Symptom experience of adverse drug reaction among male and female patients with newly diagnosed pulmonary tuberculosis in Thailand

Background: Patients with newly diagnosed pulmonary tuberculosis often suffer from adverse drug reaction symptoms, which leads to the automatic discontinuation of anti-tuberculosis drugs. Thus, understanding symptom experience of adverse drug reactions is necessary.Objective: This study aimed to examine differences in symptoms experienced in four dimensions: presence, frequency, severity, and distress of adverse drug reactions, between male and female patients.Methods: This was a quantitative survey with a cross-sectional design, with data collected between January and April 2020. A total of 394 patients with newly diagnosed pulmonary tuberculosis was selected through a purposive sampling technique. The symptom experiences of adverse drug reactions were measured using a validated instrument. Data were analyzed using mean, standard deviation, and independent t-test.Results: The most commonly reported symptom was itchiness (24.1% in males and 34.9% in females). Vomiting occurred as the most frequent symptom among males (x̅ ± SD = 2.73 ± .88), and fatigue was found to be the most severe and distressing symptom across male patients (x̅ ± SD = 2.50 ± 1.61 and 2.06 ± 1.30, respectively). In contrast, yellowing of the eyes and skin was most frequent and severe among females (x̅ ± SD = 3.17 ± .75 and 3.83 ± 1.47, respectively). In addition, flu-like symptoms were evaluated as the most distressing symptom for female patients (x̅ ± SD = 2.80 ± 1.09). The symptom burdens of the females ranged significantly and reached higher than those of the male patients at a p-value of .05 (t = 3.33).Conclusion: Females taking anti-tuberculosis drugs should be carefully monitored to deal with adverse drug reaction symptoms. This finding would help to decrease the severity of disease and improve their quality of life.Funding: This study received funding from the Ratchadaphiseksomphot Endowment Fund, Chulalongkorn University, Bangkok, Thailand (GCUGR1125633058M).

Cutting through complexity: the Breathing, Thinking, Functioning clinical model is an educational tool that facilitates chronic breathlessness management

Chronic breathlessness is a distressing symptom that is challenging to manage. The Breathing, Thinking, Functioning clinical model is an educational tool developed to support breathlessness management. Health professionals report that the model increases clinician and patient understanding of this complex symptom, and provides a simple and structured approach to personalised self-management.

Words used by the breathless patient in COPD and enhancing therapeutic care

Shortness of breath, dyspnoea and breathlessness are collective terms to describe the awareness of inadequate gas exchange within the respiratory system. Varying mechanisms, behavioural and physiological changes are caused by this ventilation–perfusion mismatch. This complex sensation encompasses many diverse concepts. The spectrum of language and words used as a consequence of this sensation vary from quality and intensity to emotions and feelings. Matching the phrases to the cause supports understanding. Studies reviewed produced clusters of verbal descriptors which reflect the multidimensional input as a consequence of being out of breath. Using these clusters has produced a comprehensive list of twelve words known as ‘The Dyspnoea 12’ which, when used, quantifies the severity of this debilitating and extremely distressing symptom. Could these verbal descriptors be used to aid the assessment and treatment of their cause in service users and provide a more holistic view to a widespread problem?

My Patient Is Twitching; Could It Be Itching?

Pediatric patients receiving palliative care may experience itching as a distressing symptom for a wide variety of reasons. Antihistamine medications are widely used for treatment of this symptom and have effectiveness if histamine is the primary mechanism of itch. Pruritus is a known adverse effect of opioid therapy, occurring in 2–10% of patients. Opioid-induced pruritus is not primarily histamine related and therefore better treated by partial opioid antagonists. Chronic health conditions such as renal disease, cholestasis, and malignancy are all associated with pruritus. This chapter presents a broad differential for the symptom as well as a range of pharmacologic and nonpharmacologic therapies.

She Won’t Stop Vomiting

Seriously ill pediatric patients may experience nausea and/or vomiting as a distressing symptom. Nausea and vomiting occur in almost half of children with cancer during their end-of-life period. There are multiple triggers that can lead to nausea and/or vomiting, including a variety of diseases and commonly used medications to treat serious illness including opiates. Identifying the source of nausea and/or vomiting, if possible, can dictate a targeted and effective treatment approach. This chapter reviews the pathophysiology thought to be responsible for eliciting nausea and/or vomiting, outlines a stepwise framework for evaluating patients with this symptom, and reviews targeted therapies including pharmacologic as well as supportive and integrative therapies.

Cancer-related breathlessness

This chapter addresses the link between cancer and breathlessness by first considering dyspnoea caused directly by malignancy (such as airway obstruction), dyspnoea indirectly caused by malignancy (e.g. pulmonary embolus), and dyspnoea caused by treatment (e.g. radiation pneumonitis). Reference is made to the complex nature of breathlessness in this setting, with clear links to physiological and psychological factors. Methodologies for diagnosing and assessing breathlessness are considered, before discussing the management and treatment of this distressing symptom. Treatment strategies are divided into non-pharmacological, such as positioning and relaxation techniques and modifications, and pharmacological interventions such as use of low-dose opiates.

Dyspnea

Dyspnea or breathlessness is one of the most distressing symptom experienced by patients with advanced disease such as cancer, end-stage chronic obstructive pulmonary disease, and heart failure. It can be either continuous or episodic (more frequent). Management is usually interdisciplinary and individualized to a given patient. A combination of strategies, such as use of opioids, oxygen, short-term steroids, and counseling, is likely to reduce the symptom burden related to dyspnea.

Bereaved Family Members’ Perceptions of the Distressing Symptoms of Terminal Patients With Cancer

Background: Few data are available on bereaved family members’ perspective on the frequency of symptoms and degree of distress among terminal patients with cancer. Methods: We sent a questionnaire to 1472 bereaved family members of terminal patients with cancer in 20 general hospitals. The questionnaire asked them (1) to indicate which symptoms the patients had, (2) to rate on a 4-point scale the extent to which the symptom was distressing, as follows: 1 = not distressing, 2 = slightly distressing, 3 = quite distressing, and 4 = very distressing at the point of 2 weeks before the patient had died. Results: We analyzed 805 questionnaires for this study. Anorexia was the commonest symptom among terminal patients with cancer experienced by bereaved family members, followed by somnolence, weight loss, fatigue, and pain. Anorexia was the most distressing symptom among terminal patients with cancer experienced by bereaved family members, followed by weight loss, pain, edema, and dyspnea. Conclusions: Anorexia and weight loss were frequent symptoms and bereaved family members felt very distressing. Furthermore, there are not means of effective treatment now. Thus, we think that further study in this field is necessary.