| 1. |
- Emilsson, Össur Ingi
(author)
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The burden and impact of chronic cough in severe disease
- 2022
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In: CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE. - : Lippincott Williams & Wilkins. - 1751-4258 .- 1751-4266. ; 16:4, s. 183-187
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Research review (peer-reviewed)abstract
- Purpose of review: Chronic cough is common in severe diseases, such as COPD, interstitial lung disease, lung cancer and heart failure, and has a negative effect on quality of life. In spite of this, patients with cough sometimes feel their cough is neglected by healthcare workers. This review aims to briefly describe cough mechanisms, highlight the burden chronic cough can be for the individual, and the clinical impact of chronic cough.Recent findings: Chronic cough is likely caused by different mechanisms in different diseases, which may have therapeutic implications. Chronic cough, in general, has a significant negative effect on quality of life, both with and without a severe comorbid disease. It can lead to social isolation, recurrent depressive episodes, lower work ability, and even conditions such as urinary incontinence. Cough may also be predictive of more frequent exacerbations among patients with COPD, and more rapid lung function decline in idiopathic pulmonary fibrosis. Cough is sometimes reported by patients to be underappreciated by healthcare.Summary: Chronic cough has a significant negative impact on quality of life, irrespective of diagnosis. Some differences are seen between patients with and without severe disease. Healthcare workers need to pay specific attention to cough, especially patients with severe disease.
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| 2. |
- Lindskog, Magnus, et al.
(author)
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Glycaemic control in end-of-life care : fundamental or futile?
- 2014
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In: Current Opinion in Supportive and Palliative Care. - 1751-4258 .- 1751-4266. ; 8:4, s. 378-382
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Research review (peer-reviewed)abstract
- Purpose of review Diabetes mellitus is one of the most common comorbidities in palliative care. Yet, the optimal handling of diabetes mellitus in dying patients is debated. This review aims to discuss comprehensively the scientific basis as of today for diabetes mellitus management decisions in end-of-life (EOL) care. Recent findings Glycaemic control provides prognostic information in EOL care of diabetes mellitus patients. Original data on how to manage dying patients with type 2 diabetes mellitus are scarce. Findings in elderly type 2 diabetes mellitus patients and expert opinions support that glycaemic control should be relaxed in dying patients with type 2 diabetes mellitus, in the absence of risk factors for true insulin dependence, to avoid symptomatic hypoglycaemia. For terminal but conscious type 1 diabetes mellitus patients, regular blood glucose measurements and continued insulin therapy is the mainstay, with some discrepancy in preferred management between palliative care physicians and diabetes consultants. No randomized controlled trials are available. Improvement is clearly needed with regard to communication about diabetes mellitus in EOL and documentation of decisions. Corticosteroid-induced diabetes mellitus is a significant problem in palliative care, but predictors exist. Summary In the absence of large observational studies or randomized controlled trials, the current body of knowledge is based on expert opinions, surveys and retrospective studies. Nevertheless, some clinically meaningful recommendations can be made. Prospective studies need to be performed in order to improve our understanding about diabetes mellitus management in EOL. The palliative care community has a joint responsibility to address these questions.
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| 3. |
- Posthuma, Rein, et al.
(author)
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Recent advances in bronchoscopic lung volume reduction for severe COPD patients
- 2023
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In: CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE. - 1751-4258 .- 1751-4266. ; 17:4, s. 296-300
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Journal article (peer-reviewed)abstract
- Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression.BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.R. Posthuma is supported by the Lung Foundation Netherlands, grant number: 5.1.17.171.0.There are no conflicts of interest.Patients with chronic obstructive pulmonary disease (COPD) suffer from respiratory symptoms and reduced quality of life due to destruction and/or inflammation of the airways and alveoli, leading to airflow limitation1. Despite pharmacological and non-pharmacological therapies, patients with advanced COPD often remain highly symptomatic with debilitating breathlessness and reduced exercise capacity. In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al.'s2 systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care1,3. BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report1.In this narrative review, we present the most recent developments in BLVR using EBV, focussing on primary research describing patient selection, (long-term) outcomes and extrapulmonary effects.Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression.BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.R. Posthuma is supported by the Lung Foundation Netherlands, grant number: 5.1.17.171.0.There are no conflicts of interest.Patients with chronic obstructive pulmonary disease (COPD) suffer from respiratory symptoms and reduced quality of life due to destruction and/or inflammation of the airways and alveoli, leading to airflow limitation1. Despite pharmacological and non-pharmacological therapies, patients with advanced COPD often remain highly symptomatic with debilitating breathlessness and reduced exercise capacity. In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al.'s2 systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care1,3. BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report1.In this narrative review, we present the most recent developments in BLVR using EBV, focussing on primary research describing patient selection, (long-term) outcomes and extrapulmonary effects.Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression.BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.R. Posthuma is supported by the Lung Foundation Netherlands, grant number: 5.1.17.171.0.There are no conflicts of interest.Patients with chronic obstructive pulmonary disease (COPD) suffer from respiratory symptoms and reduced quality of life due to destruction and/or inflammation of the airways and alveoli, leading to airflow limitation1. Despite pharmacological and non-pharmacological therapies, patients with advanced COPD often remain highly symptomatic with debilitating breathlessness and reduced exercise capacity. In the last decade, bronchoscopic lung volume reduction (BLVR) emerged as an effective intervention in a carefully selected subgroup of COPD patients characterized by severe emphysema, static lung hyperinflation and breathlessness. In Patel et al.'s2 systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care1,3. BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report1.In this narrative review, we present the most recent developments in BLVR using EBV, focussing on primary research describing patient selection, (long-term) outcomes and extrapulmonary effects.Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR.For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients wit
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| 4. |
- Ahmadi, Zainab, et al.
(author)
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Palliative oxygen for chronic breathlessness : What new evidence?
- 2017
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In: Current Opinion in Supportive and Palliative Care. - 1751-4258. ; 11:3, s. 159-164
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Research review (peer-reviewed)abstract
- Purpose of review Supplemental oxygen improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxaemia, but the effect of oxygen therapy in mild or moderate hypoxaemia to reduce symptomatic chronic breathlessness remains unclear. This review provides an overview of recent evidence about the role of oxygen therapy for the relief of chronic breathlessness in advanced illness. Recent findings In COPD, a recent Cochrane review strengthens earlier findings regarding the positive effect of supplemental oxygen compared with air during exercise test in the training setting. The novel analysis of effect of oxygen therapy on quality of life (QoL) showed no clear effect. Short-burst oxygen therapy given before exercise had no effect and should not be used. Summary Supplemental oxygen during exercise has been shown to reduce breathlessness in patients with COPD who have no or mild hypoxaemia, but it is not clear whether the reduction in breathlessness shown in the laboratory setting translates into a clinically important benefit. Further studies are needed to establish this.
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| 5. |
- Ahmadi, Zainab
(author)
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The burden of chronic breathlessness across the population
- 2018
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In: Current Opinion in Supportive and Palliative Care. - 1751-4258. ; 12:3, s. 214-218
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Research review (peer-reviewed)abstract
- Purpose of review Chronic breathlessness is a common and distressing symptom globally. It is associated with major adverse health outcomes. This review provides an overview of new evidence about the prevalence of chronic breathlessness in the population. Recent findings A literature search was conducted using MEDLINE database including studies on prevalence of chronic breathlessness and its impact on the community published between 2016 and 2018. Identified studies were divided into four themes: breathlessness in relation to sex, BMI, quality of life and age (the elderly). In the general population, breathlessness was twice as common in women as in men related to their smaller absolute lung volumes. Obesity was to be found an independent risk factor for chronic breathlessness. A strong association between chronic breathlessness and poor physical and mental health-related quality of life was found across all adult age groups. Among elderly people, breathlessness predicted activity of daily living decline over 5 years. Summary Interesting large population-based studies published recently have shed light on the association between chronic breathlessness and sex, obesity, quality of life and increasing age.
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| 6. |
- Bull, Cecilia, 1977, et al.
(author)
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Role of dietary fiber in safeguarding intestinal health after pelvic radiotherapy
- 2021
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In: Current Opinion in Supportive and Palliative Care. - : Ovid Technologies (Wolters Kluwer Health). - 1751-4258. ; 15:3, s. 180-187
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Journal article (peer-reviewed)abstract
- Purpose of review Damage to healthy bowel tissue during pelvic radiotherapy can produce devastating and life-long changes in bowel function. The surging interest in microbiota and its importance for our wellbeing has generated a bulk of research highlighting how the food we consume impacts bowel health and disease. Dietary fiber is known to promote bowel health, yet there is a limited number of studies on dietary fiber in connection to pelvic radiotherapy. Here, we review some of the literature on the subject and present the most recent publications in the field. Recent findings Advice given concerning dietary fiber intake during and after pelvic radiotherapy are inconsistent, with some clinics suggesting a decrease in intake and others an increase. Recent animal studies provide a solid support for a protective role of dietary fiber with regards to intestinal health after pelvic radiotherapy, mainly through its impact on the microbiota. No clinical study has yet provided unambiguous evidence for a similar function of dietary fiber in humans undergoing pelvic radiotherapy. There is a lack of evidence behind the dietary advice given to cancer survivors suffering from radiation-induced bowel dysfunction, and high-quality and well powered studies with long follow-up times are needed.
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| 7. |
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| 8. |
- Ekström, Magnus
(author)
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Tests to uncover and assess breathlessness : a proposed framework
- 2022
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In: Current Opinion in Supportive and Palliative Care. - 1751-4258. ; 16:4, s. 188-194
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Journal article (peer-reviewed)abstract
- Purpose of ReviewBreathlessness is a common, distressing, and limiting symptom that many people avoid by reducing their activity. This review discusses exertional tests that can be used for uncovering and assessing breathlessness depending on the person's severity of illness, function, the setting, and aim of the assessment.Recent FindingsStandardized exertional tests are useful to uncover 'hidden' breathlessness earlier in people who may have adapted their physical activity to limit their breathing discomfort. In 'more fit' ambulatory people and outpatients, cardiopulmonary exercise testing is the gold standard for assessing symptom severity, underlying conditions, and mechanisms and treatment effects. Among field tests, the 6-min walk test is not useful for assessing breathlessness. Instead, the 3-min step test and walk test are validated for measuring breathlessness change in chronic obstructive pulmonary disease. In people with more severe illness (who are most often not breathless at rest), reported tests include upper limb exercise or counting numbers aloud, but a valid and useful test for this population is lacking.SummaryA framework for selecting the most appropriate test to assess breathlessness validly is proposed, and research needs are identified.
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| 9. |
- Ekström, Magnus
(author)
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What can we learn about breathlessness from population-based and administrative health data?
- 2016
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In: Current Opinion in Supportive and Palliative Care. - 1751-4258. ; 10:3, s. 223-227
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Journal article (peer-reviewed)abstract
- Purpose of review To review the findings and methodological strengths and limitations of studies of breathlessness using population-based or routinely collected data, including the novel methodology of the registry-based randomized controlled trial (R-RCT). Recent findings Breathlessness severe enough to restrict activity is common and increases in the last months of life both among elderly in the community and among patients in specialized palliative care. During the last week of life, risk factors for more severe breathlessness have been identified. Patients with advanced chronic obstructive or interstitial lung disease experience more breathlessness than patients dying from lung cancer. Breathlessness often remains unrelieved or only partially relieved at the end of life. Summary Data from population-based or health-administrative databases can inform on the epidemiology, associated factors and the potential impact of breathlessness. Potential strengths of these data are high precision and generalizability because of large, nonselective study populations with high completeness of follow-up of outcomes such as survival. Potential limitations include residual confounding and insufficient data quality which is unaffected by increasing the sample size. The R-RCT methodology combines strengths of randomization with those of large representative databases to evaluate effectiveness in clinical care.
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| 10. |
- Evangelista, Lorraine S., et al.
(author)
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An integrated review of interventions to improve psychological outcomes in caregivers of patients with heart failure
- 2016
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In: CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE. - : LIPPINCOTT WILLIAMS & WILKINS. - 1751-4258. ; 10:1, s. 24-31
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Research review (peer-reviewed)abstract
- Purpose of reviewThis article examines interventions aimed at improving psychological outcomes (e.g., caregiver burden, quality of life, anxiety, depression, perceived control, stress mastery, caregiver confidence and preparedness, and caregiver mastery) in family caregivers of patients with heart failure.Recent findingsEight studies meeting the inclusion criteria were included in the review. The most common intervention involved psychoeducation facilitated by a nurse (6/8) and supplemented with a combination of follow-up face-to-face sessions (2/6), home visits (2/6), telephone calls (3/6), and telemonitoring (3/6). Two studies used a support group intervention of four to six sessions. Half of the interventions reported a significant effect on one or more primary outcomes, including caregiver burden (n=4), depressive symptoms (n=1), stress mastery (n=1), caregiver confidence and preparedness (n=1), and caregiver mastery (n=1).SummaryCompared with dementia and cancer family caregiving, few interventions have been evaluated in caregivers of patients with heart failure. Of the existing interventions identified in this review, considerable variability was observed in aims, intervention content, delivery methods, duration, intensity, methodological rigor, outcomes, and effects. Given this current state of the science, direct comparison of heart failure caregiver interventions and recommendations for clinical practice are premature. Thus, research priority is strongly warranted for intervention development and testing to enhance heart failure caregiver support and education.
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