Protected characteristics reported in pulmonary rehabilitation: a scoping review.

BACKGROUND: An individual's characteristics are reported to influence access, completion and outcomes of pulmonary rehabilitation and may contribute to health inequalities. Many countries have policies to promote equity among individuals' characteristics, including the UK Equality Act 2010 which lists nine protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation). OBJECTIVES: To describe the extent to which UK Equality Act 2010 protected characteristics have been collected and reported in UK studies and audits of pulmonary rehabilitation. METHODS: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines was conducted using five databases. UK studies and audits collecting data on pulmonary rehabilitation from 1 October 2010 (date of Equality Act 2010 inception) were eligible. The protected characteristics collected and how they were reported were extracted. RESULTS: Out of 45 included studies and audits (41 studies and four audits), 98% (k=44) reported age. Sex was reported in 40% (k=18), and 20% (k=9) reported gender with only male and female categories. Half (50%, k=2) of audits reported gender with male, female and transgender categories. Race was reported through ethnicity in 2% (k=1) of studies and 75% (k=3) of audits. No studies or audits explicitly reported disability, but all reported measures indicating disease severity (e.g. forced expiratory volume in 1 s % predicted: 67%, k=30). No studies or audits reported marriage and civil partnership, pregnancy and maternity, religion or belief or sexual orientation. CONCLUSIONS: Protected characteristics are not commonly reported or are inconsistently reported in UK pulmonary rehabilitation studies and audits. Without reporting these characteristics, health inequalities in pulmonary rehabilitation will remain unclear.

Factors related to the implementation of pulmonary rehabilitation in Jordan: Perspective of healthcare professionals.

BACKGROUND: Although the benefits of pulmonary rehabilitation (PR) in the management of chronic respiratory disease conditions (CRC) are well-documented, it remains underutilized. In Jordan, the scarcity of PR services denies those with CRC the opportunity to improve their functional capacity, mental health, and quality of life. OBJECTIVE: To explore the factors related to the implementation of PR in Jordan from the perspective of the healthcare professionals (HCPs). METHODS: This was a qualitative study that utilized semi-structured interviews informed by the Theoretical Domains Framework (TDF). Twenty-one HCPs were interviewed. Interview transcripts were coded against the relevant TDF domain(s) and then domains' summaries were generated. RESULTS: A total of 997 quotes were coded against the TDF domains. Knowledge, environmental context and resources, social influences, and skills domains were the ones most coded. The study identified several barriers to PR implementation such as: limited knowledge and skills pertaining to PR among HCPs, limited public awareness of PR, financial costs, limited legislation related to establishment of PR and role confusion of HCPs in PR. The main facilitators include: HCPs willingness to be involved in new programs such as PR, the perception of the importance and need for PR and HCPs beliefs about capabilities to overcome barriers for a successful implementation of PR. CONCLUSION: The current study provided information that will inform stakeholders and policymakers about the factors affecting PR implementation in Jordan. Improvements in HCPs skills and knowledge about PR, financial support, improvements in undergraduate syllabi and policies to control PR service provision are considered to be key to a successful implementation of PR.

Barriers to Pulmonary Rehabilitation.

Pulmonary rehabilitation (PR) is one of the most effective therapies for chronic respiratory diseases, yet it is significantly underutilized. There are several patient-related, geographic, societal, and health system-related barriers to PR. People with chronic respiratory disease face a collectively high burden of treatments including health care provider visits, medications, oxygen and other durable medical equipment, and providers' recommendation to undertake PR may be considered an added burden more than a likely benefit. Transportation difficulties, lack of insurance coverage, competing time priorities, low knowledge of PR, lack of perceived likely benefit, comorbidities, and other factors also pose obstacles to participation in PR for patients. Geographic availability of PR is heterogenous; in the United States, out-patient center-based PR programs are often not available within close proximity to patients' residence, posing barriers to patients' access to it. PR programs are lacking altogether in many areas; rural areas are particularly affected. Existing PR programs are often poorly funded and underresourced. Socioeconomic and racial disparities also influence patients' likelihood of receiving PR. Also, health care professionals (HCPs) often do not refer their patients with chronic respiratory disease to PR, owing to a lack of knowledge and awareness of its content and benefits, patient candidacy, or of the referral process. A limited number of multidisciplinary HCPs trained in PR likely also contributes to limited access to PR for patients. Collectively, these multifaceted barriers to PR create unacceptable health care disparities. Strategies to address barriers to PR are urgently needed in order to enable individuals who need to receive it.

Pulmonary rehabilitation in Iranian outpatients with mustard gas lung disease: a randomised controlled trial.

OBJECTIVE: People with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be beneficial in this condition. DESIGN: An assessor-blind, two-armed, parallel-design randomised controlled clinical trial. SETTING: Secondary care clinics in Iran. PARTICIPANTS: 60 men with breathlessness due to respiratory disease caused by documented mustard gas exposure, mean (SD) age 52.7 (4.36) years, MRC dyspnoea score 3.5 (0.7), St. George's Respiratory Questionnaire (SGRQ) 72.3 (15.2). INTERVENTIONS: Participants were allocated either to a 6-week course of thrice-weekly PR (n=31) or to usual care (n=29), with 6-week data for 28 and 26, respectively. OUTCOME MEASURES: Primary endpoint was change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Secondary endpoints included 6 min walk distance, quadriceps strength and bulk, body composition and health status. For logistical reasons, blood tests that had been originally planned were not performed and 12-month follow-up was available for only a small proportion. RESULTS: At 6 weeks, cycle endurance time increased from 377 (140) s to 787 (343) s with PR vs 495 (171) s to 479 (159) s for usual care, effect size +383 (231) s (p<0.001). PR also improved 6 min walk distance+103.2 m (63.6-142.9) (p<0.001), MRC dyspnoea score -0.36 (-0.65 to -0.07) (p=0.016) and quality of life; SGRQ -8.43 (-13.38 to -3.48) p<0.001, as well as quadriceps strength+9.28 Nm (1.89 to 16.66) p=0.015. CONCLUSION: These data suggest that PR can improve exercise capacity and quality of life in people with breathlessness due to mustard gas lung disease and support the wider provision of this form of care. TRIAL REGISTRATION NUMBER: IRCT2016051127848N1.

Pulmonary Rehabilitation: A Look Back, a Look Forward.

Pulmonary rehabilitation (PR) is a comprehensive approach to the management of patients with chronic lung disease that encompasses exercise, education, and psychosocial support. The development of PR programs began in the mid-20th century with the appreciation that exercise provided real benefit in chronic lung disease and that effective disease management involved patient education focused on medications, lifestyle changes, and lifelong regular exercise. Initially PR was primarily facility-based, but today PR is extending into the home with telemedicine, and this is encouraging a real partnership of patients and professionals supporting self-management. The evidence base supporting PR as a safe and effective modality has grown exponentially over the last 4 decades, and PR is strongly endorsed by virtually all the major professional societies. Importantly, PR has also clearly been shown to be cost-effective. Challenges remain, however. Access is still very limited for a variety of reason (logistics, financial, patient motivation) that need to be addressed. More focused and personalized exercise programs and monitoring strategies that encourage a patient's lifetime commitment to the principles of PR need to be developed and refined. The opportunity to really impact important clinical outcomes exists with PR, and this needs to be exploited.

Qualidade de vida e aspectos funcionais de pacientes pós-Covid-19 submetidos à reabilitação pulmonar / Quality of life and functional aspects of post-Covid-19 patients submitted to pulmonary rehabilitation

INTRODUÇÃO: pacientes que tiveram Covid-19, independente do espectro clínico da doença, podem apresentar sintomas persistentes após a alta hospitalar por até 14 meses. Estes pacientes apresentam comprometimentos funcionais e de qualidade de vida sendo, portanto, indicada a reabilitação pulmonar. Este estudo avaliou os aspectos funcionais e a qualidade de vida de pacientes pós-Covid-19 atendidos em um programa de reabilitação pulmonar. MÉTODOS: trata-se de um estudo prospectivo do tipo coorte clínica. Os pacientes pós-Covid-19 que integraram um programa de reabilitação pulmonar por seis semanas consecutivas foram avaliados em relação às variáveis funcionalidade pelo Índice de Barthel e pela escala PCFS, e a qualidade de vida pelo SF-36 na admissão (T0) e após seis semanas de reabilitação (T1). RESULTADOS: Onze pacientes que participaram do estudo apresentaram melhora da funcionalidade tanto pelo Índice de Barthel (p<0,01) como pela escala PCFS (p<0,01) e, também, melhora da qualidade de vida nos domínios capacidade funcional (p< 0,01), limitação por aspectos físicos (p<0,05) e aspectos sociais (p<0,01) no T1 em relação ao T0. CONCLUSÃO: pacientes pós-Covid-19 apresentaram melhora da funcionalidade e da qualidade de vida após um programa de reabilitação pulmonar (AU),

INTRODUCTION: patients who have Covid-19, regardless of the clinical spectrum of the disease, may present, after hospital discharge, persistent symptoms for up to 14 months. These patients have functional and quality of life impairments and, therefore, pulmonary rehabilitation for six consecutive weeks is indicated. This article evaluated the functional aspects and quality of life of post-Covid-19 patients treated in a pulmonary rehabilitation program. METHODS: this is a prospective clinical cohort study. Post-Covid-19 patients who joined a pulmonary rehabilitation program were evaluated concerning the variables functionality by the Barthel Index and the PCFS scale, and quality of life by the SF-36 at admission (T0) and after six weeks of rehabilitation treatment (T1). RESULTS: Eleven patients who participated in the study showed improved functionality both by the Barthel Index (p<0.01) and the PCFS scale (p<0.01) and also improved quality of life in the functional capacity domains (p < 0.01), limitation due to physical aspects (p<0.05) and social aspects (p<0.01) at T1 compared to T0. CONCLUSION: post-Covid-19 patients showed improved functionality and quality of life after a pulmonary rehabilitation program (AU).

Impacto de la rehabilitación pulmonar en pacientes con enfermedad pulmonar restrictiva / Impact of pulmonary rehabilitation in patients with restrictive pulmonary disease

Introducción: Las enfermedades pulmonares restrictivas presentan alteraciones en la mecánica toracopulmonar, reducción de la capacidad funcional y de la función pulmonar. Se pueden encontrar las alteraciones intrínsecas y extrínsecas donde se ven alterados el intersticio, la expansibilidad torácica e incluso afecciones del parénquima pulmonar. La rehabilitación pulmonar podría beneficiar a pacientes con la condición restrictiva y mejorar su condición funcional. Objetivo Establecer el impacto de la rehabilitación pulmonar en pacientes con compromiso respiratorio restrictivo intrínseco y extrínseco en la disnea, capacidad funcional, ansiedad/depresión y calidad de vida relacionada con la salud. Métodos Estudio descriptivo longitudinal con 50 pacientes con enfermedad pulmonar restrictiva y quienes realizaron rehabilitación pulmonar en una clínica de la ciudad de Cali, Colombia. Los participantes vinculados al estudio fueron separados en dos grupos: el primero con enfermedad restrictiva intrapulmonar (ERI) y el segundo grupo con enfermedad restrictiva extrapulmonar (ERE). Resultados La edad media de los pacientes fue de 53,3años. Entre las enfermedades restrictivas intrapulmonares se presentaron: enfermedad intersticial pulmonar difusa (EPID), postcondición de neumonías o síndrome de dificultad respiratoria aguda (SDRA) y secuelas de tuberculosis pulmonar. Y entre las enfermedades respiratorias extrapulmonares: resección pulmonar, resección de lóbulo pulmonar y resección en cuña. Al finalizar la rehabilitación pulmonar el grupo ERI presentó mejorías estadísticamente significativas en la distancia recorrida, consumo de oxígeno estimado (VO2e), disnea, ansiedad y calidad de vida. El grupo ERE presentó incremento significativo en la distancia recorrida y VO2e (AU)

Introduction: Restrictive lung diseases present alterations in thoracic-pulmonary mechanics, reduced functional capacity and lung function. Intrinsic and extrinsic alterations can be found where the interstitium, thoracic expandability and even lung parenchymal conditions are altered. Pulmonary rehabilitation could benefit patients with the restrictive condition and improve their functional condition. Objective Establish the impact of pulmonary rehabilitation in patients with intrinsic and extrinsic restrictive respiratory compromise on dyspnea, functional capacity, anxiety/depression and health-related quality of life. Methods Longitudinal descriptive study with 50 patients with restrictive lung disease who performed pulmonary rehabilitation in a clinic in the city of Cali, Colombia. The participants linked to the study were separated into two groups, the first with intrapulmonary restrictive disease (IRD) and the second group with extrapulmonary restrictive disease (ERD). Results The mean age of the patients was 53.3years. Among the restrictive intrapulmonary diseases there were: diffuse interstitial lung disease (ILD), post-condition pneumonia and/or acute respiratory distress syndrome (ARDS) and sequelae of pulmonary tuberculosis. Extrapulmonary respiratory diseases: lung resection, pulmonary lobe resection, and wedge resection. At the end of pulmonary rehabilitation, the IRD group presented statistically significant improvements in distance covered, estimated oxygen consumption (VO2e), dyspnea, anxiety, and quality of life. The ERD group presented a significant increase in the distance traveled and VO2e. Conclusion Patients with restrictive lung disease improve the distance traveled, VO2e, dyspnea, anxiety and quality of life; patients with extrapulmonary respiratory disease show improvements in functional capacity (AU)

Pulmonary rehabilitation for COVID-19: a living systematic review protocol

Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

Efecto de la rehabilitación pulmonar sobre la función respiratoria y la capacidad de ejercicio en personas con enfermedad pulmonar crónica / Effect of pulmonary rehabilitation on respiratory function and exercise capacity in people with chronic lung disease

Resumen Justificación y objetivo: Los problemas pulmonares crónicos son una de las principales causas de discapacidad en las personas adultas mayores. Estas enfermedades afectan negativamente la calidad de vida y la capacidad funcional de las personas, debido a la interacción entre el proceso normal de envejecimiento y la fisiopatología. Sin embargo, los programas de rehabilitación pulmonar parecen ser una opción terapéutica efectiva para tratar esta problemática. A pesar de esto, en Costa Rica no es una posibilidad disponible en todos los centros de salud y existe limitada evidencia sobre su efectividad. Este estudio intenta identificar el efecto de un programa de rehabilitación pulmonar sobre la función respiratoria y la capacidad de ejercicio de personas adultas mayores con enfermedad pulmonar crónica. Métodos: Se realizó un análisis retrospectivo del efecto de un programa de ejercicio físico sobre la función respiratoria y la capacidad de ejercicio en 53 personas adultas con enfermedad pulmonar crónica. Los datos fueron recolectados en el Hospital Nacional de Geriatría y Gerontología-Caja Costarricense de Seguro Social, de personas que participaron en el programa entre enero 2012 y diciembre 2017. Resultados: Hubo mejoras estadísticamente significativas en la función respiratoria (p<0,001) y la capacidad de ejercicio (p<0,001) de los sujetos, luego de participar en el programa. Conclusión: El programa de rehabilitación pulmonar mejoró la función respiratoria y la capacidad de ejercicio.

Abstract Background and aim: Chronic lung problems are one of the main causes of disability in older adults. These diseases negatively affect the quality of life and functional capacity of these people, due to the interaction between the normal aging process and the pathophysiology. However, pulmonary reconditioning programs seem to be an effective therapeutic alternative to treat this problem. Despite this, in Costa Rica it is not an option available in all health centers and there is limited evidence on its effectiveness. Therefore, this study attempts to identify the effect of pulmonary rehabilitation on the respiratory function and aerobic capacity of exercise among older adults with chronic obstructive pulmonary disease. Methods: For which a retrospective analysis of the effect of a physical exercise program on ventilatory function and aerobic capacity of exercise in 53 adults with chronic lung disease wasperformed. Data were collected at the National Hospital of Geriatrics and Gerontology - Caja Costarricense de Seguro Social, of people who participated in the program between January 2012 and December 2017. Results: It was determined that there were statistically significant improvements in respiratory function (p <0.001) and capacity of exercise (p <0.001) of the subjects after participating in the program. Conclusion: The pulmonary rehabilitation program improved respiratory function and exercise capacity.

Reabilitação pós COVID-19 / Post COVID-19 rehabilitation

A partir do conceito de "reabilitação" sintetiza evidências relevantes disponíveis sobre a reabilitação de pacientes internados e/ou recuperados da infecção pelo SARS-CoV-2 (COVID-19). Citam as principais recomendações para pacientes com Covid-10 e os Programas de Reabilitação direcionados para reabilitação na síndrome pós COVID-19 no Brasil, neste contexto, afirmam que a maioria dos programas de reabilitação é composta por equipes multiprofissionais envolvendo diferentes categorias: médico, enfermeiro, fisioterapeuta, terapeuta ocupacional, psicólogo, educador físico e fonoaudiólogo. Discorre sobre a atenção primária e apontam mudanças na forma de atendimento no cenário da pandemia da covid-19, e lista os cuidados, recomendações pertinentes

From the concept of "rehabilitation" it synthesizes relevant evidence available on the rehabilitation of hospitalized and/or recovered patients from SARS-CoV-2 (COVID-19) infection. They cite the main recommendations for patients with Covid-10 and the Rehabilitation Programs aimed at rehabilitation in post COVID-19 syndrome in Brazil, in this context, they state that most rehabilitation programs are composed of multidisciplinary teams involving different categories: doctor, nurse , physiotherapist, occupational therapist, psychologist, physical educator and speech therapist. It discusses primary care and points to changes in the form of care in the covid-19 pandemic scenario, and lists the precautions, pertinent recommendations

Rehabilitación pulmonar en fase hospitalaria y ambulatoria / Pulmonary rehabilitation in the in-hospital and outpatient phases

Los programas de rehabilitación pulmonar están diseñados para promover la capacidad aeróbica y el mejoramiento de la calidad de vida de pacientes con deficiencias pulmonares crónicas, facilitando la participación y la integración en sus diferentes áreas de desempeño y en las actividades de la vida diaria mediante la prescripción y la ejecución de ejercicio físico, así como la educación relacionada con los factores de riesgo y vida saludable. Se considera un proceso multidisciplinar donde interactúan diferentes profesionales del área de la salud que durante el acompañamiento al paciente a través de su proceso de rehabilitación tienen como objetivo orientar cambios en su estilo de vida encaminados a mejorar los niveles de actividad física, los factores nutricionales, el ejercicio y el manejo de la diabetes, disminuir el peso corporal y lograr adherencia a los medicamentos y la cesación de tabaco, basados en las teorías del cambio comportamental. El objetivo principal de los programas de rehabilitación pulmonar es empoderar al usuario de su autocuidado y facilitar el manejo de la enfermedad pulmonar crónica

Pulmonary rehabilitation programmes aim to improve aerobic capacity and enhance quality of life in patients with chronic pulmonary disease, facilitating their participation and integration in different areas and activities of daily living, through the prescription and performance of physical exercise, as well as education on risk factors and healthy living. In multidisciplinary processes, various health professionals work together to support patients through the rehabilitation process, guiding lifestyle changes to improve their level of physical activity, nutritional factors, smoking cessation, diabetes management, medication adherence and weight loss, based on theories of behavioural change. The main objective of pulmonary rehabilitation programmes is to empower users in self-care and facilitate long-term management of chronic lung disease

Prediction of Maximal Oxygen Uptake From Submaximal Exercise Testing in Chronic Respiratory Patients. New Perspectives / Predicción del consumo máximo de oxígeno mediante pruebas de ejercicio submáximo en pacientes con patología respiratoria crónica

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Recomendaciones sobre tratamiento no farmacológico en la enfermedad pulmonar obstructiva crónica de la Guía española de la EPOC (GesEPOC 2017) / Recommendations on non-Pharmacological Treatment in Chronic Obstructive Pulmonary Disease From the Spanish COPD Guidelines (GesEPOC 2017)

El tratamiento no farmacológico es fundamental en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), sin embargo, este tratamiento, en ocasiones, no recibe la importancia que merece. Los pacientes diagnosticados de EPOC deberían beneficiarse de servicios de atención integral. Estos servicios son un conjunto articulado de acciones estandarizadas dirigidas a la cobertura de las necesidades de salud del paciente, considerando el entorno y las circunstancias. La rehabilitación pulmonar es uno de los componentes esenciales del tratamiento no farmacológico en los servicios de atención integral en la EPOC. En la Guía española de la EPOC (GesEPOC) 2017 detallamos de forma sistemática la evidencia científica de los programas de rehabilitación pulmonar en fase aguda y estable. Otro aspecto importante del tratamiento no farmacológico es la actividad física y en la guía GesEPOC 2017 describimos los puntos más esenciales sobre su prescripción y revisamos las estrategias más eficaces para su adhesión. GesEPOC 2017 quiere dejar constancia de la importancia del tratamiento no farmacológico como coadyuvante al tratamiento farmacológico

Non-pharmacological treatment is essential in patients with chronic obstructive pulmonary disease (COPD), but this treatment is sometimes not given the importance it deserves. Patients diagnosed with COPD should benefit from comprehensive care services. These services comprise a protocolized set of actions aimed at covering the health needs of the patient, taking into account their environment and circumstances. Pulmonary rehabilitation is one of the essential components of non-pharmacological treatment in comprehensive COPD care services. In the Spanish COPD Guidelines (GesEPOC) 2017, we provided a systematic report of the scientific evidence for pulmonary rehabilitation programs in acute and stable phase disease. Another important issue in the non-pharmacological treatment of COPD is physical activity, and the most essential considerations regarding prescription are described in the GesEPOC guidelines, along with a review of the most effective strategies to ensure adherence. GesEPOC 2017 aims to underline the importance of non-pharmacological treatment as a co-adjuvant to pharmacological treatment

Reabilitação pulmonar: da teoria à prática / Pulmonary rehabilitation: from theory to practice

As doenças pulmonares mais prevalentes na atualidade são patologias de característica sistêmica, originadas após acometimento funcional e/ou estrutural de um ou mais pulmões, progredindo para disfunção dos músculos esqueléticos. Isso contribui para a redução da tolerância a atividade física e ao exercício. A Reabilitação Pulmonar é um processo amplo, que requer a combinação de medidas farmacológicas e não farmacológicas e inclui: treinamento físico, educação do paciente, intervenção psicológica e nutricional. Os alvos primários de qualquer Reabilitação Pulmonar são controlar a dispneia e aumentar a capacidade de atividades físicas e exercícios, restaurando a funcionalidade do indivíduo e, consequentemente, sua qualidade de vida. Sendo assim, desenvolvemos este resumo devido à relevância clínica, científica e social do tema. Nos últimos anos, a literatura disponível tem abordado com frequência a prática de testes exequíveis na pratica clínica diária e o avanço do suporte ventilatório como auxiliar na reabilitação pulmonar...

The most prevalent lung diseases today are characteristic of systemic pathologies arising after functional and/or structural involvement of one or more lung, progressing to skeletal muscle dysfunction. This contributes to a reduction in tolerance to physical activity and exercise. Pulmonary Rehabilitation is a comprehensive process that requires a combination of pharmacological and non-pharmacological measures and includes: physical training, patient education, psychological and nutritional intervention. The primary targets of any pulmonary rehabilitation are to control dyspnea and increase the capacity of physical activities and exercises, restoring the individual functionality and consequently their quality of life. Therefore, we developed this summary due to clinical and scientific relevance and social theme.In recent years, the literature has addressed frequently the practice of testing feasible in clinical practice and the advancement of ventilatory support as an aid in pulmonary rehabilitation...

Pituitary Adenylate Cyclase Activating Peptide (1-38) and its analog (Acetyl-[Ala15, Ala20] PACAP 38-polyamide) reverse methacholine airway hyperresponsiveness in rats

The aim of this study was to investigate both functionally and structurally bronchodilator effects of Pituitary adenylate cyclase activating peptide (PACAP38) and acetyl-[Ala15, Ala20] PACAP38-polyamide, a potent PACAP38 analog, in rats challenged by methacholine (MeCh). Male Wistar rats were divided randomly into five groups. Groups 1 and 2 inhaled respectively aerosols of saline or increasing doses of MeCh (0.5, 1, 2.12, 4.25, 8.5, 17, 34 and 68mg/L). The other groups received terbutaline (Terb) (250 µg/rat) (10-6 M), PACAP38 (50 µg/rat) (0.1 mM) or PACAP38 analog (50 µg/rat) associated to MeCh from the dose of 4.25 mg/L. Total lung resistances (RL) were recorded before and 2 min after MeCh administration by pneumomultitest equipment. MeCh administration induced a significant and a dose-dependent increase (p<0.05) of RL compared to control rats. Terb, PACAP38 and PACAP38 analog reversed significantly the MeCh-induced bronchial constriction, smooth muscle (SM) layer thickness and bronchial lumen mucus abundance. PACAP38 analog prevents effectively bronchial smooth muscle layer thickness, mucus hypersecretion and lumen decrease. Therefore, it may constitute a potent therapeutic bronchodilator.

O objetivo deste estudo foi investigar funcionalmente e estruturalmente efeito broncodilatador do peptídeo ativador da adenilato ciclase pituitária (PACAP1-38) e da acetil-[Ala15, Ala20]PACAP 38-poliamida, potente análogo do PACAP-38, nos ratos desafiados pelo metacolina (MeCh). Ratos Wistar machos foram aleatoriamente divididos em cinco grupos. Grupos 1 e 2, inalando aerossóis de solução salina ou doses crescentes de MeCh (0,5, 1, 2,12, 4,25, 8,5, 17, 34 e 68 mg/L). Os outros grupos recebendo terbutalina (Terb) (250 µg/rato) (10-6M), PACAP-38 (50 µg/rato) (0.1 mM) ou análogo do PACAP-38 (50 µg/rato) associados a MeCh na dose de 4,25 mg/L. A resistência pulmonar total (RL) foi registrada antes e 2 min após a administração de Mech pelo equipamento pneumomultiteste. A administração MeCh induziu aumento significativo e dose dependente (p<0,05) de RL em comparação com ratos do grupo controle. Terb e PACAP1-38 e análogo do PACAP-38 reverteram, significativamente, a constrição brônquica induzida por Mech, a espessura do músculo liso (SM) e abundância de muco do lume brônquico. O análogo PACAP-38 do mesmo modo que a Terb impediu a responsividade brônquica a MeCh e pode se constituir em um importante regulador no desenvolvimento da doença inflamatório pulmonar. Contudo, o uso do peptídeo nativo para aplicações terapêuticas é limitado por sua baixa estabilidade metabólica. Consequentemente, o análogo metabolicamente estável representa ferramenta promissora no tratamento de doenças pulmonares inflamatórias.

Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation / Impacto da reabilitacao pulmonar na qualidade de vida e na capacidade funcional de pacientes em lista de espera para transplante pulmonar

OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47%) had pulmonary fibrosis, 13 (22%) had pulmonary emphysema, and 18 (31%) had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001), the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001), role-physical, up 10 (p = 0.045); vitality, up 10 (p < 0.001); social functioning, up 15 (p = 0.001); and mental health, up 8 (p = 0.001). CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists. .

OBJETIVO: Avaliar o impacto de um programa de reabilitação pulmonar na capacidade funcional e na qualidade de vida de pacientes em lista de espera para transplante pulmonar. MÉTODOS: Pacientes em lista de espera para transplante pulmonar encaminhados a um programa de reabilitação pulmonar de 36 sessões. Os participantes foram avaliados no início e no final desse com o teste de caminhada de seis minutos (TC6) e com o questionário de qualidade de vida Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). O programa de reabilitação pulmonar foi composto por exercícios de fortalecimento muscular, treinamento aeróbico, acompanhamento clínico e psiquiátrico, acompanhamento nutricional, assistência social e palestras educacionais. RESULTADOS: Dos 112 pacientes encaminhados, 58 completaram o programa. A média de idade dos participantes foi de 46 ± 14 anos; sendo 52% do sexo feminino. Entre esses pacientes, 37 (47%) eram portadores de fibrose pulmonar, 13 (22%) tinham enfisema pulmonar, e 18 (31%), tinham outras doenças pulmonares em fase avançada. Houve uma melhora significativa na distância percorrida no TC6 ao final do programa (367 ± 136 m vs. 439 ± 114 m; p = 0,001), com um aumento médio de 72 m. Houve aumentos significativos nas pontuações dos seguintes domínios do SF-36: capacidade funcional, 22 pontos (p = 0,001); aspectos físicos, 10 (p = 0,045); vitalidade, 10 (p < 0,001); aspectos sociais, 15 (p = 0,001); e saúde mental, 8 (p = 0,001). CONCLUSÕES: O programa de reabilitação pulmonar teve um impacto positivo na capacidade de exercício e na qualidade de vida nos pacientes em lista de espera para transplante pulmonar. .

Reabilitação pulmonar na unidade de terapia intensiva: revisão de literatura / Pulmonary rehabilitation in intensive care unit: a literature review

O longo período de imobilidade na internação em unidade de terapia intensiva (UTI) desencadeia prejuízos aos sistemas musculoesquelético, cardiovascular, respiratório e neurológico. A reabilitação pulmonar na UTI, em especial o treinamento físico, visa restaurar a funcionalidade anterior ao episódio que determinou a necessidade da ventilação mecânica, reduzindo a dependência, prevenindo novas internações e, conseqüentemente, melhorando a qualidade de vida. Entretanto, é observada resistência na aplicação dessa modalidade de tratamento, devido ao receio das equipes. O objetivo do presente estudo foi efetuar uma revisão da literatura sobre as implicações dos programas de reabilitação pulmonar nas UTI. O levantamento bibliográfico foi feito nas bases de dados PubMed, Cochrane, PEDro e SciELO por meio dos descritores “reabilitação pulmonar” “no cuidado intensivo” e “na unidade de terapia intensiva”, além de estudos sugeridos por especialistas. Sete artigos (ensaios clínicos randomizados, estudos de coorte e retrospectivos) foram avaliados. Todos sugeriram que a reabilitação na UTI é benéfica e não causa efeitos colaterais. Os principais benefícios identificados foram a melhora da deambulação, aumento de força da musculatura respiratória e esquelética, além de melhora funcional ligada às atividades de vida diária. De acordo com os estudos analisados, a reabilitação pulmonar em UTI mostrou-se uma modalidade segura, bem tolerada e que determina efeitos positivos aos pacientes...

The long period of immobility in intensive care units (ICU) may be harmful to patients’ musculoskeletal, cardiovascular, respiratory and neurological systems. Pulmonary rehabilitation in ICU, particularly the physical training, aims to restore previous functionality prior to the event that determined the need for mechanical ventilation, thus reducing dependence, preventing new admissions, and improving patients’ quality of life. However, resistance has been noticed among ICU staff to applying physical training. The purpose of this study was to perform a literature review on the implications of pulmonary rehabilitation programs in the ICU. Articles were sought for in PubMed, Cochane, PEDro and SciELO databases, by means of key words “pulmonary rehabilitation”, “intensive care”, and “intensive therapy”, in addition to studies suggested by experts. Seven articles (randomised clinical trials, cohort, and retrospective studies) were assessed. All of them suggested benefits by pulmonary rehabilitation in the ICU, in addition to the absence of side effects. Main benefits were ambulation improvement, increase on strength of respiratory and skeletal muscles, plus improvement in activities of daily living. According to the studies analyzed, pulmonary rehabilitation in the ICU proves to be beneficial to patients, being a safe and well tolerated means of rehabilitation...