BACKGROUND Longus colli tendinitis(LCT)with dyspnea is a relatively less-reported condition in the literature,and physicians should be aware of its existence.Misdiagnosis of this condition may cause unnecessary treatm...BACKGROUND Longus colli tendinitis(LCT)with dyspnea is a relatively less-reported condition in the literature,and physicians should be aware of its existence.Misdiagnosis of this condition may cause unnecessary treatment for dyspnea.CASE SUMMARY Herein,we report the case of a 40-year-old man with acute neck tendonitis.The patient presented to the pneumology department clinic with a complaint of acute neck tendonitis with dyspnea.An emergency cervical magnetic resonance examination was performed,and the preliminary diagnosis was“acute longus cervicalis tendinitis.”After aggressive medical treatment,the symptoms obviously improved.CONCLUSION LCT is a self-limiting disease that usually improves after three to seven days of conservative treatment following a definite diagnosis.However,owing to its insidious onset and complex clinical manifestations,most relevant personnel are not fully understood.The definite diagnosis of LCT is based on a comprehensive understanding of the triad,rare symptoms,and the clear identification of cervical 1 and 2 levels calcification and prevertebral edema by medical imaging examination,especially magnetic resonance imaging and computed tomography.展开更多
Identify the epidemiological characteristics, etiologies and evolutionary aspects of dyspnea in infants. This was a retrospective study of infants hospitalized for dyspnea from January 1 to December 31, 2020. The para...Identify the epidemiological characteristics, etiologies and evolutionary aspects of dyspnea in infants. This was a retrospective study of infants hospitalized for dyspnea from January 1 to December 31, 2020. The parameters studied were sex, age, origin, vaccination status, existence of underlying pathology. Underlying, the diagnosis and the evolutionary modalities. Data analysis and processing were possible using Word, Excel and EPI info version 7 software. We retained 152 infants. The sex ratio was 1.34 and the median age was 4 months. Vaccines according to expanded immunization program (EPI) were up to date in 76.32%. The main antecedents with risk identified were malnutrition, hypotrophy at birth, interventricular communication. The pathologies observed were low acute respiratory diseases in 90.79%, ENT diseases in 04.60% and cardiac diseases in 03.95%. The median length of hospitalization was 4 days. Infants who died accounted for 15.13%. The median age of infants who died was 4 months. The median time to onset of death was 1.63 days. The risk factors for death were age < 6 months (p = 0.003;CI [1.27;9.33]), outdated vaccines (p = 0.012;CI [1.18;5.17]), history with risk (p = 0.031;CI [1.02;4.54]). Dyspnea in infants remains a concern in our service. Reducing mortality involves developing procedures for the management of lower respiratory ailments, continuous staff training and strengthening the technical platform.展开更多
COVID-19 patients often experience dyspnea due to several factors. The underlying unique pathophysiology of dyspnea in COVID-19 is not yet fully understood, but it is believed to be related to a combination of respira...COVID-19 patients often experience dyspnea due to several factors. The underlying unique pathophysiology of dyspnea in COVID-19 is not yet fully understood, but it is believed to be related to a combination of respiratory, cardiovascular, and neuromuscular factors. Hypoxemia is considered one of the key symptoms of COVID-19. This affects the respiratory drive, which determines the rate, depth, and pattern of breathing. The relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and chemosensitivity, has gained significant attention following the COVID-19 pandemic. The ACE2 receptors allow viral entry into the lungs, leading to the loss of surfactant, hypoxic vasoconstriction, and intrapulmonary shunting that may result in a V/Q mismatch. Additionally, acidosis, hypercapnia, elevated 2,3-diphosphogly-cerate levels and fever may shift the oxygen diffusion curve rightward, lowering arterial oxygen saturation levels and triggering ventilatory responses. This paper examines how physio pathological factors such as altered gas diffusion, chemosensory feedback, V/Q ratios, altered compliance, arterial blood gases, and respiratory muscle dysfunction in these patients affect ventilatory drive. A review of the published literature was also conducted to determine the mechanism of dyspnea. To ensure appropriate gas exchange, individuals need to augment their minute ventilation (VE) when physiological dead space is elevated. This serves as a compensatory mechanism to counteract the effects of compromised gas exchange and keep adequate oxygenation throughout the body. The respiratory centers may experience dysregulation due to the impact of the virus on the respiratory system, which could affect the rhythm-generating and pattern-generating signals that are vital for regulating the respiratory rate and depth of breathing effort. The cerebral cortex, in conjunction with the brain stem centers, plays a crucial role in regulating ventilation during prolonged hypoxemia. This interaction between these two components may help elucidate the conscious respiratory sensation (or dyspnea) experienced by patients. It is hypothesized that neuroventilatory decoupling acts as a mechanism to prevent sensory signals from translating into mechanical or ventilatory responses. This decoupling phenomenon is believed to have a notable impact on the intensity of breathlessness. By understanding the relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and altered chemosensitivity, healthcare professionals can develop strategies to optimize respiratory support for COVID-19 patients.展开更多
BACKGROUND： The insular cortex and habenular nucleus may be a regulatory center for obstructive sleep apnea syndrome, and dyspnea may be caused by insular cortex activity. The insular cortex is a cortical representat...BACKGROUND： The insular cortex and habenular nucleus may be a regulatory center for obstructive sleep apnea syndrome, and dyspnea may be caused by insular cortex activity. The insular cortex is a cortical representation of obstructive sleep apnea syndrome. The habenular nucleus is a station for descending insular cortex activity. OBJECTIVE： Through actively stimulating the rat insular cortex, to observe rat respiratory movement, myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity, and to verify a hypothesis that the insular cortex is a superior-position regulation center, and the habenular nucleus is an inferior-position nervous nuclei of the insular cortex in patients with obstructive sleep apnea syndrome. DESIGN, TIME AND SETTING： The randomized, controlled animal study was performed at the Laboratory of Electrophysiology, Department of Physiology, Norman Bathune College of Medicine, Jilin University, China from September 2004 to June 2008. MATERIALS： We used L-glutamic acid （Dingguo Biological Product Research Center, Beijing, China）, lidocaine hydrochloride （Seventh Pharmacy Co., Ltd., Wuxi, China）, electric stimulator （Nihon Kohden, Japan）, and an AVL-OPTI blood gas analyzer （AVL Scientific Co., Roswell, GA, USA）. METHODS： The insular cortex of healthy adult Wistar rats underwent electrostimulation and L-glutamic acid stimulation to record changes in the myoelectric activity of genioglossus and respiratory movement. Some rats were injected with lidocaine to block the habenular nucleus before electrostimulation or L-glutamic acid stimulation. L-glutamic acid and lidocaine were injected by microelectrodes embedded in nuclear groups. MAIN OUTCOME MEASURES： Myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity were measured following apnea in rats undergoing electrostimulation in the insular cortex and following blockade of the habenular nucleus. RESULTS： Following electrostimulation and L-glutamic acid stimulation, rats developed apnea or respiratory rhythm disorders. Simultaneously, the amplitude of myoelectric activity of the genioglossus was reduced （P 〈 0.01 ）, and the electromyogram integral was decreased （P 〈 0.01）. Arterial blood gas analysis showed arterial blood acidosis, a decrease in pH （P 〈 0.05）, and an increase in the negative value of alkaline reserve （P 〈 0.01）. Lidocaine in the habenular nuclear blocked respiratory and other index changes after insular cortex stimulation. CONCLUSION： Dyspnea induced by stimulating the insular cortex may require the habenular nucleus. Paralysis of the habenular nucleus can completely eliminate insular cortex stimulation-induced dyspnea.展开更多
The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin. Oxaliplatin improves the efficacy of this combination in patients with stage 111 colon cancer and moreover its toxicity is well tolerabl...The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin. Oxaliplatin improves the efficacy of this combination in patients with stage 111 colon cancer and moreover its toxicity is well tolerable. We describe a rare clinical case of acute dyspnoea probably related to oxaliplatin at one month from the end of the adjuvant treatment. A 74-year-old man developed a locally advanced sigmoid carcinoma （pT3N1M0）. A port a cath attached to an open-ended catheter was implanted in order to administer primary chemotherapy safely according to the FOLFOX4 schedule. One month following the end of the 6^th cycle, the patient referred a persistent cough and moderate dyspnoea. Chest radiography displayed a change in the lung interstitium, chest CT scan confirmed this aspect of adult respiratory distress syndrome, spirometry reported a decreased carbon monoxide diffusion capacity. Antibiotic and corticosteroids were administered for 10 d, then a repeated chest X ray evidenced a progressive pulmonary infiltration. A transbronehial biopsy and cytology did not show an infective process, a CT scan reported radiological abnormalities including linear and nodular densities which were becoming confluents. Antimicotic and antiviral drugs did not evidence any benefit. The antiviral therapy was stopped and high dose metilprednisolone was started. The patient died of pulmonary distress after 10 d.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreak in China,constitutes a Public Health Emergency of International Concern.It is well known t...BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreak in China,constitutes a Public Health Emergency of International Concern.It is well known that COVID-19 patients may have increased serum lactate dehydrogenase(LDH)levels in the early stage.The clinical changes in LDH may have predictive value in disease evolution and prognosis in critically ill COVID-19 patients.AIM To examine serum LDH and clinical characteristics in patients with COVID-19 and their predictive value for prognosis.METHODS This retrospective study analyzed the clinical data of forty-seven critical COVID-19 patients in the intensive care unit of the Third People's Hospital of Yichang City from January 27 to March 25,2020 and divided them into survivors and nonsurvivors.The patients were diagnosed according to the World Health Organization interim guidance and critical cases met any one of the following criteria:Respiratory failure and required mechanical ventilation,the occurrence of shock,and the combined failure of other organs that required intensive care unit monitoring and treatments,according to the diagnostic criteria of critical COVID-19.Clinical data including symptoms,detection of SARS-CoV-2,chest computed tomography(CT)images,changes in serum LDH in different clinical phases,and prognosis were collected.Statistical analysis of the data was performed.Continuous variables were expressed as median(interquartile range)and compared with the Mann-Whitney U test.Categorical variables were compared with the Chi-square test.Survival data were analyzed using Kaplan-Meier survival curves and log-rank tests.RESULTS According to chest CT images,we observed the alveolitis and fibrosis stages in all critical patients in this study.Most non-survivors died in the fibrosis stage.Nonsurvivors had fewer days of hospitalization,shorter disease duration,shorter duration of alveolitis and fibrosis,and had dyspnea symptoms at disease onset(P=0.05).Both first and lowest LDH values in the alveolitis stage were more pronounced in non-survivors than in survivors(449.0 U/L vs 288.0 U/L,P=0.0243;445.0 U/L vs 288.0 U/L,P=0.0199,respectively),while the first,lowest and highest values of serum LDH in non-survivors were all significantly increased compared to survivors in the fibrosis phase(449.0 U/L vs 225.5 U/L,P=0.0028;432.0 U/L vs 191.0 U/L,P=0.0007;1303.0 U/L vs 263.5 U/L,P=0.0001,respectively).The cut-off points of first LDH values in the alveolitis and fibrosis phase for distinction of non-survivors from survivors were 397.0 U/L and 263.0 U/L,respectively.In the fibrosis stage,non-survivors had more days with high LDH than survivors(7.0 d vs 0.0 d,P=0.0002).Importantly,patients with high LDH had a significantly shorter median survival time than patients with low LDH in the alveolitis phase(22.0 d vs 36.5 d,P=0.0002),while patients with high LDH also had a significantly shorter median survival time than patients with low LDH in the fibrosis phase(27.5 d vs 40.0 d,P=0.0008).The proportion of non-survivors with detectable SARS-CoV-2 until death in the alveolitis stage was significantly increased compared with that in the fibrosis stage(100%vs 35.7%,P=0.0220).CONCLUSION High LDH and dyspnea symptoms were positive predictors of an adverse outcome in critical COVID-19.The rapid progressive fibrosis stage was more perilous than the alveolitis stage,even if SARS-CoV-2 is undetectable.展开更多
Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatmen...Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatments available for controlling the symptom. We have developed a tailored implementation strategy directed to medical staff to promote the application of these pharmacological and non-pharmacological tools in dealing with dyspnea. The primary aim is to decrease the rate of patients that do not receive an adequate relief of dyspnea. This is a four-stage quasi-experimental study. The intervention consists in two teaching talks that will be taught in Cardiology and Respiratory Medicine Departments. The contents will be prepared by Palliative Care specialists, based on available tools for management of dyspnea and patients＇ needs. A cross-sectional study of dyspnea in hospitalized patients will be performed before and after the intervention to ascertain an improvement in dyspnea intensity due to changes in medical practices. The last phase consists in the creation of consensus protocols for dyspnea management based in our experience. The results of this study are expected to be of great value and may change clinical practice in the near future and promote a changing for the better of dyspnea care.展开更多
In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang [symbol: see text]-[symbol: see text]) wa...In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang [symbol: see text]-[symbol: see text]) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P展开更多
The chronic obstructive pulmonary disease (COPD) and asthma are chronic airway diseases that cause considerable physical, emotional and social restrictions. The life quality of patients who suffer from these diseases,...The chronic obstructive pulmonary disease (COPD) and asthma are chronic airway diseases that cause considerable physical, emotional and social restrictions. The life quality of patients who suffer from these diseases, is more affected by dyspnea then by other symptoms. That way is possible to correlate the impact of dyspnea on their life quality. The Pulmonary Rehabilitation Program (PRP) helps to improve the physical fitness and quality of life. This paper presents a study of the life quality and the dyspnea intensity in chronic lung disease patients. The research has participation of fourteen patients, distributed as seven suffering from COPD and the other seven suffering from asthma, for both gender and with an age average of 74.2 ± 8.9. The patients answer the following questionnaires: Baseline Dyspnea Index (BDI), Medical Research Council (MRC) Dyspnea Scale, Airways Questionnaire 20 (AQ20) and the Brazilian version of the Short-Form (SF-36) life quality questionnaire. From the present study, it was concluded that asthma patients have a less impaired life quality, since the dyspnea intensity is lesser, compared to the one with COPD.展开更多
Background: Dyspnea in obesity is common and dyspnea questionnaires are mostly validated for chronic respiratory diseases. The study aims to assess how modified Medical Research Council (mMRC) dyspnea scale correlates...Background: Dyspnea in obesity is common and dyspnea questionnaires are mostly validated for chronic respiratory diseases. The study aims to assess how modified Medical Research Council (mMRC) dyspnea scale correlates with post exercise dyspnea Borg scale in 6-minute walk test of the obese population. Methods: We performed a retrospective observational study on 342 obese patients with 6 MWT tests from February 2008 to November 2014 at a single tertiary hospital. Linear regression analysis was used to assess the relationship between mMRC and Borg dyspnea score. Fractional polynomial regression was used to analyze the relationship of mMRC and Borg scores with BMI. Results: MMRC dyspnea score was a strong predictor of post exercise dyspnea Borg score in the obese population in a univariate regression model (coefficient = 0.764, p ≤ 0.001). When adjusted to age, BMI, 6 MWT distance and PFT parameters in a multivariate regression model, the relationship remained statistically significant (coefficient = 0.587, p ≤ 0.001). The relationship was stronger in obese group with no airflow obstruction. Conclusion: In obese population, pre-exercise mMRC dyspnea score correlates significantly with post exercise dyspnea Borg score regardless of airflow obstruction. This is the first validity study regarding mMRC scale in assessing dyspnea in the obese population.展开更多
Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional...Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional capacity, degree of breathlessness on exertion, and body mass index. Increasingly, the reliability of physiological parameters such as FEV1 to predict patient-centered outcomes has been brought into question. Objectives: To evaluate the relationship between dyspnea as assessed by the Modified Medical Council Dyspnea (MMRC) scale, the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2014) staging and indices of lung hyperinflation and spirometry. Methods: Data were retrospectively analyzed at a 600-bed tertiary care center including spirometry, plethysmographic lung volumes, single breath carbon monoxide diffusion capacity and dyspnea graded according to MMRC, and GOLD staging. Results: Data for 331 patients were analyzed. Differences amongst FEV1, IC, IC/TLC, FRC and RV/TLC were significant between GOLD I/II and GOLD III/IV groups. The closest relationship to GOLD staging was seen with FEV1, FVC and slow vital capacity (SVC). FEV1/FVC, IC, and IC/TLC were inversely associated with MMRC score, while RV/TLC exhibited a positive relation with MMRC score. Conclusions: Indices of lung hyperinflation are closely associated, with dyspnea as assessed by MMRC grading with TLC, RV/TLC and IC exhibiting the closest relations, more so than FEV1. GOLD staging also shows strong correlations with lung volume subdivisions (weakly with TLC), more so than with FEV1. That TLC changed little between GOLD stages can be explained by the presence of collateral interalveolar channels and population characteristics different from those of other studies. These findings further support the concept that more than a reduction in FEV1, lung hyperinflation contributes to the sensation of dyspnea in airflow limitation.展开更多
Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is ma...Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is made on a postmortem examination but up to one third of the patients have symptoms such as exertional chest pain and dyspnea. Due to the correctable nature of this entity and the fact that anomalous origins of coronary arteries can be readily diagnosed by noninvasive cardiac imaging modalities, timely clinical suspicion based on symptoms is critical. We present a case of a 37 years old with exertional chest pain and dyspnea of several years duration who was found to have an anomalous origin of the left main coronary artery. A surgical correction was undertaken which resulted in resolution of his symptoms. Our case highlights the importance of keeping congenital coronary anomalies on the differential diagnosis for exertional chest pain and dyspnea in young individuals and following inconclusive noninvasive testing with more definitive diagnostic modalities.展开更多
<strong>Objective: </strong>To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea.<strong> Methods:</strong> Sixty-two patients with acute dyspne...<strong>Objective: </strong>To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea.<strong> Methods:</strong> Sixty-two patients with acute dyspnea who were treated in our hospital from January 2016 to December 2020 were randomly selected and their clinical data were retrospectively analyzed. All patients were randomly divided into a control group for routine examinations (n = 31) and an observation group for real-time beside ultrasonography (n = 31). The costs of medical examinations, examination duration, and diagnostic results of severe pneumonia, acute cardiogenic pulmonary edema, pulmonary embolism, chronic obstructive pulmonary disease, and pneumothorax (including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of the two groups of patients were compared and analyzed. <strong>Results:</strong> Compared with the control group, the observation group had significantly shorter examinations (P < 0.05). Although the cost of medical examinations of the observation group tended to be higher, the difference between groups was not significant (P > 0.05). Moreover, there were no significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, or brain natriuretic peptide between the two groups (P > 0.05). Comparison of the etiologic diagnosis results between the two groups showed that the observation group had significantly higher diagnostic sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for various causes compared with the control group (P < 0.05). <strong>Conclusion:</strong> Real-time bedside ultrasonography for the etiologic diagnosis of patients with acute dyspnea was quicker and had higher diagnostic accuracy;thus providing accurate guidance for the disease treatment, and having a higher promotional value in clinical practice compared with routine examinations.展开更多
<b>Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Tidal expiratory flow limitation (tEFL) is defined as absence of increase...<b>Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;">. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> (p < 0.00014) and RV/TLC values > 40% (p < 0.03). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and </span><span style="font-family:Verdana;">BMI contribute to tEFL.展开更多
Dyspnea is a subjective sensation often described as a feeling of respiratory effort,tightness,or air hunger.The underlying mechanisms of this symptom are multifaceted and involve factors such as respiratory centers,c...Dyspnea is a subjective sensation often described as a feeling of respiratory effort,tightness,or air hunger.The underlying mechanisms of this symptom are multifaceted and involve factors such as respiratory centers,cardiovas-cular system,airways,neuromuscular components,and metabolic factors,although not fully elucidated.The classical theory of imbalance between inspiratory neural drive(IND)and the simultaneous dynamic responses of the respiratory system posits that the disruption of a normal and harmo-nious relationship fundamentally shapes the expression of respiratory discomfort.Assessment and comprehensive treatment of dyspnea are crucial for patient rehabilitation,including subjective self-reporting and objective clinical measurements.Non-pharmacological interventions,such as pulmonary rehabilitation,fan therapy,exercise,chest wall vibration,virtual reality technology,traditional Chinese medicine(acupuncture and acupressure),and yoga,have shown promise in alleviating dyspnea symptoms.Addition-ally,oxygen therapy,has demonstrated short-term benefits for patients with pre-hospital respiratory distress and hyp-oxemia.This review provides a comprehensive overview of dyspnea,emphasizing the importance of a multifaceted approach for its assessment and management,with a focus on non-pharmacological interventions that contribute to enhanced patient outcomes and quality of life.展开更多
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 cardiopulmona...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 PCO2 （PetCO2） and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO2 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 PetCO2 （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, PetCO2 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.展开更多
文摘BACKGROUND Longus colli tendinitis(LCT)with dyspnea is a relatively less-reported condition in the literature,and physicians should be aware of its existence.Misdiagnosis of this condition may cause unnecessary treatment for dyspnea.CASE SUMMARY Herein,we report the case of a 40-year-old man with acute neck tendonitis.The patient presented to the pneumology department clinic with a complaint of acute neck tendonitis with dyspnea.An emergency cervical magnetic resonance examination was performed,and the preliminary diagnosis was“acute longus cervicalis tendinitis.”After aggressive medical treatment,the symptoms obviously improved.CONCLUSION LCT is a self-limiting disease that usually improves after three to seven days of conservative treatment following a definite diagnosis.However,owing to its insidious onset and complex clinical manifestations,most relevant personnel are not fully understood.The definite diagnosis of LCT is based on a comprehensive understanding of the triad,rare symptoms,and the clear identification of cervical 1 and 2 levels calcification and prevertebral edema by medical imaging examination,especially magnetic resonance imaging and computed tomography.
文摘Identify the epidemiological characteristics, etiologies and evolutionary aspects of dyspnea in infants. This was a retrospective study of infants hospitalized for dyspnea from January 1 to December 31, 2020. The parameters studied were sex, age, origin, vaccination status, existence of underlying pathology. Underlying, the diagnosis and the evolutionary modalities. Data analysis and processing were possible using Word, Excel and EPI info version 7 software. We retained 152 infants. The sex ratio was 1.34 and the median age was 4 months. Vaccines according to expanded immunization program (EPI) were up to date in 76.32%. The main antecedents with risk identified were malnutrition, hypotrophy at birth, interventricular communication. The pathologies observed were low acute respiratory diseases in 90.79%, ENT diseases in 04.60% and cardiac diseases in 03.95%. The median length of hospitalization was 4 days. Infants who died accounted for 15.13%. The median age of infants who died was 4 months. The median time to onset of death was 1.63 days. The risk factors for death were age < 6 months (p = 0.003;CI [1.27;9.33]), outdated vaccines (p = 0.012;CI [1.18;5.17]), history with risk (p = 0.031;CI [1.02;4.54]). Dyspnea in infants remains a concern in our service. Reducing mortality involves developing procedures for the management of lower respiratory ailments, continuous staff training and strengthening the technical platform.
文摘COVID-19 patients often experience dyspnea due to several factors. The underlying unique pathophysiology of dyspnea in COVID-19 is not yet fully understood, but it is believed to be related to a combination of respiratory, cardiovascular, and neuromuscular factors. Hypoxemia is considered one of the key symptoms of COVID-19. This affects the respiratory drive, which determines the rate, depth, and pattern of breathing. The relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and chemosensitivity, has gained significant attention following the COVID-19 pandemic. The ACE2 receptors allow viral entry into the lungs, leading to the loss of surfactant, hypoxic vasoconstriction, and intrapulmonary shunting that may result in a V/Q mismatch. Additionally, acidosis, hypercapnia, elevated 2,3-diphosphogly-cerate levels and fever may shift the oxygen diffusion curve rightward, lowering arterial oxygen saturation levels and triggering ventilatory responses. This paper examines how physio pathological factors such as altered gas diffusion, chemosensory feedback, V/Q ratios, altered compliance, arterial blood gases, and respiratory muscle dysfunction in these patients affect ventilatory drive. A review of the published literature was also conducted to determine the mechanism of dyspnea. To ensure appropriate gas exchange, individuals need to augment their minute ventilation (VE) when physiological dead space is elevated. This serves as a compensatory mechanism to counteract the effects of compromised gas exchange and keep adequate oxygenation throughout the body. The respiratory centers may experience dysregulation due to the impact of the virus on the respiratory system, which could affect the rhythm-generating and pattern-generating signals that are vital for regulating the respiratory rate and depth of breathing effort. The cerebral cortex, in conjunction with the brain stem centers, plays a crucial role in regulating ventilation during prolonged hypoxemia. This interaction between these two components may help elucidate the conscious respiratory sensation (or dyspnea) experienced by patients. It is hypothesized that neuroventilatory decoupling acts as a mechanism to prevent sensory signals from translating into mechanical or ventilatory responses. This decoupling phenomenon is believed to have a notable impact on the intensity of breathlessness. By understanding the relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and altered chemosensitivity, healthcare professionals can develop strategies to optimize respiratory support for COVID-19 patients.
基金the National Natural Science Foundation of China,No.V30270502,C010703
文摘BACKGROUND： The insular cortex and habenular nucleus may be a regulatory center for obstructive sleep apnea syndrome, and dyspnea may be caused by insular cortex activity. The insular cortex is a cortical representation of obstructive sleep apnea syndrome. The habenular nucleus is a station for descending insular cortex activity. OBJECTIVE： Through actively stimulating the rat insular cortex, to observe rat respiratory movement, myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity, and to verify a hypothesis that the insular cortex is a superior-position regulation center, and the habenular nucleus is an inferior-position nervous nuclei of the insular cortex in patients with obstructive sleep apnea syndrome. DESIGN, TIME AND SETTING： The randomized, controlled animal study was performed at the Laboratory of Electrophysiology, Department of Physiology, Norman Bathune College of Medicine, Jilin University, China from September 2004 to June 2008. MATERIALS： We used L-glutamic acid （Dingguo Biological Product Research Center, Beijing, China）, lidocaine hydrochloride （Seventh Pharmacy Co., Ltd., Wuxi, China）, electric stimulator （Nihon Kohden, Japan）, and an AVL-OPTI blood gas analyzer （AVL Scientific Co., Roswell, GA, USA）. METHODS： The insular cortex of healthy adult Wistar rats underwent electrostimulation and L-glutamic acid stimulation to record changes in the myoelectric activity of genioglossus and respiratory movement. Some rats were injected with lidocaine to block the habenular nucleus before electrostimulation or L-glutamic acid stimulation. L-glutamic acid and lidocaine were injected by microelectrodes embedded in nuclear groups. MAIN OUTCOME MEASURES： Myoelectric activities of genioglossus, arterial partial pressure of oxygen, partial pressure of carbon dioxide and acidity-alkalinity were measured following apnea in rats undergoing electrostimulation in the insular cortex and following blockade of the habenular nucleus. RESULTS： Following electrostimulation and L-glutamic acid stimulation, rats developed apnea or respiratory rhythm disorders. Simultaneously, the amplitude of myoelectric activity of the genioglossus was reduced （P 〈 0.01 ）, and the electromyogram integral was decreased （P 〈 0.01）. Arterial blood gas analysis showed arterial blood acidosis, a decrease in pH （P 〈 0.05）, and an increase in the negative value of alkaline reserve （P 〈 0.01）. Lidocaine in the habenular nuclear blocked respiratory and other index changes after insular cortex stimulation. CONCLUSION： Dyspnea induced by stimulating the insular cortex may require the habenular nucleus. Paralysis of the habenular nucleus can completely eliminate insular cortex stimulation-induced dyspnea.
文摘The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin. Oxaliplatin improves the efficacy of this combination in patients with stage 111 colon cancer and moreover its toxicity is well tolerable. We describe a rare clinical case of acute dyspnoea probably related to oxaliplatin at one month from the end of the adjuvant treatment. A 74-year-old man developed a locally advanced sigmoid carcinoma （pT3N1M0）. A port a cath attached to an open-ended catheter was implanted in order to administer primary chemotherapy safely according to the FOLFOX4 schedule. One month following the end of the 6^th cycle, the patient referred a persistent cough and moderate dyspnoea. Chest radiography displayed a change in the lung interstitium, chest CT scan confirmed this aspect of adult respiratory distress syndrome, spirometry reported a decreased carbon monoxide diffusion capacity. Antibiotic and corticosteroids were administered for 10 d, then a repeated chest X ray evidenced a progressive pulmonary infiltration. A transbronehial biopsy and cytology did not show an infective process, a CT scan reported radiological abnormalities including linear and nodular densities which were becoming confluents. Antimicotic and antiviral drugs did not evidence any benefit. The antiviral therapy was stopped and high dose metilprednisolone was started. The patient died of pulmonary distress after 10 d.
基金Supported by National Natural Science Foundation of China,No.81800070Development Fund Program of Fujian Provincial Health and Family Planning Commission,China,No.2017-1-43.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreak in China,constitutes a Public Health Emergency of International Concern.It is well known that COVID-19 patients may have increased serum lactate dehydrogenase(LDH)levels in the early stage.The clinical changes in LDH may have predictive value in disease evolution and prognosis in critically ill COVID-19 patients.AIM To examine serum LDH and clinical characteristics in patients with COVID-19 and their predictive value for prognosis.METHODS This retrospective study analyzed the clinical data of forty-seven critical COVID-19 patients in the intensive care unit of the Third People's Hospital of Yichang City from January 27 to March 25,2020 and divided them into survivors and nonsurvivors.The patients were diagnosed according to the World Health Organization interim guidance and critical cases met any one of the following criteria:Respiratory failure and required mechanical ventilation,the occurrence of shock,and the combined failure of other organs that required intensive care unit monitoring and treatments,according to the diagnostic criteria of critical COVID-19.Clinical data including symptoms,detection of SARS-CoV-2,chest computed tomography(CT)images,changes in serum LDH in different clinical phases,and prognosis were collected.Statistical analysis of the data was performed.Continuous variables were expressed as median(interquartile range)and compared with the Mann-Whitney U test.Categorical variables were compared with the Chi-square test.Survival data were analyzed using Kaplan-Meier survival curves and log-rank tests.RESULTS According to chest CT images,we observed the alveolitis and fibrosis stages in all critical patients in this study.Most non-survivors died in the fibrosis stage.Nonsurvivors had fewer days of hospitalization,shorter disease duration,shorter duration of alveolitis and fibrosis,and had dyspnea symptoms at disease onset(P=0.05).Both first and lowest LDH values in the alveolitis stage were more pronounced in non-survivors than in survivors(449.0 U/L vs 288.0 U/L,P=0.0243;445.0 U/L vs 288.0 U/L,P=0.0199,respectively),while the first,lowest and highest values of serum LDH in non-survivors were all significantly increased compared to survivors in the fibrosis phase(449.0 U/L vs 225.5 U/L,P=0.0028;432.0 U/L vs 191.0 U/L,P=0.0007;1303.0 U/L vs 263.5 U/L,P=0.0001,respectively).The cut-off points of first LDH values in the alveolitis and fibrosis phase for distinction of non-survivors from survivors were 397.0 U/L and 263.0 U/L,respectively.In the fibrosis stage,non-survivors had more days with high LDH than survivors(7.0 d vs 0.0 d,P=0.0002).Importantly,patients with high LDH had a significantly shorter median survival time than patients with low LDH in the alveolitis phase(22.0 d vs 36.5 d,P=0.0002),while patients with high LDH also had a significantly shorter median survival time than patients with low LDH in the fibrosis phase(27.5 d vs 40.0 d,P=0.0008).The proportion of non-survivors with detectable SARS-CoV-2 until death in the alveolitis stage was significantly increased compared with that in the fibrosis stage(100%vs 35.7%,P=0.0220).CONCLUSION High LDH and dyspnea symptoms were positive predictors of an adverse outcome in critical COVID-19.The rapid progressive fibrosis stage was more perilous than the alveolitis stage,even if SARS-CoV-2 is undetectable.
文摘Dyspnea is a common and disabling symptom of respiratory and heart diseases, which is growing in incidence. During hospital admis- sion, breathlessness is under-diagnosed and under-treated, although there are treatments available for controlling the symptom. We have developed a tailored implementation strategy directed to medical staff to promote the application of these pharmacological and non-pharmacological tools in dealing with dyspnea. The primary aim is to decrease the rate of patients that do not receive an adequate relief of dyspnea. This is a four-stage quasi-experimental study. The intervention consists in two teaching talks that will be taught in Cardiology and Respiratory Medicine Departments. The contents will be prepared by Palliative Care specialists, based on available tools for management of dyspnea and patients＇ needs. A cross-sectional study of dyspnea in hospitalized patients will be performed before and after the intervention to ascertain an improvement in dyspnea intensity due to changes in medical practices. The last phase consists in the creation of consensus protocols for dyspnea management based in our experience. The results of this study are expected to be of great value and may change clinical practice in the near future and promote a changing for the better of dyspnea care.
文摘In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang [symbol: see text]-[symbol: see text]) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P
文摘The chronic obstructive pulmonary disease (COPD) and asthma are chronic airway diseases that cause considerable physical, emotional and social restrictions. The life quality of patients who suffer from these diseases, is more affected by dyspnea then by other symptoms. That way is possible to correlate the impact of dyspnea on their life quality. The Pulmonary Rehabilitation Program (PRP) helps to improve the physical fitness and quality of life. This paper presents a study of the life quality and the dyspnea intensity in chronic lung disease patients. The research has participation of fourteen patients, distributed as seven suffering from COPD and the other seven suffering from asthma, for both gender and with an age average of 74.2 ± 8.9. The patients answer the following questionnaires: Baseline Dyspnea Index (BDI), Medical Research Council (MRC) Dyspnea Scale, Airways Questionnaire 20 (AQ20) and the Brazilian version of the Short-Form (SF-36) life quality questionnaire. From the present study, it was concluded that asthma patients have a less impaired life quality, since the dyspnea intensity is lesser, compared to the one with COPD.
文摘Background: Dyspnea in obesity is common and dyspnea questionnaires are mostly validated for chronic respiratory diseases. The study aims to assess how modified Medical Research Council (mMRC) dyspnea scale correlates with post exercise dyspnea Borg scale in 6-minute walk test of the obese population. Methods: We performed a retrospective observational study on 342 obese patients with 6 MWT tests from February 2008 to November 2014 at a single tertiary hospital. Linear regression analysis was used to assess the relationship between mMRC and Borg dyspnea score. Fractional polynomial regression was used to analyze the relationship of mMRC and Borg scores with BMI. Results: MMRC dyspnea score was a strong predictor of post exercise dyspnea Borg score in the obese population in a univariate regression model (coefficient = 0.764, p ≤ 0.001). When adjusted to age, BMI, 6 MWT distance and PFT parameters in a multivariate regression model, the relationship remained statistically significant (coefficient = 0.587, p ≤ 0.001). The relationship was stronger in obese group with no airflow obstruction. Conclusion: In obese population, pre-exercise mMRC dyspnea score correlates significantly with post exercise dyspnea Borg score regardless of airflow obstruction. This is the first validity study regarding mMRC scale in assessing dyspnea in the obese population.
文摘Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional capacity, degree of breathlessness on exertion, and body mass index. Increasingly, the reliability of physiological parameters such as FEV1 to predict patient-centered outcomes has been brought into question. Objectives: To evaluate the relationship between dyspnea as assessed by the Modified Medical Council Dyspnea (MMRC) scale, the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2014) staging and indices of lung hyperinflation and spirometry. Methods: Data were retrospectively analyzed at a 600-bed tertiary care center including spirometry, plethysmographic lung volumes, single breath carbon monoxide diffusion capacity and dyspnea graded according to MMRC, and GOLD staging. Results: Data for 331 patients were analyzed. Differences amongst FEV1, IC, IC/TLC, FRC and RV/TLC were significant between GOLD I/II and GOLD III/IV groups. The closest relationship to GOLD staging was seen with FEV1, FVC and slow vital capacity (SVC). FEV1/FVC, IC, and IC/TLC were inversely associated with MMRC score, while RV/TLC exhibited a positive relation with MMRC score. Conclusions: Indices of lung hyperinflation are closely associated, with dyspnea as assessed by MMRC grading with TLC, RV/TLC and IC exhibiting the closest relations, more so than FEV1. GOLD staging also shows strong correlations with lung volume subdivisions (weakly with TLC), more so than with FEV1. That TLC changed little between GOLD stages can be explained by the presence of collateral interalveolar channels and population characteristics different from those of other studies. These findings further support the concept that more than a reduction in FEV1, lung hyperinflation contributes to the sensation of dyspnea in airflow limitation.
文摘Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is made on a postmortem examination but up to one third of the patients have symptoms such as exertional chest pain and dyspnea. Due to the correctable nature of this entity and the fact that anomalous origins of coronary arteries can be readily diagnosed by noninvasive cardiac imaging modalities, timely clinical suspicion based on symptoms is critical. We present a case of a 37 years old with exertional chest pain and dyspnea of several years duration who was found to have an anomalous origin of the left main coronary artery. A surgical correction was undertaken which resulted in resolution of his symptoms. Our case highlights the importance of keeping congenital coronary anomalies on the differential diagnosis for exertional chest pain and dyspnea in young individuals and following inconclusive noninvasive testing with more definitive diagnostic modalities.
文摘<strong>Objective: </strong>To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea.<strong> Methods:</strong> Sixty-two patients with acute dyspnea who were treated in our hospital from January 2016 to December 2020 were randomly selected and their clinical data were retrospectively analyzed. All patients were randomly divided into a control group for routine examinations (n = 31) and an observation group for real-time beside ultrasonography (n = 31). The costs of medical examinations, examination duration, and diagnostic results of severe pneumonia, acute cardiogenic pulmonary edema, pulmonary embolism, chronic obstructive pulmonary disease, and pneumothorax (including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of the two groups of patients were compared and analyzed. <strong>Results:</strong> Compared with the control group, the observation group had significantly shorter examinations (P < 0.05). Although the cost of medical examinations of the observation group tended to be higher, the difference between groups was not significant (P > 0.05). Moreover, there were no significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, or brain natriuretic peptide between the two groups (P > 0.05). Comparison of the etiologic diagnosis results between the two groups showed that the observation group had significantly higher diagnostic sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for various causes compared with the control group (P < 0.05). <strong>Conclusion:</strong> Real-time bedside ultrasonography for the etiologic diagnosis of patients with acute dyspnea was quicker and had higher diagnostic accuracy;thus providing accurate guidance for the disease treatment, and having a higher promotional value in clinical practice compared with routine examinations.
文摘<b>Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;">. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> (p < 0.00014) and RV/TLC values > 40% (p < 0.03). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and </span><span style="font-family:Verdana;">BMI contribute to tEFL.
基金supported by the fund of National High Level Hospital Clinical Research Funding (2023-NHLHCRF-YSPY-01 and ZRJY2021-BJ04)the National Natural Science Foundation of China (82372560)from SJElite Medical Professionals Project of China-Japan Friendship Hospital (NO.ZRJY2021-QM18)from BG.
文摘Dyspnea is a subjective sensation often described as a feeling of respiratory effort,tightness,or air hunger.The underlying mechanisms of this symptom are multifaceted and involve factors such as respiratory centers,cardiovas-cular system,airways,neuromuscular components,and metabolic factors,although not fully elucidated.The classical theory of imbalance between inspiratory neural drive(IND)and the simultaneous dynamic responses of the respiratory system posits that the disruption of a normal and harmo-nious relationship fundamentally shapes the expression of respiratory discomfort.Assessment and comprehensive treatment of dyspnea are crucial for patient rehabilitation,including subjective self-reporting and objective clinical measurements.Non-pharmacological interventions,such as pulmonary rehabilitation,fan therapy,exercise,chest wall vibration,virtual reality technology,traditional Chinese medicine(acupuncture and acupressure),and yoga,have shown promise in alleviating dyspnea symptoms.Addition-ally,oxygen therapy,has demonstrated short-term benefits for patients with pre-hospital respiratory distress and hyp-oxemia.This review provides a comprehensive overview of dyspnea,emphasizing the importance of a multifaceted approach for its assessment and management,with a focus on non-pharmacological interventions that contribute to enhanced patient outcomes and quality of life.
文摘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 PCO2 （PetCO2） and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO2 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 PetCO2 （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, PetCO2 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.
