Characterization and Triggers of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure: Effects of Weather and Environment
- 32 Downloads
Background and Objectives
Dyspnea is one of the most disturbing symptoms for patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF). This study investigated dyspnea triggers and factors associated with worsening dyspnea in patients with COPD or HF.
COPD support group members and HF patients with reduced ejection fraction (HFrEF) and no airway obstruction answered a questionnaire describing different weather conditions (rising/falling air pressure, sunny, foggy, rainy, windy, snowy, hazy, high ozone levels, and airborne pollen) and environmental circumstances (cooking, grilling, perfumes, cigarette smoke, gasoline odor, and flower scents) and were asked to estimate the occurrence and severity of dyspnea under these conditions using predefined scales.
230 patients with COPD and 90 with HFrEF (left ventricular ejection fraction 34 ± 10%, Tiffeneau index > 70%) were analyzed. COPD patients reported dyspnea more often than HF patients in almost all weather and environmental conditions (p = 0.004 to p < 0.001), with the exception of outdoor floral scents and cigarette smoke. Severe to very severe dyspnea was reported more in COPD versus HF in all weather and environmental conditions except sunny weather (p = 0.01 to p < 0.001). COPD was associated with more severe dyspnea than HF in all conditions (all p < 0.001).
Dyspnea was triggered by a variety of weather and other environmental triggers in patients with COPD and occurred more often than in HF patients under the same conditions. Foggy weather and exposure to perfumes were associated with severe dyspnea in the majority of COPD patients, but only a minority of HF patients.
KeywordsChronic obstructive pulmonary disease Dyspnea Environment Heart failure Weather
The authors thank the patients who took part in the study and the staff of the Center for Translational & Clinical Research Aachen (CTC-A) for their help with the collection of the data.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with Ethical Standards
Conflict of interest
The authors state that they have no competing interests relating to this manuscript.
Informed consent was obtained from all individual participants included in the study.
- 1.From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) (2017) http://goldcopd.org. Accessed 08 Apr 2018
- 2.O’Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, Gelb AF, Mahler DA, Webb KA (2007) Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc 4:145–168. https://doi.org/10.1513/pats.200611-159CC CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Rutten FH, Moons KGM, Cramer M-JM, Grobbee DE, Zuithoff NP, Lammers JW, Hoes AW (2005) Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study. Br Med J 331:1379. https://doi.org/10.1136/bmj.38664.661181.55 CrossRefGoogle Scholar
- 6.Daniels LB, Clopton P, Bhalla V, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA, Maisel AS (2006) How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. Am Heart J 151:999–1005. https://doi.org/10.1016/j.ahj.2005.10.017 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Suzuki M, Makita H, Ito YM, Nagai K, Konno S, Nishimura M, Hokkaido COPD Cohort Study Investigators (2014) Clinical features and determinants of COPD exacerbation in the Hokkaido COPD cohort study. Eur Respir J 43:1289–1297. https://doi.org/10.1183/09031936.00110213 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Ren J, Li B, Yu D, Liu J, Ma Z (2016) Approaches to prevent the patients with chronic airway diseases from exacerbation in the haze weather. J Thorac Dis 8:E1–E7. https://doi.org/10.3978/j.issn.2072-1439.2015.11.61 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Santus P, Russo A, Madonini E, Allegra L, Blasi F, Centanni S, Miadonna A, Schiraldi G, Amaducci S (2012) How air pollution influences clinical management of respiratory diseases. A case-crossover study in Milan. Respir Res 13:95. https://doi.org/10.1186/1465-9921-13-95 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Macchia A, Rodriguez Moncalvo JJ, Kleinert M, Comignani PD, Gimeno G, Arakaki D, Laffaye N, Fuselli JJ, Massolin HP, Gambarte J, Romero M, Tognoni G (2012) Unrecognised ventricular dysfunction in COPD. Eur Respir J 39:51–58. https://doi.org/10.1183/09031936.00044411 CrossRefPubMedPubMedCentralGoogle Scholar