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Journal ArticleDOI

Evaluation of Clinical Methods for Rating Dyspnea

01 Mar 1988-Chest (Chest)-Vol. 93, Iss: 3, pp 580-586
TL;DR: The results show that the BDI, MRC scale, and OCD provide significantly related measures of Dyspnea, and the clinical ratings of dyspnea correlate significantly with physiologic parameters of lung function; and breathlessness may be related to the pathophysiology of the specific respiratory disease.
About: This article is published in Chest.The article was published on 1988-03-01. It has received 1374 citations till now. The article focuses on the topics: Baseline Dyspnea Index & BODE index.
Citations
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Journal ArticleDOI
TL;DR: The BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD.
Abstract: background Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible limitation in airflow. A physiological variable — the forced expiratory volume in one second (FEV 1 ) — is often used to grade the severity of COPD. However, patients with COPD have systemic manifestations that are not reflected by the FEV 1 . We hypothesized that a multidimensional grading system that assessed the respiratory and systemic expressions of COPD would better categorize and predict outcome in these patients. methods We first evaluated 207 patients and found that four factors predicted the risk of death in this cohort: the body-mass index (B), the degree of airflow obstruction (O) and dyspnea (D), and exercise capacity (E), measured by the six-minute–walk test. We used these variables to construct the BODE index, a multidimensional 10-point scale in which higher scores indicate a higher risk of death. We then prospectively validated the index in a cohort of 625 patients, with death from any cause and from respiratory causes as the outcome variables. results There were 25 deaths among the first 207 patients and 162 deaths (26 percent) in the validation cohort. Sixty-one percent of the deaths in the validation cohort were due to respiratory insufficiency, 14 percent to myocardial infarction, 12 percent to lung cancer, and 13 percent to other causes. Patients with higher BODE scores were at higher risk for death; the hazard ratio for death from any cause per one-point increase in the BODE score was 1.34 (95 percent confidence interval, 1.26 to 1.42; P<0.001), and the hazard ratio for death from respiratory causes was 1.62 (95 percent confidence interval, 1.48 to 1.77; P<0.001). The C statistic for the ability of the BODE index to predict the risk of death was larger than that for the FEV 1 (0.74 vs. 0.65).

3,688 citations


Additional excerpts

  • ...BODE index score† 0 1 2 3 4 5 6 7 8 9 10 33 (5) 55 (9) 81 (13) 95 (15) 92 (15) 75 (12) 55 (9) 60 (10) 43 (7) 24 (4) 12 (2)...

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Journal ArticleDOI
TL;DR: In this article, the authors describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.

2,933 citations

Journal ArticleDOI
TL;DR: The guidelines are intended for use by physicians involved in the care of patients with COPD, and their main goals are to inform health professionals and to reverse a widespread nihilistic approach to the management of these patients.
Abstract: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. In the European Union, COPD and asthma, together with pneumonia, are the third most common cause of death. In North America, COPD is the fourth leading cause of death, and mortality rates and prevalence are increasing. The major characteristic of COPD is the presence of chronic airflow limitation that progresses slowly over a period of years and is, by definition, largely irreversible. Most patients with COPD are, or were, cigarette smokers. Prevention by reducing the prevalence of smoking remains a priority. Although much of the damage is irreversible at the time of clinical presentation, treatments are available to improve the quality of life, the life expectancy, and perhaps the functional ability of patients with COPD. Several national and international consensus statements on optimal assessment and management of asthma have been published in recent years. These consensus statements have led to international standardization of diagnosis and management and to better care. They also form a basis for clinical audits and suggest areas of future research. However, there have been few attempts to develop consensus guidelines on management of COPD [1, 2]. The European Respiratory Society (ERS) has taken the initiative of producing a consensus statement on COPD. A Task Force of scientists and clinicians was invited to provide this European consensus. The guidelines are intended for use by physicians involved in the care of patients with COPD, and their main goals are to inform health professionals and to reverse a widespread nihilistic approach to the management of these patients. This Task Force firmly believes that treatment can significantly improve the quality and length of life of patients suffering from this chronic, progressive condition. Subcommittees of the Task Force focused on the five main sections of this project: Pathology/Pathophysiology, Epidemiology, Assessment, Treatment, and Management. Experts produced papers within each section, and these papers were brought together by the subcommittee heads. At a plenary meeting held in Wiesbaden, Germany on November 11–13, 1993, all contributions were extensively discussed, and additional working group meetings were arranged. Flowcharts for management in common clinical situations were produced. However, at all stages, members of the Task Force found themselves confronted by unresolved questions and regional differences in management across Europe. A practical approach was adopted, combining established scientific evidence and a consensus view when current data were inadequate. This approach identified more clearly those areas where further research is needed. Comments on drafts of the consensus statement were invited from participants of the original meeting, which included colleagues from North America. The edited document was sent to independent experts for external review. All members had an opportunity to comment on the document at the ERS meeting in Nice on October 2, 1994. As chairmen of the Task Force, we hope that the final document will promote better management of COPD in Europe. We would like to thank all who contributed to it. On behalf of the ERS, we also gratefully acknowledge a generous educational grant from Boehringer Ingelheim and the organizational assistance provided by M.T. Lopez-Vidriero.

1,574 citations

Journal ArticleDOI
TL;DR: There is a critical need for interdisciplinary translational research to connect Dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
Abstract: Background: Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome.Purpose: The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea.Methods: An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members.Results: Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consist...

1,331 citations


Cites background or methods from "Evaluation of Clinical Methods for ..."

  • ...Sometimes called Modified MRC Scale (19, 20) Not specified...

    [...]

  • ...Baseline Dyspnea Index (BDI) / Transition Dyspnea Index (TDI) (19, 22-24) X Functional Impairment, Magnitude of Task and Effort evoking dyspnea in chronic respiratory disease BDI Present (baseline assessment); TDI Visit to visit (change vs....

    [...]

  • ...Modified MRC Dyspnoea Scale (see also ATS Dyspnea Scale) (19, 20) X Functional status, disability assessment....

    [...]

  • ...Feinstein Index (67) X Functional Impairment, Magnitude of Task and Effort Causing Dyspnea; based on BDI (19, 22-24), but for heart failure....

    [...]

  • ...) or what patient population will be assessed better with the new instrument than with existing measures? Recent work on developing an observational respiratory distress rating for palliative care patients who are unable to self-report provides an example of such justification (19, 20, 23)....

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Journal ArticleDOI
18 Jan 2021-Nature
TL;DR: In this article, the authors report on the humoral memory response in a cohort of 87 individuals assessed at 1.3 and 6.2 months after infection with SARS-CoV-2.
Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected 78 million individuals and is responsible for over 1.7 million deaths to date. Infection is associated with the development of variable levels of antibodies with neutralizing activity, which can protect against infection in animal models1,2. Antibody levels decrease with time, but, to our knowledge, the nature and quality of the memory B cells that would be required to produce antibodies upon reinfection has not been examined. Here we report on the humoral memory response in a cohort of 87 individuals assessed at 1.3 and 6.2 months after infection with SARS-CoV-2. We find that titres of IgM and IgG antibodies against the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2 decrease significantly over this time period, with IgA being less affected. Concurrently, neutralizing activity in plasma decreases by fivefold in pseudotype virus assays. By contrast, the number of RBD-specific memory B cells remains unchanged at 6.2 months after infection. Memory B cells display clonal turnover after 6.2 months, and the antibodies that they express have greater somatic hypermutation, resistance to RBD mutations and increased potency, indicative of continued evolution of the humoral response. Immunofluorescence and PCR analyses of intestinal biopsies obtained from asymptomatic individuals at 4 months after the onset of coronavirus disease 2019 (COVID-19) revealed the persistence of SARS-CoV-2 nucleic acids and immunoreactivity in the small bowel of 7 out of 14 individuals. We conclude that the memory B cell response to SARS-CoV-2 evolves between 1.3 and 6.2 months after infection in a manner that is consistent with antigen persistence.

1,163 citations

References
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Journal ArticleDOI
TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.

64,109 citations

Book
01 Jan 1967

22,994 citations

Book
30 May 2003
TL;DR: Dorland's as discussed by the authors is the world's most trusted source on the language of medicine for over 100 years, it delivers more entries and better definitions than any other medical dictionary so you can master more of the current terminology that you need to know.
Abstract: This is a special deluxe edition with leather binding! Medicine is ever changing, and its terminology evolves constantly. If you're involved in health care in any way, you need to know the latest medical terms and what they mean. That's why you need "Dorland's"! The world's most trusted source on the language of medicine for over 100 years, it delivers more entries and better definitions than any other medical dictionary so you can master more of the current terminology that you need to know. A wealth of illustrations and a remarkably user-friendly format make reference a snap. Plus, bonus software on CD-ROM lets you load key terms and definitions onto your PDA spell medical terms correctly using spell-checker software and listen to audio pronunciations for 35,000 terms. Turn to "Dorland's" you'll be amazed at how much vital information you can glean with so much ease!

1,404 citations

Journal ArticleDOI
01 Jun 1984-Chest
TL;DR: The results indicate that dyspnea can receive a direct clinical rating that provides important information not disclosed by customary physiologic tests.

1,249 citations

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