Efficacy of pulmonary rehabilitation in chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD): The Maugeri Study.

UNLABELLED: While the effectiveness of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) is well established, its effectiveness in the most severe category of COPD, i.e. patients with chronic respiratory failure (CRF), is less well known. OBJECTIVE: To verify the effects of PR in patients with CRF, and compare the level of improvement with PR in these patients to that of COPDs not affected by CRF. METHODS: A multi-centre study was carried out on COPD patients with versus without CRF. The PR program included educational support, exercise training, and nutritional and psychological counselling. Lung function, arterial gases, walk test (6MWT), dyspnoea (MRC; BDI/TDI), and quality of life (MRF(28); SGRQ) were evaluated. RESULTS: Thousand forty seven consecutive COPD inpatients (327 with CRF) were evaluated. In patients with CRF all parameters improved after PR (0.001). Mean changes: FEV(1), 112 ml; PaO(2), 3.0 mmHg; PaCO(2), 3.3 mmHg; 6MWT, 48 m; MRC, 0.85 units; MRF(28) total score, 11.5 units. These changes were similar to those observed in patients without CRF. CONCLUSIONS: This study, featuring the largest cohort so far reported in the literature, shows that PR is equally effective in the more severe COPD patients, i.e. those with CRF, and supports the prescription of PR also in these patients.

Home mechanical ventilation in kyphoscoliosis.

The aim of the study was to determine whether intermittent positive pressure ventilation (IPPV), delivered either by nasal mask or by tracheostomy, is able to improve alveolar gas exchange in kyphoscoliotic patients with respiratory failure. We evaluated 17 patients, 10 females and 7 males, aged 52 +/- 12 (mean +/- SD) yrs. Eight had severe respiratory failure (arterial oxygen tension (PaO2) 53.2 +/- 9.3 mmHg (7.1 +/- 1.2 kPa); arterial carbon dioxide tension (PaCO2) 73.3 +/- 12.5 mmHg (9.7 +/- 1.6 kPa), breathing supplemental oxygen), and were put on IPPV via tracheostomy (TIPPV). The others (PaO2 54.5 +/- 5.5 mmHg (7.3 +/- 0.7 kPa); PaCO2 57.9 +/- 7 mmHg (7.7 +/- 0.9 kPa), breathing air), were put on IPPV via nasal mask (NIPPV). Home mechanical ventilation (HMV) was performed at night (7 +/- 1 h) by means of a volume-cycled pressure respirator in control mode. The frequency was adapted to the patient's spontaneous respiratory rate, and then eventually modified according to blood gases. A silicone mask was moulded onto the patient's nose. Supplemental oxygen (to maintain arterial oxygen saturation (SaO2) > 90%) was used only for tracheostomized patients, whereas NIPPV was performed with fractional inspiratory oxygen (FIO2) 21%. Arterial blood samples were obtained for all patients in steady-state condition, 8 +/- 1 h from the withdrawal, breathing air, after 1 and 6 months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between the perception of breathlessness and inspiratory resistive loading: report on a clinical trial.

We investigated the relationship between the sensation of breathlessness and progressively higher resistive inspiratory loadings in nine normal subjects (31 +/- 17 yr; forced expiratory volume in one second (FEV1) = 105 +/- 9% of predicted) and in eighteen chronic obstructive pulmonary disease (COPD) patients (63 +/- 7 yr; FEV1 = 43 +/- 17% of predicted). The sensation of breathlessness correlated with mouth pressure both in normals (r = 0.94) and in COPD patients (r = 0.95), with a steeper slope in patients. On this basis we studied the effect of inspiratory muscle training on the sensation of breathlessness in sixteen COPD patients (63 +/- 8 yr; FEV1 = 52 +/- 19% of predicted). After a baseline assessment of lung function, MIP (maximal inspiratory pressure), inspiratory muscle endurance and the sensation of breathlessness (Borg scale) at different inspiratory loads, the patients were divided into two groups: the first was trained by means of resistive breathing, the second used a placebo device. At the end of the training, MIP increased more in the trained group (56 +/- 10 to 69 +/- 15 cmH2O; p less than 0.001) than in the placebo group (50 +/- 17 to 56 +/- 22 cmH2O; p = NS). The Borg score fell significantly at all the considered inspiratory loads in trained patients, but not in the placebo group. We conclude that the training with inspiratory resistances decreased the sensation of breathlessness via an increase in inspiratory muscle strength and endurance.

[Functional recovery in pulmonary tuberculosis]. / Il recupero funzionale nella tubercolosi polmonare.

At first Authors explain the stages of tubercular disease in which a programme of functional respiratory rehabilitation can be advised. Then they deal with the main aspects of rehabilitating treatment in some tubercular manifestations, as sero-fibrinous pleural effusion, tubercular empyema, parenchymal fibrosis and surgical reliquates. With regard to surgical reliquates, we mostly consider pulmonary resections and pleural skinning. At last Authors recall the indications to physical exercise training, that are constituted by some reliquates of tubercular pathology, and they resume the accomplishment modalities of such a programme in order to allow every patient wide possibilities of social reintroduction.