scholarly journals Dysfunctional breathing and reaching one’s physiological limit as causes of exercise-induced dyspnoea

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 120-129 ◽  
Author(s):  
Julie Depiazzi ◽  
Mark L. Everard
Keyword(s):  
Drug Therapy ◽  
Cardiopulmonary Exercise Testing ◽  
Cost Effective ◽  
List Type ◽  
Accurate Assessment ◽  
Key Points ◽  
Physiological Limit ◽  
Young Subjects ◽  
Dysfunctional Breathing ◽  
Exercise Induced

Key pointsExcessive exercise-induced shortness of breath is a common complaint. For some, exercise-induced bronchoconstriction is the primary cause and for a small minority there may be an alternative organic pathology. However for many, the cause will be simply reaching their physiological limit or be due to a functional form of dysfunctional breathing, neither of which require drug therapy.The physiological limit category includes deconditioned individuals, such as those who have been through intensive care and require rehabilitation, as well as the unfit and the fit competitive athlete who has reached their limit with both of these latter groups requiring explanation and advice.Dysfunctional breathing is an umbrella term for an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms, which may be respiratory and/or nonrespiratory. This alteration may be due to structural causes or, much more commonly, be functional as exemplified by thoracic pattern disordered breathing (PDB) and extrathoracic paradoxical vocal fold motion disorder (pVFMD).Careful history and examination together with spirometry may identify those likely to have PDB and/or pVFMD. Where there is doubt about aetiology, cardiopulmonary exercise testing may be required to identify the deconditioned, unfit or fit individual reaching their physiological limit and PDB, while continuous laryngoscopy during exercise is increasingly becoming the benchmark for assessing extrathoracic causes.Accurate assessment and diagnosis can prevent excessive use of drug therapy and result in effective management of the cause of the individual’s complaint through cost-effective approaches such as reassurance, advice, breathing retraining and vocal exercises.This review provides an overview of the spectrum of conditions that can present as exercise-­induced breathlessness experienced by young subjects participating in sport and aims to promote understanding of the need for accurate assessment of an individual’s symptoms. We will highlight the high incidence of nonasthmatic causes, which simply require reassurance or simple interventions from respiratory physiotherapists or speech pathologists.

scholarly journals Diagnosis in children with exercise-induced respiratory symptoms: a multi-centre study

2020 ◽  
Author(s):  
Eva SL Pedersen ◽  
Cristina Ardura-Garcia ◽  
Carmen CM de Jong ◽  
Anja Jochmann ◽  
Alexander Moeller ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Respiratory Symptoms ◽  
Final Diagnosis ◽  
Diagnostic Evaluation ◽  
Outpatient Clinics ◽  
List Type ◽  
Multi Centre Study ◽  
Dysfunctional Breathing ◽  
Exercise Induced

AbstractObjectiveExercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the referring primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests performed and treatment prescribed after the diagnostic evaluation.DesignObservational study nested in the Swiss Paediatric Airway Cohort (SPAC), which includes respiratory outpatients aged 0-16 years.PatientsWe included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records.Results214 were referred for EIS (mean age 12 years, 99 (46%) female). The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%). Spirometry, body plethysmography and measurements of exhaled nitric oxide were performed in almost all; exercise-challenge tests in a third. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy.ConclusionsDiagnosis given at the outpatient clinic often differed from the diagnosis suspected by the referring physician. Diagnostic evaluation, management and follow-up were inconsistent between clinics and diagnostic groups, highlighting the need for diagnostic guidelines in children seen for EIS.Mandatory statements for Archives of Disease in ChildhoodWhat is already known on this topic (2-3 statements of max 25 words)Exercise-induced symptoms are common in childhood but not easy to diagnose because different diagnoses share similar clinical presentationsOnly few studies focused on children with exercise-induced symptoms and all have included selected groups of patients with difficult-to-diagnose problemsWhat this study adds (2-3 statements of max 25 words)Exercise-induced respiratory symptoms was the main reason for referral in one fifth of the children referred to paediatric respiratory outpatient clinics.Dysfunctional breathing is an under-recognised diagnosis; it was frequently diagnosed in the outpatient clinic (in 37%) but rarely suspected by the referring physician (6%)Diagnostic evaluation, management, and follow-up were inconsistent between clinics highlighting the need for diagnostic guidelines in children seen for EIS.

scholarly journals Reported symptoms differentiate diagnoses in children with exercise-induced respiratory problems: findings from the Swiss Paediatric Airway Cohort (SPAC)

2020 ◽  
Author(s):  
Eva SL Pedersen ◽  
Carmen CM de Jong ◽  
Cristina Ardura-Garcia ◽  
Maria Christina Mallet ◽  
Juerg Barben ◽  
...  
Keyword(s):  
Late Onset ◽  
Outpatient Clinics ◽  
Relative Risk Ratio ◽  
List Type ◽  
Multinomial Regression ◽  
Management Guidelines ◽  
Respiratory Problems ◽  
Clinical Presentations ◽  
Dysfunctional Breathing ◽  
Exercise Induced

AbstractBackgroundExercise-induced breathing problems with similar clinical presentations can have different aetiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult.ObjectiveWe studied which parent-reported, exercise-induced symptoms (EIS) can help distinguish diagnoses of EIS in children seen in respiratory outpatient clinics.MethodsThis study was nested in the Swiss Paediatric Airway Cohort (SPAC), an observational study of children aged 0-17 years referred to paediatric respiratory outpatient clinics in Switzerland. We studied children aged 6-17 years and compared information on EIS from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyse whether parent-reported symptoms differed between diagnoses (asthma as base).ResultsAmong 1109 children, EIS were reported for 732 (66%) (mean age 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnoea best distinguished thoracic DB (relative risk ratio [RRR] 5.4, 95%CI 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR 2.4, 95%CI 1.3-6.2) and asthma plus DB (RRR 1.8, 95%CI 0.9-3.4) from asthma only. Late onset of EIS was less common for extrathoracic DB (RRR 0.1, 95%CI 0.03-0.5) and thoracic DB (RRR 0.4, 95%CI 0.1-1.2) compared with asthma. Localisation of dyspnoea (throat vs. chest) differed between extrathoracic DB (RRR 2.3, 95%CI 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses.ConclusionParent-reported symptoms help distinguish different diagnoses in children with EIS. This highlights the importance of physicians obtaining detailed patient histories.Highlights boxWhat is already known about this topic?Experts suggest that information about the symptoms and their onset and duration can assist accurate diagnosis of children with exercise-induced respiratory problems, but no original studies have tested this. (29/35 words)What does this article add to our knowledge?Exercise-induced symptoms reported by parents and further information about their onset, triggers, and effects of treatment help differentiate diagnoses in children with exercise-induced respiratory problems. (25/35 words)How does this study impact current management guidelines?Our results emphasize the importance of taking detailed symptom histories of children with exercise-induced problems, and suggest which questions are most helpful.

scholarly journals Comparison of Saliva and Mid-Turbinate Swabs for Detection of COVID-19

2021 ◽  
Author(s):  
Jianyu Lai ◽  
Jennifer German ◽  
Filbert Hong ◽  
S.-H. Sheldon Tai ◽  
Kathleen M. McPhaul ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Screening Tool ◽  
Cost Effective ◽  
Probability Of Detection ◽  
List Type ◽  
Viral Detection ◽  
Suitable Alternative ◽  
High Agreement ◽  
Key Points ◽  
Nasal Swabs

AbstractBackgroundSaliva is an attractive sample for detecting SARS-CoV-2 because it is easy to collect and minimally invasive. However, contradictory reports exist concerning the sensitivity of saliva versus nasal swabs.MethodsWe recruited and followed close contacts of COVID-19 cases for up to 14 days from their last exposure and collected self-reported symptoms, mid-turbinate swabs (MTS) and saliva every two or three days. Ct values and frequency of viral detection by MTS and saliva were compared. Logistic regression was used to estimate the probability of detection by days since symptom onset for the two sample types.ResultsWe enrolled 58 contacts who provided a total of 200 saliva and MTS sample pairs; 14 contacts (13 with symptoms) had one or more positive samples. Overall, saliva and MTS had similar rates of viral detection (p=0.78). Although Ct values for saliva were significantly greater than for MTS (p=0.014), Cohen’s Kappa demonstrated substantial agreement (κ=0.83). However, sensitivity varied significantly with time relative to symptom onset. Early in the course of infection (days -3 to 2), saliva had 12 times (95%CI: 1.2, 130) greater likelihood of detecting viral RNA compared to MTS. After day 2, there was a non-significant trend to greater sensitivity using MTS samples.ConclusionSaliva and MTS specimens demonstrated high agreement, making saliva a suitable alternative to MTS nasal swabs for COVID-19 detection. Furthermore, saliva was more sensitive than MTS early in the course of infection, suggesting that it may be a superior and cost-effective screening tool for COVID-19.Key PointsSaliva is more sensitive in detecting symptomatic cases of COVID-19 than MTS early in the course of infection.Saliva performs best in the pre-symptomatic period.Saliva and MTS demonstrated high agreement making saliva a suitable and cost-effective COVID-19 screening tool.

scholarly journals The Need for Testing—The Exercise Challenge Test to Disentangle Causes of Childhood Exertional Dyspnea

2022 ◽  
Vol 9 ◽  
Author(s):  
Vera S. Hengeveld ◽  
Mattiènne R. van der Kamp ◽  
Boony J. Thio ◽  
John D. Brannan
Keyword(s):  
Challenge Test ◽  
Real Life ◽  
Common Symptom ◽  
Exertional Dyspnea ◽  
Asthmatic Children ◽  
Exercise Challenge ◽  
Common Causes ◽  
Physiological Limit ◽  
Dysfunctional Breathing ◽  
Exercise Induced

Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom. Common causes of exertional dyspnea are exercise induced bronchoconstriction (EIB), dysfunctional breathing, physical deconditioning and the sensation of dyspnea when reaching the physiological limit. These causes frequently coexist, trigger one another and have overlapping symptoms, which can impede diagnoses and treatment. In the majority of children with exertional dyspnea, EIB is not the cause of symptoms, and in asthmatic children it is often not the only cause. An exercise challenge test (ECT) is a highly specific tool to diagnose EIB and asthma in children. Sensitivity can be increased by simulating real-life environmental circumstances where symptoms occur, such as environmental factors and exercise modality. An ECT reflects daily life symptoms and impairment, and can in an enjoyable way disentangle common causes of exertional dyspnea.

Modern devices for treatment of the surgeon’s hands and the surgical field (literature review)

2020 ◽  
pp. 41-50
Author(s):  
Artem Mikhailovich Morozov ◽  
◽  
Alexey Nikolaevich Sergeev ◽  
Gennady Alexandrovich Dubatolov ◽  
Nikolay Alexandrovich Sergeev ◽  
...  
Keyword(s):  
Cost Effective ◽  
Surgical Infection ◽  
Operating Field ◽  
Functional Additives ◽  
Literary Sources ◽  
Film Forming ◽  
Key Points ◽  
Surgical Field ◽  
Ammonium Compounds ◽  
Active Substances

The aim – analyze modern Russian and foreign literary sources in order to determine modern means for treating the hands of the surgeon and the operating field. Results. One of the key points in the prevention of surgical infection is the treatment of the surgeon’s hands and the operating field with effective skin antiseptics in order to destroy pathogenic and opportunistic microorganisms that colonize intact skin. In modern practice, skin antiseptics are predominantly used containing alcohols as active substances, in particular ethyl, propyl and isopropyl, halogenated substances such as iodine and iodophores, guanidines, which include chlorhexidine digluconate, as well as quaternary ammonium compounds. Moreover, the most widespread are combined preparations containing several active substances and functional additives, which makes it possible to neutralize the negative properties of various active substances. Also, an interesting and promising direction is the use of polymer operating films or film-forming antiseptics. Currently, research is being actively carried out aimed at finding and developing modern highly effective antiseptic agents and their rational combinations that meet the necessary requirements, are optimal in their properties, cost-effective and comfortable to use.

scholarly journals Reference values for maximum oxygen uptake relative to body mass in Dutch/Flemish subjects aged 6–65 years: the LowLands Fitness Registry

2021 ◽  
Author(s):  
Geertje E. van der Steeg ◽  
Tim Takken
Keyword(s):  
Oxygen Uptake ◽  
Body Mass ◽  
Reference Values ◽  
Cardiopulmonary Exercise Testing ◽  
European Population ◽  
Study Data ◽  
Mean Difference ◽  
Maximum Oxygen Uptake ◽  
List Type ◽  
Maximum Effort

Abstract Background The maximum oxygen uptake (VO2max) during cardiopulmonary exercise testing (CPET) is considered the best measure of cardiorespiratory fitness. Aim To provide up-to-date reference values for the VO2max per kilogram of body mass (VO2max/kg) obtained by CPET in the Netherlands and Flanders. Methods The Lowlands Fitness Registry contains data from health checks among different professions and was used for this study. Data from 4612 apparently healthy subjects, 3671 males and 941 females, who performed maximum effort during cycle ergometry were analysed. Reference values for the VO2max/kg and corresponding centile curves were created according to the LMS method. Results Age had a negative significant effect (p < .001) and males had higher values of VO2max/kg with an overall difference of 18.0% compared to females. Formulas for reference values were developed: Males: VO2max/kg = − 0.0049 × age2 + 0.0884 × age + 48.263 (R2 = 0.9859; SEE = 1.4364) Females: VO2max/kg = − 0.0021 × age2 − 0.1407 × age + 43.066 (R2 = 0.9989; SEE = 0.5775). Cross-validation showed no relevant statistical mean difference between measured and predicted values for males and a small but significant mean difference for females. We found remarkable higher VO2max/kg values compared to previously published studies. Conclusions This is the first study to provide reference values for the VO2max/kg based on a Dutch/Flemish cohort. Our reference values can be used for a more accurate interpretation of the VO2max in the West-European population.

scholarly journals Sporulation in solventogenic and acetogenic clostridia

2021 ◽  
Author(s):  
Mamou Diallo ◽  
Servé W. M. Kengen ◽  
Ana M. López-Contreras
Keyword(s):  
Current Knowledge ◽  
Carbon Sources ◽  
Cost Effective ◽  
Biotechnological Production ◽  
Key Points ◽  
Wide Range ◽  
Potential Applications ◽  
A Cell ◽  
Sporulation Initiation ◽  
Solventogenic Clostridia

AbstractThe Clostridium genus harbors compelling organisms for biotechnological production processes; while acetogenic clostridia can fix C1-compounds to produce acetate and ethanol, solventogenic clostridia can utilize a wide range of carbon sources to produce commercially valuable carboxylic acids, alcohols, and ketones by fermentation. Despite their potential, the conversion by these bacteria of carbohydrates or C1 compounds to alcohols is not cost-effective enough to result in economically viable processes. Engineering solventogenic clostridia by impairing sporulation is one of the investigated approaches to improve solvent productivity. Sporulation is a cell differentiation process triggered in bacteria in response to exposure to environmental stressors. The generated spores are metabolically inactive but resistant to harsh conditions (UV, chemicals, heat, oxygen). In Firmicutes, sporulation has been mainly studied in bacilli and pathogenic clostridia, and our knowledge of sporulation in solvent-producing or acetogenic clostridia is limited. Still, sporulation is an integral part of the cellular physiology of clostridia; thus, understanding the regulation of sporulation and its connection to solvent production may give clues to improve the performance of solventogenic clostridia. This review aims to provide an overview of the triggers, characteristics, and regulatory mechanism of sporulation in solventogenic clostridia. Those are further compared to the current knowledge on sporulation in the industrially relevant acetogenic clostridia. Finally, the potential applications of spores for process improvement are discussed.Key Points• The regulatory network governing sporulation initiation varies in solventogenic clostridia.• Media composition and cell density are the main triggers of sporulation.• Spores can be used to improve the fermentation process.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

Sign in / Sign up

Export Citation Format

Share Document