Management of dyspnea in severe chronic obstructive pulmonary disease.
Progression of chronic obstructive pulmonary disease (COPD) is frequently associated with increasing dyspnea; indeed, patients with severe COPD constitute the largest group of patients with chronic respiratory insufficiency. The sensation of dyspnea in these patients is mostly related to increased work of breathing, a consequence of an increased resistive load, of hyperinflation, and of the deleterious effect of intrinsic positive end-expiratory pressure (PEEP(i)). Once optimal medical treatment has been provided, pharmacological treatments of dyspnea exist (beta2-agonists, methylxanthines, opiates) but seldom suffice. Nonpharmacological complementary treatments must be envisioned. Patients with severe hyperinflation should be screened as possible candidates for lung reduction surgery. Pulmonary rehabilitation-including chest therapy, patient education, exercise training-has been established as effective on quality of life (QoL) and dyspnea. Noninvasive positive pressure devices may be effective for symptomatic treatment of severe dyspnea: continuous positive airway pressure (CPAP) counteracts the deleterious effect of PEEP(i) in patients with severe hyperinflation; intermittent positive pressure breathing (IPPB) may decrease dyspnea and discomfort during nebulized therapy; finally noninvasive positive pressure ventilation (NIPPV) has been shown to be effective on the sensation of dyspnea and QoL in COPD with severe hypercapnia.
Janssens
J P
JP
Center for Pulmonary Rehabilitation, Hôpital de Rolle, Vaud, Switzerland.
de Muralt
B
B
Titelion
V
V
D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008168:Lung / Q000601:surgery; D008173:Lung Diseases, Obstructive / Q000150:complications*; D011175:Positive-Pressure Respiration / Q000379:methods