COPD: Providing the right treatment for the right patient at the right time.

Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.

Reasons to avoid vitamin D deficiency during COVID-19 pandemic.

The effects of vitamin D on the musculoskeletal system are well established. Its deficiency causes osteomalacia, secondary hyperparathyroidism, and an increased risk for fractures and falls. However, clinical and experimental evidence points to extra-skeletal actions of vitamin D, including on immune and respiratory systems. Thus, during this COVID-19 pandemic, a possible deleterious role of vitamin D deficiency has been questioned. This paper aims to present a brief review of the literature and discuss, based on evidence, the role of vitamin D in the lung function and in the prevention of respiratory infections. Relevant articles were searched in the databases MEDLINE/PubMed and SciELO/LILACS. The mechanisms of vitamin D action in the immune system response will be discussed. Clinical data from systematic reviews and meta-analyses show benefits in the prevention of respiratory infections and improvement of pulmonary function when vitamin D-deficient patients are supplemented. At the time of writing this paper, no published data on vitamin D supplementation for patients with COVID-19 have been found. Vitamin D supplementation is recommended during this period of social isolation to avoid any deficiency, especially in the context of bone outcomes, aiming to achieve normal values of 25(OH)D. The prevention of respiratory infections and improvement of pulmonary function are additional benefits observed when vitamin D deficiency is treated. Thus far, any protective effect of vitamin D specifically against severe COVID-19 remains unclear. We also emphasize avoiding bolus or extremely high doses of vitamin D, which can increase the risk of intoxication without evidence of benefits.

[Optimizing exercise performance with a continuously paced shuttle walk test for patients with chronic obstructive pulmonary disease]. / Optimización de la capacidad de realización de ejercicio físico mediante una prueba de la lanzadera por tramos con estimulación auditiva continua en pacientes con EPOC.

BACKGROUND: A continuously paced shuttle walk test (SWTp) was developed to test the hypothesis that speed and rhythm could be more optimally imposed by an easier-to-follow sound stimulus at every step. The objective of this study was to assess the reproducibility of the SWTp and to compare the performance of patients with chronic obstructive pulmonary disease (COPD) on the conventional and optimally paced forms of the test. PATIENTS AND METHODS: The walk test results of 24 COPD patients were studied. All patients completed 2 SWTp sessions and a conventional SWT in random order, after an initial practice test for each. A portable device was used to measure peak oxygen uptake (VO2) in 6 patients. RESULTS: The intraclass correlation coefficient (Cronbach's alpha) was 0.95 for the STWp. The Pearson correlation coefficient between distance walked and peak VO2 in the SWTp was 0.86 (P < .02). Better performance was achieved during the SWTp (peak VO2, 3.30 mL/kg/min; P < .01; distance walked, 32 m, P < .001) than during the conventional SWT. The SWTp showed excellent reproducibility. CONCLUSIONS: COPD patients can achieve better performance with the stimuli provided in the SWTp than on the SWT.

Optimización de la capacidad de realización de ejercicio físico mediante una prueba de la lanzadera por tramos con estimulación auditiva continua en pacientes con EPOC / Optimizing exercise performance with a continuously paced shuttle walk test for patients with Chronic Obstructive Pulmonary Disease

Objetivo: Se ha desarrollado una prueba de lanzadera por tramos (SWT, de shuttle walk test) con estimulación auditiva continua (SWTp, paced shuttle walk test) para comprobar la hipótesis de que es posible que los pacientes consigan una velocidad y un ritmo mejores mediante la aplicación de un estímulo sonoro, de seguimiento más fácil por ellos y correspondiente a cada paso que realizan en la prueba. El objetivo de este estudio ha sido evaluar la reproducibilidad de la SWTp y comparar el rendimiento de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) en la SWT con estimulación sonora convencional y en la SWTp con estimulación sonora óptima. Pacientes y métodos: Se han evaluado los resultados obtenidos por 24 pacientes con EPOC en la prueba de ejercicio de caminar. Todos los pacientes completaron 2 sesiones de SWTp y una sesión de SWT convencional, tras su distribución aleatoria a los grupos y después de efectuar una sesión inicial de práctica con cada una de las pruebas. Se utilizó un dispositivo portátil para determinar el consumo de oxígeno (VO2) máximo en 6 pacientes. Resultados: El coeficiente de correlación intraclase (alfa de Cronbach) fue de 0,95 para la STWp. El coeficiente de correlación de Pearson entre la distancia recorrida en la prueba y el VO2 máximo respecto a la SWTp fue de 0,86 (p < 0,02). Se consiguió un rendimiento mejor durante la SWTp (VO2 máximo de 3,30 ml/kg/min, p < 0,01; distancia recorrida de 32 m, p < 0,001), en comparación con la SWT convencional. La SWTp se acompañó de una reproducibilidad excelente. Conclusiones: Los pacientes con EPOC pueden alcanzar un rendimiento mayor con el estímulo auditivo proporcionado en la SWTp que con el correspondiente a la SWT

Background: A continuously paced shuttle walk test (SWTp) was developed to test the hypothesis that speed and rhythm could be more optimally imposed by an easier-to-follow sound stimulus at every step. The objective of this study was to assess the reproducibility of the SWTp and to compare the performance of patients with chronic obstructive pulmonary disease (COPD) on the conventional and optimally paced forms of the test. Patients and methods: The walk test results of 24 COPD patients were studied. All patients completed 2 SWTp sessions and a conventional SWT in random order, after an initial practice test for each. A portable device was used to measure peak oxygen uptake (VO2) in 6 patients. Results: The intraclass correlation coefficient (Cronbach's alpha) was 0.95 for the STWp. The Pearson correlation coefficient between distance walked and peak VO2 in the SWTp was 0.86 (P<.02). Better performance was achieved during the SWTp (peak VO2, 3.30 mL/kg/min; P<.01; distance walked, 32 m, P<.001) than during the conventional SWT. The SWTp showed excellent reproducibility. Conclusions: COPD patients can achieve better performance with the stimuli provided in the SWTp than on the SWT

Moxifloxacin versus levofloxacin against acute exacerbations of chronic bronchitis: the Latin American Cohort.

We compared the efficacy and safety of moxifloxacin and levofloxacin for the treatment of patients with acute exacerbations of chronic bronchitis (AECB) using a prospective, randomized, double blind, parallel-group clinical trial design. A total of 563 patients with AECB were enrolled (437 efficacy-valid) at 34 centers in Mexico, Argentina, Brazil, Colombia, and Peru. Patients were randomized to oral therapy with either moxifloxacin 400 mg once daily for 5 days or levofloxacin 500 mg once daily for 7 days. Clinical success was achieved in 201 out of 221 (91.0%) patients in the moxifloxacin group, and in 203 out of 216 (94.0%) in the levofloxacin group, indicating that moxifloxacin is equivalently effective to levofloxacin. Bacteriologic eradication or presumed eradication was also similar in the two treatment groups: 92.8% in the moxifloxacin group and 93.8% in the levofloxacin group. Nausea was the most common drug-related adverse event in each treatment group. The rate of discontinuation because of adverse events was very low (2%). In conclusion, a 5-day course of moxifloxacin is clinically and bacteriologically equivalent to a 7-day course of levofloxacin in the treatment of patients with AECB. The short treatment duration with moxifloxacin may have compliance advantages over other currently used therapies in the 'real-life' clinical setting.

Movimento toracoabdominal e exercícios respiratórios: revisão da literatura / Thoracoabdominal movement and breathing exercises: literature review

A parede torácica, constituida pela caixa torácica e compartimento abdominal, movimenta-se em sincronia durante o ato respiratório e reflete a participação dos músculos inspiratórios na geração de volumes pulmonares. Com a evolução tecnológica os conceitos da participaçãomuscular nas fases do ciclo e no comportamento do movimento torácico e abdominal foram se modificando. Atualmente, sabe-se que é possível estimar o volume corrente pulmonar...

Cinesioterapia no tratamento do derrame pleural / Kinesiotherapy in the treatment of pleural effusion

Derrame Pleural nao é um achado infrequente em pacientes pulmonares. Os derrames pleurais sao classificados em transudatos e exudatos. O derrame pleural transudativo desenvolve-se quando o equilíbrio entre formaçao e a reabsorçao do líquido da pleura é alterada por várias razoes; derrame exsudativo ocorre quando fatores locais da pleura como inflamaçao, infecçao ou malignidade induzem ao aumento da formaçao do líquido. Derrames transudativos e exsudativos podem ser diferenciados pelas dosagens de enzimas e proteínas como a lactatodesidrogenase em seus níveis séricos. O objetivo da fisioterapia respiratória no tratamento do derrame pleural é acelerar a reabsorçao do líquido e diminuir a possibilidade de espessamentos e aderências pleurais. As técnicas mais freqüentemente usadas incluem padroes de inspiraçao controlada sobre o lado afetado para aumentar a ventilaçao, e a manuentaçao de a pressao positiva na cavidade intra pleural, por um curto período de tempo, forçando a saída do líquido através do tubo de drenagem torácica. A cinesioterapia respiratória é amplamente usada em pacientes com desconforto respiratório e tem por objetivo, a médio prazo, proporcionar melhora na qualidade de vida do paciente e em alguns casos possibilitar o retorno às atividades produtivas. Esses resultados tem sido bem descritos na literatura.

Fisioterapia respiratória: princípios e técnicas / Principles and techniques of respiratory physiotherapy

Com o objetivo de revisar e padronizar condutas, os autores analisam a fisioterapia respiratória desde o papel do fisioterapeuta junto ao doente, passando pelos mecanismos da respiraçäo, manifestaçöes clínicas mais comuns nas enfermidades respiratórias, princípios do tratamento fisioterápico e técnicas cinesioterápicas