The Differential Diagnosis of Dyspnea

Berliner, Dominik; Schneider, Nils; Welte, Tobias; Bauersachs, Johann

doi:10.3238/arztebl.2016.0834

Cited by 113 publications

(128 citation statements)

References 46 publications

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“…Breathlessness is reported by 25% of patients in the general daily ambulatory setting [1]. While coronary heart disease or chronic heart failure is the reason for dyspnea in approximately 11% of these cases, one may speculate that acute and chronic pulmonary diseases may be amongst the main causes for breathlessness [1, 2].…”

Section: Introductionmentioning

confidence: 99%

“…While coronary heart disease or chronic heart failure is the reason for dyspnea in approximately 11% of these cases, one may speculate that acute and chronic pulmonary diseases may be amongst the main causes for breathlessness [1, 2]. In addition to chronic obstructive pulmonary disease, which is mainly caused by smoking, restrictive lung diseases (RLDs), such as fibrosing interstitial lung disease (ILD), have an incidence rate of 19.36–34.34% per 100,000 patient-years, while nonspecific fibrosis showed the highest frequency with 7.5% in a population-based study in Denmark [3].…”

Section: Introductionmentioning

confidence: 99%

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Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes

Kopf

Groener²,

Κender³

et al. 2018

Respiration

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Background: Diabetes mellitus is a significant comorbidity of interstitial lung disease (ILD). Objectives: The aim of this study was to investigate the incidence of restrictive lung disease (RLD) and ILD in patients with prediabetes and type 2 diabetes (T2D). Methods: Forty-eight nondiabetics, 68 patients with prediabetes, 29 newly diagnosed T2D, and 110 patients with long-term T2D were examined for metabolic control, diabetes-related complications, breathlessness, and lung function. Five participants with T2D, breathlessness, and RLD underwent multidetector computed tomography (MDCT) and a Six-Minute Walk Test (6MWT). Lung tissue from 4 patients without diabetes and from 3 patients with T2D was histologically examined for presence of pulmonary fibrosis. Results: Breathlessness in combination with RLD was significantly increased in patients with prediabetes and T2D (p < 0.01). RLD was found in 9% of patients with prediabetes, in 20% of patients with newly diagnosed T2D, and in 27% of patients with long-term T2D. Thus, patients with long-term T2D had an increased risk of RLD (OR 5.82 [95% CI 1.71–20.5], p < 0.01). RLD was significantly associated with glucose metabolism and albuminuria (p < 0.01); furthermore, presence of nephropathy increased the risk of RLD (OR 8.57 [95% CI 3.4–21.9], p < 0.01) compared to nondiabetics. MDCT revealed ILD in 4 patients, the 6MWT correlated with the extent of ILD, and histological analysis showed fibrosing ILD in patients with T2D. Conclusions: This study demonstrates increased breathlessness and a high prevalence of RLD in patients with T2D, indicating an association between diabetes and fibrosing ILD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes

Kopf

Groener²,

Κender³

et al. 2018

Respiration

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“…Assim, sempre que possível, a autoavaliação da intensidade da dispneia deve ser o método de avaliação a utilizar. Atualmente existem várias escalas aptas para a autoavaliação da intensidade da dispneia (Berliner, Schneider, Welte, & Bauersachs, 2016). Destas, devido à sua objetividade e facilidade de compreensão e de aplicação, destaca-se a EAN (Johnson et al, 2016).…”

Section: Enquadramentounclassified

Dyspnea in palliative care: nursing records and self-assessment of dyspnea

Alves¹,

Pina²

2018

Rev. Enf. Ref.

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ResumoEnquadramento: Os registos de enfermagem (RE) que englobam uma avaliação quantitativa da dispneia permitem adequar a prestação de cuidados de enfermagem às necessidades do doente. Objetivos: Comparar os RE e a autoavaliação da intensidade da dispneia realizada com recurso à Escala de Avaliação Numérica (EAN) por indivíduos com doenças crónicas, progressivas e avançadas, com necessidades paliativas, internados em serviços de medicina interna. Metodologia: Realizou-se uma pesquisa quantitativa, descritiva, transversal e observacional através da aplicação de EAN da intensidade da dispneia. Recolheram-se RE de 77 selecionados de forma intencional e não aleatória. Resultados: Os enfermeiros diagnosticam corretamente a dispneia em repouso e/ou dispneia funcional sem recurso a uma escala de avaliação de dispneia. Não se observam intervenções autónomas de enfermagem em todos os indiví-duos com o diagnóstico de dispneia, bem como, as intervenções não abrangem todas as dimensões da dispneia total. Conclusão: Os RE quantitativos contribuem para maior rigor na identificação, monitorização e intervenção na dispneia. Considera-se necessária uma abordagem mais sistematizada da dispneia em indivíduos com necessidades paliativas. Palavras-chave: dispneia (enfermagem), dispneia (classificação), registros de enfermagem, cuidados paliativos, avaliação da dispneia AbstractBackground: The integration of a quantitative assessment of dyspnea in nursing records (NR) allows adjusting nursing care delivery to each patient's needs. Objectives: To compare NR and the self-assessment of dyspnea intensity using the Numerical Rating Scale (NRS) in patients with advanced progressive chronic disease and palliative care needs who were admitted to internal medicine wards. Methodology: A quantitative study was conducted using a cross-sectional, descriptive, and observational approach. The NRS was applied to assess dyspnea intensity. Seventy-seven NR were selected using a non-random, purposive sampling technique. Results: Nurses diagnosed dyspnea at rest and/or functional dyspnea correctly without using a dyspnea assessment tool. Not all patients diagnosed with dyspnea had nursing care plans. In addition, the specific nursing interventions do not consider all dimensions of total dyspnea. Conclusion: Quantitative NR allow for a more accurate identification, monitoring, and management of dyspnea. A more systematic approach to dyspnea in patients with palliative care needs is required.

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“…Being able to measure fluid overload building up before it causes severe symptoms would be an asset to manage CHF and/or COPD [38]. In COPD patients, both physical inactivity due to exercise intolerance and systemic inflammation may explain prevalent loss of fat-free mass.…”

Section: Fluid Overload and Body Composition (6/23)mentioning

confidence: 99%

“…Placement of CHF into this cluster is obvious. COPD was added to this cluster because some measurement parameters relevant for CVD and CHF also are relevant for COPD [38]. Prevalence of concealed (i.e.…”

Section: General Aspects For Wearable Medical Devicesmentioning

confidence: 99%

Wearable sensors: can they benefit patients with chronic kidney disease?

Wieringa

Broers

Kooman

et al. 2017

Expert Review of Medical Devices

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Introduction: This article ponders upon wearable medical measurement devices in relation to Chronic Kidney Disease (CKD) and its' associated comorbidities -and whether these might benefit CKD-patients. We aimed to map the intersection(s) of nephrology and wearable sensor technology to help technologists understand medical aspects, and clinicians to understand technological possibilities that are available (or soon will become so). Areas covered: A structured literature search on main comorbidities and complications CKD patients suffer from, was used to steer mini-reviews on wearable sensor technologies clustered around 3 themes being: Cardiovascular-related, diabetes-related and physical fitness/frailty. This review excludes wearable dialysis -although also strongly enabled by miniaturization -because that highly important theme deserves separate in-depth reviewing. Expert commentary: Continuous progress in integrated electronics miniaturization enormously lowered price, size, weight and energy consumption of electronic sensors, processing power, memory and wireless connectivity. These combined factors boost opportunities for wearable medical sensors. Such devices can be regarded as enablers for: Remote monitoring, influencing human behaviour (exercise, dietary), enhanced home care, remote consults, patient education and peer networks. However, to make wearable medical devices succeed, the challenge to fit them into health care structures will be dominant over the challenge to realize the bare technologies themselves. ARTICLE HISTORY

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The Differential Diagnosis of Dyspnea

Abstract: The many causes of dyspnea make it a diagnostic challenge. Its rapid evaluation and diagnosis are crucial for reducing mortality and the burden of disease.

Cited by 113 publications

References 46 publications

Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes

Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes

Dyspnea in palliative care: nursing records and self-assessment of dyspnea

Wearable sensors: can they benefit patients with chronic kidney disease?

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