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.

Hospitalization needs during an outpatient rehabilitation program for severe chronic airway obstruction.

The number of days of hospitalization for respiratory disease following entry into an outpatient pulmonary rehabilitation program was reviewed for 44 patients with chronic airway obstruction whose hospitalization records were available for the year prior to entry into the program. A significant reduction in the number of days of hospitalization occurred in patients for each of the four years following entry into the program, compared to the year prior to therapy.

Correlation of psychophysiologic variables with vocational rehabilitation outcome in patients with chronic obstructive pulmonary disease.

Despite the magnitude of the public health problem presented by respiratory diseases, there have been few studies concerned with vocational rehabilitation (VR) potential of patients with chronic obstructive pulmonary disease (COPD). Certain physiologic variables which show a high degree of relationship to VR success are identified. The three independent variables which most highly correlate with the VR potential of patients with COPD are the percentages predicted for the first-second forced expiratory volume (FEV(1.0)), forced expiratory flow between 25 and 75 percent of the forced vital capacity (FEF(25-75 percent)), and maximum voluntary ventilation (MVV). The mean "cutting" percentages for inclusion in VR programs were 50, 27, and 40, respectively. The emotional variables studied do not differentiate potential VR success or failure as clearly as the physiologic factors. The criteria set forth not only can be used by rehabilitation workers but could serve as a basis for future demonstration studies.

Halotherapy for treatment of respiratory diseases.

This work elucidates the questions upon the development of a new drug-free method of a respiratory diseases treatment. Halotherapy (HT)--is mode of treatment in a controlled air medium which simulates a natural salt cave microclimate. The main curative factor is dry sodium chloride aerosol with particles of 2 to 5 mkm in size. Particles density (0.5-9 mg/m3) varies with the type of the disease. Other factors are comfortable temperature- humidity regime, the hypobacterial and allergen-free air environment saturated with aeroions. The effect of HT was evaluated in 124 patients (pts) with various types of respiratory diseases. The control group of 15 pts received placebo. HT course consisted of 10-20 daily procedures of 1 hour. HT resulted in improvements of clinical state in the most of patients. The positive dynamics of flow-volume loop parameters and decrease of bronchial resistance measured by bodyplethysmography were observed. The changes in control group parameters after HT were not statistically significant. The specificity of this method is the low concentration and gradual administration of dry sodium chloride aerosol. Data on healing mechanisms of a specific airdispersive environment of sodium chloride while while treatment the respiratory diseases are discussed.

Clinical evaluation of oscillating positive expiratory pressure for enhancing expectoration in diseases other than cystic fibrosis.

The benefit of chest physiotherapy in patients with cystic fibrosis has been well documented. However, the benefit of similar rehabilitation in patients with large amounts of sputum who have diagnoses other than cystic fibrosis has not been clearly demonstrated. The aim of this study was to evaluate the acute effectiveness of a device advised for home chest physiotherapy in comparison to postural drainage combined with chest percussion in removing secretions in patients with high sputum production due to diseases other than cystic fibrosis. Fourteen in-patients, known to spontaneously produce more than 25 mL sputum.day-1, underwent two sessions each of two treatment modalities in random order. Treatment A consisted of postural drainage and manual chest percussion. Treatment B included breathing through a commercial device claimed to combine oscillating positive expiratory pressure with oscillations of the airflow. Expiratory flows and oxygen saturation were monitored and recorded throughout the study. The amount of sputum produced in the 30 min preceding, during, and in the 60 min after completing each treatment session was recorded, together with the sensation of "chest unpleasantness due to secretions" as assessed by means of a modified visual analogue scale. The mean time that the patients tolerated treatment was not different for A and B (18.7 +/- 5 and 19.3 +/- 5 min, respectively). Sputum significantly increased during both treatment periods and in the same amount for the two modalities (2.9 +/- 2.9 to 10.9 +/- 7.1 and 2.8 +/- 3.1 to 10.1 +/- 10.8 mL for A and B, respectively). Visual analogue scale score significantly decreased at the end of each treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rehabilitation of chronic obstructive pulmonary diseases at the lung hospital (author's transl)]. / Rehabilitation von chronischen obstruktiven Lungenkrankheiten in der Lungenklinik.

The modern lung hospital offers favorable conditions for the rehabilitation of patients suffering from chronic obstructive pulmonary diseases. In the years from 1972 to 1976 2398 patients suffering from chronic bronchitis, bronchial asthma and pulmonary emphysema were subjected to a rehabilitation process at the central hospital for heart and lung diseases Bad Berka. A long-term therapy plan based on a most accurate investigation possible of all the factors which trigger off the complaint in each case was used as baseline. An account is given of the resulting diagnostic and therapeutic program carried out. In the case of chronic obstructive pulmonary diseases it is particularly difficult to assess the effectiveness of rehabilitation measures. One aspect dealt with is the restoration of working capacity. 56.7% of the men and 56.8% of the women were capable of working when they were dismissed. 31.6% of male and 26.4% of female patients were invalids, 11.7% and 16.8% respectively were old age pensioners. Rehabilitation success depended on variables such as age, degree of cardio-pulmonary limitation in performance, as well as on certain concomitant diseases and the patient's cooperation. A decisive factor in some cases was also whether suitable employment could be found for these patients whose age ranges between 40 and 60.

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.

[Possibilities of normobaric hypoxic training in rehabilitation of patients with chronic bronchitis]. / Vozmozhnosti normobaricheskoi gipoksicheskoi trenirovki v reabilitatsii bol'nykh khronicheskim bronkhitom.

To provide evidence for the potentialities of normobaric hypoxic training (NHT), oxygen cascades from the lung to tissues and responses to hypoxic and hypercapnic stimuli were analyzed in chronic bronchitis patients with Stages 1, 2, and respiratory failure. Since at Stages 2 and 3, compensatory responses are substantially decreased, there is arterial, and occasionally, venous hypoxemia, NHT is contraindicated in these patients. Compensatory responses are preserved only during early stages 0 and 1 respiratory failure, showing it expedient to employ NHT. NHT regimens (as many as 20 sessions) used in these patients improved the patients' condition and physical activity, normalized ventilation function. However, the concurrent diseases exacerbated in some cases. Medical monitoring is needed when the NHT regimen is used.

The effect of positive expiratory pressure versus forced expiration technique on tracheobronchial clearance in chronic bronchitics.

In a randomized cross-over trial, including a control measurement the effect of positive expiratory pressure (PEP) and forced expiration technique (FET) on tracheobronchial clearance was evaluated in eight chronic bronchitics with abundant sputum production (mean, 32 g/day). PEP consisted of PEP-mask breathing interspersed with breathing exercises, huffing, and coughing. FET consisted of postural drainage, breathing exercises, huffing, and coughing. Clearance was measured with a radio-aerosol technique. At 40 min after the start of therapy the mean clearance, expressed as percentage of the amount of radioactivity present at the start of therapy, was 32% after PEP, 53% after FET, and 15% in the control run. The difference between PEP, FET, and control was statistically significant (p less than 0.02). Sputum production during PEP and FET was larger than during the equivalent period of time in the control run. It is concluded that FET is more effective than PEP in enhancing tracheobronchial clearance.

[Hypoxic stimulation and inspiratory resistive training in the rehabilitation of patients with chronic bronchitis]. / Gipoksicheskaia stimuliatsiia i inspiratornyi rezistivnyi trening v reabilitatsii bol'nykh khronicheskim bronkhitom.

A study was made of the efficacy of normobaric hypoxic stimulation (NHOS) and inspiratory resistive training (IRT) in multimodality treatment and rehabilitation of patients suffering from chronic obstructive bronchitis. The results were estimated by means of exercise tests and by stimulation electromyography of the diaphragm (SEMGD). The use of NHOS and IRT in multimodality treatment of the given group patients was found to give rise to a more complete physical rehabilitation of the patients, whereas the application of SEMGD is an effective approach to the control of sessions and courses of NHOS and IRT. Besides, the use of the latter method also permits choosing the intensity of the action of the treatment methods in question on the body, particularly on the diaphragm muscle.

[The treatment of patients with chronic obstructive bronchitis by using a low-power laser at a general rehabilitation center]. / Lechenie bol'nykh khronicheskim obstruktivnym bronkhitom s ispol'zovaniem nizkoénergeticheskogo lazera v mnogoprofil'nom tsentre reabilitatsii.

100 patients with chronic obstructive bronchitis were examined and treated in the therapeutic department of rehabilitation center. Combined treatment including low-energy laser radiation produced good results. Laser therapy has improved bronchial permeability, sensitivity of bronchial beta 2-receptors to sympathomimetics. As a result, their intake was reduced or discontinued. Laser radiation combined well with other non-pharmacological modalities.

[Use of normobaric hypoxia in the combined modality therapy of patients with chronic bronchitis]. / Primenenie normobaricheskoi gipoksii v kompleksnom lechenii bol'nykh khronicheskim bronkhitom.

The authors review the main physiological alterations occurring in the body under the influence of hypoxia. Provide the data on successful use of the method in the treatment of a number of diseases with a purpose of increasing nonspecific resistance of the body. Based on the review of literature provide evidence for the use of normobaric hypoxic stimulation (NHOS) in multimodality treatment and prophylaxis of patients suffering from chronic bronchitis (CB). A study was made of the reactions of the cardiorespiratory system towards normobaric hypoxia and of the clinical effect of the continuous treatment with NHOS. The increase of nonspecific resistance of the body was noted, which manifested itself by the deceleration of CB exacerbations, optimization of the work of the cardiorespiratory system and rise of exercise tolerance after a course of NHOS. Recommendations are given for the use of the given method in multimodality treatment and rehabilitation of CB patients.

[Various problems in the diagnosis and treatment of the broncho-obstructive syndrome]. / O nekotorykh voprosakh diagnostiki i lecheniia bronkhoobstruktivnogo sindroma.

Clinico-x-ray-laboratory investigation, bronchoscopy were performed, respiratory function and ECG were studied in 212 patients with different forms of chronic bronchitis. Six groups of patients were defined with relation to the presence or absence of obstruction, its nature (permanent, transient), prevalence (small, medium and large bronchi), genesis of disease (inflammatory, allergic). The characteristics of the groups and their clinico-x-ray, functional and immunological features were presented. Treatment including methods of climatotherapy, exercise therapy, pharmacological agents (antibacterial, broncholithic and antihistaminic), physiotherapy and administered with relation to the defined groups, proved to be effective. The improvement of bronchial permeability was noted in 49.5% (ranging from 40.0 to 68.7% in different groups).

[Immediate and late results of rehabilitation at the climatic health resorts on the southern coast of the Crimea with sunlight- and meteorolabile patients with chronic bronchitis]. / Blizhaishie i otdalennye rezul'taty reabilitatsii na klimaticheskikh kurortakh Iuzhnogo berega Kryma geliometeolabil'nykh bol'nykh khronicheskim bronkhitom.

A study of the social, socioeconomic and economic indices of rehabilitation of patients with chronic obstructive and nonobstructive bronchitis has shown that one should take account of a degree of expression of heliometeolability when selecting patients with chronic bronchitis residing in West Siberia for climatic treatment in the Crimean South Coast. It has been shown that rehabilitation in the Crimean South Coast health resort area is advisable for heliometeostable patients and patients with mild and marked degrees of heliometeolability. Patients with chronic bronchitis should not be sent to the Crimea in winter and late autumn as the rehabilitation effect in this period is lowered.