ABSTRACT
OBJECTIVES: During a pulmonary rehabilitation program (PRP), patients frequently report that the classically proposed activities (as cycloergometer or treadmill) are not playful. The goal of adapted physical activities is to maintain physical activity that is more playful for patients. The Nintendo Wii Gaming Console allows a playful physical activity. However, it seems important to know if this tool allows physical activity with an effective cardiorespiratory effect. The objective was to compare the cardiorespiratory response of a 30-minute training session on cycloergometer (C) and treadmill (T) versus a 30-minute training session with Wii. METHODS: Patients admitted to the PR unit of Brest University Hospital (France) were eligible for this randomized study if they had a chronic pulmonary disease. The endpoints were heart rate (HR), pulse oxymetry, dyspnea, lower limb penibility and pleasure felt. RESULTS: Twenty patients were prospectively included. HR was significantly higher at the end of the Wii session in comparison with C session (P=0.001); there was no significant difference in HR between Wii and T. We found no significant difference for dyspnea and lower limb penibility between Wii and C (respectively P=0.8 and P=0.7) and between Wii and T (respectively P=0.96 and P=0.5). The pleasure felt was significantly greater during Wii compared to C and T (respectively P=0.001 and P=0.001). CONCLUSIONS: Exercise training using Wii with identifiable games require higher HR at the end of the session compared to C and a similar cardiorespiratory response compared to T with the same dyspnea and lower limb exertion and with a pleasure felt significantly higher. Wii can be used for exercise training during PRP.
Subject(s)
Video Games , Exercise , Exercise Test , Heart Rate , Humans , MotivationSubject(s)
Anesthesiology/standards , Hematology/standards , Nuclear Medicine/standards , Practice Patterns, Physicians'/standards , Pulmonary Medicine/standards , Venous Thromboembolism/therapy , Adult , Age Factors , Aged , Aged, 80 and over , Anesthesiology/organization & administration , Anticoagulants/therapeutic use , Diagnosis, Differential , Emergency Medical Services/organization & administration , Emergency Medical Services/standards , France , Hematology/organization & administration , Humans , Middle Aged , Nuclear Medicine/organization & administration , Pulmonary Medicine/organization & administration , Societies, Medical/standards , Venous Thromboembolism/diagnosisABSTRACT
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Acute-Phase Reaction , Disease Progression , France , Humans , Language , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/pathology , Quality of Life , Severity of Illness Index , Societies, Medical/standards , Survival AnalysisSubject(s)
Anti-Bacterial Agents/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/pathology , Acute Disease , Ambulatory Care/standards , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/economics , Choice Behavior , Cost-Benefit Analysis , Disease Progression , Humans , Pulmonary Disease, Chronic Obstructive/economicsABSTRACT
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.(AU)
La bronchopneumopathie chronique obstructive (BPCO) est la maladie respiratoire chronique dont le poids sur la santé publique est le plus grand par sa morbidité, sa mortalité et les dépenses de santé qu'elle induit. Pour les individus atteints, la BPCO est une source majeure de handicap du fait de la dyspnée, de la limitation d'activité, des exacerbations, du risque d'insuffisance respiratoire chronique et des manifestations extra-respiratoires qu'elle entraîne. Les précédentes recommandations de la Société de pneumologie de langue française (SPLF) sur la prise en charge des exacerbations BPCO date de 2003. Se fondant sur une méthodologie adaptée de GRADE, le présent document propose une actualisation de la question des exacerbations de BPCO en développant un argumentaire couvrant quatre champs d'investigation : (1) épidémiologie, (2) évaluation clinique, (3) prise en charge thérapeutique et (4) prévention. Les modalités spécifiques de la prise en charge hospitalière et ambulatoire y sont discutées, particulièrement les aspects relevant de l'évaluation de la sévérité de l'exacerbation et de la prise en charge pharmacologique.(AU)
Subject(s)
Humans , Bronchodilator Agents/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Severity of Illness Index , Acute-Phase Reaction , Pulmonary Disease, Chronic Obstructive/prevention & controlABSTRACT
COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.
Subject(s)
Pulmonary Disease, Chronic Obstructive/complications , Anemia/complications , Anemia/therapy , Anxiety Disorders/complications , Anxiety Disorders/diagnosis , Anxiety Disorders/therapy , Cardiovascular Diseases/complications , Cardiovascular Diseases/therapy , Depression/complications , Depression/diagnosis , Depression/therapy , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Humans , Lung Neoplasms/complications , Lung Neoplasms/therapy , Malnutrition/complications , Malnutrition/therapy , Metabolic Syndrome/complications , Metabolic Syndrome/therapy , Obesity/complications , Obesity/therapy , Osteoporosis/complications , Osteoporosis/therapy , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapyABSTRACT
Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.
Subject(s)
Breathing Exercises/methods , Inhalation , Pulmonary Disease, Chronic Obstructive/rehabilitation , Respiratory Muscles , Aged , Dyspnea/etiology , Dyspnea/physiopathology , Exercise Test , Exercise Tolerance/physiology , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/physiopathology , Total Lung Capacity , Treatment Outcome , Vital CapacityABSTRACT
Sarcomatoid carcinoma is a rare malignancy in the family of non-small-cell lung cancer. They belong to a mixed group of poorly differenciated neoplasia, including sarcomatous cells or sarcomatoid-like cells with giant or spindle cells. We report the case of a 69-year-old man with sarcomatoid carcinoma. We describe the main characteristics of these tumors. Diagnosis is frequently delayed and lesions are locally advanced. The prognostic is poorer than other non-small-cell lung cancer. Chemotherapy is often not efficient.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinosarcoma/pathology , Lung Neoplasms/diagnosis , Lung/pathology , Sarcoma/diagnosis , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Humans , Lung Neoplasms/pathology , Male , Prognosis , Sarcoma/pathologyABSTRACT
OBJECTIVE: To describe the features of pulmonary arterial hypertension (PAH) in elderly patients. METHODS: A single centre, descriptive study of PAH patients consecutively referred to a regional centre, from September 2002 to February, 1st, 2009. The group of patients aged 65 and above at the time of the diagnosis was compared to the younger patients. RESULTS: Sixty-six patients suffering from PAH (group 1) have been investigated by means of right heart catheterisation. There were 24 patients aged 65 and above. Mean pulmonary arterial pressure was lower in the patients aged over 65. The older patient group had more respiratory and/or cardiac co-morbidities, a lower median distance in the 6minute walk test and a higher median Pro-BNP level. Specific PAH treatments were prescribed in both groups. Fifteen patients aged 65 and above were on long-term oxygen therapy (vs four younger patients, p<0.0001). The elderly patients had a median survival of 32 months. CONCLUSION: The diagnosis of PAH in elderly patients is associated with a poor prognosis. The management of these patients needs further studies.
Subject(s)
Hypertension, Pulmonary/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , Cardiac Catheterization , Cohort Studies , Comorbidity , Exercise Test , Female , France , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Prognosis , Pulmonary Wedge Pressure , Young AdultABSTRACT
Since 1976, benfluorex has been approved in Europe as a hypolipidemic and hypoglycemic drug, and is commonly used in the treatment of the metabolic syndrome. As a derivative of fenfluramine with an appetite suppressant action, benfluorex is preferentially used in overweight patients. In contrast to fenfluramine and dexfenfluramine, to date, benfluorex has not been reported to be associated with frequent cardiovascular side-effects. The present study reports five cases of severe pulmonary arterial hypertension and one case of valvular heart disease occurring in patients exposed to benfluorex. These individuals were middle age, diabetic females with a body mass index ranging 24.2-49 kg x m(-2). No definite causal effect for cardiovascular disease with benfluorex can be drawn from such case reports. However, as benfluorex, like dexfenfluramine and fenfluramine, is metabolised into active metabolite norfenfluramine, further extensive assessment of drug exposure in newly diagnosed pulmonary arterial hypertension or valvular heart disease patients is warranted.
Subject(s)
Cardiovascular Diseases/chemically induced , Fenfluramine/analogs & derivatives , Fenfluramine/adverse effects , Appetite Depressants/adverse effects , Diabetes Mellitus/drug therapy , Diabetes Mellitus/pathology , Female , Heart Valve Diseases/chemically induced , Humans , Middle Aged , Mitral Valve/pathology , Overweight/drug therapy , Selective Serotonin Reuptake Inhibitors/adverse effectsABSTRACT
Pulmonary embolism (PE) is common and potentially serious. Three stages are described: mild PE, moderate PE (associated with an ultrasound right ventricular dysfunction) and severe PE (associated with a shock). In the first category, the prognosis is highly favourable (mortality under 5%) and the initial phase of anticoagulant treatment is well documented and codified: the treatment is based on heparin therapy (non fractionated or derivatives) and oral anticoagulants. In the severe forms, fibrinolysis is indicated in addition to the heparin therapy, given the very high mortality (up to 50%). However, the optimum care of moderate PE (intermediate mortality between 10 and 15%) remains uncertain, due to the inability to demonstrate a benefits-risk ratio in favour of fibrinolysis. In addition, this entity is still poorly defined. Although cardiac ultrasound data is useful, other parameters, such as pro-BNP, provide a better identification of these forms of intermediate prognosis. Although the evaluation of the new oral and injectable anticoagulants is promising, it mainly concerns mild PE. In addition, trials are currently under way in patients with a gloomier prognosis. The purpose is to validate or invalidate the indication of classic treatments (fibrinolysis) or new treatments (optional caval filters).
Subject(s)
Pulmonary Embolism/therapy , Acute Disease , Anticoagulants/therapeutic use , Embolectomy , Fibrinolytic Agents/therapeutic use , Humans , Severity of Illness Index , Vena Cava FiltersABSTRACT
INTRODUCTION: The initiation of oxygen therapy for acute or chronic respiratory failure is a common medical intervention, both for hospital in-patients and in out-of-hospital emergency settings. Oxygen therapy is also frequently initiated by paramedics or nurses, without any initial medical prescription, in acutely ill patients. STATE OF THE ART/PERSPECTIVES: It is important to remember that oxygen is a pharmaceutical drug, and its prescription should therefore be considered within treatment guidelines. Two main pathological situations may be encountered: tissue hypoxia and acute/chronic hypoxemia. CONCLUSION: Physicians should be aware of the clinical signs that may indicate the presence of hypoxia and the pathological situations that may lead to hypoxemia. They must also be aware of the potential complications, in particular CO(2) retention in patients with chronic type II respiratory failure as well as the overall indications, and practical issues concerning oxygen therapy.
Subject(s)
Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy , Equipment Design , Humans , Humidity , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/methodsSubject(s)
Cardiac Tamponade/drug therapy , Colchicine/therapeutic use , Gout Suppressants/therapeutic use , Adult , Cardiac Tamponade/diagnosis , Cardiac Tamponade/etiology , Colchicine/administration & dosage , Electrocardiography , Gout Suppressants/administration & dosage , Humans , Male , Pericardial Effusion/complications , Pericardial Effusion/diagnosis , Recurrence , Time FactorsSubject(s)
Catheters, Indwelling , Foreign-Body Migration , Aged , Humans , Jugular Veins , Lung Neoplasms/drug therapy , Male , Radiography, ThoracicABSTRACT
INHALED CORTICOSTEROIDS: There has been substantial improvement in asthma management over the last few years. Inhaled glucocorticoids (ICS) are the most effective therapy in the treatment of asthma. COMPLEMENTARY TREATMENTS: Additional treatments such as theophyllines, long-acting beta 2 agonists or more recently leukotriene antagonists allow in most cases the maintenance of ICS at safe dosages without substantial adverse effects. COMPLIANCE: Compliance is a major issue that can only be improved using global management strategies in which asthma education plays a prominent role.