Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention

Dysfunctional breathing is a significant cause of morbidity, adversely affecting an individual's quality of life. There is currently no data from paediatric centres on the impact of breathing retraining for dysfunctional breathing.Symptoms and quality of life were measured in 34 subjects referred sequentially for breathing retraining to the first dedicated paediatric dysfunctional breathing clinic in the UK. Data were obtained prior to the first intervention (time point 1), at discharge (time point 2) and by post 6 months later (time point 3).The mean (interquartile range) age of participants was 13.3 (9.1–16.3) years, with 52% female. Data were obtained at time points 2 and 3 in 23 and 13 subjects, respectively.Statistically significant improvements were observed in symptom scores, child quality of life and parental proxy quality of life between time points 1 and 2 (p<0.0001), while there was no significant difference in the data at time point 3 as compared with time point 2.This study suggests that physiotherapist-led breathing retraining offers significant benefit to young people with dysfunctional breathing which is maintained for at least 6 months after treatment is completed. Future studies will provide more information on the long-term effects of interventions for dysfunctional breathing.

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Balancing Unbalanced Breathing: The Clinical Use of Capnographic Biofeedback

Biofeedback ◽

10.5298/1081-5937-41.4.02 ◽

2013 ◽

Vol 41 (4) ◽

pp. 183-187

Author(s):

Andrea Meckley

Keyword(s):

Carbon Dioxide ◽

Biofeedback Training ◽

Physiological Effects ◽

Clinical Use ◽

Breathing Patterns ◽

Panic Disorders ◽

Panic Symptoms ◽

Carbon Dioxide Levels ◽

Dysfunctional Breathing ◽

The Impact

Dysfunctional breathing, primarily in the form of overbreathing or hyperventilation, has been reported to play a major role for some individuals with anxiety and panic disorders. This is due to the decrease in carbon dioxide, a state called hypocapnia, which results from hyperventilation. The author reviews the physiological effects of hypocapnia and describes how carbon dioxide levels are measured with capnography. In addition, she introduces the use of capnography as a form of biofeedback and outlines ways to incorporate capnography into a clinical setting. Capnographic biofeedback enables individuals to become aware of the impact dysfunctional breathing has on their symptoms and assists them in learning more balanced, healthy breathing patterns. Use of this type of biofeedback training has been found to decrease panic symptoms and may be useful in improving physiological functioning in other medical and psychiatric disorders as well.

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Analysis of independence in older subjects and assessment of the impact of physiotherapy intervention on functional independence and autonomy

Journal of the Neurological Sciences ◽

10.1016/j.jns.2013.07.1973 ◽

2013 ◽

Vol 333 ◽

pp. e563

Author(s):

E. Ziakova ◽

R. Furmanikova ◽

D. Bartko ◽

S. Klobucka

Keyword(s):

Functional Independence ◽

Physiotherapy Intervention ◽

Older Subjects ◽

The Impact

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The impact of dysfunctional breathing on the assessment of asthma control

Respiratory Medicine ◽

10.1016/j.rmed.2016.12.008 ◽

2017 ◽

Vol 123 ◽

pp. 42-47 ◽

Cited By ~ 13

Author(s):

Sandra Veidal ◽

Maria Jeppegaard ◽

Asger Sverrild ◽

Vibeke Backer ◽

Celeste Porsbjerg

Keyword(s):

Asthma Control ◽

Dysfunctional Breathing ◽

The Impact

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Review of postural orthostatic tachycardia syndrome: a predominantly female condition

British Journal of Cardiac Nursing ◽

10.12968/bjca.2019.0090 ◽

2019 ◽

Vol 14 (12) ◽

pp. 1-10

Author(s):

Helen Eftekhari ◽

Sajad Hayat

Keyword(s):

Online Survey ◽

Average Length ◽

The United States ◽

Postural Orthostatic Tachycardia Syndrome ◽

Childbearing Age ◽

Predominantly Female ◽

The Uk ◽

The Impact ◽

Underlying Pathophysiology

Postural orthostatic tachycardia syndrome is a debilitating and underdiagnosed condition, affecting five times as many women of childbearing age as it does men. The true prevalence is difficult to estimate, with charities reporting up to potentially 3 million people with the condition in the United States. There is a lack of awareness and knowledge regarding how to manage people with postural orthostatic tachycardia syndrome. This results in a difficult journey to diagnosis. The average length of time to diagnosis from symptom onset is 4 years in the UK with dismissals of symptoms and misdiagnosis being common experiences. The largest online survey by an American charity found that 75% of women were misdiagnosed with anxiety compared with 25% of men. This article aims to raise awareness of postural orthostatic tachycardia syndrome, its underlying pathophysiology, diagnosis and the impact on quality of life, as well as the management and socioeconomic impact of the condition. Cardiac nurses who meet people with postural orthostatic tachycardia syndrome can improve the patient experience. Being aware of the condition, validating the experiences of these young, predominantly female, patients to rebuild trust, and providing support can make a huge difference.

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Behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement (PEP-TALK): study protocol for a pragmatic randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-035014 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035014

Author(s):

Toby O Smith ◽

Scott Parsons ◽

Beth Fordham ◽

Alexander Ooms ◽

Susan Dutton ◽

...

Keyword(s):

Physical Activity ◽

Randomised Controlled Trial ◽

Behaviour Change ◽

Knee Replacement ◽

Controlled Trial ◽

Physiotherapy Intervention ◽

Randomised Controlled ◽

The Impact ◽

Weekly Group ◽

Pragmatic Randomised Controlled Trial

IntroductionWhile total hip replacement (THR) and total knee replacement (TKR) successfully reduce pain associated with chronic joint pathology, this infrequently translates into increased physical activity. This is a challenge given that over 50% of individuals who undergo these operations are physically inactive and have medical comorbidities such as hypertension, heart disease, diabetes and depression. The impact of these diseases can be reduced with physical activity. This trial aims to investigate the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after THR or TKR.Methods and analysisThe PEP-TALK trial is a multicentre, open-labelled, pragmatic randomised controlled trial. 260 adults who are scheduled to undergo a primary unilateral THR or TKR and are moderately inactive or inactive, with comorbidities, will be recruited across eight sites in England. They will be randomised post-surgery, prior to hospital discharge, to either six, 30 min weekly group-based exercise sessions (control), or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour approach discussion group. Participants will be followed-up to 12 months by postal questionnaire. The primary outcome is the University of California, Los Angeles (UCLA) Physical Activity Score at 12 months. Secondary outcomes include: physical function, disability, health-related quality of life, kinesiophobia, perceived pain, self-efficacy and health resource utilisation.Ethics and disseminationResearch ethics committee approval was granted by the NRES Committee South Central (Oxford B - 18/SC/0423). Dissemination of results will be through peer-reviewed, scientific journals and conference presentations.Trial registration numberISRCTN29770908.

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Chronic fatigue and post-exertional malaise in people living with long COVID

10.1101/2021.06.11.21258564 ◽

2021 ◽

Author(s):

Rosie Twomey ◽

Jessica DeMars ◽

Kelli Franklin ◽

S. Nicole Culos-Reed ◽

Jason Weatherald ◽

...

Keyword(s):

Online Survey ◽

Symptom Burden ◽

Chronic Fatigue ◽

Sitting Time ◽

Allied Health Professionals ◽

Physically Active ◽

Fatigue Syndrome ◽

Symptom Exacerbation ◽

Dysfunctional Breathing ◽

The Impact

Purpose: People living with long COVID describe a high symptom burden, and a more detailed assessment of chronic fatigue and post-exertional malaise (PEM) may inform the development of rehabilitation recommendations. The aims of this study were to use validated questionnaires to measure the severity of fatigue and compare this with normative data and thresholds for clinical relevance in other diseases; measure and describe the impact of PEM; and describe symptoms of dysfunctional breathing, self-reported physical activity/sitting time, and health-related quality of life. Methods: This was an observational study involving an online survey for adults living with long COVID (data collection from February-April, 2021) following a confirmed or suspected SARS-CoV-2 infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) and DePaul Symptom Questionnaire-Post-Exertional Malaise. Results: After data cleaning, n=213 participants were included in the analysis. Participants primarily identified as women (85.5%), aged 40-59 (78.4%), who had been experiencing long COVID symptoms for ≥6 months (72.3%). The total FACIT-F score was 18±10 (where the score can range from 0-52, and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Post-exertional symptom exacerbation affected most participants, and 58.7% met the scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome. PEM occurred alongside a reduced capacity to work, be physically active, and function both physically and socially. Conclusion: Long COVID is characterized by chronic fatigue that is clinically relevant and is at least as severe as fatigue in several other clinical conditions, including cancer. PEM appears to be a common and significant challenge for the majority of this patient group. Patients, researchers, and allied health professionals are seeking information on safe rehabilitation for people living with long COVID, particularly regarding exercise. Fatigue and post-exertional symptom exacerbation must be monitored and reported in studies involving interventions for people with long COVID.

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Clinical and Laboratory Improvement in Hyperadrenergic Postural Orthostatic Tachycardia Syndrome (POTS) after COVID-19 Infection

Case Reports in Cardiology ◽

10.1155/2021/7809231 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Rebecca A. Ocher ◽

Erika Padilla ◽

Jonathan C. Hsu ◽

Pam R. Taub

Keyword(s):

Heart Rate ◽

Sinus Tachycardia ◽

Symptomatic Improvement ◽

Postural Orthostatic Tachycardia Syndrome ◽

Av Block ◽

Event Monitoring ◽

Inappropriate Sinus Tachycardia ◽

History Of ◽

The Impact ◽

Catecholamine Levels

A 32-year-old woman with a history of symptomatic supraventricular tachycardia, inappropriate sinus tachycardia, and hyperadrenergic POTS was treated with ivabradine and metoprolol. She then presented with bradycardia and Mobitz II second-degree AV block on event monitoring six weeks after COVID-19 infection. Her post-viral workup revealed normalization of catecholamine levels and significant symptomatic improvement in heart rate. To the authors’ knowledge, this is the first reported case of improvement in POTS after COVID-19 infection. As our understanding of COVID-19 continues to improve, it will be vital to better understand the impact of COVID-19 dysautonomia on cardiac patients.

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