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INTRODUCTION: COPD has become more prevalent among women, revealing a specific feminine phenotype. Women experience greater dyspnea and a more impaired quality of life. The main objective of this study was to assess the effect of gender on dyspnea during a pulmonary rehabilitation program (PRP). METHODS: Retrospective study including COPD patients having participated in PRPs. The following data were analyzed according to gender before and after a PRP: dyspnea, quality of life, anxiety and depression, exercise capacity, muscle function (quadriceps and inspiratory muscles). RESULTS: More than 500 patients (252 men and 252 women) were included. We did not find a significant effect of gender on the evolution of dyspnea, anxiety or depressive disorders, exercise capacity, inspiratory muscle strength, or overall quality of life score. That said, we found a possible effect on the sub-scores of the quality of life questionnaire, and regarding quadriceps strength. All criteria improved during the program in both groups. CONCLUSIONS: During a PRP, gender does not impact the evolution of dyspnea. While women may nonetheless benefit to a greater extent in terms of quality of life sub-scores (impact, activities, symptoms) and quadriceps strength, these results still require confirmation.
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Disnea , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Humanos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Femenino , Masculino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Disnea/rehabilitación , Disnea/etiología , Resultado del Tratamiento , Factores Sexuales , Tolerancia al Ejercicio/fisiología , Fuerza Muscular/fisiología , Depresión/epidemiología , Depresión/etiología , Depresión/rehabilitación , Depresión/psicologíaRESUMEN
INTRODUCTION: Long COVID refers to persistent symptoms, lasting more than 4 weeks after acute SARS-CoV-2 infection, even though the infection itself has been successfully controlled and remedied. Patient complaints are diverse, and the underlying physiopathological mechanisms are not well understood. Dyspnea and muscle fatigue are among the most commonly reported symptoms. STATE OF THE ART: Cardiopulmonary exercise test (CPET) has been recognized as a useful tool in investigation of unexplained dyspnea. In patients with chronic lung disease, pulmonary rehabilitation is a program designed to counteract dyspnea, to increase exercise capacity and to improve quality of life. PERSPECTIVES: Publications on CPET and pulmonary rehabilitation are needed in order to deepen comprehension and enhance management of long-COVID-19. CONCLUSIONS: CPET reports have shown that symptoms persisting in the aftermath of acute SARS-CoV-2 infection may be related to deconditioning, a common occurrence after ICU stay, to cardiac dysautonomia subsequent to critical infections and, finally, to dysfunctional breathing subsequent to mild infections. These findings justify pulmonary rehabilitation, which has proven to be effective regardless of the severity of the initial infection, not only immediately after hospital discharge, but also at later points in time.
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COVID-19 , Humanos , Prueba de Esfuerzo , Síndrome Post Agudo de COVID-19 , Calidad de Vida , SARS-CoV-2 , Disnea/diagnóstico , Disnea/etiologíaRESUMEN
Hyperventilation syndrome (HVS) is a frequent disorder of which the etiology is unclear. Diagnosis is based on the ruling out of organic disease and, more positively, on results of the Nijmegen questionnaire, reproduction of symptoms during the hyperventilation provocation test (HPVT), and detected hypocapnia. Treatment is based on targeted respiratory physiotherapy consisting in voluntary hypoventilation and instructions to the patient on regular respiratory exercise over an appreciable period of time. Additional research is needed to evaluate the validity of current investigative tools leading to the diagnosis of hyperventilation syndrome and to appraise the efficacy of current respiratory physiotherapy methods.
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Hiperventilación , Humanos , Hiperventilación/diagnósticoRESUMEN
Respiratory difficulties presented by a loved one at the end of life at home can leave those around him or her unable to cope and lead to emergency hospitalizations that are not clinically justified in this context. This is why the educational role of nurses is so important. They contribute, through anticipated explanations and indications, to allow adapted attitudes likely to reduce anguish, even panic, and to make it possible to continue to live at home.
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Adaptación Fisiológica , Muerte , Humanos , Masculino , Femenino , DisneaRESUMEN
Ehlers-Danlos syndromes (EDS) represent a heterogeneous group of heritable connective tissue disorders characterized by the clinical "triad" consisting in joint hypermobility, skin hyperextensibility and tissue fragility. Respiratory manifestations associated with EDS are frequent and variable. They vary mainly according to the type of EDS. In hypermobile and classical EDS, the most frequent non-vascular types, dyspnea is a common symptom. Its etiologies are wide-ranging and can coexist in the same patient: asthma, respiratory muscle weakness, chest wall abnormalities, upper and lower airway collapse. The prevalence of obstructive sleep apnea syndrome in nvEDS is high. Identification of the relevant dyspnea mechanism is essential to providing appropriate therapeutic measures. In vascular EDS (vEDS), the main pulmonary complications are pneumothorax, hemothorax and hemoptysis. As they frequently precede the diagnosis of vEDS by several years, it is imperative to raise the possibility of vEDS in a young patient with spontaneous pneumothorax or hemothorax. The presence of suggestive computed tomography parenchymal abnormalities (emphysema, clusters of calcified nodules, cavitated nodule) can be an aid to diagnosis. Treatment is based on the usual approaches, which must be carried out with caution by an experienced operator fully informed of the diagnosis. Better knowledge of respiratory manifestations of EDS by the pneumological community would improve patient care and pave the way for further research.
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Síndrome de Ehlers-Danlos Tipo IV , Síndrome de Ehlers-Danlos , Neumotórax , Anomalías Cutáneas , Humanos , Hemotórax/complicaciones , Síndrome de Ehlers-Danlos/complicaciones , Síndrome de Ehlers-Danlos/diagnóstico , Anomalías Cutáneas/complicaciones , Neumotórax/diagnóstico , Neumotórax/epidemiología , Neumotórax/etiologíaRESUMEN
The role of the physiotherapist in the assessment and management of dyspnea. Dyspnea is the most common symptom in cardio-respiratory diseases. Recently improved comprehension of dyspnea mechanisms have underlined the need for three-faceted assessment. The three key aspects correspond to the "breathing, thinking, functioning" clinical model, which proposes a multidimensional - respiratory, emotional and functional - approach. Before initiating treatment, it is essential for several reasons to assess each specific case, determining the type of dyspnea affecting the patient, appraising the impact of shortness of breath, and estimating the effectiveness of the treatment applied. The physiotherapist has a major role to assume in the care of dyspneic patients, not only in assessment followed by treatment but also as a major collaborator in a multidisciplinary team, especially with regard to pulmonary rehabilitation. The aim of this review is to inventory the existing assessment tools and the possible physiotherapies for dyspnea, using a holistic approach designed to facilitate the choice of techniques and to improve quality of care by fully addressing the patient's needs.
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Fisioterapeutas , Humanos , Disnea/diagnóstico , Disnea/etiología , Disnea/terapia , RespiraciónRESUMEN
INTRODUCTION: The platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism. OBSERVATIONS: We report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound. CONCLUSION: This syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.
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COVID-19 , Foramen Oval Permeable , Neumonía , Humanos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/cirugía , Síndrome de Platipnea Ortodesoxia , Postura , COVID-19/complicaciones , Disnea/etiología , Disnea/complicacionesRESUMEN
Objectif : déterminer les indications de la trachéotomie chirurgicale chez l'enfant, décrire la technique et les suites opératoires. Matériel et méthode : il s'agit d'une étude descriptive rétrospective portant sur les trachéotomies pédiatriques réalisées au CHU de Bouaké de janvier 2016 à décembre 2022. Les indications de la trachéotomie, la technique opératoire et l'évolution ont été étudiées. Le test exact de Fisher a été utilisé pour évaluer le lien entre le motif de la trachéotomie et les pathologies au seuil α de 5%. Résultats : pendant la période d'étude, 32 enfants ont été trachéotomisés. Leur âge variait entre 9 mois et 15 ans avec un âge moyen de 7,2 ans. Il s'agissait de 22 garçons et 10 filles. L'impossibilité d'intuber le patient (65,62%) et la dyspnée laryngée sévère (25%) constituaient les motifs de la trachéotomie. Les corps étrangers laryngo-trachéaux et la papillomatose laryngée représentaient respectivement 37,5% et 21,87% des pathologies. Nous n'avons pas noté de lien significatif entre le motif de la trachéotomie et les pathologies (p=1,000). L'intervention a été réalisée sous sédation dans 78,12% des cas. L'ouverture trachéale était en forme de « H ¼ et de siège sous-isthmique. Les suites opératoires étaient simples chez 93,75% des patients. La décanulation a été effective dans 24 cas (75%). Conclusion : les principaux motifs de la trachéotomie dans notre expérience sont l'impossibilité d'intuber le patient et la dyspnée laryngée sévère. Les pathologies étaient dominées par les corps étrangers laryngo-trachéaux et la papillomatose laryngée. Les suites opératoires étaient généralement satisfaisantes.
Objective: to determine the indications for surgical tracheotomy in children, to describe the technique and the postoperative course. Material and method: This is a retrospective descriptive study of pediatric tracheotomies performed at the Bouaké University Hospital from January 2016 to December 2022. The indications for tracheotomy, the operating technique and the evolution were studied. Fisher's exact test was used to assess the link between the reason for the tracheotomy and the pathologies at the α threshold of 5%. Results: during the study period, 32 children were tracheotomized. Their age varied between 9 months and 15 years with an average age of 7.2 years. They were 22 boys and 10 girls. The impossibility of intubating the patient (65.62%) and severe laryngeal dyspnea (25%) were the reasons for the tracheotomy. Laryngo-tracheal foreign bodies and laryngeal papillomatosis accounted for 37.5% and 21.87% of pathologies respectively. We did not note any significant link between the reason for the tracheotomy and the pathologies (p=1,000). The intervention was performed under sedation in 78.12% of cases. The tracheal opening was "H" shaped and sub-isthmic. The postoperative course was simple in 93.75% of patients. Decanulation was effective in 24 cases (75%). Conclusion: the main reasons for tracheotomy in our experience are the impossibility of intubating the patient and severe laryngeal dyspnea. The pathologies were dominated by laryngo-tracheal foreign bodies and laryngeal papillomatosis. The postoperative course was generally satisfactory
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Humanos , Masculino , FemeninoRESUMEN
In the front line, from the beginning of the pandemic, to take care of patients hospitalized for severe forms of Covid-19, health professionals have not failed, despite the precautions taken, to contract the virus and develop the disease, sometimes with severe forms. Two hospital caregivers testify about their respective experiences and the repercussions on their daily life due to a long Covid.
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COVID-19 , Humanos , Síndrome Post Agudo de COVID-19 , Cuidadores , Pandemias , Personal de SaludRESUMEN
INTRODUCTION: Metastatic pleural effusion is a cause of dyspnea. The American thoracic society has strongly suggested that studies evaluating thoracic ultrasonography as potentially predictive of improvment of dyspnea are needed. METHODS: We conducted a prospective monocentric observational study to assess chest ultrasound predictors of response to thoracentesis. Fifteen patients with metastatic pleural effusion were included. RESULTS: The initial mean VAS score was5 ± 2,9 cm. The majority of patients had pleural effusions equal to or greater than 5 intercostal spaces (EIC) in height, while 7 patients had an abnormal curvature of the hemidiaphragm (flattened or inverted). PRIMARY ENDPOINT: The volume removed was greater in the group with anechoic pleurisy compared to the group with sonographic septation, notwithstanding complex pleural effusion (non-septated, relatively hyperechoic, with some spots in the effusion). The patients with complex pleural effusions had an higher score of dyspnea. SECONDARY ENDPOINTS: The 7 patients with abnormal diaphragmatic curvature presented significant dyspnea with a pain score of approximately 7 and profuse pleurisy occupying 8 intercostal spaces in height. The effusions of those who could not normalize their curvature had a complex aspect and the volume removed was lower. CONCLUSIONS: The ultrasound characteristics of pleural effusions seem to be predictors of improvment of dyspnea after thoracentesis. The septated and complex aspects are probably predictors of non improvment of dyspnea.
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Neoplasias , Derrame Pleural , Pleuresia , Humanos , Toracocentesis/efectos adversos , Proyectos Piloto , Estudios Prospectivos , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Disnea/diagnóstico , Disnea/etiología , Pleuresia/diagnóstico , Pleuresia/etiologíaRESUMEN
INTRODUCTION: The goal of the present study is to assess the relationship between functional respiratory parameters measured by the forced oscillation technique (FOT) in COPD patients and (1) dyspnea; (2) inspiratory capacity (IC), along with the variations occurring subsequent to bronchodilation. METHODS: This cross-sectional study analyzed 40 stable COPD patients. Dyspnea was assessed by means of the San Diego Shortness of Breath Questionnaire. Forced oscillations were measured before and after bronchodilation by means of routine pulmonary function tests (PFTs). RESULTS: The reactance parameters measured by the FOT correlated with dyspnea (AX5: r=0.46; P=0.003) similarly to IC (r=-0.46; P=0.003). Changes in AX5 following bronchodilation led to a predicted 12% and 200mL improvement in IC, AX5 (area under the ROC curve=0.85, P<0.001). CONCLUSIONS: Forced oscillation technique (FOT) appears to be an interesting complement to routine PFTs in COPD assessment. Reactance parameters are correlated with dyspnea and their response to bronchodilators is a predictor of significantly improved inspiratory capacity (IC). All in all, FOT may be considered as a functional test with regard to pulmonary hyperinflation, a critical determinant of dyspnea.
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Broncodilatadores , Enfermedad Pulmonar Obstructiva Crónica , Resistencia de las Vías Respiratorias , Broncodilatadores/farmacología , Broncodilatadores/uso terapéutico , Estudios Transversales , Disnea/diagnóstico , Disnea/etiología , Volumen Espiratorio Forzado/fisiología , Humanos , Oscilometría/métodos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Pruebas de Función Respiratoria/métodos , EspirometríaRESUMEN
Spirometry in the Medical Practice - Part 2: Interpretation Abstract. The way in which spirometry should be assessed correctly was defined internationally in 2005. Compared to before, it was newly defined that the FEV1/VC ratio is used as a parameter to detect an obstruction. An obstruction is of significance if this measured value is below the 5 % percentile, which is usually indicated as a Z-Score of minus 1,645 in the automatically generated protocol. To generate this value, the software must contain the modern GLI standard values and the patient data (gender, age, height). A proven obstruction shows significant reversibility if bronchospasmolysis improves FEV1 by at least 12 % and 200 ml absolute. The determination of the severity of obstruction is based on the extent of the reduction in FEV1 relative to the individual norm. Even after reading both parts of this publication, ambiguities will still arise in individual cases when performing spirometry in clinical practice. In such cases, it is worthwhile to present these findings to the local pulmonologist for co-assessment. This results in a learning effect that will consolidate expertise.
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Pulmón , Enfermedad Pulmonar Obstructiva Crónica , Volumen Espiratorio Forzado , Humanos , Espirometría , Capacidad VitalRESUMEN
Spirometry in the Medical Practice - Part 1: Measuring Abstract. Today, every practitioner, as well as every hospital emergency, should be able to perform spirometry. However, the measurement requires solid basic knowledge as well as a certain amount of experience so that consistent and reproducible measurements are possible. Since the measurement depends heavily on the cooperation of the patient, typical errors must be recognised and corrected immediately. A rounded forced expiratory flow volume curve, or a sudden drop of the curve towards zero at the end of exhalation as well as clearly deviating curves or values in the minimum required three measurement manoeuvres are clear hints for an insufficiently forced expiration or an expiration that was stopped too early. Pulmonary function assistants need instructions as to when application of a rapid acting beta agonist with repeated spirometry to detect possible reversibility is necessary. This includes knowing how long therapeutic bronchodilators must be stopped prior to the test.
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Broncodilatadores , Pulmón , Volumen Espiratorio Forzado , Humanos , Espirometría , Encuestas y Cuestionarios , Capacidad VitalRESUMEN
INTRODUCTION: Complications following COVID-19 are starting to emerge; neurological disorders are already described in the literature. CASE REPORT: This case is about a 20-year old male with a severe COVID-19, hospitalized in a Reanimation and Intensive Care Unit with an Acute Respiratory Distress Syndrome, thromboembolic complication and secondary bacterial infection. This patient had a non-specific neurological disorder with a pseudobulbar palsy, (MRI, ENMG and lumbar puncture were normal), associated 4 months later with persistent left shoulder motor deficit and respiratory failure. Respiratory and neurological check-up led to a diagnosis of the Parsonage-Turner syndrome or neuralgic amyotrophy affecting C5-C6 nerve roots, the lateral pectoral and phrenic nerves at the origin of the scapular belt, amyotrophy and left diaphragm paralysis. CONCLUSIONS: This case shows that persistant dyspnoea after COVID 19 infection should lead to a search for a diaphragmatic cause which is not always the result of Reanimation Neuropathy but may also indicate a neuralgic amyotrophy. It is the fourth case of neuralgic amyotrophy following COVID-19. This brings the medical community to consider the risk of diaphragm paralysis apart from critical illness polyneuropathy. Respiratory muscle evaluation and diaphragmatic ultrasound should be considered in case of persistent dyspnoea.
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Neuritis del Plexo Braquial , COVID-19 , Parálisis Respiratoria , Neuritis del Plexo Braquial/diagnóstico , Neuritis del Plexo Braquial/etiología , Humanos , Masculino , Nervio Frénico , Parálisis Respiratoria/diagnóstico , Parálisis Respiratoria/etiología , SARS-CoV-2 , Adulto JovenRESUMEN
It is currently well established that more than half of heart failure patients have preserved ejection fraction. The diagnosis of heart failure with preserved ejection fraction is complex in clinical practice despite ESC recommendations issued in 2019. In this context, the demonstration of increased left ventricular filling pressures at rest or during exercise allows a definite diagnosis of heart failure with preserved ejection fraction in patients with signs and/or symptoms compatible with the diagnosis and a preserved ejection fraction. The spectral tissue Doppler-derived E/e' ratio by transthoracic Doppler echocardiography has been validated in the noninvasive assessment of left ventricular diastolic pressures at rest and during exercise. Several studies report the validity of E/e' in the diagnosis of heart failure with preserved ejection fraction in patients with both isolated exertional and acute dyspnea, as well as in risk stratification. In light of the current literature, E/e' deserves to be included on every transthoracic Doppler echocardiography report in patients with suspected heart failure with preserved ejection fraction. This updated review provides an overview of the diagnostic relevance of E/e' in patients in its two modes of clinical presentation, isolated exertional dyspnea and the decompensated congestive form.
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Ecocardiografía Doppler , Insuficiencia Cardíaca , Diástole , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
INTRODUCTION: Inspiratory muscle training (IMT) is part of the management of patients with pulmonary diseases during rehabilitation. Since the last recommendations of the Société de pneumologie de langue française, several studies have focused on the role of inspiratory muscle training during pulmonary rehabilitation. BACKGROUND: IMT, in comparison to standard care or sham-IMT, improves the strength and endurance of the inspiratory muscles, decreases dyspnoea during the activities of daily living, improves walking distance and quality of life. However, the different studies did not show an additional effect of IMT during a pulmonary rehabilitation program compared to a rehabilitation program without IMT, with regard to improvement of exercise capacity and quality of life. OUTLOOK: One study showed an improvement in dyspnoea of effort, but these results are yet to be confirmed. Finally, it seems appropriate to associate IMT with an exercise-training program before chest or abdominal surgery, even if further studies are necessary. CONCLUSION: During a pulmonary rehabilitation program, IMT does not provide additional benefits. However, when patients cannot perform a global exercise training, IMT has shown benefit. IMT provides additional benefits in pre-operative programs.
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Actividades Cotidianas , Calidad de Vida , Ejercicios Respiratorios , Tolerancia al Ejercicio , Humanos , Fuerza Muscular , Músculos RespiratoriosRESUMEN
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infectious disease well described in patients living with HIV (PLHIV) but that can occur in other immunosuppressed patients. Currently, its incidence decreases in PLHIV but increases in non-HIV immunosuppressed patients, particularly in case of hematological diseases. Thus, in elderly, the diagnosis of PJP should be evoked in case of subacute pneumonia rapidly evolving to an acute respiratory distress, with or without interstitial pneumonia at chest radiography, and a context of immunosuppression.
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Disnea , Infecciones Oportunistas , Pneumocystis carinii , Neumonía por Pneumocystis , Anciano , Disnea/diagnóstico , Disnea/etiología , Infecciones por VIH/complicaciones , Humanos , Huésped Inmunocomprometido , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnósticoRESUMEN
This manuscript illustrates an unusual cause of dyspnea. Cardiac tumor are uncommon, especially fusiform cells carcinoma.
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Carcinoma/complicaciones , Disnea/etiología , Neoplasias Cardíacas/complicaciones , Anciano , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Femenino , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Humanos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
Microcirculatory dysfunction despite the absence of angiographically obvious significant coronary artery disease may potentially generate symptomatic myocardial ischemia; comprehensive assessment both noninvasive and invasive could prove to be of critical interest. We report the case of a 54-year old patient referred for an exertion dyspnea that proved to be caused by both micro and microvascular dysfunction. We present key elements for diagnosis, functional evaluation and management and demonstrate the potential role of speckle tracking imaging in that setting.
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Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Dobutamina , Disnea/fisiopatología , Microvasos/diagnóstico por imagen , Microvasos/fisiopatología , Esfuerzo Físico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall palliative management of COPD remains to be improved. The aim of this study was to describe pulmonologists' practice of palliative care for COPD patients in order to identify obstacles to it. MATERIAL AND METHOD: A survey was sent to all pulmonologists whose email appeared in the 2017 French-language Respiratory Medicine Society's directory. RESULTS: A total of 294 responses were obtained, among which 287 were analysed. Overall, 81.6% of the pulmonologists said that they identify a distinct palliative phase from "sometimes to often" in the care of COPD patients. When not identified, the most common reason given (68.8%) was the difficulty of defining when to start palliative care. Aspects of the palliative approach, which were considered the most problematic for pulmonologists, were the discussion of end of life care, and the impression that COPD patients have a low demand for information. 31% of pulmonologists reported that they gathered information about patients' wishes to undergo resuscitation and endotracheal intubation in 61 % to 100% of patients who they judged to have the most severe disease. CONCLUSION: Uncertainty as to when to begin a palliative approach for COPD patients and perceptions around communication in chronic diseases appear to be the main obstacles to a palliative approach.