Efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO® project: a multicentre randomized controlled trial.

OBJECTIVE: To evaluate whether temporary positive expiratory pressure provides benefit in patients with lung diseases and chronic hypersecretion. DESIGN: Single blind multicentre randomized trial. SETTING: Five Italian rehabilitation centres. PARTICIPANTS: Ninety-eight patients with chronic obstructive pulmonary disease and/or chronic bronchitis (n=78), or bronchiectasis (n=20), with a peak cough expiratory flow >150 l/min and sputum production >30 ml/day, randomly included into two treatment groups. INTERVENTIONS: For 10 consecutive days, the active group performed twice a day 20-minute cycles of manually assisted breathing techniques in sequence with the addition of 15 minutes of temporary positive expiratory pressure, while the control group was treated by manually assisted breathing techniques alone. MEASURES: Within and between group changes of arterial oxygenation index, lung volumes and respiratory muscles strength were recorded at enrolment and after 3 and 10 treatment sessions. Pre-to-post treatment change of sputum volume and bronchial encumbrance (Δ-visual analog scale), sputum density and purulence were compared daily within the study period. RESULTS: No significant changes were recorded for the oxygenation index, while dynamic lung volumes and respiratory muscle strength significantly (P <0.05) improved in the active group. The group comparison analysis of the pre-to-post change showed that inspiratory capacity was significantly higher in the active than in the control group (+19.5% and +2.2%, P=0.044) at day 10. A greater improvement in Δ-visual analog scale was recorded in the active group at day 3 and 8. CONCLUSIONS: These preliminary data suggest that temporary positive expiratory pressure improves lung volumes and speeds up the improvement of bronchial encumbrance in patients with lung diseases and hypersecretion.

[Effect of rehabilitation using antihomotoxic drug together with energy stabilizing electromagnetic therapy on morphological, biochemical, and system immunity indices in children with recurrent bronchitis].

There is now good evidence that the use of electromagnetic millimeter waves the following curative effects: analgesic, normalization of relations or increased formation of neurohumoral substances. The introduction of a therapeutic practice complex biological drugs that trigger, not overwhelming the body auxiliary immunological reaction, based on the activation of the regulation clones of T-lymphocytes and helper functions, is an important step in achieving a qualitatively level of health patients with chronic disease.

[Organisational and legal issues of medical rehabilitation for patients with occupational diseases caused by dust].

The study based on Rehabilitation Center No 2 in Rostov region covered 100 male patients with dust obstructive bronchitis. The authors considered organisational and legal problems of medical rehabilitation for patients with occupational diseases caused by dust. The authors also specified and suggested stages of individual medical rehabilitation and efficiency criteria for rehabilitation, exeplified by dust obstructive bronchitis patients. Data show that creation and accomplishment of individual medical rehabilitation programs for dust obstructive bronchitis patients enable to optimize rehabilitation process, provide continuity of medical rehabilitation, evaluate efficiency of rehabilitation measures on each step of medical rehabilitation. Higher efficiency of rehabilitation is achieved by individual rehabilitation added by nebulizer treatment, efferent therapy, psychologic correction and specialized education for chronic patients with obstructive lung diseases.

[Efficiency of complex rehabilitation in chronic obstructive pulmonary disease and occupational bronchitis].

AIM: To evaluate the efficiency of the rehabilitation in patients with obstructive pulmonary disease (COPD) and occupational bronchitis (OB) and the disabled due to these diseases, which was based on the authors' developed procedure and criteria for evaluating the efficiency of rehabilitative measures. MATERIALS AND METHODS: The efficiency of implementation of 55 individual rehabilitation programs (RP) elaborated by the Medicosocial Examination Bureau for the disabled due to COPD and OB was evaluated. RESULTS: The authors have determined qualitative criteria for evaluating the efficiency of rehabilitation: the extent to which the recommended rehabilitation measures being implemented, the trend in the magnitude of various vital activity categories and social inadequacy and in the disability group on regular examination, the results of implementation of some parts of an individual RP, the conformity of the achieved results to the rehabilitation potential of a disabled patient. The evaluation procedure supposes a unified quantitative gradation of each criterion. Overall, rehabilitation is more effective in COPD than in OB. CONCLUSION: The developed criteria and procedures for evaluating the efficiency of rehabilitation in patients with COPD and OB show a great informative value and practical content richness, which permits one to make corrections into the rehabilitation process. Functional impairments, the degree of vital activity restrictions and social inadequacy, as well as the rehabilitation potential and rehabilitation prognosis are concomitantly evaluated, which allows minor changes to be assessed in the clinical, personality, and social status of a patient.

A prospective qualitative exploration of views about attending pulmonary rehabilitation.

BACKGROUND AND PURPOSE: Pulmonary rehabilitation has been found to be an effective strategy for managing chronic obstructive pulmonary disease (COPD). However, attendance at such programmes is not optimal, therefore, this study aimed to develop an in-depth understanding of views regarding attendance at pulmonary rehabilitation and experiences which may have shaped these views. METHODS: An inductive qualitative study was carried out within the framework of Interpretative Phenomenological Analysis. Five female and four male individuals with COPD who had been referred for pulmonary rehabilitation participated in semi-structured interviews. Interviews were conducted prior to participation in pulmonary rehabilitation. RESULTS: Three main themes were identified that related to views about attending pulmonary rehabilitation. The first is entitled 'Desired benefits of attending pulmonary rehabilitation', which described realistic hopes about impact on daily life. The second theme was called 'Evaluating the threat of exercise', and it encompassed both positive and negative evaluations; some interviewees described fear and avoidance of exercise, while others were determined to overcome symptoms. These attitudes extended to views about pulmonary rehabilitation. The third theme was called 'Attributing value to pulmonary rehabilitation'. Contrasting opinions about the value of attending pulmonary rehabilitation appeared to be influenced by the nature of prior interactions with health personnel and systems as well as information about the programme provided at referral. The referrer's attitude towards pulmonary rehabilitation appeared to be particularly influential. CONCLUSION: In summary, when considering rehabilitation attendance, potential participants are able to identify possible benefits, but previous experiences of symptoms and attitudes towards their condition can influence views both positively and negatively. Information and enthusiasm conveyed by the referring clinician, as well as previous interactions with health professionals can have powerful impact on views about attending. Referral practices should be informative and enthusiastic to increase the likelihood of uptake.

[Efficiency of aerosol therapy in rehabilitation programs for patients with occupational broncho-pulmonary diseases].

The authors demonstrated efficiency of aerosol therapy using "Dovolenskaya" mineral water in treating patients with occupational pulmonary diseases. Results are improved bronchial drainage, normal pro- and antioxidant status, lower inflammatory activity in patients with pneumoconiosis and occupational dust bronchitis.

[Diagnostics and therapeutic approach in clinical remission of chronic bronchitis].

Clinical examination and laboratory tests performed on 708 patients with chronic obstructive and non-obstructive bronchitis (COB and CNB), demonstrated heterogeneous character of the group of these patients in clinical remission. This suggests that it is appropriate to distinguish between the stages of complete and partial remission, implying different tasks concerning treatment and rehabilitation. Remission of CNB is characterized by minimal deviation of clinical and laboratory parameters; functional balance between the lipid peroxidation-antioxidative activity (LP-AA) system and immunity is preserved. At the stage of rehabilitation of these patients the major attention is paid to the general sanitary measures (physiotherapy exercises, climate therapy). The stage of partial remission in COB and CNB is characterized by residual activity of the inflammatory process, a disbalance between the LP-AA system and immunity, most prominent in partial remission of COB. Rehabilitation of these patients, in addition to physiotherapy exercises and tempering of the organism, should include special activity, directed towards the normalization of LP and immunity parameters.

Improving dyspnea management in three adults with chronic obstructive pulmonary disease.

This case report describes occupational therapy intervention for three adult outpatients with chronic obstructive pulmonary disease (COPD) at one large urban hospital. The occupational therapy intervention was based on the Management of Dyspnea Guidelines for Practice (Migliore, in press). The learning and practice of controlled breathing were promoted in the context of physical activity exertion in a domiciliary environment. In addition to promoting dyspnea management, the controlled-breathing strategies aimed to facilitate energy conservation and to increase perceived breathing control. Although no causality can be determined in a case study design, the patients' dyspnea with activity exertion decreased and their functional status and quality of life increased following goal-directed, individualized occupational therapy intervention combined with exercise training.

Early determinants of first hospital admissions for asthma and acute bronchitis among Swedish children.

AIM: To assess the changing impact of prenatal and perinatal factors with increasing age on first admissions for asthma and acute bronchitis. METHODS: The Swedish Medical Birth Registry was linked to the National Hospital Discharge Registry for 214,276 Swedish children born in 1987 and 1988. The linkage comprised first admissions for acute bronchitis or asthma from 1987 to 1995. First admissions for gastroenteritis were included to distinguish between factors specific to asthma or bronchitis and non-specific factors related to an increased risk of hospital admission. RESULTS: Admissions for asthma and acute bronchitis before 2 y of age had a close dose-response relationship with maternal smoking, low gestational age, low maternal age and older siblings. Very premature children exposed to more than 9 cigarettes a day in utero ran a 10 times higher risk of hospitalization than postmature children without exposure to maternal smoking. However, the proportion of admissions attributed to maternal smoking was only 4.7% after adjustments for significant covariates. The number of significant determinants declined in children with their first admission for asthma after 2 y of age but male gender and low educational level were independent determinants in all age groups. Older siblings were related to an increased risk of first asthma admission before 2 y of age but a slightly reduced risk of first admission after 2 y of age. CONCLUSION: This study illustrates the varied epidemiology of asthma in different age groups. Maternal smoking was an important determinant for admission before 2 y of age but mainly in combination with other factors. The decline in hospital admissions in early childhood would therefore be small, even after the elimination of maternal smoking, if other significant perinatal and socioeconomic factors were unchanged.

[Staged medical rehabilitation of patients with chronic obstructive bronchitis]. / Etapnaia meditsinskaia reabilitatsiia bol'nykh khronicheskim obstruktivnym bronkhitom.

The author believes that adequate rehabilitation of patients with chronic obstructive bronchitis (COB) can be achieved only under staged approach, i.e. cooperation of outpatient, inpatient and sanatorium treatments. Each of the stages is characterized. This three-stage rehabilitation improves the patient's mobility due to higher physical performance and tolerance to dyspnea.

[Tracheostomy valve with integrated cough flap for improving hands-free speech in laryngectomized patients--development and clinical applications]. / Tracheostomaventil mit integrierter Hustenklappe zur Verbesserung der fingerfreien Sprache des Laryngektomierten--Entwicklung und klinischer Einsatz.

BACKGROUND: Following successful voice restoration after laryngectomy either by a voice prosthesis, a surgical shunt or microvascular laryngoplasty, a further goal in rehabilitation is the insertion of a tracheostoma valve, which enables the patient to speak without using his fingers for closure of the tracheostoma. One important disadvantage of the tracheostoma valves, which are available today, is the necessity of removal of the valve in case of coughing, because the valve could be thrown from the stoma by the strong air flow during coughing. As many laryngectomies suffer from chronic bronchitis, this coughing problem is one of the reasons why only few patients could be provided with this useful aid. METHOD: At the department of biomedical engineering of the faculty of medicine at the university of Groningen, the Netherlands, 1994 two prototypes of a tracheostoma valve with an integrated cough lid were developed. These devices contain two separate valve systems: the normal speaking valve and a special coughing valve, which opens at a certain air flow and closes automatically after the coughing attack. Thus no manipulations are necessary during coughing, the patient can speak undisturbed. The ADEVA company (Lübeck, Germany) undertook the industrial production of this new type of tracheostoma valve creating different modifications of the prototype #2. PATIENTS: In four series with 6-8 patients per group the modified tracheostoma valves were tested clinically and the occurring faults or lack of correct function eliminated by small changes in the production. RESULTS: Meanwhile a suitable model for routine use is available, which was tested in 30 patients so far. This suitability was achieved by improvements in the valve mechanism, the valve seal and the adjustment mechanisms for the individual pressure level of the speaking and the coughing valve. CONCLUSION: The newly developed tracheostoma valve with integrated coughing lid (Window, ADEVA-medical Company, Lübeck, Germany) provides further improvement in speech rehabilitation of laryngectomies. The low acceptance of tracheostoma valves, which enable the patient to speak without using his fingers for closure of the tracheostoma, possibly may be raised by this new aid.

[The scientific validation and outlook for the practical use of halo-aerosol therapy]. / Nauchnoe obosnovanie i perspektivy prakticheskogo primeneniia galoaérozol'noi terapii.

The paper describes a new medical technique--halo-aerosol therapy, the main acting factor of which is dry highly dispersed aerosol of sodium chloride in natural concentration. Halo-aerosol therapy represents a new trend in aerosol medicine. It includes two methods: halotherapy and halo-inhalation. Biophysical and pathophysiological foundations of the new method, how it can be realized are outlined. Clinical reasons are provided for application of halo-aerosol therapy for prevention, treatment and rehabilitation of patients with respiratory diseases. Characteristics and differences of the two halo-aerosol therapy variants are analysed.

[The use of the microclimate of artificial sylvinite speleoclimatic chambers in treating patients with chronic obstructive bronchitis]. / Ispol'zovanie mikroklimata iskusstvennykh sil'vinitovykh speleoklimaticheskikh kamer v lechenii bol'nykh khronicheskim obstruktivnym bronkhitom.

67 patients with purulent and 63 with catarrhal chronic obstructive bronchitis (COB) were subjected to clinico-laboratory, functional and bronchoscopic examinations. 41% of the patients had COB exacerbation, 59% were in partial remission. As shown by improvement in clinical, immunological and morphological indices, blood biochemistry, sputum microscopy, spirometry, bronchoscopy findings, artificial sylvinite speleotherapy is effective in acute and purulent COB.

[Methods for the costing process in the field of economic evaluation of a rehabilitation program for patients with chronic obstructive lung diseases]. / Methoden zur Kostenerfassung im Rahmen der ökonomischen Evaluation einer Rehabilitationsmassnahme bei chronischen Atemwegserkrankungen.

Studies in health economics especially economic evaluations of health care technologies and programmes are getting more and more important. However, in Germany there are no established, validated and commonly used instruments for the costing process. For the economic evaluation of a rehabilitation programme for patients with chronic lung diseases such as asthma and chronic bronchitis we developed methods for identification, measurement and validation of resource use during the inpatient rehabilitation programme and during the outpatient follow-up period. These methods are based on methodological considerations as well as on practical experience from conducting a pilot study. With regard to the inpatient setting all relevant diagnostic and therapeutic resource uses could be measured basing on routine clinical documentation and validated by using the cost accounting of the clinic. For measuring the use of resources during the follow-up period in an outpatient setting no reliable administrative data are accessible. Hence, we compared a standardised retrospective patient questionnaire used in a 20-minute interview (n = 50) and a cost diary for the continuing documentation by the patient over a period of 4 weeks (n = 50). Both tools were useful for measuring all relevant resource uses in sufficient detail, but because of higher participation rates and lower dropouts the structured interview appears to be more suitable. Average total costs per month were 1591 DM (interview), respectively 1867 DM (cost diary). Besides productivity loss, costs for medication and GP visits caused the relatively highest resource uses. Practicable instruments were developed for the costing process as part of an economic evaluation in a German rehabilitation setting for pulmonary diseases. After individual modification, these could also be used for different indications and in other institutional settings.

[Effectiveness of treatment in patients with pulmonary tuberculosis and chronic bronchitis by exposure on vertebro-osteo-sternal joints]. / Effektivnost' lecheniia bol'nykh tuberkulezom legkikh i khronicheskim bronkhitom metodom vozdeistviia na vertebrokostnosternal'nye sochleneniia.

A hundred and twenty six patients with infiltrative destructive pulmonary tuberculosis were examined. In 62 patients of them, the vertebroosteosternal joints were exposed as part of multimodality treatment in order to arrest an exacerbation of chronic bronchitis. A control group included 64 patients. The exposure of vertebroosteosternal joints was found to enhance the efficiency of treatment for chronic bronchitis in patients with pulmonary tuberculosis. This treatment promotes lower inflammatory intensity, diminished antigenemia and anti-protein antibody production. To arrest lesions in the bronchial tree with the proposed package of methods also favours a higher efficiency of treatment of a tuberculous process.

Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods.

OBJECTIVE: To compare the short-term effects of postural drainage (PD), oscillating positive expiratory pressure (using the FLUTTER device), and expiration with the glottis open in the lateral posture (ELTGOL) on oxygen saturation, pulmonary function, and sputum production in patients with an acute exacerbation of chronic bronchitis. DESIGN: A prospective, randomized study. SETTING: A clinical ward. PATIENTS: Ten patients with chronic bronchitis exacerbation received PD, FLUTTER, and ELTGOL by the same respiratory therapist at about the same time of day on separate days and in random order. MAIN OUTCOME MEASURES: Oxygen saturation and pulmonary function were measured before, immediately after, and 15 minutes and 1 hour after each treatment. Improvement in sputum production was measured by total sputum wet weight immediately after and for 1 hour after treatment. INTERVENTIONS: PD consisted of positioning the patients in a posture that allows bronchial drainage by gravity. FLUTTER is a device that is claimed to combine oscillating positive expiratory pressure with oscillations of the airflow. ELTGOL is an airway clearance technique that uses lateral posture and different lung volumes to control expiratory flow rate to avoid airway compression. The total time spent for treatments was 30 minutes. RESULTS: All techniques were well tolerated, and oxygen saturation and pulmonary function did not change significantly during and after treatments. Thirty minutes after the beginning of treatment, sputum production increased significantly with all techniques, but during the 1 hour after the end of treatment, it was significantly larger with FLUTTER (from 15.0 +/- 8.6g to 19.0 +/- 9.3g, p < .01) and ELTGOL (from 17.0 +/- 7.0g to 20.6 +/- 6.9g, p < .02) than with PD (from 15.5 +/- 4.0g to 17.5 +/- 3.7g, NS). CONCLUSIONS: All three treatments were safe and effective in removing secretions without causing undesirable effects on oxygen saturation, but FLUTTER and ELTGOL techniques were more effective in prolonging secretion removal in chronic bronchitis exacerbation than was the PD method.

[Halotherapy in the combined treatment of chronic bronchitis patients]. / Galoterapiia v kompleksnom lechenii bol'nykh khronicheskim bronkhitom.

Halotherapy proved to be a highly effective method in a complex sanatorium treatment of patients with chronic bronchitis. Its use promotes more rapid liquidation of clinical manifestations of disease, improves indices of vent function of lungs, especially those values that characterize bronchial conduction (volume of forced exhalations per second, index Tiffno), increases tolerance to physical load, normalizes indices of reduced immunity and leads to increasing the effectiveness of patient treatment in sanatorium.