic outcome study, we investigated the effects of baseline anxiety and Dyspnea-related fear on perceived Dyspnea and other outcomes of a well-established pulmonary rehabilitation program for COPD. Results Seventy-three patients participated in the study. At baseline, higher Dyspnea-related fear was associated with higher levels of Dyspnea during ergometer exercise, but also with a steeper decrease of exercise Dyspnea during the course of pulmonary rehabilitation, whereas lower Dyspnea-related fear was associated with an increase in exercise Dyspnea, even when controlling for anxiety, lung function, and exercise intensity. Furthermore, higher Dyspnea-related fear was associated with reduced quality of life (mastery subscale) and maximal exercise capacity at baseline, but also with a steeper increase in quality of life (emotions and mastery subscale) and exercise capacity during rehabilitation. However, the association of Dyspnea-related fear with worse 6-min walking distance and impairment in daily activities persisted throughout rehabilitation. Conclusions Results indicate a mediating effect of Dyspnea-related fear on the association between anxiety and exercise-related Dyspnea. Exercise in pulmonary rehabilitation in people with higher baseline Dyspnea-related fear may act as a correction of excessive symptom reports through exposure to dyspneic situations.
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Fearful imagery induces hyperventilation and Dyspnea in medically unexplained Dyspnea.
Chinese medical journal, 2008Co-Authors: Jiangna Han, Ilse Van Diest, Omer Van Den Bergh, Yuanjue Zhu, Dm Luo, Karel P. Van De WoestijneAbstract:BACKGROUND Medically unexplained Dyspnea refers to a condition characterized by a sensation of Dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting symptoms, specifically Dyspnea. METHODS Forty patients with medically unexplained Dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO(2) (PetCO(2)) and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO(2) falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder. RESULTS In patients with medically unexplained Dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO(2) (P < 0.05). Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects (P < 0.01). The patients reported symptoms of Dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO(2) fall was significantly correlated with the intensity of Dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety symptoms on the other. CONCLUSIONS Fearful imagery provokes hyperventilation and induces subjective symptoms of Dyspnea and palpitation in patients with medically unexplained Dyspnea.
Richard M Schwartzstein - One of the best experts on this subject based on the ideXlab platform.
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A Multidimensional Profile of Dyspnea in Hospitalized Patients
Chest, 2019Co-Authors: Jennifer P. Stevens, Richard M Schwartzstein, Robert W Lansing, Andrew R. Sheridan, Heather B. Bernstein, Kathy Baker, Robert B BanzettAbstract:Background Dyspnea is prevalent among hospitalized patients but little is known about the experience of Dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of Dyspnea in patients admitted with Dyspnea to a tertiary care hospital. Methods We selected patients who reported breathing discomfort of at least 4/10 on admission (10 = unbearable). Research staff recruited 156 patients within 24 hours of admission and evaluated daily patients' current and worst Dyspnea with the Multidimensional Dyspnea Profile; patients participated in the study 2.6 days on average. The Multidimensional Dyspnea Profile assesses overall breathing discomfort (A1), intensity of five sensory qualities of Dyspnea, and 5 negative emotional responses to Dyspnea. Patients were also asked to rate whether current levels of Dyspnea were "acceptable." Results At the time of the first research interview, patients reported slight to moderate Dyspnea (A1 median 4); however, most patients reported experiencing severe Dyspnea in the 24 hours before the interview (A1 mean 7.8). A total of 54% of patients with Dyspnea ≥4 on day 1 found the symptom unacceptable. The worst Dyspnea each day in the prior 24 hours usually occurred at rest. Dyspnea declined but persisted through hospitalization for most patients. "Air hunger" was the dominant sensation, especially when Dyspnea was strong (>4). Anxiety and frustration were the dominant emotions associated with Dyspnea. Conclusions This first multidimensional portrait of Dyspnea in a general inpatient population characterizes the sensations and emotions dyspneic patients endure. The finding that air hunger is the dominant sensation of severe Dyspnea has implications for design of laboratory models of these sensations and may have implications for targets of palliation of symptoms.
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prevalence of Dyspnea among hospitalized patients at the time of admission
Journal of Pain and Symptom Management, 2018Co-Authors: Jennifer P. Stevens, Carl R Odonnell, Richard M Schwartzstein, Robert B Banzett, Kathy Baker, Tenzin Dechen, Michael D HowellAbstract:Abstract Context Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. Objectives There is no large-scale study of the prevalence and intensity of patient-reported Dyspnea at the time of admission to the hospital. Methods Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's 1) current level of Dyspnea on a 0–10 scale with 10 anchored at "unbearable," 2) worst Dyspnea in the past 24 hours before arrival at the hospital on the same 0–10 scale, and 3) activities that were associated with Dyspnea before admission. The prevalence of Dyspnea was identified, and tests of difference were performed across patient characteristics. Results We analyzed 67,362 patients, 12% of whom were obstetric patients. Fifty percent of patients were admitted to a medical-surgical unit after treatment in the emergency department. Among all noncritically ill inpatients, 16% of patients experienced Dyspnea in the 24 hours before the admission. Twenty-three percent of patients admitted through the emergency department reported any Dyspnea in the past 24 hours. Eleven percent experienced some current Dyspnea when interviewed within 12 hours of admission with 4% of patients experiencing Dyspnea that was rated 4 or greater. Dyspnea of 4 or more was present in 43% of patients admitted with respiratory diagnoses and 25% of patients with cardiovascular diagnoses. After multivariable adjustment for severity of illness and patient comorbidities, patients admitted on the weekend or during the overnight nursing shift were more likely to report Dyspnea on admission. Conclusion Dyspnea is a common symptom among all hospitalized patients. Routine documentation of Dyspnea is feasible in a large tertiary care center.
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multidimensional Dyspnea profile an instrument for clinical and laboratory research
European Respiratory Journal, 2015Co-Authors: Robert B Banzett, Carl R Odonnell, Richard M Schwartzstein, Tegan Guilfoyle, Mark B Parshall, Paula Meek, Richard H Gracely, Robert W LansingAbstract:There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea Profile (MDP) assesses overall breathing discomfort, sensory qualities, and emotional responses in laboratory and clinical settings. Here we provide the MDP, review published evidence regarding its measurement properties and discuss its use and interpretation. The MDP assesses dyspnoea during a specific time or a particular activity (focus period) and is designed to examine individual items that are theoretically aligned with separate mechanisms. In contrast, other multidimensional dyspnoea scales assess recalled recent dyspnoea over a period of days using aggregate scores. Previous psychophysical and psychometric studies using the MDP show that: 1) subjects exposed to different laboratory stimuli could discriminate between air hunger and work/effort sensation, and found air hunger more unpleasant; 2) the MDP immediate unpleasantness scale (A1) was convergent with common dyspnoea scales; 3) in emergency department patients, two domains were distinguished (immediate perception, emotional response); 4) test–retest reliability over hours was high; 5) the instrument responded to opioid treatment of experimental dyspnoea and to clinical improvement; 6) convergent validity with common instruments was good; and 7) items responded differently from one another as predicted for multiple dimensions.
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Dyspnea affective response comparing copd patients with healthy volunteers and laboratory model with activities of daily living
BMC Pulmonary Medicine, 2013Co-Authors: Carl R Odonnell, Richard M Schwartzstein, Robert W Lansing, Tegan Guilfoyle, Daniel Elkin, Robert B BanzettAbstract:Laboratory-induced Dyspnea (breathing discomfort) in healthy subjects is widely used to study perceptual mechanisms, yet the relationship between laboratory-induced Dyspnea in healthy volunteers and spontaneous Dyspnea in patients with chronic lung disease is not well established. We compared affective responses to Dyspnea 1) in COPD patients vs. healthy volunteers (HV) undergoing the same laboratory stimulus; 2) in COPD during laboratory Dyspnea vs. during activities of daily living (ADL). We induced moderate and high Dyspnea levels in 13 COPD patients and 12 HV by increasing end-tidal CO2 (PETCO2) during restricted ventilation, evoking air hunger. We used the multidimensional Dyspnea profile (MDP) to measure intensity of sensory qualities (e.g., air hunger (AH) and work/effort (W/E)) as well as immediate discomfort (A1) and secondary emotions (A2). Ten of the COPD subjects also completed the MDP outside the laboratory following Dyspnea evoked by ADL. COPD patients and HV reported similar levels of immediate discomfort relative to sensory intensity. COPD patients and HV reported anxiety and frustration during laboratory-induced Dyspnea; variation among individuals far outweighed the small differences between subject groups. COPD patients reported similar intensities of sensory qualities, discomfort, and emotions during ADL vs. during moderate laboratory Dyspnea. Patients with COPD described limiting ADL to avoid greater Dyspnea. In this pilot study, we found no evidence that a history of COPD alters the affective response to laboratory-induced Dyspnea, and no difference in affective response between Dyspnea evoked by this laboratory model and Dyspnea evoked by ADL.
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Pathophysiology of Dyspnea
The New England journal of medicine, 1995Co-Authors: Harold L. Manning, Richard M SchwartzsteinAbstract:Dyspnea may be defined as an uncomfortable sensation of breathing. The sense of respiratory effort, chemoreceptor stimulation, mechanical stimuli arising in lung and chest wall receptors, and neuroventilatory dissociation may all contribute to the sensation of Dyspnea. Different mechanisms likely give rise to qualitatively different sensations of Dyspnea. In most patients, Dyspnea is probably due to a combination of mechanisms. For example, in asthma, a heightened sense of effort, neuroventilatory dissociation, and vagal stimuli arising from bronchoconstriction and airway inflammation may all play a role. Patients with different disorders and different mechanisms of Dyspnea use different phrases to describe their breathing discomfort. Hence, the language patients use to describe their Dyspnea may provide clues to the etiology of their symptoms.
T Witek - One of the best experts on this subject based on the ideXlab platform.
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a long term evaluation of once daily inhaled tiotropium in chronic obstructive pulmonary disease
European Respiratory Journal, 2002Co-Authors: Richard Casaburi, Adam Wanner, Richard Zuwallack, S S Menjoge, C W Serby, Donald A Mahler, P W Jones, T WitekAbstract:Currently available inhaled bronchodilators used as therapy for chronic obstructive pulmonary disease (COPD) necessitate multiple daily dosing. The present study evaluates the long-term safety and efficacy of tiotropium, a new once-daily anticholinergic in COPD. Patients with stable COPD (age 65.2±8.7 yrs (mean±sd), n=921) were enrolled in two identical randomized double-blind placebo-controlled 1-yr studies. Patients inhaled tiotropium 18 µg or placebo (mean screening forced expiratory volume in one second (FEV 1 ) 1.01 versus 0.99 L, 39.1 and 38.1% of the predicted value) once daily as a dry powder. The primary spirometric outcome was trough FEV 1 ( i.e. FEV 1 prior to dosing). Changes in dyspnoea were measured using the Transition Dyspnea Index, and health status with the disease-specific St. George9s Respiratory Questionnaire and the generic Short Form 36. Medication use and adverse events were recorded. Tiotropium provided significantly superior bronchodilation relative to placebo for trough FEV 1 response (∼12% over baseline) (p versus placebo 2.7%, p Tiotropium is an effective, once-daily bronchodilator that reduces dyspnoea and chronic obstructive pulmonary disease exacerbation frequency and improves health status. This suggests that tiotropium will make an important contribution to chronic obstructive pulmonary disease therapy.
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a long term evaluation of once daily inhaled tiotropium in chronic obstructive pulmonary disease
European Respiratory Journal, 2002Co-Authors: Richard Casaburi, Adam Wanner, Richard Zuwallack, S S Menjoge, C W Serby, Donald A Mahler, P W Jones, Pedro G San, T WitekAbstract:Currently available inhaled bronchodilators used as therapy for chronic obstructive pulmonary disease (COPD) necessitate multiple daily dosing. The present study evaluates the long-term safety and efficacy of tiotropium, a new once-daily anticholinergic in COPD. Patients with stable COPD (age 65.2+/-8.7 yrs (mean+/-SD), n=921) were enrolled in two identical randomized double-blind placebo-controlled 1-yr studies. Patients inhaled tiotropium 18 microg or placebo (mean screening forced expiratory volume in one second (FEV1) 1.01 versus 0.99 L, 39.1 and 38.1% of the predicted value) once daily as a dry powder. The primary spirometric outcome was trough FEV1 (i.e. FEV1 prior to dosing). Changes in dyspnoea were measured using the Transition Dyspnea Index, and health status with the disease-specific St. George's Respiratory Questionnaire and the generic Short Form 36. Medication use and adverse events were recorded. Tiotropium provided significantly superior bronchodilation relative to placebo for trough FEV1 response (approximately 12% over baseline) (p<0.01) and mean response during the 3 h following dosing (approximately 22% over baseline) (p<0.001) over the 12-month period. Tiotropium recipients showed less dyspnoea (p<0.001), superior health status scores, and fewer COPD exacerbations and hospitalizations (p<0.05). Adverse events were comparable with placebo, except for dry mouth incidence (tiotropium 16.0% versus placebo 2.7%, p<0.05). Tiotropium is an effective, once-daily bronchodilator that reduces dyspnoea and chronic obstructive pulmonary disease exacerbation frequency and improves health status. This suggests that tiotropium will make an important contribution to chronic obstructive pulmonary disease therapy.
