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Refractory breathlessness

Michaela Schunk, Friederike Schulze, Claudia Bausewein
BACKGROUND/OBJECTIVE: Breathlessness is a highly prevalent and distressing symptom in patients with cancer and advanced chronic diseases. Symptom management is often overlooked. We explored the experiences of patients, caregivers, and health care providers (HCPs) and their expectations for future service developments. DESIGN: This is a multiperspective qualitative study drawing on semistructured interviews. SETTING/SUBJECTS: Participants were recruited from palliative, respiratory, and cardiology departments of the Munich University Hospital and from a chronic obstructive pulmonary disease (COPD) patient group...
December 27, 2018: Journal of Palliative Medicine
Deborah Duncan, Abigail Ashby
Breathlessness or dyspnoea is a subjective experience that can be described as an unpleasant or uncomfortable awareness of breathing. It is a subjective experience for patients and often they learn to adapt to the limitations caused by their condition, which makes their breathlessness less apparent to others. Breathlessness can be subdivided in the context of chronic refractory breathlessness, such as acute breathlessness, which is either an episodic breathlessness or breathlessness crisis. Chronic refractory breathlessness is defined as breathlessness at rest or on minimal exertion that will persist chronically despite optimal treatment of the underlying causative factors...
July 2, 2018: British Journal of Community Nursing
Rebecca F D'Cruz, Georgios Kaltsakas, Eui-Sik Suh, Patrick B Murphy, Nicholas Hart
PURPOSE OF REVIEW: Breathlessness is a common symptom in many chronic diseases and may be refractory to pharmacotherapy. In this review, we discuss the pathophysiology of breathlessness and the role of positive airway pressure (PAP) devices to ameliorate it. RECENT FINDINGS: Breathlessness is directly related to neural respiratory drive, which can be modified by addressing the imbalance between respiratory muscle load and capacity. Noninvasive PAP devices have been applied to patients limited by exertional breathless and, as the disease progresses, breathlessness at rest...
September 2018: Current Opinion in Supportive and Palliative Care
Caroline Phillips, Clare Harris, Nathaniel Broughton, Thomas Pulimood, Liam Ring
We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on "bubble" echocardiography confirmed the diagnosis...
2018: Case Reports in Critical Care
Mary Y Y Qian, John Politis, Michelle Thompson, Darren Wong, Brian Le, Louis Irving, Natasha Smallwood
BACKGROUND AND OBJECTIVE: Many patients with advanced COPD experience refractory breathlessness and individualized breathlessness interventions may improve management of this complex symptom. The aims of this study were to develop, implement and assess the efficacy of a breathlessness intervention for patients with COPD and refractory breathlessness and to evaluate patient acceptability. METHODS: An individualized breathlessness plan, information leaflets, breathlessness education and a hand-held fan were offered to consecutive patients with severe COPD and refractory breathlessness attending a tertiary integrated respiratory and palliative care service...
May 15, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
Matthew Maddocks, Natasha Lovell, Sara Booth, William D-C Man, Irene J Higginson
People with advanced chronic obstructive pulmonary disease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns, patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. The unpredictable course of COPD and the difficulty of predicting survival are barriers to timely referral and receipt of palliative care...
September 2, 2017: Lancet
Lucy Speakman, Helen Walthall
Interstitial lung disease (ILD) refers to a cluster of fibroinflammatory conditions. There are limited treatment options and most patients have severe dyspnoea. The prognosis is poor. This study aims to evaluate current literature on the assessment and management of refractory breathlessness in ILD. Few tools are available to assess dyspnoea in advanced respiratory disease. Holistic assessment requires a combination of tools but there are few disease specific tools. The role of opioids is well established in the reduction of breathlessness, but there is insufficient evidence that benzodiazepines are beneficial...
September 2, 2017: British Journal of Community Nursing
Morag Farquhar
PURPOSE OF REVIEW: Informal carers play a key role in supporting patients living with breathlessness in advanced disease, but with considerable impacts on their own well being. The purpose was to review recent advances in our understanding of the caring role in refractory breathlessness, its impacts on carers, and interventions to support them. RECENT FINDINGS: A systematic literature search resulted in 28 included articles that could be mapped to four broad areas of carer enquiry: the carer role (n = 6), role impact (n = 7), carer support (n = 11) and carer views (n = 4)...
September 2017: Current Opinion in Supportive and Palliative Care
Natasha Smallwood, Nicole Gaffney, Alexandra Gorelik, Louis Irving, Brian Le, Jennifer Philip
BACKGROUND: Refractory breathlessness is a common, distressing symptom in patients with advanced chronic obstructive pulmonary disease (COPD). The judicious, off-licence prescription of opioids, together with other management strategies, can improve breathlessness, however, internationally there is profound reluctance to prescribe opioids for breathlessness in COPD. AIMS: To understand Australian junior doctors' knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD...
September 2017: Internal Medicine Journal
Anna Spathis, Sara Booth, Catherine Moffat, Rhys Hurst, Richella Ryan, Chloe Chin, Julie Burkin
Refractory breathlessness is a highly prevalent and distressing symptom in advanced chronic respiratory disease. Its intensity is not reliably predicted by the severity of lung pathology, with unhelpful emotions and behaviours inadvertently exacerbating and perpetuating the problem. Improved symptom management is possible if clinicians choose appropriate non-pharmacological approaches, but these require engagement and commitment from both patients and clinicians. The Breathing Thinking Functioning clinical model is a proposal, developed from current evidence, that has the potential to facilitate effective symptom control, by providing a rationale and focus for treatment...
April 21, 2017: NPJ Primary Care Respiratory Medicine
Shanmuga Sundaram Rathakrisnnan, Ramona Ramasamy, Tamilarasu Kaliappan, Rajendiran Gopalan, Ramasmy Palanimuthu, Premkrishna Anandhan
INTRODUCTION: Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
Mendwas D Dzingina, Charles C Reilly, Claudia Bausewein, Caroline J Jolley, John Moxham, Paul McCrone, Irene J Higginson, Deokhee Yi
BACKGROUND: Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified. AIMS: To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs. DESIGN: A cross-sectional secondary analysis of data from a randomised controlled trial...
April 2017: Palliative Medicine
Charles C Reilly, Claudia Bausewein, Rachel Garrod, Caroline J Jolley, John Moxham, Irene J Higginson
BACKGROUND: The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease. AIM: To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease. DESIGN: A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034)...
October 2017: Palliative Medicine
Aileen Collier, Katrina Breaden, Jane L Phillips, Meera Agar, Caroline Litster, David C Currow
CONTEXT: Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic. OBJECTIVES: The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves. METHODS: The qualitative study used semistructured interviews...
January 2017: Journal of Pain and Symptom Management
Monika Singh, Megha Sharma, Minakshi Bhardwaj, Prajwala Gupta, Arvind Ahuja
Primary tracheal malignancies are rare and present with non specific symptoms hence delaying the diagnosis. A 41-year-old male presented with repeated paroxysmal episodes of breathlessness for which he was being treated with bronchodilators and steroids. Computed Tomography (CT) chest was done revealing a small polypoidal mass lesion arising from lower trachea/carina. On fibre optic bronchoscopy an infiltrative growth was seen at the lower end of trachea following which biopsy was obtained. On histopathologic examination a diagnosis of primary adenoid cystic carcinoma was made...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
Marjolein Gysels, Charles C Reilly, Caroline J Jolley, Caty Pannell, Femke Spoorendonk, John Moxham, Claudia Bausewein, Irene J Higginson
CONTEXT: Dignity is poorly conceptualized and little empirically explored in end-of-life care. A qualitative evaluation of a service offering integrated palliative and respiratory care for patients with advanced disease and refractory breathlessness uncovered an unexpected outcome, it enhanced patients' dignity. OBJECTIVES: To analyze what constitutes dignity for people suffering from refractory breathlessness with advanced disease, and its implications for the concept of dignity...
October 2016: Journal of Pain and Symptom Management
C Bausewein
BACKGROUND: Breathlessness is a frequent and distressing symptom in advanced disease. It can have a significant impact on the quality of life of both patients and relatives. OBJECTIVES: A summary of nonpharmacological and pharmacological measures for breathlessness based on existing evidence is provided. MATERIALS AND METHODS: Analysis of primary studies, reviews and guidelines for the named symptoms and their management were analyzed. RESULTS: Recognition and assessment are essential for the management of breathlessness...
October 2016: Der Internist
Sara Booth, Richella Ryan, Anna Spathis
PURPOSE OF REVIEW: The review considers the evidence for different service models existing for helping people manage the chronic, irreversible breathlessness that accompanies advanced disease. RECENT FINDINGS: Many of the service models that are delivering care have not yet published their results in the scientific literature because these ideas, and the methods to evaluate them, are relatively new. There are three randomized controlled trials published which demonstrate the effectiveness of this approach and one which suggests that more episodes of some intervention components are not necessarily better...
September 2016: Current Opinion in Supportive and Palliative Care
Hayley Barnes, Julie McDonald, Natasha Smallwood, Renée Manser
BACKGROUND: Breathlessness is a common and disabling symptom which affects many people with advanced cardiorespiratory disease and cancer. The most effective treatments are aimed at treating the underlying disease. However, this may not always be possible, and symptomatic treatment is often required in addition to maximal disease-directed therapy. Opioids are increasingly being used to treat breathlessness, although their mechanism of action is still not completely known. A few good sized, high quality trials have been conducted in this area...
March 31, 2016: Cochrane Database of Systematic Reviews
Miriam J Johnson, Sara Booth, David C Currow, Lawrence T Lam, Jane L Phillips
CONTEXT: The handheld fan is an inexpensive and safe way to provide facial airflow, which may reduce the sensation of chronic refractory breathlessness, a frequently encountered symptom. OBJECTIVES: To test the feasibility of developing an adequately powered, multicenter, multinational randomized controlled trial comparing the efficacy of a handheld fan and exercise advice with advice alone in increasing activity in people with chronic refractory breathlessness from a variety of medical conditions, measuring recruitment rates; data quality; and potential primary outcome measures...
May 2016: Journal of Pain and Symptom Management
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