#chronic obstructive pulmonary treatment

[lalithacsh]

Copd Awareness: Types, Causes, Symptoms, and Prevention Tips

Delve into COPD Awareness: Chronic lung diseases like emphysema & chronic bronchitis caused by smoking. Symptoms include coughing & shortness of breath.

To Know More: https://lalithachestandskinhospital.com/blog/copd-awareness-types-causes-symptoms-and-prevention-tips/

[soumyafwr]

Chronic Obstructive Pulmonary Disease (COPD) Treatment Market Size, Analysis and Forecast 2031

[neamamhmd9]

Save My Family From the war nightmare in Gaza

Hello My name is Neama, I'm 24 years old and I'm trying to save my family from the war. I used to work for the medical staff and help treat patients and children through my profession as a medical analysis specialist. We are the ones who separate doubt and certainty, but the occupation came and we were displaced. Because of this harsh war, I couldn't continue my profession of helping and saving children, and this saddens me.

My father, Mohammed, is 69 years old, and my mother, Amal, is 60 years old. We are a family of 7 (Ahmed, 32 years old, Alaa, 36 years old, Mariam, 27 years old, Ne’ma, 24 years old, Mahmoud, 22 years old) and the family of my widowed sister, 38 years old, who has four orphaned children (Tulin, 10 years old, Obaida, 9 years old, Laith, 6 years old, Ghaith, 5 years old). We lived a life full of happiness. We had dreams that were shattered by the barbaric Israeli attack that does not differentiate between young and old. After our house was completely destroyed, we were displaced to the southern Gaza Strip in search of a safe life, but this enemy does not differentiate at all and targets us in the shelter tents and their harsh conditions of extreme heat, lack of privacy, abundance of insects, and scarcity of water and food. We are now suffering from famine because of this war.

My father, Mohammed, suffers from a chronic disease (chronic pulmonary obstruction and difficulty breathing), and his condition has deteriorated, making him depend on oxygen tubes. One of my sisters has special needs (quadriplegia), while my other sister is a widow with four orphaned children and suffers from a chronic illness (ulcerative colitis)

You can contribute in any way you see fit to move my family out of Gaza to get the necessary medical treatment and live in a safe environment, every effort creates a useful impact and contributes to making a real difference. Through financial donations, you can contribute any amount you see fit, whether small or large, via the link or share it with your friends and anyone who can help us

Thank you very much for your humanity and standing with us. We hope that the war will end and peace will prevail in the world. Thank you all in advance for your support. May God protect and bless us all

https://gofund.me/5c9c46ba

[visionresearchreports]

According to Vision Research Reports, the global chronic obstructive pulmonary disease treatment market size is expected to hit around US$ 33.03 billion by 2032 and projected to expand at a CAGR of 5.1% over the forecast period of 2023 to 2032.

[tempural]

Started with this B/W sketchbook drawing. Got inspired by the look of the sketchbook spiral on the side, cuz it looked like film notches. Made me think of x-ray scans. Ended up doing the whole medical route on the final drawing.

Coloring method was mostly pressing the "invert" tool to turn the canvas black. Then painting red/yellow with gradient maps. And then drawing the glowing blue lines, as well as typing the "medical" text, on an "add" layer.

Spoilers and long head canons and unlicensed medical talk under the cut.

The text reads:

REVIEWED BY PONY EXPRESS AUTODOC MODEL-SCUMSUCK

PATIENT: CURLY

Near total body disruption from explosive decompression

Complete dermal vascular system collapse

Severe radiation poisoning

Hyperosmolar hyperglycemic state

Muscle and bone cachexia

Single eye rupture

Chronic obstructive pulmonary

Testicular rupture

Severe leukopenia

Itchiness and dry eye

RECOMMENDED TREATMENT

Administer intravenous therapy and catheter

Support neck and spine

Change bandages as supplies last

Orally administer paracetamol for pain

Turn and reposition patient every 2 hours to prevent bed sores

Create relaxing enviroment

Listen attentively to understand emotional state

Allow time for exercise and meditation

Encourage positive thinking

Brush teeth

Administer mouthwash

SIGNED OFF BY DOCTOR ANYA

Of course none of the treatment is actually good. In the game itself, you give him paracetamol (TYLENOL) for pain haha. So I thought I'd go along with the bad medical advice. Including that universal medical advice you get to do "exercise and meditation" if you are in a bad mood :)

I think I spent about as much time looking up the medical stuff (specifically things in relation to explosion damage and radiation damage - thinking of the Byford Dolphin Incident as well as Hisashi Ouchi) as I did with the coloring! We don't know what exactly happened with Curly, but I'd just guess with my lack of medical knowledge that the ship crashed, something exploded, and he was exposed to intense radiation.

Realistically he wouldn't be surviving with the level of medical care they have available on the ship, so I drew a couple things I thought would help him... namely the IV and catheter haha. Also thought it'd be a fun time to introduce my favorite headcanon to gift cute characters: the gift of genital nullification. Yes, I drew this mostly to show off my not-buff and no-pp headcanons!!!!

I like Curly with no skin, no muscle, no hair. It's ok if he had those before. I probably wouldn't draw him "recovered" with perfectly functioning prosthetic limbs and magically regrown vocal cords and sexy 8 pack abs. That's just me. He could get a wheelchair, perhaps some sort of eye controlled assisted communication like Stephen Hawking (but Curly doesn't seem to be able to control his jaw or cheek?).

Thinking about ~da dystopian future~ and what support he would even get? His job ain't gettin him anything :P He doesn't seem to be in the sort of society with universal healthcare, they'd drain his savings and then put him in a dark room with a nurse that turns him over once every 24 hours... Well, that's if they find him. I think he's staying frozen for 20 years and then melting like Walt Disney once the power runs out.

[mindblowingscience]

Lung diseases kill millions of people around the world each year. Treatment options are limited, and animal models for studying these illnesses and experimental medications are inadequate. Now, writing in ACS Applied Bio Materials, researchers describe their success in creating a mucus-based bioink for 3D printing lung tissue. This advancement could one day help study and treat chronic lung conditions. While some people with lung diseases receive transplants, donor organs remain in short supply. As an alternative, medications and other treatments can be used to manage symptoms, but no cure is available for disorders such as chronic obstructive pulmonary disease and cystic fibrosis. Researchers continue to seek better medications, often relying on testing in rodents. But these animal models may only partially capture the complexities of pulmonary diseases in humans, and they might not accurately predict the safety and efficacy of new drugs.

Continue Reading.

[promptsforyourwhumpfic]

The Grand A-Z List of Whump 1/3

This list contains ~290 items listed A to H

As always, I heavily encourage people to research topics thoroughly when writing as it is important to avoid stereotypes/misinformation. This list's intention is not to glorify/romanticise sensitive topics in any way.

This part one-of-three comprehensive lists of injuries, Illnesses and tropes - including those from the Whumptober 2023 trope vote!

All submissions are listed in italics, and those who wanted to be tagged will be included at the end. If you have any more submissions: please send them via DM/my ask box.

[I-Q] [R-Z] [NSFW List]

List below the cut:

#

"I don't need your help."

"I'm doing this to make you better"

"I'm fine, take care of them!"

“I’m Fine”

"Kill me instead"

"Let me in."

"Look at me."

"Should I know you?"

"Take me instead."

(No) Anaesthetic

A

A Good Ol' Sickfic

Abandoned

Abdominal Pain

Aching Wounds

Acne

Adrenaline Crash

Adrift (in space/at sea)

Agoraphobia

Airsickness

Alien abduction

Allergies

Alopecia

Ambulance Ride

Ambush

Amnesia/memory loss

Amputations

Anaemia

Anesthesia

Angina (Heart condition that causes pain)

Animal Attack/Bite

Ankle Sprain

Anthrax

Anxiety/Anxiety attack(s)

Aphasia

Appendicitis

Arrested

Arthritis

Asking for help

Asphyxiation

Assumed Dead

Asthma/Asthma Attack

Auctions

Autoimmune disease

Avalanches

B

Backache

Bad Caretakers

Bandaged Head

Banished

Barbed Wire

Bear trap

Beaten up by ex-friends

Beaten with blunt object (i.e, bat or pipe)

Beatings

Bedrest

Bedside Vigil/Hospital Vigil

Begging

Betrayed by close friend/team/family

Bites (Animal, Bug, Human….)

Biting

Black Eye

Blackmail

Bleeding Out

Bleeding Through

Bandages

Blindfolded

Blindness (this could be temporary or permanent)

Blisters

Blood Loss

Blood Poisoning

Bloodied Knuckles

Bloodstains/blood trail

Bloody handprints

Bloody nose

Blunt force trauma

Blurred vision

Body modification

Body Sharing

Body Switching

Bounty on their head

Brain Damage

Brainwashing

Breakdowns

Breathless

Bridal Carry

Broken Bones (Ribs, Arm, Leg)

Broken Nose

Broken Promises

Bronchitis

Bruises

Building Collapse

Bullet Removal

Bumpy roads jarring injuries

Buried Alive

Burning Building

Burns/Scalding

Busted kneecap

C

Cancer

Caning

Capgras syndrome/delusion (belief that someone close to/important to the person has been replaced by an imposter)

Capsulitis

Captivity

Captured

Car chases (and maybe a car crash)

Carbon monoxide poisoning

Cardiac Arrest

Caretaker has to “play nice” with whumper.

Caretaker has to hurt whumpee while undercover.

Caretaker sacrificing something dear to them to get something the whumpee needs.

Caretaker turned Whumpee

Caretaker-whumper who's a parental whumper. But their "love" is not real love. Or even right treatment.

Carsickness

Cataracts

Catatonia

Caught in a fire

Caught in an explosion

Cauterization

Cave In

Cavity

Celebrity whump (exploitation in the music/movie industries…)

Chaffing from ropes/handcuffs/shackles

Chained/Shackled

Checking for injuries

CHF - congestive heart failure

Chicken Pox

Chills

Chloroform

Choking

Chronic pain

Claustrophobia

Cleaning wounds alone

Cold/Flu,

Collapsed Lung

Collapsing (into someone’s arms is usually nice, bonus points for cradling their head as they lower the whumpee to the floor)

Collapsing after they win

Collapsing/Fainting/Passing Out

Collars

Coma

Comfort after a nightmare

Common cold

Completely betrayed by their own team

Complications

Concussion

Confusion

Constipation

Constricted Airways

COPD - Chronic obstructive pulmonary disease makes breathing increasingly more difficult.

Corporal Punishment

Corset too tight and won’t unbutton

Coughing

Coughing Up Blood

CPR

Cramps

Crikes (intubation through neck)

Crush injury

Crying

Cuddle pile

Curses

Cuts/Grazes

Cutting off hair (more of an emotional hurt)

Cyanide poisoning

D

Damaged Larynx/Vocal Cords

De-aging

Deathbed Confessions (don’t have to actually die and stay dead, just the threat of dying)

Defeat

Defenestration (throwing out a window)

Dehydration

Deja Vu

Delirium (bonus points for this being drug/ fever induced)

Deluded whumper/thinking they’re helping the whumpee

Dengue Fever

Denial

Depression

Dermatitis

Diabetes (type 1 and 2)

Diarrhea

Diseases ('mystery' diseases are the best kind)

Dislocations

Disorientation

Disowned by Family

Displaced hip

Dissociation

Distress call

Dizziness

Dragged Away

Dream sequence

Driving to the hospital with a whumpee slumped barely-conscious in the seat of the car

Drowning

Drunkenness

E

Ear Infection

Edema (swelling from build up of fluid)

EKG

Electrical Burns

Electrical shock

Electrocution

Emergency field surgery

Emergency Surgery

Emotional angst

Emotional manipulation

Endometriosis

Enemy to Caretaker

Energy Drain

Environmental whump

ER

Execution

Exes reunited with one wanting a relationship and the other just wanting friendship.

Exhaustion

Experimentation

Exposure

Extreme Weather

Eye injury

F

Facing Phobias

Failed Escape

Failure to thrive

Fainting

Fainting (but also fainting aftermath) / Fainting due to lack of sleep, food, or overworking fainting from exhaustion

Falling

Falling for Caretaker/Whumpee/Whumper

Falling Through Ice

Fatigue/Exhaustion

Fever

Fibromyalgia (Chronic Pain)

Field medicine

Fighting (while injured)

Financial difficulty faced + how whumper might take advantage of that + how caretaker handles everything (well/badly)

Finding your loved one dead without explanation but thinking they’re still alive.

Fireman's carry

Flare ups

Flashbacks

Flinching away

Flu

Food Poisoning

Forced to... (Break out, Choose, Hurt, Kneel, Scream, Watch)

Forehead kisses

Forgotten by team

Foul-tasting medicine

Found family

Found unconscious

Fracture (Arm, Hyoid bone etc)

Freezing / cold whump

Friendly Fire

Frostbite

G

Gagged/Muzzled

Gangrene infection

Gaslighting

Gas (noxious, poisonous etc)

Gastritis

Glass (shards, debris etc)

Grief

Gunshot Wound

H

Hair Pulling/Cutting/Matting/Stroking

Hallucinations

Hanahaki

Handcuffs

Handgag

Hard ground

Haunted

Hay Fever

Head injuries/concussion

Head trauma

Headache/Migraine

Heart Palpitations

Heartburn

Heat Exhaustion

Heatstroke

Heavy metal poisoning

Held at gunpoint/knifepoint/weapon point

Hematohidrosis (Sweating blood)

Hemophilia/Hematophilia (Blood unable to clot)

Haemothorax

Hernia

Hidden Illness/Injury/Scar/Medical Issues

Hiding

High Blood Pressure

High Fever (like dangerously high)

High Pain Tolerence

Hit by a car

Home Sickness

Hospital Codes

Hostage Situation

House burnt down

Huddling for Warmth

Human Shield

Human Weapon

Hunger

Hungover

Hunted for Sport

Hurt no comfort

Hyperalgesia,

Hypermobility

Hyperventilating

Hypo/Hyperthermia

Hypo/Hyperthyroidism

Hypoglycemia

Hypotension/ Hypertension

Hypoxia

TAG LIST: Thank you very much to the following people for submitting ideas! (I apologise if some tags did not work, I'm not sure why tumblrs not letting me tag you!)

@I-eat-worlds | @greygullhaven | @letsgowhump | @cyberwhumper @firapolemos05 | @originaldeerhottub | @whumpilicious | @drawing-dinos82 | @carenrose | @stellarinuscronicles | @gottheseasonalblues | @marvelflame2010 | @sowhumpful | @avamcu | @courtneygacha | @lordofthewhumps | @autismmydearwatson | @kuddelmuddell | @the-most-handsome-ginger | @whirls-and-swirls | @painsandconfusion

[materialsscienceandengineering]

Mucus-based bioink could be used to print and grow lung tissue

Lung diseases kill millions of people around the world each year. Treatment options are limited, and animal models for studying these illnesses and experimental medications are inadequate. Now, writing in ACS Applied Bio Materials, researchers describe their success in creating a mucus-based bioink for 3D printing lung tissue. This advancement could one day help study and treat chronic lung conditions. While some people with lung diseases receive transplants, donor organs remain in short supply. As an alternative, medications and other treatments can be used to manage symptoms, but no cure is available for disorders such as chronic obstructive pulmonary disease and cystic fibrosis. Researchers continue to seek better medications, often relying on testing in rodents. But these animal models may only partially capture the complexities of pulmonary diseases in humans, and they might not accurately predict the safety and efficacy of new drugs.

Read more.

[religion-is-a-mental-illness]

By: Madeleine Rowley

Published: Jun 18, 2024

Mandatory ideological training has now come to the drugstore. In California, pharmacists and pharmacy technicians, in order to keep their license, must study the latest in gender identity, colonialism, and white privilege. Such “cultural competency” courses are required by a state law that went into effect this year.

When the bill was introduced, Democratic Assemblyman Christopher Ward, the lead sponsor, said that the continuing education class would help “ensure pharmacists are looking out for the well-being of LGBTQ+ individuals.” 

Like many licensed professionals, pharmacists are required to take continuing education courses, usually with titles like “Chronic Obstructive Pulmonary Disorder (COPD)” and “Trimming Trends: Unveiling the Latest in Weight Management Guidelines.” Though this new training requires only an hour of the pharmacist’s time every two years, it’s another demonstration of compelling people to passively accept dubious assertions and assumptions, or risk losing their livelihoods.

One such course, titled Caring for All: The Pharmacy Professional’s Role in LGBTQ+ Health and Equity comes from the California Pharmacists Association (CPhA). The outline, obtained by The Free Press, features many charts that are hard to square with the duties of a pharmacist. There is a chart illustrating many “systems of oppression.” These include “sexism,” “cis-sexism,” “heterosexism,” and “adultism.” 

Another chart describes “effects of colonialism and colonization on pre-colonial ways of being.” It states: “Racism creates race: otherness and whiteness.” Some of the pre-colonial ways of being pharmacists are taught include “two-spirit,” the term used by Native Americans to describe someone who has “both a masculine and feminine spirit.” 

The training also suggests that pharmacists introduce a question about a customer’s gender at their first interaction. The course gives this prompt: “Hello, my name is Jay. I use they/them and he/him pronouns. How would you like me to address you?”

Click here to see a slide show of the training.

What does any of this have to do with being a pharmacist? Not much, said several pharmacists The Free Press spoke to.

Lisa Marino, 54, a hospital pharmacist in Los Angeles County, says the new cultural competency course provides nothing that relates to her job. “Our role is to aid in providing safe and appropriate use of medication for all people, regardless of culture, and with a respect for everyone’s privacy and dignity,” said Marino. “This feels like indoctrination.”

Joe, 50, who asked The Free Press not to use his last name, worked as a pharmacist for 25 years and owns an independent pharmacy in Los Angeles County. He says that respecting all customers, no matter their race or sexual orientation, is a given.

“To be a competent pharmacist, you need to know about medications, professional ethics, and the law,” said Joe. “That’s it.” 

Dr. Carrie Mendoza is an emergency medicine physician and the recently appointed director of Genspect USA, an organization that seeks evidence-based treatments for people with gender distress. She says people are taught to be so hyper-sensitive to avoid offending people, especially to those in a designated “marginalized” group, that pharmacists may be afraid to bring up legitimate concerns. “A pharmacist might not raise medication safety concerns such as adverse effects [or] inappropriate dosing. . . out of fear they will be called discriminatory,” said Mendoza. “Political trainings like this undermine safety for all patients and should be immediately removed from our healthcare system.”

But one of the three CPhA cultural competency course authors, Dr. Tam Phan, an assistant professor of clinical pharmacy at the University of Southern California—and the clinical pharmacy program coordinator at the Los Angeles LGBT Center—told The Free Press in an email that a pharmacist’s role has expanded beyond quick interactions at the prescription counter. 

“Pharmacist prescriptive authority in California has expanded to immunizations, hormonal contraceptives, travel medicine, nicotine replacement products, and HIV. . . treatments,” he wrote. “For pharmacists who are not interacting with patients directly, LGBTQ+ cultural sensitivity is still important since pharmacists should be knowledgeable of potential drug interactions between hormones being used in gender affirmation with the patient’s other medications.”

==

This has nothing to do with "well-being." The point is to proselytize and indoctrinate at any and every available opportunity, to embed their particular ideological commitments as deeply into society as possible.

[mcatmemoranda]

CDC recommends everyone ages 75 and older get an RSV vaccine.

CDC recommends adults ages 60–74 who are at increased risk of severe RSV disease get an RSV vaccine.

The RSV vaccine is not currently an annual vaccine. If you have received an RSV vaccine already (including last year), you should not get another RSV vaccine at this time.

You can get one at any time, but the best time to get vaccinated is in late summer and early fall.

Conditions that increase your risk for severe illness include:

Chronic heart or lung disease

Weakened immune system

Certain other medical conditions

Living in a nursing home

To protect infants and some young children, CDC recommends the maternal vaccine (Pfizer’s Abrysvo) for pregnant people during weeks 32–36 of pregnancy, or an RSV monoclonal antibody (nirsevimab) for babies given after birth and for some young children ages 8–19 months.

Adults who get RSV usually have mild or no symptoms. Symptoms are usually consistent with an upper respiratory tract infection, which can include rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. Milder illness in adults typically resolves in 1–2 weeks. However, RSV can also cause severe disease and hospitalization in adults.

RSV can sometimes also lead to exacerbation of serious conditions such as:

Asthma

Chronic obstructive pulmonary disease (COPD)

Heart failure

Epidemiologic evidence indicates that all adults ages 75 or older and adults ages 60–74 with certain risk factors are at increased risk of severe RSV.

Conditions that increase the risk for severe RSV

The following conditions increase the risk of severe RSV:* 

Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, or congenital heart disease [excluding isolated hypertension])

Chronic lung or respiratory disease (e.g., chronic obstructive pulmonary disease, emphysema, asthma, interstitial lung disease, or cystic fibrosis)

End-stage renal disease or dependence on hemodialysis or other renal replacement therapy

Diabetes mellitus complicated by chronic kidney disease, neuropathy, retinopathy, or other end-organ damage, or requiring treatment with insulin or sodium-glucose cotransporter-2 (SGLT2) inhibitor

Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness (e.g., poststroke dysphagia, amyotrophic lateral sclerosis, or muscular dystrophy [excluding history of stroke without impaired airway clearance])

Chronic liver disease (e.g., cirrhosis)

Chronic hematologic conditions (e.g., sickle cell disease or thalassemia)

Severe obesity (body mass index ≥40 kg/m2)

Moderate or severe immune compromise†

Residence in a nursing home

Other chronic medical conditions or risk factors that a health care provider determines would increase the risk for severe disease due to viral respiratory infection (e.g., frailty,§ situations in which health care providers have concern for presence of undiagnosed chronic medical conditions, or residence in a remote or rural community where transportation of patients with severe RSV disease for escalation of medical care is challenging¶)

Source

[soumyafwr]

https://twikkers.nl/blogs/248273/Chronic-Obstructive-Pulmonary-Disease-COPD-Treatment-Market-Size-Analysis-and

Chronic Obstructive Pulmonary Disease (COPD) Treatment Market Size, Analysis and Forecast 2031

[partisan-by-default]

AstraZeneca’s Fasenra, an injectable treatment for severe asthma, is more effective during attacks than the oral steroid that has been the standard of care for 50 years, cutting the need for further treatment by 30%, according to a study published on Wednesday.

The antibody drug known chemically as benralizumab was approved by U.S. and EU regulators in 2017 as a treatment for a severe form of the breathing disorder called eosinophilic asthma that targets a type of white blood cell associated with lung inflammation.

The new study, led by King’s College London researchers, involved 158 patients in Britain who were at high risk of an asthma or chronic obstructive pulmonary disease (COPD) attack.

The researchers found that Fasenra can be more effective than the oral corticosteroid prednisolone when injected during an attack, also called an exacerbation, which can involve symptoms such as wheezing, coughing and chest tightness. Steroids such as prednisolone can reduce inflammation in the lungs but also may cause severe side effects.

The exacerbations account for 30% of COPD flare-ups and nearly half of all asthma attacks, and can become more frequent as the disease progresses.

[dailyunsolvedmysteries]

The Bhopal Tragedy

On the night of December 2nd, 1984, a Union Carbide plant in Bhopal, India, began leaking 27 tonnes of the deadly gas methyl isocyanate. None of the six safety systems designed to contain such a leak were operational, allowing the gas to spread throughout the city of Bhopal. Half a million people were exposed to the gas and 25,000 have died to date as a result of their exposure. More than 120,000 people still suffer from ailments caused by the accident and the subsequent pollution at the plant site. These ailments include blindness, extreme difficulty in breathing and gynaecological disorders. In the Immediate aftermath, the health care system immediately became overloaded. In the severely affected areas, nearly 70% were under-qualified doctors. Medical staff were unprepared for the thousands of casualties. Doctors and hospitals were not aware of proper treatment methods for MIC gas inhalation. There were mass funerals and cremations. Within a few days, trees in the vicinity became barren, and bloated animal carcasses had to be disposed of. 170,000 people were treated at hospitals and temporary dispensaries, and 2,000 buffalo, goats, and other animals were collected and buried. Supplies, including food, became scarce owing to suppliers' safety fears. Fishing was prohibited, causing further supply shortages. Formal statements after a few weeks were issued that air, water, vegetation, and foodstuffs were safe, but people were warned not to consume fish. The number of children exposed to the gases was at least 200,000. Within weeks, the State Government established a number of hospitals, clinics, and mobile units in the gas-affected area to treat the victims.  A cohort of 80,021 exposed people was registered, along with a control group, a cohort of 15,931 people from areas not exposed to MIC. Nearly every year since 1986, they have answered the same questionnaire. It shows excess mortality and morbidity in the exposed group. Bias and confounding factors cannot be excluded from the study. Because of migration and other factors, 75% of the cohort is lost, as the ones who move out are not followed. A number of clinical studies are performed. The quality varies, but the different reports support each other. Studied and reported long-term health effects are: Eyes: Chronic conjunctivitis, scars on cornea, corneal opacities, early cataracts Respiratory tracts: Obstructive and/or restrictive disease, pulmonary fibrosis, aggravation of tuberculosis and chronic bronchitis Neurological system: Impairment of memory, finer motor skills, numbness, etc. Psychological problems: Post traumatic stress disorder (PTSD) Children's health: Peri- and neonatal death rates increased. Failure to grow, intellectual impairment, etc. Missing or insufficient fields for research are female reproduction, chromosomal aberrations, cancer, immune deficiency, neurological sequelae, post traumatic stress disorder (PTSD) and children born after the disaster. Late cases that might never be highlighted are respiratory insufficiency, cardiac insufficiency (cor pulmonale), cancer and tuberculosis. Bhopal now has high rates of birth defects and records a miscarriage rate 7x higher than the national average. The site has never been properly cleaned up and it continues to poison the residents of Bhopal.

[obfuscated-abstract]

Title: Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention

Date: January 2020 Published in: Autonomic Neuroscience Publicly available: It is now.

Citation: Reilly, C. C., Floyd, S. V., Lee, K., Warwick, G., James, S., Gall, N., & Rafferty, G. F. (2020). Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (pots): The impact of a physiotherapy intervention. Autonomic Neuroscience, 223, 102601. https://doi.org/https://doi.org/10.1016/j.autneu.2019.102601

Full text

Abbreviations:

BPAT: breathing pattern assessment tool

COPD: chronic obstructive pulmonary disease

DB: dysfunctional breathing

HVS: hyperventilation syndrome

POTS: postural orthostatic tachycardia syndrome

Article summary

Abstract

Introduction

POTS is a chronic syndrome with complex symptoms of orthostatic intolerance. It is defined as an increase in heart rate of ≥ 30bpm in adults (≥40 bpm in children) within 10 minutes of standing with no orthostatic drop in blood pressure.

POTS is more common in women. Symptoms can be debilitating (impairment comparable to congestive heart failure and COPD) and include palpitations, light headedness/syncope, chest discomfort, breathlessness, neuropathic pain, chronic fatigue, poor sleep efficience, gastrointestinal symptoms, syncope, cognitive slowing, and psychological distress.

Breathlessness is a common symptom in POTS. Breathlessness is often attributed to changes in breathing pattern, frequency, and/or quality occuring alongside cardiac symptoms. Breathlessness can be episodic, triggered by physical activity, stressful thoughts and events.

Dysfunctional breathing (DB) is an umbrella term describing breathing disorders where chronic changes in breathing pattern result in breathlessness and other symptoms without respiratory or cardiac disease. The most studied form of DB is hyperventilation syndrome (HVS)

Boulding et al. (2016) suggest classifying dysfunctional breathing into the following: 1) Hyperventilation syndrome (a respiratory pattern associated with symptoms both related to respiratory alkalosis and independent of hypocapnia), 2) Periodic deep sighing (frequent sighing with an irregular breathing pattern), 3) Thoracis dominant breathing (a respiratory pattern occurring separate to somatic disease may be considered dysfunctional and results in dyspnoea), 4) Forced abdominal expiration (inappropriate and excessive use of abdominal muscle contraction to aid expiration), 5) Thoraco-abdominal asynchrony (a respiratory pattern in which there is delay between rib cage and abdominal contraction resulting in ineffective breathing movements)

Patients with POTS often undergo extensive investigations due to the complexity of potential comorbidities but there is no guidance or consensus on the assessment of breathlessness.

Methods

Retrospective study of POTS patients referred to repiratory physiotherapy

Respiratory physiotherapy outpatient's referral criteria: tests performed and identification of DB/HVS are explained

Physiotherapy assessment and outcome measures

A standardised physiotherapy assessment of symptoms was performed on all patients (details provided in the paper)

Physiotherapy intervention:

The physiotherapy intervention was standaradised in terms of education and breathing re-training exercises and was delivered by a consultant physiotherapist of a highly specialised respiratory physiotherapist. Each patient was assessed and treated by the same physiotherapist.

Physiotherapy treatment

The educational component focused on patient's understanding of respiratory physiology and the mind-body link

Breathing re-training intervention involved teaching breathing control (details provided). The breathing retraining exercises were standardised and progressive. All techniques used were standard respiratory physiotherapy techniques commonly applied for acute and chronic respiratory disease. Their use for breathlessness in POTS had no previously been assessed.

Patients were discharged when they were confident to continue the re-training programme independently or if they did not attend for follow-up appointments.

Data analysis: details and figures provided in the paper

Results

Demographic information is given in Table 1

Signficiant improvements were observed and are noted in Table 2

Discussion

This paper is the first to characterise DB/HVS and investigate the impact of physiotherapy in POTS. The results indicate that breathing retraining results in significant improvements in breathing pattern and symptom burden thus potentially improving their health related quality of life. Further studies are needed.

Significance of the findings

it is estimated that DB/HVS affects 10% of the general population and is more prevalent in women than men. Patients with POTS who reported respiratory symptoms had DB/HVS. DB/HVS may coexist alongside chronic respiratory diseases and COPDalthough the relationship is unclear.

Although there were statistically significant improvements for the patient cohort as a whole, not all patients had complete resolutions of their DB/HVS and there are several limitations in interpreting the results for this study.

Unexplained breathlessness or 'air hunger' are predominant symptoms of DB/HVS and can result in significant patient morbidity and an array of non-respiratory symptoms which can themselves provoke anxiety/panic and further breathing irregularity

Whilst orthostatic tachycardia is the main symptom of POTS, orthostasis causes a variety of other symptoms through a vaireity of different mechanisms. The paper provides an overview of the hypothesised mechanisms.

Psychological influences (stress, axniety, depression, etc.) are highly prevalent in POTS patients and predispose them to DB/HVS. The impact of this study's intervention could, therefore, be partly related to a change in anxiety thanks to education, greater understanding of DB/HVS, and empowerment.

Proposed improvements for further studies include the inclusion of pre-post PaCO2 measurements, the exclusion of asthma and pulmonary hypertension, analysis of why patients attended appointments (and addressing the issues)

Access to respiratory physiotherapy outpatient services is limited across the NHS and many POTS patients are instead seen by muscluloskeletal physiotherapists due to comorbidities. Increased awareness may improve treatment for these patients

More data is needed to investigate the prevalence of dysfunctional breathing in POTS and how it relateds to other chronic conditions. More detailed investigation and assessment guidelines and techniques are needed.

Limitations

No control data were available

Outcome measures were potentially not sensitive to non-hyperventilatory dysfunctional breathing

Observational nature and small sample size did not allow exploration of the role of confounding variables

A selection bias may have been introduced due to this being a convenience sample

The Nijmegen score used to characterise these patients has not been validated in this patient population. Its limitations highlight the need for a holistic POTS-specific measure.

Physiological outcome measures for the diagnosis of HVS are often limited to specialist services so alternative diagnostic tests are sought. The Breathing Pattern Assessment Tool (BPAT) has demonstrated good sensitivity and specificity for the diagnosis of DB in refractory asthma. Responsiveness of the BPAT to treatment remains to be ascertained.

Measuring Neural Respiratory Drive (NRD) in breathlessness patients with POTS may be advantageous. NRD provides a global measure of breathlessness and a physiological correlate to breathlessness but there is no data on whether NRD is increased in POTS or on NRD pre-post respiratory interventions

Conclusion