RESUMEN
Objectives: This study aimed to investigate the dynamic patterns of perception and expectations among COPD patients. Methods: Conducted at the Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, in Milan, Italy, the research involved 28 participants (16 males; mean age 72.8 ± 9.9) in face-to-face interviews. Utilizing a Grounded Theory approach, complemented by clinical data, recorded, and transcribed interviews underwent enhancement through the integration of two pictorial tools. Results: The central theme that emerged was a profound sense of responsibility toward their condition, perceived as a significant threat to life. Key symptoms, such as shortness of breath, coupled with negative expectations about their condition, contributed to depressive mood and avoidance behaviors. A notable proportion (N = 17; 60.71%) of participants struggled to envision a positive future, expressing a pervasive sense of hopelessness, which significantly influenced their health behaviors and adherence to medical recommendations. Conversely, individuals who felt supported and optimistic about treatment efficacy exhibited more positive expectations and adopted proactive coping strategies. Discussion: Recognizing the dynamic nature of patients' perceptions and negative illness expectations is essential to create personalized therapeutic interventions and meet the specific needs of COPD patients, ultimately improving the overall effectiveness of their care journey.
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Adaptación Psicológica , Teoría Fundamentada , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Masculino , Femenino , Anciano , Persona de Mediana Edad , Depresión/psicología , Depresión/etiología , Anciano de 80 o más Años , Disnea/psicología , Disnea/etiología , Disnea/terapia , Investigación Cualitativa , Medicina de Precisión/métodos , Actitud Frente a la Salud , Conductas Relacionadas con la Salud , Percepción , Entrevistas como AsuntoAsunto(s)
Influenza Pandémica, 1918-1919 , Gripe Humana , Neumonía Viral , Humanos , Masculino , Adulto Joven , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Pulmón/diagnóstico por imagen , Pulmón/patología , Radiografía Torácica , Fiebre/diagnóstico , Fiebre/etiología , Tos/diagnóstico , Tos/etiología , Gripe Humana/complicaciones , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Influenza Pandémica, 1918-1919/historia , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Historia del Siglo XX , Historia del Siglo XXI , Monitoreo Epidemiológico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Preparación para una Pandemia , Vacunas contra la Influenza/administración & dosificaciónRESUMEN
BACKGROUND: In recent years, there has been a significant increase in the survival rates of cancer patients. However, this has also led to an increase in side effects, such as dyspnoea, which can negatively impact of patients. We propose a programme for re-educating effort. The main objective is to test the effectiveness of this programme in improving respiratory symptoms and functionality in cancer patients. METHODOLOGY: Experimental, prospective, longitudinal, randomised study with a parallel fixed-assignment scheme (CG-IG). The patients were selected from the Medical Oncology Service of the University Hospital Complex of Salamanca (CAUSA), Spain. Two parallel intervention programmes were designed for the two study groups (Conventional Clinical Practice-Effort Re-education Programme). Primary variables: dyspnoea (MRC), functionality (Barthel); secondary variables: physical performance (SPPB) and functional capacity (ECOG) and the socio-demographic variables (age, sex, anatomopathological diagnosis, and number of treatment lines). RESULTS: The study sample consisted of 182 patients, with 12 excluded, resulting in a final sample size of n = 170. Sex distribution (CG: 52.9% male and 47.1% female; IG: 49.4% male and 50.6% female). The primary oncological diagnosis was lung cancer, and the most frequent tumour stages were III and IV. Statistically significant differences were found between the IG and CG scores (p < 0.001, d = 0.887, 95% CI) and between the IG and CG scores (p = 0.004, d = 0.358, 95% CI), indicating that the IG performed better. CONCLUSION: The results of this study support the beneficial effects of an exercise re-education programme, carried out by an interdisciplinary team in improving the autonomy of oncology patients with dyspnoea. TRIAL REGISTRATION: The clinical trial was registered in ClinicalTrials.gov (NCT04186754). (03 September 2019).
Asunto(s)
Disnea , Neoplasias , Rendimiento Físico Funcional , Humanos , Masculino , Femenino , Disnea/etiología , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias/complicaciones , Anciano , España , Estudios Longitudinales , Educación del Paciente como Asunto/métodos , AdultoRESUMEN
BACKGROUND: Dabbing is recently getting popular among young adults. It is a new method of using the most active form of marijuana where large amounts of concentrated tetrahydrocannabinol are inhaled. Tetrahydrocannabinol is associated with a feeling of 'High' which makes the user feel joyous and relaxed. With increasing use of such techniques, dabbing becomes an important differential for evaluation of acute respiratory failure with pneumonitis especially in the adult population. CASE PRESENTATION: A Fifty-one years old Caucasian man presented to the hospital with chest pressure and shortness of breath. The patient was noted to be hypoxic, desaturating down to 82-83% on nasal cannula oxygen. Imaging revealed bilateral lung infiltrates. Patient was started on high flow oxygen, broad spectrum antibiotics and intravenous corticosteroids. The patient gradually improved and was able to come off oxygen completely. He was discharged home on prednisone taper. CONCLUSIONS: Dabbing is a newer technique which has been gaining popularity for marijuana usage. With the legalization of marijuana, newer techniques are getting popular. Our case report emphasizes the importance of keeping dabbing as a differential when a patient presents with respiratory failure and has concerns for pneumonitis. Patients might not reveal until specifically asked about their practices.
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Dronabinol , Neumonía , Humanos , Masculino , Persona de Mediana Edad , Dronabinol/efectos adversos , Insuficiencia Respiratoria , Antibacterianos/efectos adversos , Terapia por Inhalación de Oxígeno , Tomografía Computarizada por Rayos X , Disnea/etiologíaRESUMEN
CASE PRESENTATION: A 76-year-old male Vietnam veteran with a medical history of OSA on CPAP, mild COPD, Parsonage-Turner syndrome (a rare neurologic syndrome manifesting with shoulder and arm pain), hypertension, gastroesophageal reflux, hiatal hernia, and prior endocarditis presented with 1 year duration progressive exertional dyspnea with minimal activity by referral from an outside pulmonologist. The patient reported possible exposure to Agent Orange during his service but was otherwise without significant occupational or environmental exposures. His exercise tolerance was well-maintained up until the last 12 months. Aside from marginal cigarette use, he denied any recreational drug use or any anorectic use. The patient provided records from a recent right heart catheterization (RHC) months earlier for review.
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Disnea , Oximetría , Humanos , Masculino , Anciano , Disnea/etiología , Disnea/diagnóstico , Oximetría/métodos , Diagnóstico DiferencialRESUMEN
The differential diagnosis of dysphagia and dyspnoea with cervicofacial oedema is wide and includes diseases with variable prognosis that may require an urgent approach. This article presents the case of a middle-aged man who came to the emergency room referring to the symptoms described, with a history of central venous access established approximately 4 years ago. The patient was diagnosed with superior vena cava syndrome and treated with anticoagulants and removal of the catheter. After a week of admission with anticoagulation, the patient clinically improved with a considerable decrease in thrombus and pharyngolaryngeal and subcutaneous mucosal oedema. In the differential diagnosis of dysphagia and dyspnoea, we must also consider systemic diseases, and more specifically, these symptoms such as those described, and think about this entity because of its severity.
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Trastornos de Deglución , Síndrome de la Vena Cava Superior , Humanos , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/diagnóstico , Masculino , Trastornos de Deglución/etiología , Trastornos de Deglución/diagnóstico , Persona de Mediana Edad , Diagnóstico Diferencial , Anticoagulantes/uso terapéutico , Disnea/etiología , Cateterismo Venoso Central/efectos adversos , Edema/etiologíaRESUMEN
A man in his early 50s with previously treated pulmonary tuberculosis (TB) presented with a 3-month history of cough, expectoration and progressive breathlessness, accompanied by significant weight loss. Examination revealed tachycardia, tachypnoea, hypoxaemia and unilateral diminished breath sounds. Investigations showed anaemia, leucocytosis and a homogeneous opacity on the left side of the CXR. ECG and echocardiography suggested pulmonary thromboembolism (PTE). A CT pulmonary angiogram confirmed a chronic embolus and a severely fibrosed left lung. A comprehensive thrombophilia workup yielded normal results and the PTE was attributed to his history of TB. Sputum analysis confirmed reactivated TB, leading to the initiation of antitubercular therapy. The patient improved clinically with plans for a repeat CT pulmonary angiography to assess the need for pulmonary thromboendarterectomy after completing TB treatment. This case highlights the possible association of TB and PTE, its management and why it should be considered as a differential diagnosis in patients with a history of TB presenting with exacerbated breathlessness.
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Antituberculosos , Embolia Pulmonar , Tuberculosis Pulmonar , Humanos , Masculino , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico por imagen , Persona de Mediana Edad , Diagnóstico Diferencial , Antituberculosos/uso terapéutico , Angiografía por Tomografía Computarizada , Disnea/etiología , Disnea/diagnóstico , EcocardiografíaRESUMEN
INTRODUÇÃO: A longa experiência em troca valvar cirúrgica nos ensinou acerca da durabilidade limitada de biopróteses. E assim como estas, as próteses implantadas via transcateter degeneram com o tempo, requerendo intervenção adicional. O desafio torna-se ainda maior quando a indicação do procedimento deveu-se ao alto risco cirúrgico, sendo o reimplante transcateter de válvula aórtica (TAVI-in-TAVI) a única opção viável. DESCRIÇÃO DO CASO: Homem, 87 anos, idoso não frágil, foi submetido a primeira TAVI em 2016 com implante de bioprótese Acurate TF Symetis M devido à estenose aórtica grave (etiologia bicúspide e calcífica). O ecocardiograma transtorácico (ETT) pósprocedimento mostrava a bioprótese normofuncionante, orifício efetivo de fluxo (OEF) 1,8 cm², gradiente sistólico médio 8 mmHg, refluxo paraprotético discreto e fração de ejeção do ventrículo esquerdo (FEVE) de 45%. Paciente manteve-se em classe funcional (CF) I até 2024, quando foi internado por piora da dispneia, evoluindo para CF III. Realizado ETT com imagem sugestiva de fratura de folheto e disfunção biventricular importante (FEVE=35% e FAC= 22%). Como consequência de risco cirúrgico proibitivo (EUROSCORE II de 30%), optou-se pela realização de TAVI-in-TAVI após compensação clínica, porém evoluiu com choque cardiogênico e necessidade de inotrópico. Devido à instabilidade clínica não foi possível realizar tomografia computadorizada para planejamento do implante, decidido prosseguir com procedimento monitorizado por ETT. Procedimento realizado sob sedação, com angiografia para visualização de coronárias e TAVI prévia, seguido de implante de bioprótese MyVal (Meril Lifesciences) n° 24.5mm com pós-dilatação. Injeção de controle demonstrava prótese aórtica bem posicionada, refluxo paravalvar discreto com coronárias pérvias e bom fluxo. ETT pós-procedimento: endoprótese bem posicionada, abertura e mobilidade preservadas, OEF 2,1 cm², gradiente sistólico médio 3 mmHg, FEVE 36%, FAC 26%, mantendo refluxo paraprotético discreto. Recebeu alta 8 dias após TAVI-in-TAVI em CF NYHA I. CONCLUSÃO: Sabemos que TAVI-in-TAVI em pacientes selecionados, apresentam bons resultados, porém em nosso paciente foi realizado em caráter de urgência demonstrando efetividade. A intervenção percutânea TAVI-in-TAVI de urgência, mostrou-se factível diante de paciente com instabilidade hemodinâmica e resultou em melhora clínica e ecocardiográfica substanciais do paciente.
Asunto(s)
Humanos , Masculino , Anciano , Estenosis de la Válvula Aórtica , Reimplantación , Reemplazo de la Válvula Aórtica Transcatéter , Hemodinámica , Prótesis e Implantes , Choque Cardiogénico , Bioprótesis , Tomografía Computarizada por Rayos X , DisneaRESUMEN
INTRODUÇÃO Os mixomas são tumores primários cardíacos correspondendo em sua grande maioria de natureza benigna e de constituição sólida, sendo a prevalência mais comum no lado esquerdo (75 a 80% dos casos), com predomínio no sexo feminino. Apesar da histogênese mais comum ser benigna deve-se prosseguir com exérese precoce devido às possíveis complicações, em especial morte súbita e acidentes vasculares. O ecocardiograma é o exame diagnóstico de escolha pois caracteriza tamanho, localização e mobilidade da tumoração assim como a capacidade de obstrução e/ou de formação de êmbolos. Outra opção é a ressonância magnética cardíaca pois além das características anatômicas nos fornece dados de características do microambiente do tumor. DESCRIÇÃO DO CASO Paciente do sexo feminino, 40 anos, proveniente de São Paulo (SP). Deu entrada neste Serviço referenciada de hospital secundário com história de palpitações em precórdio associada a dispneia e astenia intensa com duração de 20 minutos há cerca de 3 meses. Nega queixas durante o período interepisódio assim como nega dor torácica. Como antecedentes patológicos possui fibrilação atrial (FA) paroxística com controle de frequência cardíaca com propranolol 40mg/dia e hipertensão arterial sistêmica (HAS) em uso de losartana 50mg/dia. Nega internações prévios devido o quadro supracitado. Em ECOTT realizado no serviço de origem presença de imagem hiperecoica, homogênea, aderida ao septo interatrial em átrio esquerdo medindo em seus maiores diâmetros aproximadamente 2,6x2,2cm sugestiva de mixoma atrial esquerdo. Prosseguindo investigação realizou novo ECOTT no Instituto Dante Pazzanese de Cardiologia (IDPC) onde observou-se imagem sugestiva de linha de dissecção que se inicia logo após a emergência da artéria subclávia esquerda que se estende até a aorta abdominal proximal. Atualmente recebendo propranolol 40mg/dia e losartana 50mg/dia, evoluindo com bons controles pressóricos e frequência cardíaca sendo programado a exérese de mixoma localizado em atrial esquerdo pela equipe do miocárdio do IDPC e posterior acompanhamento no ambulatório da equipe. CONCLUSÃO Apesar de se tratar de tumores raros e possuírem histologia benigna, os mixomas devem ser investigados e prosseguir com ressecção tumoral com brevidade, devido aos riscos de embolização. Idealmente a investigação deve ser iniciada com o ecocardiograma, seja o transesofágico ou transtorácico, como foi no caso relatado acima onde flagrou-se o mixoma em átrio esquerdo.
Asunto(s)
Humanos , Femenino , Adulto , Atrios Cardíacos , Mixoma , Fibrilación Atrial , Dolor en el Pecho , Espectroscopía de Resonancia Magnética , Muerte Súbita , Disección , DisneaRESUMEN
INTRODUÇÃO Cardiomiopatia (CMP) induzida por estresse, como a cardiomiopatia de Takotsubo, pode ter características clínicas semelhantes à isquemia miocárdica, como elevação de troponinas, alterações no Eletrocardiograma (ECG), mas sem obstrução coronariana ou lesões isquêmicas. Semelhante, a CMP induzida por Feocromocitoma possui sintomas também semelhantes a CMP hipertrófica, hipertensão e edema pulmonar devido a fatores cardiogênicos ou não cardiogênicos. Ambas supracitadas podem ter associação com excesso de catecolaminas, mas raramente estão associadas. RELATO DO CASO Paciente masculino, 46 anos, diabético, com história de estresse por situações familiares importantes, recentemente. Chega no serviço de emergência, com queixas de dispnéia, náuseas e êmese, iniciados há 1 dia, associado a retenção urinária e parestesia em mãos e paraparesia de membros inferiores. Refere também tratamento com Amoxicilina + Clavulanato há um mês por Colecistite Aguda. Na chegada, paciente se encontrava taquicárdico, taquipneico e saturando 98% em uso de óculos nasal a 2l/min, além de acidose metabólica. Realizou-se uma tomografia computadorizada de abdome, que evidenciou uma massa em Adrenal, sugestivo de Feocromocitoma, bem como metanefrinas urinárias e catecolaminas positivas. Ainda na emergência, evoluiu com insuficiência respiratória aguda por edema agudo de pulmão, necessitando de manejo com Nitroglicerina e 03 ampolas de Furosemida e uso de máscara não reinalante a 10l/min. Foi encaminhado para Unidade de Terapia Intensiva, onde foi realizado um ECG com alterações primárias da repolarização, seguido de alterações nos valores de Troponina e alterações no Ecocardiograma (ECO) de acinesia apical, hipocinesia de todos os segmentos médios e contratilidade preservada em segmentos basais. Cateterismo cardíaco com achados semelhantes ao ECO e presença de balonamento na ventriculografia, além de ausência de lesões obstrutivas em coronárias. CONCLUSÃO A excepcionalidade desse caso diz respeito ao quadro de síndrome coronariana aguda com dois motivos plausíveis e evidenciados na condução do caso, sendo eles: CMP de Takotsubo e a induzida por Feocromocitoma. Fica evidente, pela evolução do quadro, a gravidade do mesmo e a importância de considerar diagnósticos diferenciais, inclusive os menos comuns.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Feocromocitoma , Cardiomiopatía de Takotsubo , Edema Pulmonar , Insuficiencia Respiratoria , Cateterismo Cardíaco , Catecolaminas , Colecistitis Aguda , Disnea , ElectrocardiografíaRESUMEN
INTRODUÇÃO A endomiocardiofibrose (EMF) é uma cardiomiopatia restritiva, caracterizada por envolvimento fibrótico do endocárdio e miocárdio normalmente na região apical, levando a disfunção diastólica, porém, preservando função sistólica. É uma doença de etiologia desconhecida e ainda muito relacionada a países subdesenvolvidos com forte relação às síndromes hipereosinofilicas. Seu diagnóstico pode ser aventado através do ecodopplercardiograma e ressonância magnética cardíaca, podendo muitas vezes ser confundida com trombo em região apical ventricular. DESCRIÇÃO DO CASO Paciente de 38 anos, feminina, proveniente de São Paulo capital. Relata internação anterior há 4 meses em serviço externo por quadro de dor torácica com alteração de enzimas cardíacas, porém, sem evidência de coronariopatia isquêmica na Cinecoronariografia. Evidenciado em ecocardiograma transtorácico (ECOTT) uma hipertrofia excêntrica do ventrículo esquerdo (VE) com imagem hiperecogênica em região apical de 19mm podendo corresponder a trombo. Prosseguindo a investigação, realizada uma ressonância magnética cardíaca descrevendo trombo aderido à parede do ventrículo esquerdo, medindo 2,3 cm, além de hipocinesia dos segmentos apicais e realce miocárdico tardio subendocárdico não transmural nos segmentos apicais. A mesma comparece ao serviço com novo episódio de dispneia e dor precordial, agora com sinais de hipervolemia e hipereosinofilia (>1500). Em novo ECOTT realizado evidenciou-se aumento biatrial, disfunção sistólica do ventrículo direito, hipertensão pulmonar, refluxo de grau importante em valva mitral e tricúspide associado a uma obliteração do ápice em parede endocárdica até base do VE, poupando demais paredes, sugestivo de EMF. Com base nos exames iniciais, configurou-se o diagnóstico de EMF pela ressonância magnética e sua correlação com hipereosinofilia. Dessa forma, após o diagnóstico a paciente evolui com melhora clínica e seguirá tratamento em ambulatório do miocárdio. CONCLUSÕES Relatamos um caso de EMF associada a hipereosinofilia ainda em investigação etiológica. O caso supracitado traz uma paciente jovem proveniente de um país em desenvolvimento com diagnóstico de uma doença ainda pouco compreendida e de difícil diagnóstico, podendo muitas vezes passar-se como um trombo em região apical cardíaca, gerando subdiagnósticos e manejo incorreto.
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Humanos , Femenino , Adulto , Fibrosis Endomiocárdica/diagnóstico , Eosinofilia , Dolor en el Pecho , Cardiomiopatía Restrictiva , Espectroscopía de Resonancia Magnética , DisneaRESUMEN
Idiopathic pulmonary fibrosis (IPF) is a restrictive chronic lung disease that results in scarring of the tissue due to an unknown cause. Dyspnea is experienced by 90 % of patients and is correlated with reduced quality of life and survival times. Breathing techniques can improve perceived dyspnea, however, are not readily taught outside of inpatient hospital settings and pulmonary rehabilitation programs, the latter being accessed by only 3 % of patients with chronic lung disease. Telehealth may be an option to increase access to this imperative symptom management education to improve symptom management and patient outcomes. AIMS: 1) To determine the feasibility of a telehealth breathing intervention for patients living with IPF; 2) To determine the usability of the telehealth system; 3) To describe within-group changes in dyspnea, quality of life, anxiety, and depression. DESIGN: A single-group, pre-post intervention. METHODS: Study participants were recruited from community-dwelling patients living with IPF. Pre-intervention data was collected on symptoms using standardized questionnaires. Participants enrolled in one telehealth Zoom session per week over the course of four weeks and practiced breathing exercises 10-minutes per day. Following the intervention, participants completed post-intervention, feasibility, and usability questionnaires. Data were analyzed using descriptive statistics. RESULTS: All feasibility benchmarks were met. Following the intervention, mean symptom scores improved, however were not statistically significant. CONCLUSION: These data indicate that a telehealth breathing intervention is a feasible option to increase access to the symptom management strategy of breathing techniques to manage perceived dyspnea to positively influence symptoms experienced by patients living with idiopathic pulmonary fibrosis.
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Estudios de Factibilidad , Fibrosis Pulmonar Idiopática , Telemedicina , Humanos , Fibrosis Pulmonar Idiopática/psicología , Femenino , Masculino , Anciano , Persona de Mediana Edad , Calidad de Vida/psicología , Anciano de 80 o más Años , Ejercicios Respiratorios/métodos , Disnea , Encuestas y CuestionariosRESUMEN
Long COVID has been linked to a decline in physical activity and functional capacity. However, it remains unclear which physical symptoms are associated with specific aspects of movement behaviors and functional capacity. We aimed to investigate the associations of fatigue, dyspnea, post-exertional malaise, myalgia, and the co-occurrence of symptoms with movement behaviors and functional capacity in individuals with Long COVID. A cross-sectional multicenter study was conducted. Questionnaires were used to assess fatigue, dyspnea, post-exertional malaise, and myalgia. Accelerometry was employed to assess sedentary time, steps per day, light physical activity, and moderate-to-vigorous physical activity. The six-minute walk test, 30-s chair stand test, and timed up and go were used to assess functional capacity. One hundred and two community-dwelling individuals who had been living with Long COVID for 15 ± 10 months participated in the study. Fatigue, post-exertional malaise, and the co-occurrence of physical symptoms showed a negative association with step count, while post-exertional malaise was also negatively associated with moderate-to-vigorous physical activity. Dyspnea showed a negative association with the functional score, including all tests. Our findings suggest that fatigue, post-exertional malaise, and the co-occurrence of physical symptoms are negatively associated with physical activity, while dyspnea is negatively associated with functional capacity in individuals with Long COVID.
Asunto(s)
Acelerometría , COVID-19 , Disnea , Ejercicio Físico , Fatiga , Humanos , Masculino , Femenino , COVID-19/fisiopatología , COVID-19/complicaciones , Estudios Transversales , Persona de Mediana Edad , Fatiga/fisiopatología , Anciano , Disnea/fisiopatología , Síndrome Post Agudo de COVID-19 , SARS-CoV-2/aislamiento & purificación , Movimiento , Encuestas y Cuestionarios , Mialgia/fisiopatología , AdultoRESUMEN
BACKGROUND: Post-acute sequelae of COVID-19 (PASC) is incurring a huge health and economic burden worldwide. There is currently no effective treatment or recommended drug for PASC. METHODS: This prospective randomized controlled study was conducted in a hospital in China. The effect of intermittent hypoxia exposure (IHE; 5-min hypoxia alternating with 5-min normal air, repeated five times) on dyspnea and fatigue was investigated in patients meeting the NICE definition of PASC. Patients were computationally randomized to receive normoxia exposure (NE) and routine therapy or IHE and routine therapy. Six-minute walk distance (6MWD) and spirometry were tested before and after the interventions; the Borg Dyspnea Scale (Borg) and the modified Medical Research Council Dyspnea Scale (mMRC) were used to assess dyspnea; and the Fatigue Assessment Scale (FAS) and the Chalder Fatigue Scale-11 (CFQ-11) were used to assess fatigue. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300070565). FINDINGS: Ninety-five participants (33 males and 62 females) were recruited between March 1, 2023 and December 30, 2023. Forty-seven patients in the IHE group received 10.0 (9.0, 15.0) days of IHE, and 48 patients in NE group received 10.0 (8.0, 12.0) days of NE. 6MWD, forced vital capacity (FVC), FVC %pred, forced expiratory volume in 1 s (FEV1), FEV1 %pred, tidal volume (VT), and dyspnea and fatigue scales markedly improved after IHE (p < 0.05), and improvements were greater than in the NE group (all p < 0.05). Furthermore, participants in IHE group had better subjective improvements in dyspnea and fatigue than those in the NE group (p < 0.05). Compared with <10 days of IHE, ≥10 days of IHE had a greater impact on 6MWD, FVC, FEV1, FEV1 %pred, VT, FAS, and CFQ-11. No severe adverse events were reported. INTERPRETATION: IHE improved spirometry and 6MWD and relieved dyspnea and fatigue in PASC patients. Larger prospective studies are now needed to verify these findings.
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COVID-19 , Disnea , Fatiga , Hipoxia , Síndrome Post Agudo de COVID-19 , Humanos , Disnea/fisiopatología , Disnea/etiología , Masculino , Femenino , COVID-19/complicaciones , COVID-19/fisiopatología , Fatiga/etiología , Fatiga/fisiopatología , Persona de Mediana Edad , Estudios Prospectivos , Hipoxia/fisiopatología , Adulto , Prueba de Paso/métodos , Anciano , Espirometría/métodos , ChinaRESUMEN
OBJECTIVE: To investigate whether an early comprehensive pulmonary rehabilitation intervention initiated during hospital admission is safe and effective for patients with acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Prospective randomized controlled study. SUBJECTS/PATIENTS: Patients with acute exacerbation of chronic obstructive pulmonary disease. METHODS: In total, 108 patients were randomized to the early comprehensive pulmonary rehabilitation and usual care groups within 48 hours. The 6-min walking distance, quality of life, breathlessness, and inspiratory muscle strength were measured on admission and discharge. Any adverse events of pulmonary rehabilitation were recorded. RESULTS: On discharge, the patients in the early comprehensive pulmonary rehabilitation group had a more significant improvement in the 6-min walking distance (47.5 vs 23.0, p = 0.04). There was no significant difference in quality of life and breathlessness between the 2 groups. In the early comprehensive pulmonary rehabilitation group, inspiratory muscle strength and peak inspiratory flow were significantly improved, and the changes were much more pronounced than in the usual care group. There were no adverse events. CONCLUSION: Early comprehensive pulmonary rehabilitation is safe and effective for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease, and should be performed during the early stage of hospitalization.
Asunto(s)
Hospitalización , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Humanos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Masculino , Femenino , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Fuerza Muscular/fisiología , Resultado del Tratamiento , Disnea/rehabilitación , Disnea/etiología , Disnea/fisiopatologíaRESUMEN
CASE PRESENTATION: A 62-year-old woman came to our hospital with worsening cough and dyspnea over the preceding week, during which time she had been treated with azithromycin and prednisone for suspected pneumonia. She had no fever, chills, or sweats, but her cough had become productive of clear to blood-tinged phlegm during the interval. Medical history was significant for insulin-dependent diabetes mellitus and OSA. She had quit smoking 44 years earlier and had no history of lung disease. She was a bank teller residing in southeastern Minnesota and described no relevant inhalational or environmental exposures, drug use, aspiration, or travels preceding her illness.
Asunto(s)
Tos , Disnea , Tomografía Computarizada por Rayos X , Humanos , Femenino , Persona de Mediana Edad , Tos/etiología , Tos/diagnóstico , Disnea/etiología , Disnea/diagnóstico , Diagnóstico Diferencial , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/etiología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/complicacionesRESUMEN
PURPOSE: The objective of this study was to explore functional improvements by sex for patients with refractory angina pectoris using a 6-min walk test (6MWT) after enhanced external counterpulsation (EECP) therapy. METHODS: All patients who completed EECP from 2015 to 2023 were identified for analysis retrospectively, utilizing the electronic medical record. Patients completed 35 1-hr EECP sessions 5 d/wk over 7 wk. All baseline and post-EECP intervention 6MWT, exertional angina, and dyspnea measurements were assessed on the first and last sessions, respectively. Paired and unpaired t tests and linear and stepwise multivariable regression analyses were performed. RESULTS: The cohort consisted of 116 patients (24 female) with a mean age of 69 ± 13 yr. After EECP, there was a mean improvement of 128 m (72%) in distance walked during the 6MWT ( P < .001) with 126 ± 91 m improvement in males and 134 ± 73 m in females. The improvement in angina and dyspnea scores was 3.5 ± 2.1 and 4.2 ± 2.4, respectively. There were no differences between the sexes for improvements in 6MWT distance, angina, or dyspnea. Univariate associations for change in 6MWT distance included body mass index (BMI; adjusted R2 = .05) and being a nonsmoker (adjusted R2 = .03). The only independent predictor for increasing distance during 6MWT was BMI (adjusted R2 = .1; P = .001). CONCLUSION: Patients who have refractory angina pectoris can improve their functional capacity while simultaneously decreasing exertional angina and dyspnea using EECP. This study highlights the equal efficacy of EECP therapy for females.