TREATMENTS FOR DYSPNEA--EDUCATION, EXPOSURE OR TRAINING

描述：(改编自申请者的摘要)呼吸困难，或短促 呼吸困难是患者最常见和最严重的主诉 肺部疾病。它扰乱了人们的日常生活，减少了 生活质量。调查人员已经证明，感官和 呼吸困难的情感维度可以显著减少 慢性阻塞性肺疾病(COPD)患者的自测速度 运动训练计划，让护士暴露在呼吸困难中- 受监控的环境。12个疗程后呼吸困难的减少 锻炼计划的出现是因为两者都有更好的锻炼表现 (更高的效率和调节)，这需要更少的 通风和脱敏(症状相对于 通风)。这项研究的总体目标是确定 回家散步时呼吸困难的减少程度是否与走路时一样多 在受监测的环境中短暂接触症状或典型的 高强度肺康复运动训练。初级阶段 目的是测试三种治疗方法的疗效差异。 呼吸困难：关于呼吸困难的教育和回家行走的处方； 护士指导下的教育和回家步行暴露于呼吸困难 方剂；高效率的肺康复模式。 高强度运动、教育和回家步行处方。 次要目标是确定呼吸困难是否在以下情况下减少 一次递增的跑台试验以及治疗是否有效 取决于疾病严重程度、性别、种族或对家庭的忠诚度 步行处方。这项研究还试图确定 反应持续时间因治疗方法不同而不同。这个 设计是一项为期一年的实验性纵向研究。 将分配90名患有慢性阻塞性肺疾病并有呼吸困难的患者 随机分为三个治疗组中的一个。所有团体都将收到 关于处理呼吸困难的策略和家庭锻炼的教育 处方药。此外，暴露组还将完成四项自我评估 在跑步机上进行有节奏的训练，以允许护士指导的暴露 到呼吸困难，高强度训练组将完成24小时 高强度跑步机训练。即刻和长期 结果包括：a)感觉和情感方面的呼吸困难 锻炼；b)有日常生活活动的呼吸困难；c)锻炼 能力；d)健康状况；e)与健康有关的生活质量，包括 功能地位、社会地位和健康认知；f)自我 疗效；g)对呼吸困难的感知控制；h)情绪状态。如果较短 而对呼吸困难进行较小强度的治疗被证明与 大强度运动训练方案在减轻慢性阻塞性肺疾病症状中的作用 呼吸困难和生活质量的改善对护理的影响 慢性阻塞性肺病患者将是相当多的。

DESCRIPTION: (adapted from applicant's abstract) Dyspnea, or shortness of breath, is the most frequent and severe complaint of patients with pulmonary disease. It disrupts activities of daily living and decreases quality of life. The investigators have shown that the sensory and affective dimensions of dyspnea can be significantly decreased in chronic obstructive pulmonary disease (COPD) patients by a self-paced exercise training program that provides exposure to dyspnea in a nurse- monitored environment. This reduction in dyspnea after a 12-session exercise program occurred because of both better exercise performance (increased efficiency and conditioning), which requires less ventilation, and desensitization (a decrease in the symptom relative to ventilation). The overall objective of this study is to determine whether dyspnea decreases as much with home walking as it does with short exposure to the symptom in a monitored environment or with typical high-intensity pulmonary rehabilitation exercise training. The primary aim is to test differences in the effectiveness of three treatments for dyspnea: education about dyspnea and a home walking prescription; nurse-coached exposure to dyspnea with education and a home walking prescription; and a model of pulmonary rehabilitation with high- intensity exercise, education, and a home walking prescription. Secondary aims are to determine if dyspnea decreases after as little as one incremental treadmill test and whether the treatment response depends on disease severity, gender, ethnicity, or adherence to a home walking prescription. The study also seeks to determine whether the duration of the response differs depending upon the treatment. The design is an experimental longitudinal study extending over one year. Ninety patients with COPD and limited by dyspnea will be assigned randomly to one of three treatment groups. All groups will receive education about strategies for dealing with dyspnea and a home exercise prescription. In addition, the exposure group will complete four self- paced sessions on a treadmill designed to allow nurse-coached exposure to dyspnea, and the high intensity training group will complete 24 sessions of high intensity treadmill training. Immediate and long-term outcomes include: a) sensory and affective dimensions of dyspnea with exercise; b) dyspnea with activities of daily living; c) exercise capacity; d) health status; e) health-related quality of life, including functional status, social status, and health perception; f) self- efficacy; g) perceived control of dyspnea; and h) mood state. If shorter and less intensive treatments for dyspnea prove to be as effective as a high-intensity exercise training program in decreasing the symptom of dyspnea and improving the quality of life, the impact on the care of patients with COPD will be substantial.