Document Detail

Management of dyspnea in severe chronic obstructive pulmonary disease.
MedLine Citation:
PMID:  10869878     Owner:  NLM     Status:  MEDLINE    
Progression of chronic obstructive pulmonary disease (COPD) is frequently associated with increasing dyspnea; indeed, patients with severe COPD constitute the largest group of patients with chronic respiratory insufficiency. The sensation of dyspnea in these patients is mostly related to increased work of breathing, a consequence of an increased resistive load, of hyperinflation, and of the deleterious effect of intrinsic positive end-expiratory pressure (PEEP(i)). Once optimal medical treatment has been provided, pharmacological treatments of dyspnea exist (beta2-agonists, methylxanthines, opiates) but seldom suffice. Nonpharmacological complementary treatments must be envisioned. Patients with severe hyperinflation should be screened as possible candidates for lung reduction surgery. Pulmonary rehabilitation-including chest therapy, patient education, exercise training-has been established as effective on quality of life (QoL) and dyspnea. Noninvasive positive pressure devices may be effective for symptomatic treatment of severe dyspnea: continuous positive airway pressure (CPAP) counteracts the deleterious effect of PEEP(i) in patients with severe hyperinflation; intermittent positive pressure breathing (IPPB) may decrease dyspnea and discomfort during nebulized therapy; finally noninvasive positive pressure ventilation (NIPPV) has been shown to be effective on the sensation of dyspnea and QoL in COPD with severe hypercapnia.
J P Janssens; B de Muralt; V Titelion
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of pain and symptom management     Volume:  19     ISSN:  0885-3924     ISO Abbreviation:  J Pain Symptom Manage     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-08-01     Completed Date:  2000-08-01     Revised Date:  2006-08-15    
Medline Journal Info:
Nlm Unique ID:  8605836     Medline TA:  J Pain Symptom Manage     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  378-92     Citation Subset:  IM    
Center for Pulmonary Rehabilitation, Hôpital de Rolle, Vaud, Switzerland.
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MeSH Terms
Dyspnea / diagnosis*,  etiology*,  physiopathology,  therapy
Lung / surgery
Lung Diseases, Obstructive / complications*
Positive-Pressure Respiration / methods

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