Dyspnea—When a Sensation Becomes a Symptom

Schwartzstein, Richard M.

doi:10.1001/jama.2022.19248

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…However, studies were small with a maximum 7-day duration. Two subsequent phase 3 RCTs (20 mg morphine versus placebo) showed no benefit for breathlessness [ 16 , 17 ] at 7 days, but interpretation of results was hindered in the 2020 RCT by the inclusion of less severely breathless participants (modified Medical Research Council (mMRC) breathlessness scale 2) and allowable “as-needed” immediate-release morphine in both arms [ 16 ], and in the 2022 RCT by the lack of standardised exercise testing [ 17 , 18 ]. Of note, an exploratory substudy of the 2022 RCT showed a signal of benefit regarding increased level of physical activity and active calories in the morphine arms [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol

et al. 2023

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Chronic breathlessness, a persistent and disabling symptom despite optimal treatment of underlying causes, is a frightening symptom with serious and widespread impact on patients and their carers. Clinical guidelines support the use of morphine for the relief of chronic breathlessness in common long-term conditions, but questions remain around clinical effectiveness, safety and longer-term (>7 days) administration. This trial will evaluate the effectiveness of low-dose oral modified release morphine in chronic breathlessness.This is a multicentre, parallel group, double-blind, randomised, placebo-controlled trial. Participants [n=158] will be opioid-naïve with chronic breathlessness due to heart or lung disease, cancer or post-COVID-19. Participants will be randomised 1:1 to 5 mg oral modified-release morphine/placebo twice daily and docusate/placebo 100 mg twice daily for 56 days. Non-responders at Day 7 will dose escalate to 10 mg morphine/placebo twice daily at Day 15.The primary endpoint (Day 28) measure will be worst breathlessness severity (past 24 h). Secondary outcome measures include worst cough, distress, pain; functional status; physical activity; quality of life; and early identification and management of morphine-related side effects. At Day 56, participants may opt to take open-label, oral modified-release morphine as part of usual care and complete quarterly breathlessness and toxicity questionnaires.The study is powered to be able to reject the null hypothesis and an embedded normalisation process theory-informed qualitative sub-study will explore the adoption of morphine as a first-line pharmacological treatment for chronic breathlessness in clinical practice if effective.

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Section: Introductionmentioning

confidence: 99%

Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol

et al. 2023

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Goals of chronic obstructive pulmonary disease management: a focused review for clinicians

Raghavan,

Hatipoğlu,

Aboussouan

2024

Current Opinion in Pulmonary Medicine

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Purpose of review The diagnosis of chronic obstructive pulmonary disease (COPD) encompasses heterogeneous pathophysiological mechanisms which can shape an individual patient's experience. This paper reviews available therapeutic options for the clinician intending to individualize care toward patient goals. Recent findings The contemporary targeted interventions for COPD include the novel phosphodiesterase inhibitor ensifentrine, the interleukin-4 receptor (IL4R alpha subunit) antibody dupilumab, augmentation therapy for alpha-1 antitrypsin deficiency. Other interventions promoting physical and mental well being include re-envisioned pulmonary rehabilitation, self-management, targeting of comorbidities such as sarcopenia, and virtual health coaching interventions to expand patient access. Opioids did not relieve dyspnea and did not change total step count. Summary Advances in precision therapy are complemented by the discovery of novel pathophysiology pathways and behavioral and rehabilitation interventions as a holistic view of COPD management emerges. The management of COPD continues to evolve with new tools including precision medicine and individualized care. Comorbidities remain important determinants of health, yet their prevalence and impact are underestimated.

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Physical Activity Enforces Well-being or Shame in Children and Adolescents With Asthma: A Meta-ethnography

Westergren,

Aagaard,

Hall

et al. 2024

INQUIRY

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Asthma symptoms and experiences of dyspnea challenge participation in physical activity (PA). Therefore, in-depth understanding of experiences with PA is essential. In this meta-ethnography, we synthesized published qualitative studies of experiences of children and adolescents with asthma that influenced, or limited, participation in PA. We followed Noblit and Hare’s 7 phases of meta-ethnography. We searched relevant databases by December 18, 2023 for published peer-reviewed studies (Medline (OVID), Embase (OVID), PsycINFO (OVID), CINAHL (EBSCHOhost), SPORTDiscus (EBSCHOhost), SocINDEX (EBSCHOhost), and Social Science Citation Index (WoS)) and theses (ProQuest Nursing & Allied Health Source, ProQuest Healthcare Administration Database, and ProQuest Public Health Database). We conducted study selection and assessment of methodological quality and data extraction using Joanna Briggs Institute’s methodology. Sixteen reciprocally related qualitative studies, representing experiences of 238 children and adolescents aged 4 to 18 years were included. We translated primary study concepts and findings into 3 themes covering relationships with others, emotions, and behaviors related to PA participation: (1) feeling related to and connected with friends and family in PA; (2) acquiring and managing new PA and asthma skills; and (3) enjoying PA and experiencing well-being. We also defined 3 themes covering aspects related to PA limitations: (4) feeling misunderstood and penalized in relation to PA; (5) experiencing nervousness, embarrassment, shame, and sadness during PA; and (6) withdrawing from PA due to asthma, environment, and/or socially imposed attitudes. The themes were synthesized into the following lines of argument: children and adolescents with asthma experience that PA enforces empathic/non-empathic relationships, vulnerability, and awareness; PA enhances resilient participation and well-being, or reinforces resignment to isolation and shame. From the outset of either relatedness or being penalized, youngsters with asthma either manage well and experience well-being, or experience shame and withdrawal. Registration: PROSPERO No. 164797

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Dyspnea—When a Sensation Becomes a Symptom

Cited by 3 publications

References 13 publications

Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol

Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol

Goals of chronic obstructive pulmonary disease management: a focused review for clinicians

Physical Activity Enforces Well-being or Shame in Children and Adolescents With Asthma: A Meta-ethnography

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