Respiratory medicine
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Respiratory medicine · Mar 2007
ReviewPsychological aspects in the perception of dyspnea in obstructive pulmonary diseases.
Dyspnea is an impairing symptom in obstructive pulmonary diseases. Besides multiple physiological pathways contributing to this sensation recent research has demonstrated an important role of psychological factors in the perception of dyspnea. The present review article synthesizes the research literature with regard to psychological aspects of the perception of dyspnea as well as other dyspnea-related issues such as course of disease, neuropsychological correlates and interventions that focus on psychological or behavioural changes. ⋯ Neuropsychological deficits might further contribute to this association. Different psychological and behavioural interventions might reduce comorbid psychological disorders and thus improve the perception of dyspnea. However, future research is clearly required to substantiate current findings.
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Respiratory medicine · Mar 2007
Comparative StudyClinical characteristics and outcomes of empyema thoracis in 117 patients: a comparative analysis of tuberculous vs. non-tuberculous aetiologies.
Empyema thoracis remains a major problem in developing countries. Clinical outcomes in tuberculous empyema are generally believed to be worse than in non-tuberculous aetiologies because of the presence of concomitant fibrocavitary parenchymal disease, frequent bronchopleural fistulae and poor general condition of patients. We performed a prospective study over a 2-year period with the objective of comparing the clinical characteristics and outcomes of patients with tuberculous vs. non-tuberculous empyema. ⋯ Tuberculous empyema remains a common cause of thoracic empyema in India though it ranked second amongst all causes of empyema after community acquired lung infections in this study. Tuberculous empyema is associated with longer duration of symptoms, greater duration of pleural drainage and more residual pleural fibrosis.
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Respiratory medicine · Mar 2007
Randomized Controlled Trial Multicenter StudyAdjunct armodafinil improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome.
Armodafinil is the R-enantiomer of racemic modafinil and has a significantly longer half-life than the S-enantiomer. This study evaluated armodafinil 150 mg/day as an adjunct treatment for residual excessive sleepiness in patients with obstructive sleep apnea/hypopnea syndrome (OSA/HS) who were otherwise well controlled with nasal continuous positive airway pressure (nCPAP). We assessed the ability of armodafinil to improve wakefulness and cognition and reduce fatigue in this population. ⋯ Adjunct treatment with armodafinil significantly improved alertness, overall clinical condition, and long-term memory. Armodafinil also reduced fatigue and the impact of sleepiness on daily activities in patients with OSA/HS who have residual excessive sleepiness notwithstanding regular use of nCPAP. Armodafinil was well tolerated.
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Respiratory medicine · Mar 2007
ReviewMeasurement of breathlessness in advanced disease: a systematic review.
There is a plethora of assessment tools available to measure breathlessness, the most common and disabling symptom of advanced cardio-respiratory disease. The aim of this systematic review was to identify all measures available via standard search techniques and review their usefulness for patients with advanced disease. ⋯ As yet there is no one scale that can accurately reflect the far-reaching effects of breathlessness on the patient with advanced disease and their family. Therefore, at present, we would recommend combining a unidimensional scale (e.g. VAS) with a disease-specific scale (where available) or a multidimensional scale in conjunction with other methods (such as qualitative techniques) to gauge psychosocial and carer distress for the assessment of breathlessness in advanced disease.