A portable automatic cough analyser in the ambulatory assessment of cough

<p>Abstract</p> <p>Background</p> <p>Cough is one of the main symptoms of advanced lung disease. However, the efficacy of currently available treatment remains unsatisfactory. Research into the new antitussives requires an objective assessment of cough.</p> <p>Methods</p> <p>The aim of the study was to test the feasibility of a new automatic portable cough analyser and assess the correlation between subjective and objective evaluations of cough in 13 patients with chronic cough. The patients' individual histories, a cough symptom score and a numeric cough scale (1-10) were used as a subjective evaluation of cough and a computerized audio-timed recorder was used to measure the frequency of coughing.</p> <p>Results</p> <p>The pre-clinical validation has shown that an automated cough analyser is an accurate and reliable tool for the ambulatory assessment of chronic cough. In the clinical part of the experiment for the daytime, subjective cough scoring correlated with the number of all cough incidents recorded by the cough analyser (r = 0.63; p = 0.022) and the number of cough incidents per hour (r = 0.60; p = 0.03). However, there was no relation between cough score and the time spent coughing per hour (r = 0.48; p = 0.1). As assessed for the night-time period, no correlation was found between subjective cough scoring and the number of incidents per hour (r = 0.29; p = 0.34) or time spent coughing (r = 0.26; p = 0.4).</p> <p>Conclusion</p> <p>An automated cough analyser seems to be a feasible tool for the ambulatory monitoring of cough. There is a moderate correlation between subjective and objective assessments of cough during the daytime, whereas the discrepancy in the evaluation of night-time coughing might suggest that subjective analysis is unreliable.</p

Reading numbers aloud as a tool for the evaluation of breathlessness in Polish cancer patients

Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale (NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 &#177; SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 &#177; 1.89, NRS 5.75 &#177; 2.37 and VAS 5.11 &#177; 2.34. The average value for PEF was 183.26 &#177; 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 &#177; 29.93 and for NN/Bmax was 2.92 &#177; 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = &#8211;0.52 and R = &#8211;0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73&#8211;80Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale(NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 &#177; SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 &#177; 1.89, NRS 5.75 &#177; 2.37 and VAS 5.11 &#177; 2.34. The average value for PEF was 183.26 &#177; 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 &#177; 29.93 and for NN/Bmax was 2.92 &#177; 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = &#8211;0.52 and R = &#8211;0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73&#8211;8

Need for palliation in patients with the severe COPD - a questionnaire study

Background. Traditionally in Poland, palliative medicine and hospice care is focused on patients with malignant diseases. COPD patients, however, also express the need for palliation of symptoms and end-ofthe life support The aim of this study was to assess the opinion of severe and very severe COPD patients on their most distressing chronic symptoms, social activity and the need for additional palliative support. Material and methods. 26 patients with advanced COPD, staged according to GOLD criteria answered the short questionnaire concerning symptoms, social activities and the need for additional palliative care. Results. All patients suffered chronic symptoms despite of intensive treatment, the majority of them limited social live and all patients expressed the need for additional palliative support. Conclusions. Polish pulmonologists and palliative medicine doctors should join the international discussion aiming on the definition of end-of-the life needs of patients with chronic, life-limiting diseases and evaluation of the potential benefits by addition of palliative care.Background. Traditionally in Poland, palliative medicine and hospice care is focused on patients with malignant diseases. COPD patients, however, also express the need for palliation of symptoms and end-ofthe life support The aim of this study was to assess the opinion of severe and very severe COPD patients on their most distressing chronic symptoms, social activity and the need for additional palliative support. Material and methods. 26 patients with advanced COPD, staged according to GOLD criteria answered the short questionnaire concerning symptoms, social activities and the need for additional palliative care. Results. All patients suffered chronic symptoms despite of intensive treatment, the majority of them limited social live and all patients expressed the need for additional palliative support. Conclusions. Polish pulmonologists and palliative medicine doctors should join the international discussion aiming on the definition of end-of-the life needs of patients with chronic, life-limiting diseases and evaluation of the potential benefits by addition of palliative care

Fatal course of Churg-Strauss disease

Churg-Strauss syndrome (CSS) is an allergic vasculitis, which is commonly characterized by asthma and allergic rhinitis, eosinophila and eosinophillic infiltration of organs. Approximately 60-90% of patients with CSS are long-term survivors. We presented the case of fatal case of the disease complicated by pulmonary embolism, arrhythmia, and eventually - cerebral bleeding.Churg-Strauss syndrome (CSS) is an allergic vasculitis, which is commonly characterized by asthma and allergic rhinitis, eosinophila and eosinophillic infiltration of organs. Approximately 60-90% of patients with CSS are long-term survivors. We presented the case of fatal case of the disease complicated by pulmonary embolism, arrhythmia, and eventually - cerebral bleeding

Difficult-to-treat asthma - an uncontrolled disease. Is there any relation to the experience from palliative medicine?

Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting &#946;2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients&#8217; spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials.Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting &#946;2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients&#8217; spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials