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INTRODUCTION: After severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, patients may show lung sequelae on radiology and functional impairment at the 1-year follow-up. We aimed to describe the persistence of symptoms, radiological alterations, or reduced diffusing capacity of the lung for carbon monoxide (DLCO ) at 1-year follow-up in patients from the Spanish Registry RECOVID. METHODS: RECOVID collected symptom and radiological and functional lung tests data on hospitalized patients with coronavirus disease 2019 during the acute phase and at the 6- and 12-month follow-up visits. RESULTS: Of the 2500 enrolled survivors (90% admitted to the ward), 1874 had follow-up visits for up to a year. Of these, 42% continued to present with symptoms, 27% had radiological sequelae and 31% had reduced DLCO . Independently associated factors included female sex, asthma and the requirement for invasive or non-invasive mechanical ventilation. Complete radiological resolution was 72.2% at 12 months; associated factors with incomplete recovery were age, male sex, oxygen or respiratory support, corticosteroids and an initial SpO2 /FiO2 <450 or CURB-65 ≥2. Reduced DLCO was observed in 31% of patients at 12 months; associated factors were older age, female sex, smoking habit, SpO2 /FiO2 <450 and CURB-65 ≥2 and the requirement of respiratory support.At 12 months, a proportion of the asymptomatic patients showed reduced DLCO (9.5%), radiological findings (25%) or both (11%). CONCLUSIONS: The factors associated with symptom persistence, incomplete radiological resolution and DLCO <80% differed according to age, sex, comorbidities and respiratory support. The burden of symptoms, reduced DLCO and incomplete radiological resolution were considerable in patients with SARS-CoV-2 pneumonia at the 1-year follow-up after hospitalisation.
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COVID-19 , Humanos , Masculino , Feminino , SARS-CoV-2 , PulmãoRESUMO
BACKGROUND: Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT. METHODS: This was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO2) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO2) and respiratory and leg symptoms. RESULTS: Ten IPF patients [71.7 (6) years old, 90% males] were included. FVC and DLCO were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO2 during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices. CONCLUSIONS: This is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.
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Teste de Esforço/métodos , Fibrose Pulmonar Idiopática/terapia , Oxigenoterapia/métodos , Oxigênio/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saturação de Oxigênio , Projetos PilotoRESUMO
RATIONALE: In chronic obstructive pulmonary disease (COPD), the benefits of pulmonary rehabilitation (PR) tend to wane over time. Whether maintenance techniques may help sustain the benefits achieved after completion of the initial PR program remains controversial. OBJECTIVES: To determine whether a long-term (3-yr) maintenance program after PR preserves the short-term effects on outcomes in patients with COPD. METHODS: This was a multicenter prospective randomized trial including 143 patients with moderate-severe COPD, with 3 years of PR maintenance following an 8-week outpatient PR program. Patients were randomized to maintenance intervention group (IG) and standard monitoring program or control group (CG). The effects on BODE index, 6-minute-walk test distance (6MWD), and health-related quality of life were compared at 12, 24, and 36 months. MEASUREMENTS AND MAIN RESULTS: A total of 138 (96.5%) completed the 8-week program. At this time, all outcomes (BODE, 6MWD, and health-related quality of life) showed clinically and statistically significant improvements (P ≤ 0.001). During the follow-up period, the magnitude of change in 6MWD differed between IG and CG (P = 0.042), with a slight initial increase in the IG during the first year and smaller decline afterward. The BODE index changes differed between baseline and measurements at Month 24 (P = 0.043). At 3 years, the adherence rate of IG patients was 66% and 17% for the CG group (P < 0.001). CONCLUSIONS: This study shows a 2-year beneficial effect of a program of rehabilitation maintenance on the BODE index and 6MWD when compared with a standard strategy. This effect vanishes after the second year of follow-up. Clinical trial registered with www.clinicaltrials.gov (NCT 01090999).
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Doença Pulmonar Obstrutiva Crônica/reabilitação , Teste de Esforço/estatística & dados numéricos , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Background: Pulmonary rehabilitation is already an established technique for patients with chronic respiratory disease, aimed at improving breathlessness, exercise capacity, health status, and well-being. The aim of this study was to assess the knowledge and perceptions about pulmonary rehabilitation post-COVID-19 infection among Ecuadorian physicians. Methods: We conducted a cross-sectional online survey-based study using a 27-item questionnaire to assess the knowledge about specific topics related to pulmonary rehabilitation. The sample comprised Ecuadorian physicians who were currently enrolled to an active medical practice that included care to COVID-19 patients. Descriptive statistics were applied for demographic variables of interest. A chi-square goodness of fit test was used to determine whether the observed frequencies of each of the answers per query were within or outside of the expected frequencies by chance. Results: In total, 295 participants answered the survey, out of which 57.3% were general practitioners. Most agreed that COVID-19 infected patients must be followed-up with some measurement of respiratory function (81.4%, p=0.000), but only 18.3% (n=54, p=0.000) were aware of specific guidelines related to rehabilitation. 93.6% (n=276, p=0.000) considered that pulmonary rehabilitation provides a benefit, of any kind, to patients with past COVID-19 infection. Conclusions: Most physicians considered pulmonary rehabilitation beneficial following COVID-19. However, there is uncertainty on how to adequately follow up patients, complementary tests, and specific guidelines outlining rehabilitative interventions.
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an inflammatory pulmonary disorder with systemic inflammatory manifestations that are mediated by circulating acute-phase reactants. This study compared an enzyme-linked immunosorbent assay (ELISA) to a nephelometric technique for the measurement of serum C-reactive protein (CRP) and serum amyloid A (SAA) and investigated how the choice of assay influenced the estimation of inflammation in patients with stable COPD. METHODS: CRP and SAA concentrations measured by ELISA and nephelometry in 88 patients with COPD and 45 control subjects were used to evaluate the performance of these methods in a clinical setting. RESULTS: With both assays, the concentrations of CRP and SAA were higher in COPD patients than in controls after adjustment for age and sex. There was a moderate correlation between the values measured by ELISA and those measured by nephelometry (logCRP: r = 0.55, p < 0.001; logSAA: r = 0.40, p < 0.001). However, the concentrations of biomarkers determined by nephelometry were significantly higher than those obtained with ELISA for CRP (mean difference = 2.7 (9.4) mg/L) and SAA (mean difference = 0.31 (14.3) mg/L). CONCLUSION: Although the serum CRP and SAA concentrations measured by ELISA and nephelometry correlated well in COPD patients, the ELISA values tended to be lower for CRP and SAA when compared with nephelometric measurements. International standardization of commercial kits is required before the predictive validity of inflammatory markers for patients with COPD can be effectively assessed in clinical practice.
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Biomarcadores/sangue , Proteína C-Reativa/análise , Doença Pulmonar Obstrutiva Crônica/imunologia , Proteína Amiloide A Sérica/análise , Proteínas de Fase Aguda/metabolismo , Idoso , Estudos de Casos e Controles , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Expiração/fisiologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Nefelometria e Turbidimetria , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/metabolismo , EspanhaRESUMO
BACKGROUND: There is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR). RESEARCH QUESTION: To determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR. STUDY DESIGN AND METHODS: A multicentre open-label pragmatic parallel-group randomized clinical trial was conducted. Two groups were created at completion of an 8-week intensive outpatient hospital PR programme. Intervention group (IG) patients were given appropriate training equipment and instructed to perform three weekly training sessions and send performance data through an app to a web-based platform. Patients in the control group (CG) were advised to exercise regularly (usual care). RESULTS: Ninety-four patients (46 IG, 48 CG) were randomized. The analysis of covariance showed non-significant improvements in 6-min walk distance [19.9m (95% CI -4.1/+43.8)] and Chronic Respiratory Disease Questionnaire - Emotion score [0.4 points (0-0.8)] in the IG. Secondary linear mixed models showed improvements in the IG in Short Form-36 mental component summary [9.7, (4.0-15.4)] and Chronic Respiratory Disease Questionnaire - Emotion [0.5, (0.2-0.9)] scores, but there was no association between compliance and outcomes. Acute exacerbations were associated with a marginally significant decrease in 6-minute walk distance of 15.8m (-32.3/0.8) in linear models. CONCLUSIONS: The TelePR maintenance strategy was both feasible and safe but failed to show superiority over usual care, despite improvements in some HRQoL domains. Acute exacerbations may have an important negative influence on long-term physical function. CLINICALTRIALS. GOV IDENTIFIER: NCT03247933.
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Doença Pulmonar Obstrutiva Crônica , Telerreabilitação , Exercício Físico , Humanos , Qualidade de Vida , CaminhadaRESUMO
OBJECTIVES: Patients with chronic respiratory failure due to kyphoscoliosis (CHRF-KS) constitute a specific population with impaired health-related quality of life (HRQL). Thus far, no studies have examined factors related to HRQL. The objective of the present study was to identify clinical, functional and exertion-related factors associated with HRQL. METHODS: We investigated 27 patients (12 males). Respiratory function tests, dyspnea ratings, peripheral and respiratory muscle function and exercise testing were performed. The Chronic Respiratory Disease Questionnaire (CRDQ) was used to assess HRQL. Bivariate correlations were used to investigate the relationships between CRDQ dimensions and the clinical, functional and exertion-related characteristics of the study participants. RESULTS: The general characteristics of the study sample were as follows: age: 61 (IQR: 12) years, FVC: 32.6% (IQR: 10.2) and pCO2: 48 mmHg (IQR: 8.7). Peripheral muscle strength, dyspnea and exercise capacity were identified as significant factors associated with poorer HRQL. The CRDQ dimensions of fatigue and emotional function showed greater correlations with the patients' general characteristics. Dyspnea CRDQ scores did not correlate with dyspnea in any of the scales used. CONCLUSION: Of the various factors examined, dyspnea, exercise capacity and peripheral muscle strength have been identified as significant factors associated with HRQL in CHRF-KS patients.
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Dispneia/etiologia , Cifose/complicações , Qualidade de Vida , Escoliose/complicações , Doença Crônica , Estudos Transversais , Dispneia/fisiopatologia , Teste de Esforço , Feminino , Humanos , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Estudos Prospectivos , Testes de Função Respiratória , Fatores de Risco , Escoliose/fisiopatologia , Inquéritos e QuestionáriosRESUMO
A cross-sectional prospective design was used to compare the effectiveness of the shuttle walking test (SWT) and the maximal cycle ergometry test (CET) to assess the functional capacity of patients with chronic hypercapnic respiratory failure due to severe kyphoscoliosis. Twenty-four patients completed both the SWT and CET. Heart rate, blood pressure, leg fatigue, chest pain and dyspnea (Borg's scale) were measured immediately after each test. Correlation coefficients and Bland-Altman analysis were used to compare the two methods. Borg's dyspnea, leg and chest pain after exercise were not significantly different between tests. Only heart rate (SWT 130[20.7] versus CET 116[28.75]; p = 0.048) and diastolic blood pressure (SWT: 85.5[13.75] versus CET 95[17.5]; p = 0.021) were slightly but significantly different between the two protocols. There was a good positive correlation between the distance walked in SWT and maximal oxygen consumption (r = 0.675; p < 0.001). SWT and CET testing elicited similar clinical and hemodynamic responses. SWT is a feasible measure of functional capacity in this patient group.
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Teste de Esforço/métodos , Tolerância ao Exercício , Doença Pulmonar Obstrutiva Crônica/reabilitação , Caminhada/fisiologia , Pressão Sanguínea/fisiologia , Estudos Transversais , Frequência Cardíaca/fisiologia , Humanos , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/etiologia , Curvaturas da Coluna Vertebral/complicações , Estatísticas não ParamétricasRESUMO
BACKGROUND: Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). OBJECTIVE: To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. METHOD: A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. RESULTS: Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman's coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p<0.001 and r=0.72 p<0.001 respectively), daily time spent on vigorous PA (>7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). CONCLUSIONS: BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings.
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Biomarcadores/sangue , Densidade Óssea/fisiologia , Remodelação Óssea/fisiologia , Fibrose Cística/fisiopatologia , Exercício Físico , Vitamina D/análogos & derivados , Vitamina K/fisiologia , Absorciometria de Fóton , Adulto , Estudos Transversais , Humanos , Estado Nutricional , Vitamina D/química , Vitamina D/metabolismo , Vitamina D/fisiologia , Vitamina K/química , Vitamina K/metabolismoRESUMO
Background: There is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR).Research question: To determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR.Study design and methods: A multicentre open-label pragmatic parallel-group randomized clinical trial was conducted. Two groups were created at completion of an 8-week intensive outpatient hospital PR programme. Intervention group (IG) patients were given appropriate training equipment and instructed to perform three weekly training sessions and send performance data through an app to a web-based platform. Patients in the control group (CG) were advised to exercise regularly (usual care).Results: Ninety-four patients (46 IG, 48 CG) were randomized. The analysis of covariance showed non-significant improvements in 6-min walk distance [19.9m (95% CI ∧4.1/+43.8)] and Chronic Respiratory Disease Questionnaire Emotion score [0.4 points (00.8)] in the IG. Secondary linear mixed models showed improvements in the IG in Short Form-36 mental component summary [9.7, (4.015.4)] and Chronic Respiratory Disease Questionnaire Emotion [0.5, (0.20.9)] scores, but there was no association between compliance and outcomes. Acute exacerbations were associated with a marginally significant decrease in 6-minute walk distance of 15.8m (∧32.3/0.8) in linear models. (AU)
Contexto previo: Existe incertidumbre con respecto a la eficacia de los enfoques basados en telesalud en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) para mantener los beneficios logrados con la rehabilitación pulmonar (RP) intensiva.Pregunta de investigación: Determinar si un programa de telerrehabilitación pulmonar de mantenimiento (TeleRP), después de una RP inicial intensiva, es superior a la atención habitual para mantener en el tiempo los beneficios logrados por la RP intensiva.Diseño del estudio y métodos: Se realizó un ensayo clínico aleatorizado, pragmático, abierto, multicéntrico, de grupos paralelos. Se crearon 2 grupos al finalizar un programa de RP intensiva en rèc)gimen ambulatorio de 8 semanas de duración. A los pacientes del grupo de intervención (GI) se les proporcionó el equipo de entrenamiento apropiado y se les instruyó para realizar 3 sesiones de entrenamiento semanales y enviar los datos de rendimiento a travèc)s de una aplicación a una plataforma web. Se aconsejó a los pacientes del grupo de control (GC) que hicieran ejercicio regularmente (cuidado habitual).Resultados: Se aleatorizaron 94 pacientes (46 GI, 48 GC). El análisis de covarianza mostró mejoras no significativas en la distancia en la prueba de marcha de 6min (19,9m [IC 95%: ∧4,1/+43,8]) y el cuestionario de enfermedad respiratoria crónica-factor emocional (0,4 puntos [0-0,8]) en el GI. Los modelos lineales mixtos secundarios mostraron mejoras en el GI en las puntuaciones de la sección mental del SF-36 (9,7 [4,0-15,4]) y el cuestionario de enfermedad respiratoria crónica-factor emocional (0,5 puntos [0,2-0,9]), pero no se demostró asociación entre el cumplimiento y los resultados. Las exacerbaciones agudas se asociaron con una disminución marginalmente significativa en la distancia en la prueba de la marcha de 6min de 15,8m (∧32,3/0,8) en los modelos lineales.
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Humanos , Telerreabilitação , Telemedicina , Doença Pulmonar Obstrutiva Crônica , EspanhaRESUMO
In patients with chronic obstructive pulmonary disease (COPD), skeletal muscle dysfunction is a major comorbidity that negatively impacts their exercise capacity and quality of life. In the current guidelines, the most recent literature on the various aspects of COPD muscle dysfunction has been included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale has been used to make evidence-based recommendations on the different features. Compared to a control population, one third of COPD patients exhibited a 25% decline in quadriceps muscle strength, even at early stages of their disease. Although both respiratory and limb muscles are altered, the latter are usually more severely affected. Numerous factors and biological mechanisms are involved in the etiology of COPD muscle dysfunction. Several tests are proposed in order to diagnose and evaluate the degree of muscle dysfunction of both respiratory and limb muscles (peripheral), as well as to identify the patients' exercise capacity (six-minute walking test and cycloergometry). Currently available therapeutic strategies including the different training modalities and pharmacological and nutritional support are also described.
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Debilidade Muscular/terapia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Exercícios Respiratórios , Impedância Elétrica , Eletrodiagnóstico , Medicina Baseada em Evidências , Teste de Esforço , Terapia por Exercício , Tolerância ao Exercício , Feminino , Grelina/uso terapêutico , Força da Mão , Hélio/uso terapêutico , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Desnutrição/complicações , Desnutrição/terapia , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Debilidade Muscular/reabilitação , Apoio Nutricional , Oxigênio/uso terapêutico , Resistência Física , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida , Músculos Respiratórios/fisiopatologia , Espirometria , Esteroides/uso terapêuticoRESUMO
BACKGROUND: Bronchial variability in COPD patients may be a phenotypic feature associated with clinical characteristics and differential treatment response. We analyzed whether symptoms, quality of life, and exercise capacity varied in COPD patients as a function of bronchodilator test results, and compared responses to an exercise program. METHODS: A positive bronchodilator test result was defined as FVC and/or FEV1 improvement of > 12% plus > 200 mL after 400 µg of salbutamol. We studied 198 COPD subjects: 94 with positive reversibility, and 104 with negative reversibility. Training sessions were carried out on 3 non-consecutive days each week, for 12 weeks, and consisted of a combination of resistance and strength training. Subjects were evaluated on 2 consecutive days at baseline, and at the end of the 12-week training program. RESULTS: Those with positive reversibility had shorter time to exhaustion in the endurance test (19.1 ± 12.6 min vs 24.5 ± 14.5 min, P = .03), shorter shuttle walk test distance (380.6 ± 158.2 m vs 438.5 ± 149.1 m, P = .02), and lower Chronic Respiratory Disease Questionnaire scores (18.7 ± 4.6 vs 19.8 ± 4.3, P = .01). There were no significant differences in peak exercise, peripheral muscle strength, dyspnea, or improvement after exercise training. CONCLUSIONS: Compared to COPD subjects with negative reversibility, those with positive reversibility walked for shorter distances, and had shorter endurance times and worse quality of life, but the improvements after exercise training were similar.
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Broncodilatadores/administração & dosagem , Tolerância ao Exercício , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Idoso , Testes de Provocação Brônquica , Dispneia/etiologia , Teste de Esforço , Volume Expiratório Forçado , Humanos , Pessoa de Meia-Idade , Condicionamento Físico Humano/fisiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Treinamento Resistido , Índice de Gravidade de Doença , Inquéritos e Questionários , Capacidade Vital , Caminhada/fisiologiaRESUMO
BACKGROUND: Research has provided evidence for the safety, feasibility, and efficacy of exercise training in patients with COPD. However, little is known about the impact of exercise training in patients with chronic respiratory failure due to kyphoscoliosis. We evaluated the effect of an exercise training program on exercise capacity, muscle strength, dyspnea, and quality-of-life indices in subjects with chronic respiratory failure due to kyphoscoliosis. METHODS: The 34 subjects were clinically stable, had been receiving nighttime home mechanical ventilation for ≥ 6 months, and were randomly assigned to the exercise group (n = 17) or the control group (n = 17). The exercise group conducted cycle and strength training on 3 non-consecutive days per week for 12 weeks. We measured pulmonary function, exercise capacity, peripheral muscle strength, dyspnea scores, and quality of life. RESULTS: Statistical analysis was carried out on the data from 16 subjects in the exercise group and in 11 subjects in the control group. Three of the lung-function parameters in the exercise group significantly changed: PaCO2 (P = .04), inspiratory pressure (P = .03), and expiratory pressure (P = .04); and endurance time (P = .002) and shuttle walk distance (P = .001) increased significantly. The exercise group had significantly greater improvements in peripheral muscle strength, dyspnea, and quality of life. CONCLUSIONS: In patients with chronic respiratory failure due to kyphoscoliosis, exercise training improved exercise capacity, peripheral muscle strength, dyspnea, and quality of life. (Deutschen Register Klinischer Studien DRKS00000443).
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Terapia por Exercício , Cifose/complicações , Insuficiência Respiratória/reabilitação , Idoso , Doença Crônica , Dispneia/etiologia , Tolerância ao Exercício , Feminino , Humanos , Cifose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Qualidade de Vida , Insuficiência Respiratória/etiologiaRESUMO
Pulmonary rehabilitation (PR) has been shown to improve dyspnea, exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). PR has also shown benefits in diseases other than COPD but the level of evidence is lower. The fundamental components of PR programs are muscle training, education and chest physiotherapy. Occupational therapy, psychosocial support and nutritional intervention should also be considered. Home programs have been shown to be as effective as hospital therapy. The duration of rehabilitation programs should not be less than 8 weeks or 20 sessions. Early initiation of PR, even during exacerbations, has proven safe and effective. The use of oxygen or noninvasive ventilation during training is controversial and dependent on the patient's situation. At present, the best strategy for maintaining the benefits of PR in the long term is unknown. Longer PR programs or telemedicine could play a key role in extending the results obtained.
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Doença Pulmonar Obstrutiva Crônica/reabilitação , Exercícios Respiratórios , Terapia Combinada , Gerenciamento Clínico , Exercício Físico , Serviços de Assistência Domiciliar , Humanos , Pneumopatias/reabilitação , Neoplasias Pulmonares/reabilitação , Neoplasias Pulmonares/cirurgia , Apoio Nutricional , Obesidade/complicações , Obesidade/dietoterapia , Terapia Ocupacional , Oxigenoterapia , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Respiração com Pressão Positiva , Doença Pulmonar Obstrutiva Crônica/complicações , Terapia de Relaxamento , Treinamento Resistido , Terapia Respiratória , Apoio SocialRESUMO
We sought to investigate whether the serum concentrations of several inflammatory biomarkers are related to the cyclooxygenase-2 (COX2) -765G>C polymorphism in chronic obstructive pulmonary disease (COPD) and a control group of non-COPD smokers. Serum inflammatory markers (CRP, SAA, CXCL8, and sICAM-1) were measured by ELISA in 144 patients with COPD and in 55 control subjects. Genomic DNA was extracted from peripheral blood leukocytes, and the COX2 -765G>C (rs20417) polymorphism was genotyped. After adjustment for age and active smoking, CRP and SAA concentrations were associated with the COX2 polymorphism in controls (p=0.041 and 0.014, respectively) but not in COPD patients. The CXCL8 and sICAM-1 concentrations were not associated with the COX2 polymorphism for either cases or controls. The results of the present study indicate that there is a relationship between the COX2 -765G>C polymorphism and the concentrations of CRP and SAA in non-COPD smokers and that this relationship does not exist in COPD patients.
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Proteína C-Reativa/análise , Ciclo-Oxigenase 2/genética , Polimorfismo de Nucleotídeo Único , Doença Pulmonar Obstrutiva Crônica/imunologia , Proteína Amiloide A Sérica/análise , Fumar/imunologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/imunologia , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Predisposição Genética para Doença/genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Proteína Amiloide A Sérica/imunologia , Fumar/sangueRESUMO
Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.
Assuntos
Pneumopatias/reabilitação , Garantia da Qualidade dos Cuidados de Saúde/normas , Transtornos Respiratórios/reabilitação , Terapia Respiratória/normas , Acreditação , Doença Crônica , Dispneia/etiologia , Dispneia/reabilitação , Medicina Baseada em Evidências , Acessibilidade aos Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido , Pneumopatias/cirurgia , Doenças Neuromusculares/complicações , Doenças Neuromusculares/reabilitação , Pneumonectomia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Controle de Qualidade , Qualidade de Vida , Registros , Transtornos Respiratórios/etiologia , Terapia Respiratória/métodos , Serviço Hospitalar de Terapia Respiratória/organização & administração , Serviço Hospitalar de Terapia Respiratória/normas , EspanhaRESUMO
ABSTRACT Background Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). Objective To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. Method A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. Results Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman’s coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p<0.001 and r=0.72 p<0.001 respectively), daily time spent on vigorous PA (>7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). Conclusions BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings.