• Title/Summary/Keyword: 호흡곤란 환자

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A Case of a Huge Mass Due to Pleural Metastasis and Management of Dyspnea in a Patient with Terminal Breast Cancer (말기 유방암 환자에서 발생한 흉막 전이에 의한 거대 종양 1예와 호흡곤란의 치료)

  • Lee, Na Ri
    • Journal of Hospice and Palliative Care
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    • v.17 no.2
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    • pp.85-89
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    • 2014
  • Pleural metastasis from breast cancer is a common manifestation. While pleural effusion is the most frequent finding, it is relatively rare for pleural nodularity and plaque that do not accompany pleural effusion. We report a patient with a rapidly growing huge pleural mass without pleural effusion caused by breast cancer. The patient was treated for severe dyspnea caused by the pleural mass. Along with the case report, we performed a systematic review of management of dyspnea in terminal cancer patients.

Assessment of the Relationship between Pulmonary Function Test and Dyspnea Index in Patients with Bronchial Asthma (기관지천식 환자에서 폐기능검사와 호흡곤란지수의 관련성에 관한 연구)

  • Kim, Se-Kyu;Cheon, Seon-Hee;Chang, Joon;Ha, Jong-Won;Hong, Chein-Soo;Kim, Sung-Kyu;Lee, Won-Young
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.5
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    • pp.392-399
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    • 1992
  • Background: Despite dyspnea is a predominant complaint of patients with respiratory disease, the mechanisms contributing to the sensation of breathlessness are poorly understood. Traditionally, physicians have measured objective pulmonary function to assess severity of dyspnea. But it will be also useful to measure subjective dyspnea index because dyspnea probably depends on a complex interplay of mechanical, experimental, emotional and other factors. Method: We measured breathlessness at rest, after Methacholine challenge and then bronchodilator inhalation using a Visual Analogue Scale (VAS) and Borg Scale Dyspnea Index (BSDI) in stable asthmatic patients. Spirometry was performed concomittently. Results: There was no correlation between dyspnea index and FEV1. There was also no correlation between the change in dyspnea index and change in FEV1. The change in dyspnea index after methacholine and bronchodilator was greater in clinically mild asthmatic patients than clinically severe symptomatic group. Conclusion: In asthmatic patients, there was a wide variation in sensory response for any given FEV1, and the change in perception of dyspnea was greater in those with clinically mild symptoms. The measurement of dyspnea index may yield information complementary to that obtained by spirometry.

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Pulmonary Function, Dyspnea and SGRQ in Patients With COPD (만성 폐쇄성 폐질환자의 폐기능, 주관적인 호흡곤란정도 및 SGRQ와의 상관관계)

  • Kang, In-Soon;Jeon, Jeong-Hae
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.10 no.8
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    • pp.2134-2140
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    • 2009
  • The purpose of this study is to compare relationship among pulmonary function, dyspnea, and health-related quality of life in patients with COPD. The instruments were used FEV1(%), the Baseline Dyspnea Index(BDI), the Medical Research Council Scale(MRCS), and the St. George's respiratory questionnaire(SGRQ). Dyspnea of patients with moderate and severe stage were deeper than one of patients with mild stage(BDI F=5.452, p=.007; MRCS F=4.925, p=.011). And health-related quality of life of patients with severe stage were poorer than one of patients with mild stage(F=3.778, p=.030). There were significant, but weak, correlations between scores of the BDI(r=.471), the MRCS(r=-.403), the SGRQ(r=-.476) and FEV1. There were strong correlations between scores of the BDI(r=-.752), the MRCS(r=.645) and the SGRQ. And FEV1 didn't correlated with the BDI, the MRCS, and the SGRQ scores in patient of moderate stage and severe stage. But there were also strong correlations between the BDI(r=-.719), the MRCS(r=.607) and the SGRQ in patient of moderate stage and severe stage. Specially, correlation between the BDI and the SGRQ were higher than one between the MRCS and the SGRQ. In conclusion, Using the BDI for evaluation of the subjective dyspnea with objective pulmonary functional test in patients with COPD, it will able to grasp the health-related quality of life.

Relationship between Dyspnea and Disease Severity, Quality of Life, and Social Factor in Patients with Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환자에서 질병 중증도 및 삶의 질을 비롯한 사회적 요인과 호흡곤란과의 관계)

  • Kim, Eun-Jin;Park, Jae-Hyung;Yoon, Suk-Jin;Lee, Seung-Jun;Cha, Seung-Ick;Park, Jae-Yong;Jung, Tae-Hoon;Kim, Chang-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.4
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    • pp.397-403
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    • 2006
  • Background: Chronic obstructive pulmonary disease(COPD) is categorized by the percentage of the predicted $FEV_1$(Forced expiratory volume in 1 second) result which is highly correlated with disease severity(morbidity and mortality). In COPD patients, dyspnea seems to be different from disease severity. We investigated whether dyspnea is correlated with disease severity, as measured by $FEV_1$, quality of life(QoL), occupation, and supporting level of family members and neighbors. Method: Thirty-six clinically stable patients with chronically irreversible airflow limitation were enrolled. We used the Medical Research Council(MRC) dyspnea scale to assess the level of dyspnea and the Korean St. Goerge's respiratory questionnaire(SGRQ) as measure the QoL. Result: The mean percentage of the predicted $FEV_1$ was 32.0%. Dyspnea was not correlated with GOLD stage using $FEV_1$(p=0.114). With deteriorating level of dyspnea the scores of symptoms(p=0.041), activity(p=0.004), impact(p=0.001), and total SGRQ score(p<0.001) were significantly increased. Dyspnea was not correlated with the level of occupation(p=0.259). The supporting level of family members and neighbors was significantly negatively correlated with dyspnea scale(p=0.011). Conclusion: In the management of COPD patients, we have to remember that the level of subjective dyspnea is correlated with QoL(symptom, activity and impact on society) and social supporting level as well as GOLD stage($FEV_1$).

The Effects of Self-Efficacy Promoting Pulmonary Rehabilitation Program in Out-Patients with Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환 외래환자에서 자기효능감증진 호흡재활프로그램의 효과)

  • Jung, Jang Hee;Kim, Jung Youp
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.6
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    • pp.533-546
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    • 2006
  • Background: The aim of this study was to determine the effectiveness of self-efficacy promoting pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Methods: thirty six patients, with clinically stable COPD were randomly assigned: 18 to a rehabilitation group and another 18 as a control group, The subjects participated in a the self-efficacy promoting pulmonary rehabilitation program for 8 weeks. This program consisted of education, breathing retraining, exercise training, relaxation and counseling. The control group received education only. The outcome variables were self-efficacy, dyspnea, exercise endurance, pulmonary function, and quality of life. Dyspnea was measured using the modified Borg scale. Exercise endurance was measured by the six minute walking distance. The quality of life was measured by the quality of life index for pulmonary disease patients. Results: In the rehabilitation group after performing the self-efficacy promoting pulmonary rehabilitation program, the self-efficacy score, exercise endurance, and quality of life score were higher than the control group (p=0.007, p=0.038, and p=0.039, respectively). and the exertional dyspnea score was significantly lower than controls(p=0.045). However, the dyspnea score and FEV1 were similar after performing the self-efficacy promoting pulmonary rehabilitation program. Conclusion: The self-efficacy promoting pulmonary rehabilitation program is effective to in improve self-efficacy, exertional dyspnea, exercise endurance and quality of life in patients with COPD.

Methacholine Responsiveness of Bronchial and Extrathoracic Airway in Patients with Chronic Cough (만성 기침 환자에서 기관지와 흉곽외 기도의 Methacholine 유발검사의 의의)

  • Shim, Jae-Jeong;Kim, Je-Hyeong;Lee, Sung-Yong;Kwan, Young-Hwan;Lee, So-Ra;Lee,, Sang-Yeub;Lee, Sang-Hwa;Suh, Jung-Kyung;Cho, Jae-Youn;In, Kwang-Ho;Yoo, Se-Hwa;Kang, Kyung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.4
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    • pp.853-860
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    • 1997
  • Background : Chronic cough, defined as a cough persisting for three weeks or longer, is a common symptom for which outpatient care is sought. The most common etiologies of chronic cough are postnasal drip, asthma, and gastroesophageal reflux. Methacholine challenge is a useful diagnostic study in the evaulation of chronic cough, particularly useful in chronic cough patients with asthmatic symptom. Patients with chronic cough may have dysfunction of bronchial and extrathoracic airways. To evaluate if dysfunction of the bronchial and extrathoracic airways causes chronic cough, we assessed bronchial (BHR) and extrathoracic airway (EAHR) responsiveness to inhaled methacholine in patients with chronic cough. Method : 111 patients with chronic cough were enrolled in our study. Enrolled patients had no recorded diagnosis of asthma, bronchopulmonary disease, hypertension, heart disease or systemic disease and no current treatment with bronchodilator or corticosteroid. Enrolled patients consisted of 46 patients with cough alone, 24 patients with wheeze, 22 patients with dyspnea, 19 patients with wheeze and dyspnea. The inhaled methacholine concentrations causing a 20% fall in forced expiratory volume in 1s($PC_{20}FEV_1$) and 25% fall in maximal mid-inspiratory flow ($PC_{25}MIF_{50}$) were used as bronchial and extra thoracic hyperresponsiveness. Results : There were four response patterns to methacholine challenge study : BHR in 27 patients, EAHR in 16 patients, combined BHR and EAHR in 8 patients, and no hyperresponsiveness in 60 patients. In patients with cough alone, there were BHR in 3 patients, EAHR in 9 patients, and combined BHR and EAHR in 2 patients. In patients with wheeze and/or dyspnea, there were BHR in 24 patients, EAHR in 7 patients, and BHR and EAHR in 6 patients. Compared with patients with wheeze and/or dyspnea, patients with cough alone had more common EAHR than BHR. In patients with wheeze and/or dyspnea, BHR was more common than EAHR. Conclusion : These results show that among patients with hyperresponsiveness to methacholine, those with dyspnea and/or wheezing had mainly bronchial hyperresponsiveness, whereas those with chronic cough alone had mainly extrathoracic airway hyperresponsiveness.

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Right Ventricle Ejection Fraction Contributes Severity of Dyspnea in Chronic Obstructive Pulmonary Disease (COPD) (만성폐쇄성폐질환 환자의 호흡곤란 평가에서 우심실 박출계수의 의의)

  • Lee, Jung Eun;Min, Bo Ram;Park, Jae Seok;Park, Hun Pyo;Jun, Mi Jung;Won, Kyung Sook;Choi, Won Il
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.6
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    • pp.631-637
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    • 2006
  • Background: Patients with COPD generally complain of very different degrees of dyspnea regardless of their pulmonary function. The study, we assessed the right ventricular ejection fraction in relation to dyspnea in COPD patient. Methods: The pulmonary function including the diffusion capacity was measured. The right ventricle ejection fraction (RVEF) was measured using a first-pass radionuclide scan by multigated acquisition (MUGA). Forty patients with chronic obstructive pulmonary disease (COPD) were stratified for dyspnea according to the Medical Research Council (MRC) scale. Moderate dyspnea and severe dyspnea is defined as MRC 2/3 (n = 16) and MRC 4/5 (n = 24) respectively. Results: The baseline pulmonary function tests including DLCO and the resting arterial blood gas were similar in the moderate and severe dyspnea group, with the exception of the residual volume (% predicted) (moderate $160{\pm}27$, severe $210{\pm}87$, p < 0.03). The right ventricle ejection fraction was significantly (p < 0.001) lower in the severe dyspnea group ($25{\pm}8$) than in the moderate group ($35{\pm}6$). The independent factor assessed by multiple logistic regression revealed only the severity of dyspnea to be significantly associated with RVEF (p < 0.02). Conclusion: This study showed that the right ventricle ejection fraction would contributes to severity of dyspnea in patients with a similar pulmonary function.

A Case of Continuous Positive Airway Pressure Therapy in a Patient with Central Sleep Apnea and Heart Failure (중추성 수면 무호흡이 동반된 심부전 환자에서 지속적 상기도 양압술 적용 1례)

  • An, Jee Young;Kim, Shin Bum;Kang, Hyeon Hui
    • Sleep Medicine and Psychophysiology
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    • v.24 no.2
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    • pp.118-123
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    • 2017
  • Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.

Acute Respiratory Distress Syndrome Related with Blood Transfusion in a Dog with Chronic Kidney Disease (만성신장질환 개에서 수혈과 관련된 급성호흡곤란증후군)

  • Jung, Joohyun;Choi, Mincheol
    • Journal of Veterinary Clinics
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    • v.32 no.1
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    • pp.94-97
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    • 2015
  • An 11-year-old intact male Yorkshire terrier had intermittent vomiting, anorexia and depression for a month. Clinical laboratory works showed azotemia and anemia. Chronic kidney disease with developing anemia was diagnosed clinically. Clinical signs were resolved but anemia was deteriorated and blood transfusion was performed. On 10 hours after transfusion, the dog showed acute respiratory distress. Transfusion related acute respiratory distress syndrome (ARDS) was diagnosed based on acute clinical signs, risk factors of transfusion, bilateral alveolar infiltration on thoracic radiographs, and $PO_2:FiO_2$ ratio less than 200 on arterial blood analysis. The dog died within 2 hours after ARDS diagnosis.

A Successful Decannulation Case Two Years Later A Tracheostomy (2년후에 발거가 가능했던 기관 cannula 발거곤란병)

  • 이종원;김종영;김성곤;권령춘;양한모
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1976.06a
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    • pp.87.3-87
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    • 1976
  • The authors experienced a case of a difficult decannulation in a 4 years old boy, in which. case decannulation was possible 2 years later a tracheostomy. Some immunoglogical phenomena could be considered in this case as though cancer can remiss spontaneously. Such complications of tracheostomy as subglottic edema and perichondritis could become relatively less troublesome to breathing during his aging process. And another reason for the easy decannulation is considered as the patient could be accustomed to breathing through natural air pathway by continual cannula corking training.

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