Resistance Training With Ankle Weight Cuffs Is Feasible in Patients With Acute Exacerbation of COPD.

PURPOSE: Quadriceps muscle weakness is a serious complication of physical inactivity following hospitalization due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Preventing strength loss during AECOPD is therefore a high priority. We aimed to evaluate the feasibility of progressive knee-extension resistance training, using ankle weight cuffs on patients with AECOPD, based on prespecified criteria for feasibility. METHODS: Thirty-four patients (18 men, mean age 74 years, forced expiratory volume in 1 second = 33% predicted) with AECOPD participated in daily knee-extension strength training. During training, the patients were seated on the bedside and performed 3 sets of 10-repetition maximum loads, using ankle weight cuffs. The primary outcome was the change in load from the first to last training sessions. The secondary outcomes were changes in maximal isometric knee-extension strength, the Sit-to-Stand (STS) and Timed Up and Go (TUG) tests. RESULTS: The training load increased progressively by a mean (standard deviation) of 54% ± 41% (when calculated on an individual basis), from a mean of 6.5 ± 3.3 to 9.2 ± 3.5 kg over the course of 5.6 ± 2.3 training days (P < .001). Knee-extension strength improved by a mean of 12% (P = .02), whereas the TUG and STS test performances improved by 11% (P = .001) and 19% (P = .03), respectively. Ninety-eight percent of the planned training sessions were completed with no side effects. CONCLUSIONS: Progressive resistance training with ankle weight cuffs is feasible in patients who are severely disabled due to AECOPD. The approach is simple and seems to counteract the loss of muscle strength and function during hospitalization.

[Computed tomography showing universal bone lesions in a patient with myelomatosis]. / Patient med myelomatose med infiltrat på røntgen af thorax.

A 71-year-old man was referred to the lung department with pain in the right side of the chest through three months, especially when physically active. The patient presented with a tendency to shortness of breath, fatigue, low energy level and night sweats. The tentative diagnosis of pleural tumour/metastases was made. Chest x-ray showed pleural thickening and poorly defined ribs on the right side, consistent with bone destruction. Computed tomography showed a big mass in the 5th rib and universal bone lesions. Biopsy from the rib revealed the diagnosis of myelomatosis.

[Tuberculosis and water pipes as source of infection]. / Tuberkulose og vandpibesmitte.

Since 1990 the incidence rate of tuberculosis has been increasing in Storstroem County, both in persons born in Denmark and in immigrants/fugitives. The increase in patients born in Denmark has been seen mainly among younger males. Subtypes LC2 and C2 were selected for further investigation of the sources and modes of infection, as the number of infected patients was increasing and the index patients were well known. All contacts were traced and investigated according to the Danish recommendations. In total, 49 patients were treated, and 63 other persons shared their households. By comparison of infected contacts in households with infected patients who had shared a water pipe with a known patient, risk rates of 0.76 and 0.73 were found. When a positive Mantoux test was included, the figures were 0.60 and 0.64, respectively. As risk rates for the two modes of infection were the same, we recommend that the use of water pipes should be included in the routine search for carriers of infection.

Response to pneumococcal vaccine in chronic obstructive lung disease--the effect of ongoing, systemic steroid treatment.

Forty-nine patients with chronic obstructive lung disease (COPD) were block-randomized in four groups to investigate, if different degrees of steroid-load influenced the effect of pneumococcal-vaccination on antibody level and clinical variables during 6 months of follow-up. The groups included 13 patients without systemic steroids for the previous 3 months, all vaccinated at entrance in the study and treated with steroids for 4 weeks. Nine patients had chronic steroid treatment both before and during the investigation; they were vaccinated at the entrance in the study. Fifteen patients without systemic steroids for the previous 3 months were vaccinated after the end of a 4-week steroid treatment. Twelve patients served as controls, and were not vaccinated. Totally, 60%-78% of vaccinated patients in the three groups had a rise in antibody level, and a later decrease compared to two of the 12 control patients (p<0.01). This difference was also significant (p<0.05) for the patients vaccinated at entrance in the hospital. No differences were observed among the clinical variables: pneumonia, exacerbations, admittance to hospital, increase in the use of steroids or beta-agonists, and the use of antibiotics. We conclude that a rise in antibody level after pneumococcal vaccination can be expected in patients with COPD despite of the use of systemic steroids. The clinical effect of vaccination is debatable.