Dysfunctions of COVID-19
Respiratory dysfunction in Coronavirus Disease (COVID-19) patients is closely related to the severity of the disease after onset. Symptoms of dyspnea are often seen clinically as a sign of the severity of the disease, but it has been observed that, in some COVID-19 patients, the improvement in dyspnea is disproportionate to the recovery from the disease. The American Thoracic Society has defined dyspnea as “a symptom characterized by a subjective sense of labored breathing, which differs significantly in intensity”. Dyspnea, as a subjective feeling, is caused by different stimuli. The pathophysiological mechanism of dyspnea was first introduced by Campbell and Howell in 1960 with the theory of “length-tension inappropriateness”. Hypoxia is a major pathophysiological change in the progression of respiratory disease to respiratory dysfunction and is one of the common dysfunctions in COVID-19 patients, except in mild cases.
Clinical Rehabilitation of COVID-19
Patients often have a decline in physical function due to dyspnea and reduced activity. All kinds of rehabilitation activities should be carried out according to local conditions and individual condition to improve patients’ physical ability. Adjust the treatment in time based on the change of the patient’s condition. Instruct patients to master correct breathing methods to improve respiratory function to the maximum extent, such as appropriate body position, effectual breathing patterns, various types of breathing exercises, and a decline in respiratory function. Guide patients to carry out active physical activities according to their conditions to improve their bodies immunity and promote their body function to return to the normal level gradually. Educate patients about the clinical characteristics and rehabilitation of Corona Virus Disease (COVID-19) to enhance their confidence in overcoming the disease and improve their treatment compliance. Rehabilitation diagnosis and treatment are the same as that of other diseases.
Thyroid nodules and multinodular goiter
This chapter focuses on nodular thyroid disease includes a discussion on the prevalence and pathogenesis of thyroid nodules. A thyroid nodule is a discrete lesion within the thyroid caused by an excess proliferation of cells compared to the surrounding normal thyroid parenchyma. The incidence of goiter, either due to iodine deficiency or environmental goitrogens, varies with the geographic region examined. Iodine deficiency is the most common worldwide etiology of goiter. Patients may present with symptoms such as a lump or swelling in the neck, hoarseness of voice, neck pressure or pain, cough, dyspnea, or dysphagia. US is the primary imaging modality recommended to confirm the presence of a nodule, to document the presence of other more clinically significant nodules, to identify suspicious sonographic features in nodules, and to document the presence of abnormal regional adenopathy.
Determinants of Dyspnea in Patients with Different Grades of Stable Asthma
Published in Journal of Asthma, 2003
Dyspnea is a main feature of symptomatology in asthma, and its perception does not necessarily correlates well with airway obstruction. The aim of this study was twofold: 1 to identify factors determining the subjective degree of dyspnea in patients with different grades of stable bronchial asthma and 2 to compare various clinical methods existing for grading dyspnea. The investigation comprised 153 outpatients with stable asthma. The parameters studied were the following: demographic characteristic of subjects, baseline dyspnea score by means of three clinical instruments (baseline dyspnea index [BDI], Medical Research Council [MRC] scale, and modified Borg scale), asthma severity, standard measures of physiologic lung function, anxiety, depression, subconscious illness attention, and asthma-related quality of life (HRQOL). The dyspnea scores were all significantly interrelated (r = 0.77–0.85, p<0.001). The three clinical scales for grading dyspnea were significantly correlated with the same parameters: airflow obstruction, lung hyperinflation, emotional factors, HRQOL, age, age at asthma onset, asthma duration, female gender, clinical severity, and lower economical, and educational levels. Multiple regression analysis showed that independent factors determining clinical dyspnea scores were: age, airway obstruction, and emotional status. Moreover, in patients with severe asthma, lung hyperinflation helped to explain the individual dyspnea score. These data suggest that clinical methods are appropriate for evaluating the impact of dyspnea on daily activities of asthmatic patients. BDI, MRC, and Borg clinical dyspnea scales showed similarly information in subjects with asthma. Independently of asthma severity, older age, airway obstruction, and psychological disturbance were associated with higher degree of dyspnea. However, if subjects had severe airway obstruction, lung hyperinflation was a major determinant of baseline dyspnea score.
C ONCORDANCE OF F IELD AND E MERGENCY D EPARTMENT A SSESSMENT IN THE P REHOSPITAL M ANAGEMENT OF P ATIENTS WITH D YSPNEA
Published in Prehospital Emergency Care, 2003
Objective. Dyspnea is a common complaint of patients treated by emergency medical services (EMS). Few studies have examined the ability of paramedics to distinguish between etiologies of dyspnea. The authors evaluated the degree of agreement related to cardiac versus noncardiac sources of dyspnea between field and emergency department (ED) assessment of patients transported at the advanced life support level. Methods. This was a retrospective, cohort study of consecutive patients aged ≥35 years transported by paramedics with dyspnea. The authors compared the concordance between the EMS and ED diagnoses. They also investigated whether patients whose assessments were discordant had worse outcomes. Results. Paramedics correctly assessed the cause of dyspnea in 172 of 222 (77%) patients (kappa = 0.60; 95% confidence interval [CI] = 0.51, 0.69). Among single-source (i.e., cardiac or noncardiac) dyspnea patients, prehospital providers correctly assessed 70 of 84 (83%) noncardiac causes and 98 of 114 (86%) cardiac causes (kappa = 0.69; 95% CI = 0.59, 0.79). When the ED diagnosis included both cardiac and noncardiac etiologies, paramedics treated seven of 24 (29%) patients as noncardiac, 13 of 24 (54%) as cardiac, and four of 24 (17%) as combined-source dyspnea. The authors did not observe any statistically significant differences in in-hospital mortality, intubation frequency, or hospital length of stay in patients whose prehospital dyspnea diagnosis was discordant. Conclusion. The authors conclude that in this EMS system, field assessment of dyspnea by paramedics is in agreement with that arrived at in the ED in a high proportion of patients with dyspnea from a single source. However, field assessment of dyspnea from multiple etiologies is less concordant.
Impact of Pulmonary Rehabilitation on the Major Dimensions of Dyspnea in COPD
Published in COPD: Journal of Chronic Obstructive Pulmonary Disease, 2013
The evaluation of dyspnea and its responsiveness to therapy in COPD should consider the multidimensional nature of this symptom in each of its sensory-perceptual (intensity, quality), affective and impact domains. To gain new insights into mechanisms of dyspnea relief following pulmonary rehabilitation (PR), we examined effects on the major domains of dyspnea and their interaction with physiological training effects. This randomized, controlled study was conducted in 48 subjects with COPD. Subjects received either 8-weeks of PR or usual care (CTRL). Pre- and post-intervention assessments included: sensory-perceptual (i.e., exertional dyspnea intensity, dyspnea descriptors at end-exercise), affective (i.e., intensity of breathing-related anxiety during exercise, COPD self-efficacy, walking self-efficacy) and impact (i.e., activity-related dyspnea measured by the Baseline/Transition Dyspnea Index, Chronic Respiratory Questionnaire dyspnea component, St. George's Respiratory Disease Questionnaire activity component) domains of dyspnea; functional performance (i.e., 6-minute walk, endurance shuttle walk); pulmonary function; and physiological measurements during constant work rate cycle exercise at 75% of the peak incremental work rate. Forty-one subjects completed the study: PR (n = 17) and CTRL (n = 24) groups were well matched for age, sex, body size and pulmonary function. There were no significant between-group differences in pre- to post-intervention changes in pulmonary function or physiological parameters during exercise. After PR versus CTRL, significant improvements were found in the affective and impact domains but not in the sensory-perceptual domain of dyspnea. In conclusion, clinically meaningful improvements in the affective and impact domains of dyspnea occurred in response to PR in the absence of consistent physiological training effects.