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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Restrictive lung disease is often first detected when patients complain of dyspnea on exertion. Many forms of exercise testing are available, from simple hallway oximetry to the more formal and more complex cardiopulmonary exercise test. Although the use of exercise for diagnosis, treatment, and predicting outcomes is largely understudied in this population, it has recently been shown to be of value in some settings. Exercise testing may be a valuable diagnostic tool in determining the extent of lung disease in sarcoidosis. Medinger et al. reported that the symptom-limited exercise test detected pulmonary dysfunction earlier than history, physical examination, chest radiography, and spirometry alone. Furthermore, Delobbe et al. noted that in patients with biopsy-proved sarcoidosis, cardiopulmonary exercise testing was a more sensitive indicator of early lung disease than pulmonary function tests. The American College of Chest Physicians/American Thoracic Society have published an updated consensus statement for cardiopulmonary exercise testing. Christensen et al. reported that patients with restrictive lung disease may be at risk for hypoxemia with light exercise while on an airplane, and suggest that these patients be considered for in-flight oxygen therapy. Lastly, Herridge and the Canadian Critical Care Trial Group used the 6-minute walk test to prove that survivors of acute respiratory distress syndrome have significant functional limitation 1 year after discharge from the intensive care unit largely secondary to neuromuscular sequelae. Exercise testing appears to be a valuable tool in evaluating, treating, and predicting outcomes in patients with restrictive lung disease. Further study will help to support its use in other restrictive lung diseases.
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PMID:Role of exercise evaluation in restrictive lung disease: new insights between March 2001 and February 2003. 1290 12

The purpose of this study was to examine the effects of a home-based pulmonary rehabilitation program on lung function, dyspnea, exercise tolerance, and quality of life in 23 Koreans with moderate to severe chronic lung disease. The outcome measures were forced expiratory volume in 1s (FEV1, % predicted), Borg score, 6 min walking distance (6MWD), and chronic respiratory disease questionnaire (CRDQ). Experimental group (n=15) performed the 8-week home-based pulmonary rehabilitation program, composed of inspiratory muscle training, upper and lower extremity exercise, relaxation, and telephone visit. Patients in control group (n=8) were only given educational advice. The experimental group showed a lower level of exertional dyspnea, more exercise tolerance, and greater improvement in health-related quality of life than the control group (p<0.05). Lung function was not statistically different. This study yielded evidence for the beneficial effects of home-based pulmonary rehabilitation program.
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PMID:The effects of home-based pulmonary rehabilitation in patients with chronic lung disease. 1456 68

The syndrome resulting from combined pulmonary fibrosis and emphysema has not been comprehensively described. The current authors conducted a retrospective study of 61 patients with both emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lungs on chest computed tomography. Patients (all smokers) included 60 males and one female, with a mean age of 65 yrs. Dyspnoea on exertion was present in all patients. Basal crackles were found in 87% and finger clubbing in 43%. Pulmonary function tests were as follows (mean+/-sd): total lung capacity 88%+/-17, forced vital capacity (FVC) 88%+/-18, forced expiratory volume in one second (FEV1) 80%+/-21 (% predicted), FEV1/FVC 69%+/-13, carbon monoxide diffusion capacity of the lung 37%+/-16 (% predicted), carbon monoxide transfer coefficient 46%+/-19. Pulmonary hypertension was present in 47% of patients at diagnosis, and 55% during follow-up. Patients were followed for a mean of 2.1+/-2.8 yrs from diagnosis. Survival was 87.5% at 2 yrs and 54.6% at 5 yrs, with a median of 6.1 yrs. The presence of pulmonary hypertension at diagnosis was a critical determinant of prognosis. The authors hereby individualise the computer tomography-defined syndrome of combined pulmonary fibrosis and emphysema characterised by subnormal spirometry, severe impairment of gas exchange, high prevalence of pulmonary hypertension, and poor survival.
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PMID:Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity. 1645 4

Idiopathic nontransplant-related childhood bronchiolitis obliterans is an uncommon disease. Most patients present with chronic recurrent dyspnea, cough and wheezing, which are also features of asthma, by far a much more common condition. The present case study reports on a six-year-old girl who presented to a tertiary care centre with recurrent episodes of respiratory distress on a background of baseline tachypnea, chronic hypoxemia and exertional dyspnea. Her past medical history revealed significant lung disease in infancy, including respiratory syncytial virus bronchiolitis and repaired gastroesophageal reflux. She was treated for 'asthma exacerbations' throughout her early childhood years. Bronchiolitis obliterans was subsequently diagnosed with an open lung biopsy. She did not have sustained improvement with systemic corticosteroids, hydroxychloroquine or clarithromycin. Cardiac catheterization confirmed the presence of secondary pulmonary hypertension. Treatment options remain a dilemma for this patient because there is no known effective treatment for this condition, and the natural history is not well understood. The present case demonstrates the need for careful workup in 'atypical asthma', and the urgent need for further research into the rare lung diseases of childhood.
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PMID:Pediatric interstitial lung disease masquerading as difficult asthma: management dilemmas for rare lung disease in children. 1624 29

A syndrome including upper-lobe emphysema and pulmonary fibrosis of the lower lungs was recently characterized. It is found most often in men who are smokers or ex-smokers of more than 40 pack-years; their mean age is 65 years. Exertional dyspnea is always present. There are basal crackles. The disease has no known cause; the only certain risk factor is smoking. Pulmonary function tests show respiratory volumes and flows that are often normal or subnormal, while carbon monoxide transfer is substantially reduced and exercise hypoxemia is present. Diagnosis is based on findings from millimeter-slices of computed tomography of the chest, which show either centrilobular emphysema or upper-zone bullous emphysema, associated in 90% of cases with very suggestive paraseptal emphysema and diffuse infiltrating fibrosing lung disease at the bases (subpleural reticular opacities, honeycomb images, traction bronchiectasis), with more frequent ground glass opacities than in idiopathic pulmonary fibrosis. Pulmonary hypertension is present in almost half of all patients and represents the principal negative prognostic factor for this condition, which has a median survival of 6 years.
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PMID:[Combined pulmonary fibrosis and emphysema]. 1744 36

Lymphangioleiomyomatosis (LAM) is a rare, cystic lung disease that is associated with mutations in tuberous sclerosis genes, renal angiomyolipomas, lymphatic spread, and remarkable female gender restriction. The clinical course of LAM is characterized by progressive dyspnea on exertion, recurrent pneumothorax, and chylous fluid collections. Lung function declines at approximately twofold to threefold times the rate of healthy subjects, based on an annual drop in FEV1 of 75 to 120 mL in reported series. The diagnosis of pulmonary LAM can be made on high-resolution CT (HRCT) scan with reasonable certainty by expert radiologists, but generally requires a lung biopsy in cases in which tuberous sclerosis complex, angiomyolipomata, or chylous effusions are absent. The currently available treatment strategies are based on the antagonism of estrogen action, and are empiric and unproven. A trial of bronchodilators is warranted in patients with reversible airflow obstruction seen on pulmonary function testing. Pleurodesis should be performed with the initial pneumothorax, because the rate of recurrence is high. Angiomyolipomas that exceed 4 cm in size are more likely to bleed and should be evaluated for embolization. Air travel is well-tolerated by most patients with LAM. Lung transplantation is an important option for LAM patients, and can be safely performed by experienced surgeons despite prior unilateral or bilateral pleurodesis in most patients. Women with unexplained recurrent pneumothorax, tuberous sclerosis, or a diagnosis of primary spontaneous pneumothorax or emphysema in the setting of limited or absent tobacco use should undergo HRCT scan screening for LAM. Multicenter clinical trials based on several well-defined molecular targets are currently underway in the United States and Europe.
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PMID:Lymphangioleiomyomatosis: a clinical update. 1862 34

A 35-year-old man was admitted to our hospital because of abnormal shadows on the chest radiograph and dry cough and exertional dyspnea. He was given a diagnosis of hard metal lung disease 15 years previously and was treated with corticosteroid. Laboratory examination revealed hypoxemia and reduced pulmonary vital capacity. Chest radiograph and high-resolution computed tomography (HRCT) on admission showed ground-glass opacities with volume loss and small cystic spaces. Bronchoalveolar lavage fluid (BALF) demonstrated bizarre multinucleated giant cells and transbronchial lung biopsy (TBLB) specimens showed interstitial pneumonia with multinucleated giant cells. He has worked as a metal grinder, and tungsten was detected in his BALF metal analysis. His illness was diagnosed as hard metal lung disease with giant cell interstitial pneumonia (GIP). We considered this case as a type of chronic hypersensitivity pneumonitis due to his high sensitivity and his disease worsened gradually for four years. Since hard metal lung disease may recur in individuals with high sensitivity, we should always be aware of the possibility of recurrence of this disease.
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PMID:[A case of hard metal lung disease presenting a type of chronic hypersensitivity pneumonitis]. 1870 May 71

The nodular bronchiectatic form of nontuberculous mycobacterial (NTM) lung disease and diffuse panbronchiolits (DPB) show similar clinical and radiographic findings. The present study was performed to clarify the clinicoradiographic similarities as well as the differences between NTM lung disease and DPB. The initial clinicoradiographic features of 78 patients with the nodular bronchiectatic form of NTM lung disease (41 patients with Mycobacterium avium complex infection and 37 patients with Mycobacterium abscessus infection) were compared with those of 35 patients with DPB. Old age, female sex, a history of tuberculosis treatment, and hemoptysis were related to NTM lung disease while exertional dyspnea, coarse crackles, history of sinusitis, obstructive abnormalities in pulmonary function tests, and hypoxemia were related to DPB. The number of lobes involved with bronchiolitis and bronchiectasis on chest computed tomography were more numerous in DPB patients. There is considerable overlap in the clinical and radiographic appearances of the nodular bronchiectatic form of NTM lung disease and DPB, although some clinicoradiographic features differ between two diseases. The correct diagnosis, including aggressive microbiologic evaluation, should be made for the appropriate management of patients presenting with bilateral bronchiectasis and bronchiolitis.
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PMID:Comparison of clinical and radiographic characteristics between nodular bronchiectatic form of nontuberculous mycobacterial lung disease and diffuse panbronchiolitis. 1954 4

Exercise dyspnea is a common symptom of restrictive lung diseases. Not only from the clinical perspective but also from the pathophysiological point of view, restrictive lung disorders represent a very heterogeneous group of diseases. Exercise testing is mandatory because pulmonary function tests at rest are not reliable for the diagnostic evaluation and functional characterisation of these patients. Cardiopulmonary exercise testing (CPET) with measurement of gas exchange is the favoured tool. It is an excellent method to investigate exercise dyspnea, describe altered physiological response to exercise and characterise the involved organ systems heart, lung and muscle. This paper addresses the pathophysiology of restrictive lung diseases and the principles of cardiopulmonary exercise testing, discusses case reports and assesses the clinical value of CPET in patients with restrictive lung disease.
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PMID:[Differential diagnosis of restrictive lung diseases: utility of cardiopulmonary exercise testing]. 1992 18

Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease characterized by abnormal accumulation of surfactant-associated phospholipoproteinaceous material in the pulmonary alveoli. The clinical findings of slow-onset dyspnea or dyspnea on exertion and persistent dry cough are nonspecific; radiographic findings of "bat-wing configuration" and "crazy paving" appearance in high-resolution computed tomography are suggestive, but not diagnostic of PAP. The current gold standard of PAP diagnosis involves histopathological examination of alveolar specimens obtained from bronchoalveolar lavage and transbronchial lung biopsy. The characteristic histopathological features are intraalveolar periodic acid Schiff (PAS)-positive eosinophilic homogeneous material with well-preserved architecture ofalveolar septa. The current standard medical treatment of PAP involves the physical removal of the surfactant-associated phospholipoproteinaceous alveolar deposit by whole lung lavage, which causes clinical and radiological improvement in a majority of patients. Some patients have been successfully treated with recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF).
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PMID:Pulmonary alveolar proteinosis: an overview for internists and hospital physicians. 2046 23


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