Whole-body vibration training versus conventional balance training in patients with severe COPD-a randomized, controlled trial.

BACKGROUND: Whole-body vibration training (WBV) performed on a vibration platform can significantly improve physical performance in patients with chronic obstructive pulmonary disease. It has been suggested that an important mechanism of this improvement is based on an improvement in balance. Therefore, the aim of this study was to investigate the effects of WBV compared to conventional balance training. METHODS: 48 patients with severe COPD (FEV1: 37 ± 7%predicted) and low exercise performance (6 min walk distance (6MWD): 55 ± 10%predicted) were included in this randomized controlled trial during a 3 week inpatient pulmonary rehabilitation. All patients completed a standardized endurance and strength training program. Additionally, patients performed 4 different balance exercises 3x/week for 2 sets of 1 min each, either on a vibration platform (Galileo) at varying frequencies (5-26 Hz) (WBV) or on a conventional balance board (BAL). The primary outcome parameter was the change in balance performance during a semi tandem stance with closed eyes assessed on a force measurement platform. Muscular power during a countermovement jump, the 6MWD, and 4 m gait speed test (4MGST) were secondary outcomes. Non-parametric tests were used for statistical analyses. RESULTS: Static balance performance improved significantly more (p = 0.032) in favor of WBV (path length during semi-tandem stand: - 168 ± 231 mm vs. + 1 ± 234 mm). Muscular power also increased significantly more (p = 0.001) in the WBV group (+ 2.3 ± 2.5 W/kg vs. - 0.1 ± 2.0 W/kg). 6MWD improved to a similar extent in both groups (WBV: 48 ± 46 m, p < 0.001 vs. BAL: 38 ± 32 m; p < 0.001) whereas the 4MGST increased significantly only in the WBV-group (0.08 ± 0.14 m/s2, p = 0.018 vs. 0.01 ± 0.11 m/s2, p = 0.71). CONCLUSIONS: WBV can improve balance performance and muscular power significantly more compared to conventional balance training. TRIAL REGISTRATION: Clinical-Trials registration number: NCT03157986; date of registration: May 17, 2017. https://clinicaltrials.gov/ct2/results?cond=&term=NCT03157986&cntry=&state=&city=&dist = .

Effects of Vibration Training in Interstitial Lung Diseases: A Randomized Controlled Trial.

BACKGROUND: Numerous studies have reported positive effects of exercise training in patients with interstitial lung disease (ILD) on physical capacity and quality of life. However, evidence is rare on the effects of specific forms of training and further pathophysiological mechanisms in these patients. OBJECTIVES: In this multicenter study we aimed to explore the clinical effects of whole-body vibration training (WBVT) in patients with ILD on various outcome measures, including proinflammatory cytokines and myostatin. METHODS: We randomly assigned 26 patients with different forms of multidisciplinary confirmed fibrotic ILDs either to the WBVT group (n = 11; 55% male, 61 ± 14 years old, forced vital capacity 83.2 ± 29.3% predicted, 6-min walking distance [6MWD] 478 ± 79 m) performing 3 months of a standardized training (3 times per week), or to a control training group (CTG, n = 15; 60% male, 63 ± 9 years old, FVC 74.6 ± 20.5% predicted, 6MWD 455 ± 85 m) performing sham WBV training. Training in the two groups was performed on a GalileoTM vibration plate (6-20 vs. 5 Hz). The functional assessments before and after the intervention period included pulmonary function, 6MWD test, chair rise test, ultrasonographic measurement of quadriceps muscle thickness (cross-sectional area), quality of life questionnaires, and serum samples. RESULTS: We observed a significant increase in 6MWD (∆Training = 30 m [12-67], p = 0.024) and a decrease of myostatin (∆Training = -465 pg/mL [-713 to -166], p = 0.008) in the WBVT group. In contrast, no significant differences were observed in the CTG. CONCLUSIONS: The present study demonstrates that WBVT is able to significantly increase 6MWD and decrease myostatin in patients with fibrotic ILDs. Therefore, WBVT seems to be a beneficial and feasible training modality in ILD patients. Clinical Trial Registry: German Clinical Trials Registry (DRKS00012930).

The prevalence of diagnosed α1-antitrypsin deficiency and its comorbidities: results from a large population-based database.

α1-Antitrypsin deficiency (AATD) is a genetically determined disorder that is associated with different clinical manifestations. We aimed to assess the prevalence of diagnosed AATD and its comorbidities using a large healthcare database.In this retrospective longitudinal observational study, we analysed data from 4 million insurants. Using International Classification of Diseases revision 10 (ICD-10) codes, we assessed the prevalence, comorbidities and healthcare utilisation of AATD patients (E88.0 repeatedly coded) relative to non-AATD patients with chronic obstructive pulmonary disease (COPD), emphysema or asthma.In our study population, we identified 673 AATD patients (590 aged ≥30 years), corresponding to a prevalence of 23.73 per 100 000 in all age groups and 29.36 per 100 000 in those ≥30 years. Based on the number of AATD cases detected in the sample size (673 out of 2 836 585), we extrapolated that there were 19 162 AATD cases in Germany during the years studied. AATD patients had a higher prevalence of arterial hypertension, chronic kidney disease and diabetes relative to non-AATD asthma or emphysema patients. When compared to non-AATD COPD patients, AATD patients had significantly more consultations and more frequent and longer hospitalisations.Our data strengthen the assumption that AATD is associated with a variety of other diseases. Healthcare utilisation appears to be higher among AATD patients as compared to patients with non-AATD-related obstructive lung diseases.

Benefits of High-Intensity Exercise Training to Patients with Chronic Obstructive Pulmonary Disease: A Controlled Study.

BACKGROUND: Various exercise training programs are used for patients with chronic obstructive pulmonary disease (COPD) of different severity. OBJECTIVES: To investigate the impact of individualized high-intensity training on exercise capacity with COPD. METHODS: A total of 49 patients agreed to participate. Of these, 31 were assigned to the training group and 18 served as controls. The training group exercised twice a week for 90 min with consecutively increasing loads. At the time of enrollment (T0), as well as after 3 (T1) and 6 (T2) months, a 6-min walk test (6-MWT) was performed and data on health-related quality of life, femoral muscle thickness, and various serum markers were obtained. RESULTS: The training group improved in their 6-MWT results (T0 = 407 ± 152 m vs. T1 = 459 ± 127 m, p = 0.002, vs. T2 = 483.2 ± 130.1 m, p = 0.004), in their cross-sectional area of the musculus rectus femoris (T0 = 6.2 ± 1.2 cm2 vs. T1 = 6.9 ± 1.2 cm2, p = 0.003, vs. 7.5 ± 1.6 cm2, p = 0.002), and in their St. George's Respiratory Questionnaire (SGRQ) score (T0 = 43.3 ± 18.0 vs. T1 = 36.0 ± 18.4, p = 0.001, vs. T2 = 34.7 ± 18. 0, p = 0.004). Serum levels of myostatin, irisin, resistin, and α-Klotho did not change significantly within the training period. Of note, the exercise group showed an inverse relationship between serum levels of resistin and those of α-Klotho after 6 months (r = -0.608, p = 0.021). CONCLUSIONS: COPD patients undergoing an individualized, structured, high-intensity training program improved their exercise capacity, gained muscle mass, and improved their quality of life.

Severe central sleep apnea is associated with atrial fibrillation in patients with left ventricular systolic dysfunction.

BACKGROUND: The results of previous studies investigating the association between atrial fibrillation (AF) and central sleep apnea (CSA) in patients with left ventricular (LV) systolic dysfunction are contradictory. METHODS: We prospectively enrolled 267 patients in this cross-sectional study with LV ejection fractions ≤50%, who were screened for sleep disordered breathing using cardiorespiratory polysomnography after patients with predominantly obstructive sleep apnea or insufficient sleep studies had been excluded. RESULTS: AF at study entry was found in 70 of 267 patients (26%). CSA with an apnea/hypopnea index (AHI) ≥15/hour was present in 116 patients (43%) and 67 patients (25%) had severe CSA with an AHI > 30/hour. Univariate analysis revealed a significant association between AF and severe CSA, age, male gender, arterial hypertension, left atrial diameter, brain natriuretic peptide, chronic kidney disease, New York Heart Association class, digitalis, and the lack of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Multivariate analysis revealed a significant association between AF and severe CSA (odds ratio [OR]: 5.21; 95% confidence interval [CI]: 1.67-16.27, P = 0.01), age (OR: 1.22 per 5-year increase; 95% CI: 1.05-1.40, P = 0.01), left atrial diameter (OR 1.61 per 5-mm increase; 95% CI: 1.22-2.01, P < 0.01), and digitalis (OR: 2.7; 95% CI: 1.26-5.79, P = 0.01). CONCLUSIONS: AF is associated with severe CSA but not with moderate CSA in addition to age, use of digitalis, and left atrial size in patients with LV systolic dysfunction. Future studies evaluating the potential benefit of adaptive servo-ventilation therapy to prevent AF or to decrease the AF burden in heart failure patients should therefore focus on patients with severe central sleep apnea.

Effect of a Three-Week Inpatient Rehabilitation Program on 544 Consecutive Patients with Very Severe COPD: A Retrospective Analysis.

BACKGROUND: Pulmonary rehabilitation improves exercise capacity, symptoms, and quality of life in chronic obstructive pulmonary disease (COPD) patients, and is therefore recommended in all stages of the disease. However, there are insufficient data on patients with very severe disease. OBJECTIVE: To describe the effect of an in-house multidisciplinary pulmonary rehabilitation program on patients with very severe COPD. METHODS: We performed a retrospective analysis of 544 consecutive patients with very severe COPD (FEV1 0.97 ± 0.26 l) that underwent an in-house pulmonary rehabilitation program (23.44 ± 4.97 days). The studied outcome parameters were the 6-min walk test (6-MWT), health-related quality of life as analyzed by the COPD Assessment Test (CAT) and a dyspnea score [modified Medical Research Council (mMRC) scale], and lung function [forced expiratory volume in 1 s (FEV1) and residual volume (RV)]. RESULTS: We found significant improvements regarding 6-MWT scores (from 321.93 ± 115.67 to 365.82 ± 111.79 m; p < 0.001), CAT scores (from 23.21 ± 6.75 to 19.57 ± 7.35; p < 0.001), mMRC scale scores (from 3.17 ± 1.14 to 2.81 ± 1.22; p < 0.001), and FEV1 (from 0.97 ± 0.26 to 1.08 ± 0.33 l; p < 0.001). A number of baseline variables were significantly correlated with the improvements that occurred during the program (Δ): baseline 6-MWT with Δ6-MWT (r = -0.316; p < 0.001), baseline CAT with ΔCAT (r = -0.302; p < 0.001), baseline mMRC with ΔmMRC (r = -0.444; p < 0.001), and baseline RV with ΔRV (r = -0.284; p < 0.001), demonstrating that improvements were more pronounced in patients with worse baseline characteristics. Patients on long-term oxygen therapy (LTOT) exhibited significantly greater improvements regarding CAT than patients not on LTOT. CONCLUSION: Patients with very severe COPD exhibit clinically meaningful improvements when undergoing pulmonary rehabilitation.

A randomized clinical trial to assess the influence of a three months training program (gym-based individualized vs. calisthenics-based non-invidualized) in COPD-patients.

INTRODUCTION: Pulmonary rehabilitation has been demonstrated to improve exercise capacity, dyspnoea, quality of life and to reduce the adverse effects of acute exacerbations. Current guidelines recommend exercise training in patients with mild to very severe disease. However, there is insufficient data comparing the efficacy of different training approaches and intensities. METHODS: Between January 2009 and December 2012, 105 COPD patients were screened to participate in the study. 61 patients were randomly assigned into an individualized training group or into a non-individualized training group. Both groups exercised once a week for 60 minutes over a time period of three months. At the beginning and after three months, the following measurements were performed: 6-minute walking test (6-MWT), health-related quality of life (St. Georges Respiratory Questionnaire; SGRQ and COPD-Assessment-Test; CAT), M. rectus femoris cross-sectional area, and inflammatory markers in peripheral blood. RESULTS: Only in the individualized training group we observed a significant change of the 6-MWT (increase of 32.47 m; p = 0.012) and the cross-sectional area of the M. rectus fermoris (increase of 0.57 cm2; p = 0.049), while no significant changes occurred in the non-individualized training group. Peroxisome-proliferator-activated receptor-γ coactivator 1α increased in the individualized training only after the three months training period (increase of 0.43 relative copies; p = 0.017), all other myokines and inflammatory markers were not influenced by either of the programs. The total drop-out-rate was 44.3%. CONCLUSION: A low frequency outpatient training program may induce modest improvements in exercise capacity and muscle mass only if it is performed on an individualized basis.

Benefits of whole body vibration training in patients hospitalised for COPD exacerbations - a randomized clinical trial.

BACKGROUND: Patients with stable COPD show improvements in exercise capacity and muscular function after the application of whole body vibration. We aimed to evaluate whether this modality added to conventional physiotherapy in exacerbated hospitalised COPD patients would be safe and would improve exercise capacity and quality of life. METHODS: 49 hospitalised exacerbated COPD patients were randomized (1:1) to undergo physiotherapy alone or physiotherapy with the addition of whole body vibration. The primary endpoint was the between-group difference of the 6-minute walking test (day of discharge - day of admission). Secondary assessments included chair rising test, quality of life, and serum marker analysis. RESULTS: Whole body vibration did not cause procedure-related adverse events. Compared to physiotherapy alone, it led to significantly stronger improvements in 6-minute walking test (95.55 ± 76.29 m vs. 6.13 ± 81.65 m; p = 0.007) and St. Georges Respiratory Questionnaire (-6.43 ± 14.25 vs. 5.59 ± 19.15, p = 0.049). Whole body vibration increased the expression of the transcription factor peroxisome proliferator receptor gamma coactivator-1-α and serum levels of irisin, while it decreased serum interleukin-8. CONCLUSION: Whole body vibration during hospitalised exacerbations did not cause procedure-related adverse events and induced clinically significant benefits regarding exercise capacity and health-related quality of life that were associated with increased serum levels of irisin, a marker of muscle activity. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005979. Registered 17 March 2014.

Detection of obstructive sleep apnoea by an electronic nose.

Diagnosis of obstructive sleep apnoea syndrome (OSAS) is technically demanding, cost-intensive and time-consuming. The measurement of volatile organic compounds by an electronic nose is an innovative method that determines distinct molecular patterns of exhaled breath in different patient groups. We addressed the following questions: What is the diagnostic accuracy of an electronic nose in the detection of OSAS and the ability to detect effects of standard therapy in patients with OSAS? Are these results related to changes in distinct markers of airway inflammation and extracellular remodelling? We included 40 OSAS patients and 20 healthy controls. Exhaled breath of all participants was analysed using the Cyranose 320 electronic nose. Pharyngeal washings were performed to sample the upper airway compartment. For statistical analysis linear discriminant analysis was employed. We identified a linear discriminant function separating OSAS from control (p<0.0001). The corresponding area under the receiver-operating curve was 0.85 (95% CI 0.75-0.96; sensitivity 0.93 and specificity 0.7). In pharyngeal washing fluids of OSAS patients, we observed higher levels of α1-antitrypsin and markers of extracellular remodelling compared to controls. The electronic nose can distinguish between OSAS patients and controls with high accuracy.

Novel protein biomarkers for pneumonia and acute exacerbations in COPD: a pilot study.

Introduction: Community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in high morbidity, mortality, and socio-economic burden. The usage of easily accessible biomarkers informing on disease entity, severity, prognosis, and pathophysiological endotypes is limited in clinical practice. Here, we have analyzed selected plasma markers for their value in differential diagnosis and severity grading in a clinical cohort. Methods: A pilot cohort of hospitalized patients suffering from CAP (n = 27), AECOPD (n = 10), and healthy subjects (n = 22) were characterized clinically. Clinical scores (PSI, CURB, CRB65, GOLD I-IV, and GOLD ABCD) were obtained, and interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-2-receptor (IL-2R), lipopolysaccharide-binding protein (LBP), resistin, thrombospondin-1 (TSP-1), lactotransferrin (LTF), neutrophil gelatinase-associated lipocalin (NGAL), neutrophil-elastase-2 (ELA2), hepatocyte growth factor (HGF), soluble Fas (sFas), as well as TNF-related apoptosis-inducing ligand (TRAIL) were measured in plasma. Results: In CAP patients and healthy volunteers, we found significantly different levels of ELA2, HGF, IL-2R, IL-6, IL-8, LBP, resistin, LTF, and TRAIL. The panel of LBP, sFas, and TRAIL could discriminate between uncomplicated and severe CAP. AECOPD patients showed significantly different levels of LTF and TRAIL compared to healthy subjects. Ensemble feature selection revealed that CAP and AECOPD can be discriminated by IL-6, resistin, together with IL-2R. These factors even allow the differentiation between COPD patients suffering from an exacerbation or pneumonia. Discussion: Taken together, we identified immune mediators in patient plasma that provide information on differential diagnosis and disease severity and can therefore serve as biomarkers. Further studies are required for validation in bigger cohorts.

Influence of an Acute Exacerbation During Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease Awaiting Lung Transplantation.

PURPOSE: Pulmonary rehabilitation (PR) has been shown to be an effective intervention in patients with very severe chronic obstructive pulmonary disease (COPD) awaiting lung transplantation (LTx). The objective of this study was to characterize the prevalence of acute exacerbations (AEs) during PR and their impact on the outcomes of pre-LTx PR. METHODS: In this retrospective analysis, 559 patients with COPD awaiting LTx who were referred to a 4-wk inpatient PR program were evaluated. A total of 114 patients (20%) acquired an AE during PR and continued in an adapted fashion. Pulmonary function testing, 6-min walk test (6MWT), and a health-related quality-of-life questionnaire (SF-36) were administered on admission and on discharge of PR. RESULTS: Following PR, both groups, patients with and without AE, increased their 6MWT significantly (P < .001) to a clinically relevant amount (58 ± 72 and 52 ± 64 m, respectively). The sum scores of the SF-36 also improved significantly without any between-group differences. No observed changes were different between the two groups. No relevant predictors for PR outcomes could be detected by logistic regression. CONCLUSIONS: Our data show that patients with end-stage COPD listed for LTx can achieve clinically relevant improvements in functional exercise capacity and quality of life even if they develop an AE during PR.

Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can result in a large variety of chronic health issues such as impaired lung function, reduced exercise performance and diminished quality of life. Our study aimed to investigate the efficacy, feasibility and safety of pulmonary rehabilitation in COVID-19 patients and to compare outcomes between patients with a mild/moderate and a severe/critical course of the disease. METHODS: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive 3-week inpatient pulmonary rehabilitation programme were included in this prospective, observational cohort study. Several measures of exercise performance (6-min walk distance (6MWD)), lung function (forced vital capacity (FVC)) and quality of life (36-question short-form health survey (SF-36)) were assessed before and after pulmonary rehabilitation. RESULTS: 50 patients were included in the study (24 with mild/moderate and 26 with severe/critical COVID-19). On admission, patients had a reduced 6MWD (mild: median 509 m, interquartile range (IQR) 426-539 m; severe: 344 m, 244-392 m), an impaired FVC (mild: 80%, 59-91%; severe: 75%, 60-91%) and a low SF-36 mental health score (mild: 49 points, 37-54 points; severe: 39 points, 30-53 points). Patients attended a median (IQR) 100% (94-100%) of all provided pulmonary rehabilitation sessions. At discharge, patients in both subgroups improved in 6MWD (mild/moderate: +48 m, 35-113 m; severe/critical: +124 m, 75-145 m; both p<0.001), FVC (mild/moderate: +7.7%, 1.0-17.8%, p=0.002; severe/critical: +11.3%, 1.0-16.9%, p<0.001) and SF-36 mental component (mild/moderate: +5.6 points, 1.4-9.2 points, p=0.071; severe/critical: +14.4 points, -0.6-24.5, p<0.001). No adverse event was observed. CONCLUSION: Our study shows that pulmonary rehabilitation is a feasible, safe and effective therapeutic option in COVID-19 patients independent of disease severity.

Pulmonary rehabilitation in long COVID: more than just natural recovery!?

In the light of missing randomised controlled trials, some arguments suggest that pulmonary rehabilitation has beneficial effects beyond natural recovery https://bit.ly/3ze2xvw.

Benefits of pulmonary rehabilitation in patients with advanced lymphangioleiomyomatosis (LAM) compared with COPD - a retrospective analysis.

Lymphangioleiomyomatosis (LAM) is a rare and progressive cystic lung disease with limited therapeutic options. We retrospectively analyzed the effects of a comprehensive 4-week inpatient pulmonary rehabilitation (PR) program in 58 patients with advanced LAM (FEV1: 45 ± 34%predicted, 6-min walk distance (6MWD): 338 ± 167 m). Exercise performance (6MWD: + 49 ± 50 m; p < 0.001) and quality of life (SF-36 physical component: + 2.4 ± 7.8 points; p = 0.049 and mental component: + 5.2 ± 12.1 points; p < 0.001) increased significantly after PR comparable to an COPD cohort. There were no clinical parameters that predicted changes in outcomes following PR. PR seems to be an effective therapeutic option even in patients with advanced LAM. TRIAL REGISTRATION: Clinical-Trials registration number: NCT04184193 ; date of registration: December 3, 2019.

Sleep and rheumatic diseases.

This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective. BACKGROUND: A large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep. Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep. THERAPY: Sleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD.

Measuring Sleep Quality and Efficiency With an Activity Monitoring Device in Comparison to Polysomnography.

BACKGROUND: Monitoring for physical activity becomes popular and actually many devices are available. Some physical activity monitors (PAMs) provide data about sleep quality for the user, but there are scarce data concerning validity and usability of these measurements. This study compared the data of sleep parameters generated by a PAM with the polysomnography (PSG). METHODS: In 2016, data of 26 patients in two consecutive PSGs as well as in two daytime and nighttime measurements with a PAM according to physical activity and sleep quality were collected. Furthermore, sleep quality, using the Pittsburgh sleep quality index (PSQI), daytime fatigue, using the multidimensional fatigue inventory (MFI-20) and additionally data of a sleep diary were collected. RESULTS: There were positive correlations of both methods with respect to total sleep time (TST) (r = 0.76, P < 0.01) and sleep efficiency (r = 0.71, P < 0.01). Data analysis over two nights showed that over 90% of the TST (95% confidence interval (CI) -1.59 to 0.82) and of the sleep efficiency (95% CI -8.28 to 15.51) were within the limits of agreement. The analysis of the PSQI and the sleep efficiency of the PAM showed no significant correlations. The daytime fatigue correlated negatively with the physical activity (r = -0.72, P < 0.01). CONCLUSION: The sleep efficiency and TST measured with the PAM sufficiently reflect the PSG sleep parameters and the subjects' subjective feelings. At the same time, PAM results are also correlated with the subjectively perceived quality of sleep. Further investigations to assess the long-term results are pending.

Effect of Pulmonary Rehabilitation on Inspiratory Capacity During 6-min Walk Test in Patients With COPD: A PROSPECTIVE CONTROLLED STUDY.

PURPOSE: Purpose of this study was to analyze the impact of a pulmonary rehabilitation (PR) program on the measured inspiratory capacity (IC) in patients with chronic obstructive pulmonary disease (COPD) while performing a 6-min walk test (6MWT). METHODS: Before and after PR, IC was measured by spirometry both at the beginning and at the end of the 6MWT for 15 patients with COPD in the PR group (PRG) and compared with a similar calisthenics training group (CTG; n = 15). In addition, the COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ), and other lung function tests were recorded and compared. RESULTS: Both groups were not significantly different at baseline. Compared with the CTG, the PRG achieved a significant increase in the delta of IC measured during the 6MWT (0.5 ± 0.2 L [PRG] vs -0.2 + 0.2 L [CTG], P = .001). Significant differences were found for the 6MWT walking distance (PRG: 99 ± 36 m vs CTG: 5 ± 25 m, P = .001). No significant increase in dyspnea while performing the 6MWT was found in either group. The differences in the CAT score and the SGRQ Global score were significant only for the PRG in intragroup comparisons, whereas the intergroup comparison showed no significant differences. Except for residual volume, no significant changes in all parameters of the static lung function tests were observed in either group. CONCLUSION: Participation in a PR may lead to a significant and clinically relevant increase in IC and the walking distance. Additional research is necessary to define the effects of this increase in IC on exercise capacity.

Obstructive sleep apnea patients can be identified by ion mobility spectrometry-derived smell prints of different biological materials.

BACKGROUND: The analysis of obstructive sleep apnoea syndrome (OSAS) is time- and cost-intensive. A number of studies demonstrated that the non-invasive analysis of exhaled breath (EB) may be suitable to distinguish between OSAS patients and healthy subjects (HS). Methods/Population: We included OSAS patients (n = 15) and HS (n = 15) in this diagnostic proof-of-concept-study. All participants underwent polygraphy to verify or exclude OSAS and performed spirometry to exclude pulmonary ventilatory diseases. The volatile organic compound profile of EB and of the headspaces over EB condensate, pharyngeal washing fluid, and serum was measured using ion mobility spectrometry (IMS) (BioScout®) and an e-nose (Cyranose® 320). For the statistical analysis, we fitted classification tree models using recursive partitioning, followed by a leave-one-out cross-validation. For the cross-validated predictions we calculated descriptive classification statistics, p-values from a [Formula: see text]-test with continuity correction, as well as ROC curves. RESULTS: Using IMS, OSAS patients and HS could be distinguished with high accuracy (values ranged from 79% to 97%). The results of the e-nose-derived analyses (with the exception of EB) were less accurate. However, the cross-validated accuracy for EB was very good (0.9), reflecting a positive predictive value of 100% and a negative predictive value of 83%. For each material, we identified the best five substances that may be used for diagnostic purposes. 2-Methylfluran was found in three different biological materials to be discriminative between OSAS and HS. CONCLUSION: The results strengthen the hypothesis that substances detectable in headspace measurements of different airway and blood materials may undergo a transition from blood into the alveoli (and EB) or vice versa. This means that substances from different compartments could be used to distinguish patients with airway diseases (in this case OSAS) from healthy controls.