Magnus Ekström1. 1. Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden.
Abstract
PURPOSE OF REVIEW: Treatments for chronic breathlessness, including opioids and oxygen, have shown efficacy in the controlled laboratory setting, whereas effects have been inconsistent or absent in trials in daily life. This review discusses the lack of standardized exertion as a potential cause of false negative findings for breathlessness in daily life. RECENT FINDINGS: The level of breathlessness can be modified by patients by changing their level of physical activity. Effects of opioids and oxygen have been shown at standardized level of exertion (iso-time) but not at the end of symptom-limited (peak) exertion. Trials in daily life reporting no effects on breathlessness did not standardize the exertion or employed insensitive methods, such as the 6-min walk test that should not be used for measuring breathlessness. Novel tests - the 3-min walk and stepping tests have been validated in chronic obstructive pulmonary disease and are responsive for measuring change in breathlessness. SUMMARY: Breathlessness should be measured at standardized exertion, otherwise treatment effects may be biased or overlooked. Tests for valid measurement of breathlessness in clinical practice and daily life are available and emerging.
PURPOSE OF REVIEW: Treatments for chronic breathlessness, including opioids and oxygen, have shown efficacy in the controlled laboratory setting, whereas effects have been inconsistent or absent in trials in daily life. This review discusses the lack of standardized exertion as a potential cause of false negative findings for breathlessness in daily life. RECENT FINDINGS: The level of breathlessness can be modified by patients by changing their level of physical activity. Effects of opioids and oxygen have been shown at standardized level of exertion (iso-time) but not at the end of symptom-limited (peak) exertion. Trials in daily life reporting no effects on breathlessness did not standardize the exertion or employed insensitive methods, such as the 6-min walk test that should not be used for measuring breathlessness. Novel tests - the 3-min walk and stepping tests have been validated in chronic obstructive pulmonary disease and are responsive for measuring change in breathlessness. SUMMARY:Breathlessness should be measured at standardized exertion, otherwise treatment effects may be biased or overlooked. Tests for valid measurement of breathlessness in clinical practice and daily life are available and emerging.
Authors: Cornelia A Verberkt; Marieke H J van den Beuken-van Everdingen; Jos M G A Schols; Niels Hameleers; Emiel F M Wouters; Daisy J A Janssen Journal: JAMA Intern Med Date: 2020-10-01 Impact factor: 21.873
Authors: Susan S Jacobs; Jerry A Krishnan; David J Lederer; Marya Ghazipura; Tanzib Hossain; Ai-Yui M Tan; Brian Carlin; M Bradley Drummond; Magnus Ekström; Chris Garvey; Bridget A Graney; Beverly Jackson; Thomas Kallstrom; Shandra L Knight; Kathleen Lindell; Valentin Prieto-Centurion; Elisabetta A Renzoni; Christopher J Ryerson; Ann Schneidman; Jeffrey Swigris; Dona Upson; Anne E Holland Journal: Am J Respir Crit Care Med Date: 2020-11-15 Impact factor: 21.405
Authors: Hayley Lewthwaite; Emily M Koch; Magnus Ekström; Alan Hamilton; Jean Bourbeau; François Maltais; Benoit Borel; Dennis Jensen Journal: J Thorac Dis Date: 2020-05 Impact factor: 3.005