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      Is chronic breathlessness less recognised and treated compared with chronic pain? A case-based randomised controlled trial

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          Abstract

          Chronic breathlessness is a major cause of suffering in chronic obstructive pulmonary disease (COPD) [1]. Despite the impact on patients' daily lives, chronic breathlessness might be under-recognised and under-treated. No previous study has explored physicians' ability to identify chronic breathlessness in relation to other chronic symptoms.

          Abstract

          This study highlights the need for improved assessment and management of chronic breathlessness in clinical practice http://ow.ly/S7Ua30kPmjW

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          Most cited references11

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          Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness.

          Breathlessness that persists despite treatment for the underlying conditions is debilitating. Identifying this discrete entity as a clinical syndrome should raise awareness amongst patients, clinicians, service providers, researchers and research funders.Using the Delphi method, questions and statements were generated via expert group consultations and one-to-one interviews (n=17). These were subsequently circulated in three survey rounds (n=34, n=25, n=31) to an extended international group from various settings (clinical and laboratory; hospital, hospice and community) and working within the basic sciences and clinical specialties. The a priori target agreement for each question was 70%. Findings were discussed at a multinational workshop.The agreed term, chronic breathlessness syndrome, was defined as breathlessness that persists despite optimal treatment of the underlying pathophysiology and that results in disability. A stated duration was not needed for "chronic". Key terms for French and German translation were also discussed and the need for further consensus recognised, especially with regard to cultural and linguistic interpretation.We propose criteria for chronic breathlessness syndrome. Recognition is an important first step to address the therapeutic nihilism that has pervaded this neglected symptom and could empower patients and caregivers, improve clinical care, focus research, and encourage wider uptake of available and emerging evidence-based interventions.
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            Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review.

            Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD.
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              Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

              Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. The aim of this study was to systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness.PubMed, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible.We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in carbon dioxide tension (0.27 kPa, 95% CI 0.08-0.45 kPa,) and no significant change in oxygen tension and oxygen saturation (both p>0.05). Nonserious respiratory depression (definition variable/not stated) was described in four out of 1064 patients. One cancer patient pretreated with morphine for pain needed temporary respiratory support following nebulised morphine for breathlessness (single case study).We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed.
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                Author and article information

                Journal
                Eur Respir J
                Eur. Respir. J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                September 2018
                15 September 2018
                : 52
                : 3
                : 1800887
                Affiliations
                [1 ]Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
                [2 ]Center for Primary Health Care Research, Dept of Clinical Sciences in Malmö, Lund University, Lund, Sweden
                [3 ]IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
                Author notes
                Zainab Ahmadi, Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, SE-221 00 Lund, Sweden. E-mail: zai.ahmd@ 123456gmail.com
                Article
                ERJ-00887-2018
                10.1183/13993003.00887-2018
                6340635
                30002106
                65f06a5d-6f41-4cd7-89b6-4953c0c01919
                Copyright ©ERS 2018

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 06 January 2018
                : 30 June 2018
                Funding
                Funded by: The Scientific Committee of Blekinge County Council
                Funded by: Hjärt-Lungfonden http://doi.org/10.13039/501100003793
                Funded by: Svenska Läkaresällskapet http://doi.org/10.13039/501100007687
                Funded by: The Swedish Respiratory Society
                Categories
                Agora
                Research Letters

                Respiratory medicine
                Respiratory medicine

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