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Introduction: Stiff-person Syndrome (SPS) is a rare autoimmune central nervous system disorder characterized by rigidity of the trunk and proximal limb muscles due to continuous co-contraction of agonists and antagonists with superimposed intermittent and often disabling spasms of the involved musculature. Dyspnea was assessed on each subject via a vertical Visual Analogue Scale assessed on the day of study visit (VAS1day) and over the preceding two weeks (VAS2weeks), and by the University of San Diego Shortness Of Breath Questionnaire (UCSD-SOBQ).

[...]in patients with unexplained dyspnea, careful evaluation for chest wall abnormalities should be explored with imaging after more common causes are excluded. Surgical procedures have become less invasive, and as this case reflects, even a minor outpatient surgical intervention can result in significant improvement in a patient's quality of life.

The Official ATS Statement on dyspnea (2012) defined dyspnea as \"a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity\" and stated that there are \"distinct mechanisms and afferent pathways are reliably associated with different sensory qualities (notably work/effort, tightness, and air hunger/unsatisfied inspiration)\"; and noted that \"dyspnea sensations also vary in their unpleasantness and in their emotional and behavioral significance.\" Using the MDP, research staff interviewed patients who reported dyspnea > 4/10 at admission to medical/surgical floors in a tertiary care hospital. 104 patients consented to the study on the day of admission and completed the MDP (3 rated A1 less than 4 at the time of interview).

Among patients with relapsed small-cell lung cancer after the failure of platinum-based chemotherapy, tarlatamab therapy led to a greater overall and progression-free survival benefit than chemotherapy, with fewer severe adverse events.

Background Breathlessness is the most common and intrusive symptom of advanced non-malignant respiratory and cardiac conditions. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention, theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease in managing their breathlessness. Having published the effectiveness and cost effectiveness of BIS for patients with advanced cancer and their carers, we sought to establish its effectiveness, and cost effectiveness, in advanced non-malignant conditions. Methods This was a single-centre Phase III fast-track single-blind mixed method RCT of BIS versus standard care for breathless patients with non-malignant conditions and their carers. Randomisation was to one of two groups (randomly permuted blocks). Eighty-seven patients referred to BIS were randomised (intervention arm n = 44; control arm n = 43 received BIS after four-week wait); 79 (91 %) completed to key outcome measurement. The primary outcome measure was 0–10 numeric rating scale for patient distress due to breathlessness at four weeks. Secondary outcome measures were Chronic Respiratory Questionnaire, Hospital Anxiety and Depression Scale, Client Service Receipt Inventory, EQ-5D and topic-guided interviews. Results Qualitative analyses showed the positive impact of BIS on patients with non-malignant conditions and their carers; quantitative analyses showed a non-significant greater reduction in the primary outcome (‘distress due to breathlessness’), when compared to standard care, of –0.24 (95 % CI: –1.30, 0.82). BIS resulted in extra mean costs of £799, reducing to £100 when outliers were excluded; neither difference was statistically significant. The quantitative findings contrasted with those previously reported for patients with cancer and their carers, which showed BIS to be both clinically and cost effective. For patients with non-malignant conditions there was a notable trend of improvement over both trial arms to the key measurement point; participants may have experienced a therapeutic effect from the research interviews, diluting the intervention’s impact. Conclusions BIS had a statistically non-significant effect for patients with non-malignant conditions, and slightly increased service costs, but had a qualitatively positive impact consistent with findings for advanced cancer. Trials of palliative care interventions should consider multiple, mixed method, primary outcomes and ensure that protocols limit potential contaminating therapeutic effects in study designs. Trial registration Current Controlled Trials ISRCTN04119516 (December 2008); ClinicalTrials.gov NCT00678405 (May 2008)

The frequency of COPD exacerbations during treatment with a triple inhaler — delivering a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled glucocorticoid — was compared with that with a LABA–LAMA or LABA–inhaled glucocorticoid.

Background Respiratory muscle weakness in heart failure (HF) can deteriorate its symptoms such as fatigue, dyspnea, and impaired functional status. Pulmonary rehabilitation can strengthen these muscles. This study aimed to determine the impact of breathing exercises on fatigue severity, dyspnea, and functional classification in HF patients. Methods A three-arm single-blind randomized controlled trial was conducted on 90 hospitalized HF patients in three 30-participant groups including diaphragmatic breathing group (DG), incentive spirometry group (SG), and control group (CG). The interventions were performed thrice daily for 10 days in DG and SG. The Fatigue Severity Scale (FSS), Borg dyspnea scale, and New York Heart Association (NYHA) functional classification were used before and after the intervention. Data were analyzed using SPSS-20 software. Results After the intervention, the patients’ frequency with severe fatigue decreased by 30% in both DG and SG ( p  < 0.001); the mean dyspnea score in DG and SG respectively reduced by 0.7 and 0.9 units at rest ( p  < 0.001) and reduced by 2.93 and 2.73 units during activity ( p  < 0.001); the total patients’ frequency in functional class III and IV was significantly decreased by 30% in DG and 33.3% in SG ( p  < 0.001). The intervention groups were not significantly different regarding fatigue severity, dyspnea, and functional classification. While in CG these outcomes had no significant reduction after the intervention. Conclusion In this study breathing exercises could reduce fatigue and dyspnea, and improve NYHA functional classification of HF patients which can be included in nursing care plans for respiratory rehabilitation in HF. Trial registration This study was prospectively registered by the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir/ ) on 14/04/2024 with registration ID: IRCT20240306061197N.

OBJECTIVES: The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung transplantation (LTx) candidates. MATERIALS AND METHODS: Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical Research Council (MRC) dyspnea scale were recorded. RESULTS: Of 23 patients 57% were males; the mean age was 35±10 (range: 16–48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic pulmonary fibrosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there was a significant improvement (median: 60 m) in 6MWT scores (360 [70–254] m vs. 300 [139–489] m; p=0.018). In addition, a clinical improvement was observed in Borg (p=0.000) and MRC scores (p=0.008). CONCLUSION: Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.

Background Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that significantly affects patients' quality of life. Non-invasive positive pressure ventilation (NPPV) and pulmonary rehabilitation have both shown promise in improving symptoms and lung function in COPD patients. However, the combined effects of home-based pulmonary rehabilitation and NPPV on moderate to severe COPD patients remain unclear. Objective This study aimed to evaluate the efficacy of home pulmonary rehabilitation combined with non-invasive positive pressure ventilation (CPRNG group) compared to conventional treatment (CTG group) in patients with moderate to severe COPD. Methods A total of 269 patients with moderate to severe COPD were enrolled, with 137 patients in the CTG group and 132 in the CPRNG group. The primary outcome measures included the COPD assessment test (CAT) score, modified medical research council scale (mMRC) score, forced expiratory volume in one second (FEV₁) percentage, 6-min walk test, and arterial oxygen pressure (PaO₂). Secondary outcomes included various dimensions of quality of life (impact, symptoms, and activity) measured through patient-reported outcomes. Results Baseline comparisons between groups showed no significant differences in sociodemographic characteristics, disease duration, or symptoms. The CPRNG group showed significant improvements compared to the CTG group in the CAT score ( p  = 0.028), mMRC score ( p  = 0.015), FEV1% ( p  = 0.008), 6-min walk test ( p  = 0.001), and PaO₂ ( p  < 0.001). Additionally, improvements in impact, symptoms, activity, and overall scores were significantly better in the CPRNG group ( p  < 0.05). Conclusions Home pulmonary rehabilitation combined with non-invasive positive pressure ventilation significantly improves multiple dimensions of quality of life, particularly in controlling symptoms and enhancing daily activities in COPD patients. This combined therapy proves to be an effective treatment strategy, offering notable benefits in lung function, exercise capacity, and overall quality of life in COPD patients. Trial registration The clinical trial was registered retrospectively on the Chinese Clinical Trial Registry (ChiCTR, www.chictr.org.cn ID: ChiCTR2500096605) on 2025–01-26, as required by The Fourth Hospital of Institutional (Changsha Fourth Hospital, Hunan Province, China) Review Board guidelines. Ethics approval date: January 2023 to December 2025.

Nesiritide was approved by the FDA on the basis of small clinical trials for the treatment of acute heart failure. In this large clinical trial, nesiritide did not improve outcomes in patients with acute heart failure, and it can no longer be recommended for this condition. Acute decompensated heart failure is a major health problem that is associated with several million hospitalizations worldwide each year, poor short-term outcomes, and high costs. 1 – 3 Despite the magnitude of the problem, rates of early death and rehospitalization have not improved over the past several decades. 3 Nesiritide, a recombinant B-type natriuretic peptide (BNP) with vasodilatory properties, 4 – 7 was approved in 2001 for use in patients with acute heart failure on the basis of studies showing a reduction in pulmonary-capillary wedge pressure and improvement in dyspnea at 3 hours. 5 , 6 , 8 However, subsequent pooled analyses of data from small, randomized trials . . .