[Oral nutritional supplement in patients with COPD who completed PR program: six months and one year follow ups]. / Pulmoner rehabilitasyon programini tamamlayan KOAH tanili olgularda oral nütrisyonel destek; alti ay ve bir yillik takipleri.

INTRODUCTION: Oral nutritional supplement (ONS), an important part of multidisciplinary pulmonary rehabilitation (PR) program, is indicated according to body composition abnormalities in the patients with chronic obtructive pulmonary disease (COPD). We evaluated efficacy of oral nutritional supplement (ONS) during 5-8 months in patients with COPD who completed PR program. MATERIALS AND METHODS: The data of 41 patients with stable COPD were recorded after the approval had been taken. Patients were grouped according to ONS duration. Group 1 consisted of patients who took ONS during 2 months, group 2: 5 months, group 3: 8 months. In all patients, pulmonary function tests, quality of life, exercise capacity and body composition datas were recorded before and after PR program, at 3rd, 6th month and in 20 patients 1 year follow-up visit. RESULT: In all groups, improvements after PR in exercise capacity, dyspnea, and body composition sustained at 3 and 6 month. Quality of life was protected in group 1 during six month, in other groups it was over values before PR despite loss at 6. month. All improvements after PR were similiar between groups. In 20 patients with one year follow up, while the improvements in dyspnea and body composition were preserved, both exercise capacity and quality of life decreased, exercise capacity was lower than values before PR. CONCLUSIONS: In patients with COPD, after multidisplinary PR program, the improvements in dyspnea, exercise capacity, quality of life were maintained during six months regardless of body composition and ONS duration. Furthermore, while the improvements in body composition, dyspnea, quality of life were protected, exercise capacity was found to be lower than baseline.

Increasing quality of life in pulmonary arterial hypertension: is there a role for nutrition?

Pulmonary arterial hypertension (PAH) is a progressive disease primarily affecting the pulmonary vasculature and heart. PAH patients suffer from exercise intolerance and fatigue, negatively affecting their quality of life. This review summarizes current insights in the pathophysiological mechanisms underlying PAH. It zooms in on the potential involvement of nutritional status and micronutrient deficiencies on PAH exercise intolerance and fatigue, also summarizing the potential benefits of exercise and nutritional interventions. Pubmed/Medline, Scopus, and Web of Science were searched for publications on pathophysiological mechanisms of PAH negatively affecting physical activity potential and nutritional status, and for potential effects of interventions involving exercise or nutritional measures known to improve exercise intolerance. Pathophysiological processes that contribute to exercise intolerance and impaired quality of life of PAH patients include right ventricular dysfunction, inflammation, skeletal muscle alterations, and dysfunctional energy metabolism. PAH-related nutritional deficiencies and metabolic alterations have been linked to fatigue, exercise intolerance, and endothelial dysfunction. Available evidence suggests that exercise interventions can be effective in PAH patients to improve exercise tolerance and decrease fatigue. By contrast, knowledge on the prevalence of micronutrient deficiencies and the possible effects of nutritional interventions in PAH patients is limited. Although data on nutritional status and micronutrient deficiencies in PAH are scarce, the available knowledge, including that from adjacent fields, suggests that nutritional intervention to correct deficiencies and metabolic alterations may contribute to a reduction of disease burden.

Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi+12 trial.

BACKGROUND: Pulmonary arterial hypertension is often associated with skeletal-muscle weakness. The purpose of this randomized controlled trial was to determine the effects of an 8-week intervention combining muscle resistance, aerobic and inspiratory pressure-load exercises on upper/lower-body muscle power and other functional variables in patients with this disease. METHODS: Participants were allocated to a control (standard care) or intervention (exercise) group (n=20 each, 45±12 and 46±11years, 60% women and 10% patients with chronic thromboembolic pulmonary hypertension per group). The intervention included five, three and six supervised (inhospital) sessions/week of aerobic, resistance and inspiratory muscle training, respectively. The primary endpoint was peak muscle power during bench/leg press; secondary outcomes included N-terminal pro-brain natriuretic peptide levels, 6-min walking distance, five-repetition sit-to-stand test, maximal inspiratory pressure, cardiopulmonary exercise testing variables (e.g., peak oxygen uptake), health-related quality of life, physical activity levels, and safety. RESULTS: Adherence to training sessions averaged 94±0.5% (aerobic), 98±0.3% (resistance) and 91±1% (inspiratory training). Analysis of variance showed a significant interaction (group×time) effect for leg/bench press (P<0.001/P=0.002), with both tests showing an improvement in the exercise group (P<0.001) but not in controls (P>0.1). We found a significant interaction effect (P<0.001) for five-repetition sit-to-stand test, maximal inspiratory pressure and peak oxygen uptake (P<0.001), indicating a training-induced improvement. No major adverse event was noted due to exercise. CONCLUSIONS: An 8-week exercise intervention including aerobic, resistance and specific inspiratory muscle training is safe for patients with pulmonary arterial hypertension and yields significant improvements in muscle power and other functional variables.

Integrated Transitions of Care for Patients With Rare Pulmonary Diseases.

PURPOSE/OBJECTIVES: Many continuing education (CE) resources are available to support case management professionals in developing competencies in transitions of care (TOC) that apply generally across disease areas. However, CE programs and tools are lacking for advanced TOC competencies in specific disease areas. This article describes 2 projects in which leading TOC, case management, and CE organizations collaborated to develop CE-accredited interdisciplinary pathways for promoting safe and effective TOC for patients with rare pulmonary diseases, including pulmonary arterial hypertension (PAH) and idiopathic pulmonary fibrosis (IPF). PRIMARY PRACTICE SETTING(S): The interdisciplinary pathways apply to PAH and IPF case management practice and TOC across settings that include community-based primary care and specialty care, PAH or IPF centers of expertise, acute care and post-acute settings, long-term care, rehabilitation and skilled nursing facilities, and patients' homes. FINDINGS/CONCLUSIONS: Both PAH and IPF are chronic, progressive respiratory diseases that are associated with severe morbidity and mortality, along with high health care costs. Because they are relatively rare diseases with nonspecific symptoms and many comorbidities, PAH and IPF are difficult to diagnose. Early diagnosis, referral to centers of expertise, and aggressive treatment initiation are essential for slowing disease progression and maintaining quality of life and function. Both the rarity and complexity of PAH and IPF pose unique challenges to ensuring effective and safe TOC. Expert consensus and evidence-based approaches to meeting these challenges, and thereby improving PAH and IPF patient outcomes, are presented in the 2 interdisciplinary TOC pathways that are described in this article. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In coordinating care for patients with complex pulmonary diseases such as PAH and IPF, case managers across practice settings can play key roles in improving workflow processes and communication, transition planning, coordinating TOC with centers of expertise, coordinating care and TOC for patients with comorbidities, providing patient and caregiver education, promoting engagement between patients and the team, advancing the care plan, and improving ongoing adherence to treatment in order to maximize the patient's pulmonary function. Details regarding these interprofessional roles and responsibilities are provided in the full interdisciplinary TOC pathways for PAH and IPF.

Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension: a preliminary study.

BACKGROUND: Management of chronic thromboembolic pulmonary hypertension (CTEPH) has recently improved because of advances in pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and disease-targeted medications. However, patients with inoperable CTEPH or persistent pulmonary hypertension (PH) after these interventions continue to exhibit impaired exercise capacity and limited quality of life (QOL). METHODS: Eight patients with inoperable or residual CTEPH (mean age, 64±12 years; WHO functional class II/III, 6/2; mean pulmonary artery pressure, 47±13 mmHg) in stable condition and receiving disease-targeted medications participated in a 12-week home-based pulmonary rehabilitation program (muscle strength training, respiratory exercises, and walking) with supervised hospital sessions from March 2012 to January 2014. Efficacy parameters were prospectively evaluated at baseline and at completion of the 12-week program. RESULTS: After completion of the pulmonary rehabilitation program, the 6-minute walking distance (6MWD) (33.3±25.1 m), St. George׳s Respiratory Questionnaire activity score, quadriceps force, and 7-day physical activity level were significantly improved compared with baseline. All subjects completed the rehabilitation program. Although one patient experienced presyncope during the in-hospital exercise sessions, no other severe adverse events or complications of pulmonary rehabilitation were observed. CONCLUSIONS: These findings suggest that home-based pulmonary rehabilitation with closely supervised sessions may safely improve exercise capacity, leg muscle strength, general activity in daily life and health-related QOL in CTEPH patients.

Cardiopulmonary rehabilitation and cancer rehabilitation. 1. Cardiac rehabilitation review.

UNLABELLED: Cardiac rehabilitation includes not only the rehabilitation of people with ischemic heart disease but also those with congestive heart failure, heart transplantation, congenital heart disease, and other conditions. New advances in medical treatment have arisen, and there are new approaches in treatment, including alternative medicine and complementary care. New surgical approaches that help restore cardiac function have also been introduced, and rehabilitation professionals must be aware of these advances and be able to incorporate this knowledge into the practice of rehabilitation medicine. OVERALL ARTICLE OBJECTIVES: (a) To identify major categories of cardiac disease, (b) to elucidate appropriate interventions and support for patients with coronary artery disease, (c) to describe the new interventions available for the treatment of cardiac disease, and (d) to describe the appropriate role of cardiac rehabilitation for people with various forms of cardiac disease.