Dyspnea and Hyperinflation in Chronic Obstructive Pulmonary Disease: Impact on Physical Activity

Marchetti, Nathaniel; Kaplan, Alan

doi:10.3949/ccjm.85.s1.02

Cited by 6 publications

(5 citation statements)

References 60 publications

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“…However, they may be able to exhale only a portion of the inhaled volume, resulting in air trapping and hyperinflation. 15 As patients breathe more rapidly (eg, during exercise), they have even shorter time for exhalation and, less and less “room” to breathe in (ie progressively increased end-expiratory lung volume and decreased inspiratory capacity), both of which enhance dyspnea or shortness of breath because of inability to “get air in.” This phenomenon can be illustrated by asking the patient to take a deep breath in, exhale only a small amount of the breath (air trapping), and then attempt to take in three quick breaths. The patient will experience acute dyspnea and discomfort, as they will have more difficulty with inhalation because of residual air in the lungs (ie hyperinflation).…”

Section: Pathophysiology Of Copdmentioning

confidence: 99%

“…This maneuver mimics what happens with hyperinflation during rest (static hyperinflation) and also during increased activity (dynamic hyperinflation) when the respiratory rate is faster. 15 Exertion leaves less time to exhale and, consequently no room to let new air in. Common descriptors of air trapping, which are important to know to understand patients’ experiences and estimating disease severity, include “air hunger,” “unsatisfied” or “unrewarded” inhalation, “shallow breathing,” “suffocating,” and “cannot get a deep breath.” 15 , 16 …”

Section: Pathophysiology Of Copdmentioning

confidence: 99%

See 1 more Smart Citation

GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting

Yawn

Mintz

Doherty

2021

COPD

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early detection and appropriate treatment and management of COPD can lower morbidity and perhaps mortality. Clinicians in the primary care setting provide the majority of COPD care and are pivotal in the diagnosis and management of COPD. In this review, we provide an overview of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 report, with a focus on the management of COPD in the primary care setting. We discuss the pathophysiology of COPD; describe COPD risk factors, signs, and symptoms that may facilitate earlier diagnosis of COPD; and reinforce the importance of spirometry use in establishing the diagnosis of COPD. Disease monitoring, as well as a review of the 2020 GOLD treatment recommendations, is also discussed. Patients and families are important partners in COPD management; therefore, we outline simple steps that may assist them in caring for those affected by COPD. Finally, we discuss nonpharmacological treatment options for COPD, COPD monitoring tools that may aid in the evaluation of disease progression and response to therapy, and the importance of developing a COPD action plan on an individualized basis.

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Section: Pathophysiology Of Copdmentioning

confidence: 99%

Section: Pathophysiology Of Copdmentioning

confidence: 99%

GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting

Yawn

Mintz

Doherty

2021

COPD

View full text Add to dashboard Cite

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“…3 In patients with chronic obstructive pulmonary disease (COPD), this can precipitate a downward spiral of dyspnea-induced inactivity, thus resulting in physical deconditioning, progression of disease and disability. 12 Thus, some studies have shown that COPD patients were more likely to be frail, and that this was associated with airflow limitations, reduced physical function, dyspnea, disability, anxiety and depression. 13 Frailty is a medical syndrome with multiple causes and contributors that confers vulnerability to stressors and increases the risk of different negative outcomes at older age, such as dependency and/or death.…”

Section: Introductionmentioning

confidence: 99%

Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study

et al. 2022

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CONTEXT: Dyspnea is a symptom present in several chronic diseases commonly seen among older adults. Since individuals with dyspnea tend to stay at rest, with consequently reduced levels of physical activity, they are likely to be at greater risk of developing frailty, especially at older ages. DESIGN AND SETTING: Cross-sectional study at community level, Brazil. OBJECTIVE: To analyze the relationships between self-reported dyspnea, health conditions and frailty status in a sample of community-dwelling older adults. METHOD: Secondary data from the follow-up of the Frailty in Brazilian Elderly (FIBRA) study, involving 415 community-dwelling older adults (mean age: 80.3 ± 4.68 years), were used. The variables analyzed were sociodemographic characteristics, reported dyspnea, clinical data and frailty phenotype. Associations between dyspnea and other variables (age, sex, education and body mass index) were verified through the crude (c) and adjusted (a) odds ratios. RESULTS: The prevalence of dyspnea in the entire sample was 21.0%. Dyspnea was more present in individuals with pulmonary diseases, heart disease, cancer and depression. Older adults with multimorbidities (adjusted odds ratio, ORa = 2.91; 95% confidence interval, CI = 1.41-5.99) and polypharmacy (ORa = 2.02; 95% CI = 1.15-3.54) were more likely to have dyspnea. Those who reported dyspnea were 2.54 times more likely to be frail (ORa = 2.54; 95% CI = 1.08-5.97), and fatigue was their most prevalent phenotype component. CONCLUSION: Dyspnea was associated with different diseases, multimorbidities, polypharmacy and frailty. Recognizing the factors associated with dyspnea may contribute to its early identification and prevention of its negative outcomes among older adults.

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“…Activity-related breathlessness-one of the most common symptoms of chronic obstructive pulmonary disease (COPD)-is generally noticed and reported by patients from the early stages of COPD progression [1,2]. Activity-related breathlessness has a severe impact on all aspects of patients' lives, preventing them from full participation in anything in life that involves physical activity [3,4].…”

Section: Introductionmentioning

confidence: 99%

Effects of Tiotropium/Olodaterol on Activity-Related Breathlessness, Exercise Endurance and Physical Activity in Patients with COPD: Narrative Review with Meta-/Pooled Analyses

et al. 2020

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One of the most debilitating symptoms of chronic obstructive pulmonary disease (COPD) is breathlessness, which leads to avoidance of physical activities in daily living and hastens clinical deterioration. Treatment of patients with COPD with inhaled long-acting muscarinic antagonist (LAMA)/long-acting β 2 -agonist (LABA) combination therapy improves airflow limitation, reduces breathlessness compared with LAMA or LABA monotherapies, and improves health status and quality of life. A large clinical trial programme focusing on the effects of tiotropium/olodaterol combination therapy demonstrated that this LAMA/LABA combination improves lung function and reduces hyperinflation (assessed by serial inspiratory capacity measurements) compared with either tiotropium alone or placebo in patients with COPD. Tiotropium/olodaterol also increases exercise endurance capacity and improves patient perception of the intensity of breathlessness compared with placebo. In this narrative review, we focus on the relationship between improving symptoms during activity, the ability to remain active in daily life and how this may impact quality of life. We consider the benefits of therapy optimisation by means of dual bronchodilation with tiotropium/olodaterol, and present new data from meta-analyses/pooled analyses showing that tiotropium/olodaterol improves inspiratory capacity compared with placebo and tiotropium and improves exercise endurance time compared with placebo after 6 weeks of treatment. We also discuss the importance of taking a holistic approach to improving physical activity, including pulmonary rehabilitation and exercise programmes in parallel with bronchodilator therapy and psychological programmes to support behaviour change. Graphic Abstract

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Dyspnea and Hyperinflation in Chronic Obstructive Pulmonary Disease: Impact on Physical Activity

Cited by 6 publications

References 60 publications

GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting

GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting

Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study

Effects of Tiotropium/Olodaterol on Activity-Related Breathlessness, Exercise Endurance and Physical Activity in Patients with COPD: Narrative Review with Meta-/Pooled Analyses

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