1,721,066 research outputs found
Respiratory outcomes of patients with amyotrophic lateral sclerosis: An italian nationwide survey
No full textRehabilitation of patients with coexisting COPD and heart failure
No full textChronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) frequently coexist, significantly reducing the patient's quality of life (QoL) and increasing morbidity, disability and mortality. For both diseases, a multidisciplinary disease-management approach offers the best outcomes and reduces hospital readmissions. In both conditions, muscle dysfunction may dramatically influence symptoms, exercise tolerance/performance, health status and healthcare costs. The present review describes muscular abnormalities and mechanisms underlying these alterations. This review also discusses studies on training programs for patients with COPD, CHF and, where available, combined COPD-CHF diagnosis. Dyspnea, peripheral muscles and activities of daily living (ADL) represent a potential starting point for improving patients' functioning level and quality of life in COPD and CHF. A synergy of the combined diagnostic, pharmacological and rehabilitation treatment interventions is also essential. Integration between exercise training, drug therapy and nutritional care could be a valid, synergic and tailored approach for patients presenting with both diseases, and may have a positive impact on the exercise performance
Care-Related intervention in Rehabilitative Pneumology: Pulmonary Rehabilitation in Chronic Obstructive Broncopneumopathies (COPD) can benefit from a multidisciplinary approach? [Cure correlate in Pneumologia Riabilitativa: La Riabilitazione Polmonare nelle Broncopneumopatie Croniche Ostruttive (BPCO) può trarre beneficio da un approccio multidisciplinare?]
No full textLa Broncopneumopatia Cronica Ostruttiva (BPCO) è una comune malattia, prevenibile e trattabile, caratterizzata da persistenti sintomi respiratori e limitazione al flusso aereo. Patologie cardiovascolari, osteoporosi, depressione e ansia,
condizionamento neuromuscolare e apnee ostruttive del sonno sono comorbilità frequenti e importanti nella BPCO,
spesso sotto diagnosticate e associate a peggiore stato di salute e prognosi. La riabilitazione respiratoria migliora i sintomi, la qualità della vita, la funzione polmonare e lo stato di salute in pazienti con patologie croniche ostruttive. Per definizione è un intervento ad ampio spettro che si basa su una valutazione del paziente seguita da terapie personalizzate, essa include inoltre riallenamento allo sforzo, intervento educazionale e modifica dello stile di vita volto al miglioramento della condizione fisica e psicologica di persone affette da patologie croniche respiratorie e al
miglioramento della aderenza alla terapia e allo stile di vita. La limitazione all’esercizio fisico in pazienti con BPCO è
multifattoriale, è dovuta a una limitazione ventilatoria, alterazione degli scambi intrapolmonari dei gas, alterazione
vascolare polmonare e cardiaca, disfunzione muscolare e a presenza di comorbilità. La riabilitazione pneumologica ha come obiettivo il miglioramento della funzione cardiorespiratoria e muscolare, miglioramento dei sintomi e della qualità di vita nelle attività quotidiane, agendo in sinergia con l’effetto della terapia inalatoria. La BPCO ha una storia naturale variabile, spesso l’insufficienza respiratoria cronica complica le fasi di progressione della malattia. È stato dimostrato che il supplemento di ossigeno e la ventilazione meccanica non invasiva migliorano la sopravvivenza e riducono il rischio di ricoveri ospedalieri in pazienti affetti da BPCO. Studi successivi hanno poi evidenziato il ruolo benefico di utilizzare supplemento di ossigeno e NIV durante sia i programmi di fisioterapia respiratoria sia durante le ore notturne. In conclusione, un approccio ad ampio spettro per diagnosi e stadiazione della BPCO anche alla luce delle comorbidità spesso presenti potrebbe convogliare verso un approccio multidisciplinare e sinergico sia in termini di trattamento farmacologico che non farmacologico di una sindrome infiammatoria sistemicaCardiovascular diseases, osteoporosis, depression/anxiety, musculoskeletal impairment and obstructive sleep apnea are frequent and important comorbidities in COPD, often under-diagnosed, and associated with poor health status and prognosis. Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care in patients with chronic respiratory disease. By definition it is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change and designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors. Exercise limitation in patients with COPD is multifactorial and includes ventilatory limitation, gas transfer abnormalities, pulmonary vascular and cardiac dysfunction, limb muscle dysfunction, and comorbid impairments. Overall, pulmonary rehabilitation aims to improve cardiorespiratory and skeletal muscle function improving respiratory symptoms and quality of life in daily life activities adding a synergic support to the pharmacologic inhaled therapy. COPD has a variable natural history, but most of the time chronic respiratoryfailure complicates disease progression. Supplemental oxygen and noninvasive mechanical ventilation have been proven to improve survival and reduce hospital admissions in COPD patients. Furthermore additional studies have shown that exercise performance benefit from supplemental oxygen and NIV used both during rehabilitation exercise programs and over the night. In conclusion, an overarching approach to diagnosis, assessment of severity of COPD and its frequent comorbidities should guide to a multidisciplinary and synergic approach in terms of pharmacological and nonpharmacological management of a systemic inflammatory syndrome
An implementation protocol for noninvasive ventilation prescription: the physiotherapist's role in an Italian hospital
No full textFor patients with chronic respiratory failure or sleep breathing disorders, adaptation and training are important prerequisites for successful home noninvasive ventilation (NIV) and CPAP. In Europe, management of NIV/CPAP is sometimes performed by physiotherapists (PTs). However, their role within the NIV/CPAP management team is not well defined
The role of respiratory management of Pompe disease
No full textSummaryRespiratory failure is an unavoidable event in the natural history of some neuromuscular diseases, while appearing very infrequently in others. In some cases, such as Pompe disease, respiratory failure progresses more rapidly than motor impairment, sometimes being the onset event. Home mechanical ventilation improves survival and quality of life of these patients, with a reduction in healthcare costs. Therefore, pulmonologists must improve their skills in order to play a more relevant role in the care of these patients. The aim of this statement is to provide pulmonologists with some simple information in order for them to fulfil their role of primary caregiver, enabling appropriate and rapid diagnosis and treatment
Is There Any Additional Effect of Tele-Assistance on Long-Term Care Programmes in Hypercapnic COPD Patients? A Retrospective Study
No full textThe evidence for tele-assistance (TA) in hypercapnic chronic obstructive pulmonary disease (COPD) patients on long-term oxygen therapy (LTOT) is scarce. The aim of this study was to evaluate the effects of addition of long-term TA to LTOT with or without non-invasive ventilation (NIV) in these patients. Retrospective analysis of a previous randomised study of patients on LTOT. According to the care programme patients were divided into Group 1: LTOT; Group 2: LTOT + NIV; Group 3: LTOT + TA and Group 4: LTOT + NIV+TA. Primary outcomes: time to first exacerbation and hospitalisation during 12 months of long-term care. Risk of exacerbation was statistically different among groups (p = 0.0002). TA addition to NIV significantly reduced exacerbation risk when compared with that to all groups. Hospitalisation risk was statistically different among groups (p = 0.049). Addition of TA to LTOT but not to NIV significantly reduced hospitalisation risk when compared to Group 1 (p = 0.013). Risk of mortality did not differ among groups (p = 0.074). In chronically hypercapnic COPD patients on LTOT, 1. TA alone and with greater efficacy when combined with NIV may reduce the frequency of exacerbations and 2. TA added to LTOT, but not to NIV, may reduce the frequency of hospitalisations
Does quadriceps contractile fatigue influence rehabilitation outcomes in COPD-chronic respiratory failure patients?
Full text linkBackground: In patients with moderate COPD, response to pulmonary rehabilitation including exercise training varies according to the presence of peripheral muscle fatigue (pMF) of quadriceps. This study investigates the role of pMF in predicting pulmonary rehabilitation outcomes in more severe COPD patients who have already developed chronic respiratory failure (COPD-CRF). Methods: A post hoc analysis of a prospective randomised controlled trial was performed at Istituti Clinici Scientifici Maugeri Lumezzane (Brescia, Italy), involving 30 COPD-CRF patients undergoing a pulmonary rehabilitation programme comprising 20 endurance training sessions. Pre-to-post assessment included a 6-min walk test (6MWT), Fatigue Severity Scale (FSS), Barthel dyspnoea index, and quality-of-life questionnaires. We assessed the contractile pMF of quadriceps via electrical nerve stimulation pre-to-post a cycling fatiguing task, using the change in potentiated quadriceps twitch for pMF. Results: At baseline, 12 (40%) patients developed pMF (pMF group), while 18 (60%) did not (no-pMF group). The pMF group had a lower baseline 6-min walk distance (6MWD) with greater FSS and lower quadriceps thickness. After pulmonary rehabilitation, no change in contractile pMF was found in the overall group, but pMF ameliorated only in the pMF group. The pMF group had a greater increase in 6MWD (71.67±53.64 m versus 35.28±36.01 m, p<0.05) and was more likely to exceed the minimal clinically important difference in 6MWD (OR 6.25, 95% CI 1.05-37.07; p=0.044). Other pulmonary rehabilitation outcomes improved similarly between groups. Conclusion: Baseline quadriceps pMF predicted greater improvement in the 6MWT in COPD-CRF patients, suggesting it may be a new target for predicting pulmonary rehabilitation outcomes and optimising training protocols
Assessment of Symptoms in Patients with COPD: Strengths and Limitations of Clinical Scores
No full textPurpose of Review: Health questionnaires are valuable tools to quantify, in an objective and standardized manner, the impact of chronic obstructive pulmonary disease on the health status of patients and on their well-being, and to track changes over time.Therefore, filling out these questionnaires allows clinicians to obtain the necessary information that can be easily related to clinical outcomes. Recent Findings: Most importantly, symptoms’ assessment represents a very relevant part of these clinical tools when applied to patients suffering from chronic respiratory diseases. Comparing scores between visits is also indicative of the patient’s health status, as changes in quality of life are related to worse outcomes such as hospitalization and exacerbation. However, each respiratory questionnaire may be peculiar in catching specific aspects of a similar symptom (i.e., dyspnoea); therefore, different tools are not interchangeable or comparable.Summary: Detecting the minimal clinically important difference is a necessary evaluation procedure which affords the change inpatient’s management and directs the therapeutic action towards more active treatments
Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
No full textOBJECTIVE: To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD). DESIGN: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ). RESULTS: Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897-98.927); standardized mean difference, 3.86 (95% CI, 2.04-5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, -8.041 (95% CI, -15.273 to -0.809); standardized mean difference, -1.23 (95% CI, -2.14 to -0.31)]. CONCLUSIONS: Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed
A Pulmonary Rehabilitation Decisional Score to Define Priority Access for COPD Patients
Full text linkThis retrospective study aimed to evaluate, through an ad hoc 17-item tool, the Pulmonary Rehabilitation Decisional Score (PRDS), the priority access to PR prescription by respiratory specialists. The PRDS, scoring functional, clinical, disability, frailty, and participation parameters from 0 = low priority to 34 = very high priority for PR access, was retrospectively calculated on 124 specialist reports sent to the GP of subjects (aged 71 ± 11 years, FEV1% 51 ± 17) consecutively admitted to our respiratory outpatient clinic. From the specialist's report the final subject's allocation could be low priority (LP) (>60 days), high priority (HP) (30-60 days), or very high priority (VHP) (<30 days) to rehabilitation. The PRDS calculation showed scores significantly higher in VHP versus LP (p < 0.001) and significantly different between HP and VHP (p < 0.001). Comparing the specialist's allocation decision and priority choice based on PRDS cut-offs, PR prescription was significantly more appropriate in VHP than in HP (p = 0.016). Specialists underprescribed PR in 49% of LP cases and overprescribed it in 46% and 30% of the HP and VHP prescriptions, respectively. A multicomprehensive score is feasible being useful for staging the clinical priorities for PR prescription and facilitating sustainability of the health system
- …
