The influence of physiotherapy on the concentration of interleukin-8 in patients suffering from chronic obstructive pulmonary disease

Wstęp: Interleukina-8, chemokina produkowana przez makrofagi i komórki nabłonka, silny chemoatraktant dla neutrofili, odgrywa zasadniczą rolę w aktywacji neutrofilów i eozynofilów w drogach oddechowych u chorych na POChP i może służyć jako marker nasilenia reakcji zapalnej. Zapalenie to w przypadku pacjentów z POChP może charakteryzować się zwiększoną liczbą neutrofilów w plwocinie, a także podwyższonym stężeniem interleukiny-8. Celem niniejszej pracy było określenie wpływu fizjoterapii na stężenie interleukiny-8 w indukowanej plwocinie u chorych na POChP. Materiał i metody: Badaniami objęto 44 chorych (21 mężczyzn, 23 kobiety, średnia wieku 56,47 &#177; 9,52) leczonych w SP ZOZ Szpitalu Specjalistycznym MSWiA w Głuchołazach, usprawnianych w Dziale Usprawniania Leczniczego, z rozpoznaną POChP (wskaźnik FEV1%VC < 65%), z niezmieniającym się leczeniem farmakologicznym w trakcie fizjoterapii. U wszystkich chorych przed fizjoterapią przeprowadzono test wydolnościowy na bieżni ruchomej według zmodyfikowanego protokołu Bruce&#8217;a oraz dokonano oceny duszności na podstawie 20-punktowej skali Borga w celu kwalifikacji do fizjoterapii. U wszystkich chorych zastosowano kompleksową 3-tygodniową fizjoterapię pulmonologiczną, której podstawą był trening wydolnościowy na ergometrze rowerowym. Wielkość obciążeń treningowych dobierano indywidualnie dla każdego chorego na podstawie oceny tolerancji wysiłku. Standardowy program fizjoterapii obejmował również ćwiczenia mięśni oddechowych, ze szczególnym uwzględnieniem mięśni brzucha i przepony, inhalacje z roztworu izotonicznego NaCl, drenaż ułożeniowy z oklepywaniem klatki piersiowej, relaksację oraz spacery. U wszystkich chorych oznaczono stężenie IL-8 w indukowanej plwocinie przed rozpoczęciem kompleksowej fizjoterapii i po jej zakończeniu. Stężenie IL-8 określono za pomocą testu ELISA. Wyniki: Wykazano, że stężenie interleukiny-8 było istotnie niższe po 3-tygodniowej fizjoterapii. Interleukina-8 w plwocinie spadła od 18,91 &#177; 25,2 do 9,69 &#177; 14,06 ng/ml (p = 0,0215). Największy spadek stężenia IL-8 dotyczył chorych z jej najwyższym wyjściowym stężeniem. Wnioski: Obniżenie stężenia IL-8 w indukowanej plwocinie po kompleksowej fizjoterapii chorych na POChP wskazuje na obniżenie aktywności neutrofilów, co może być jedną z przyczyn poprawy stanu klinicznego pacjentów. Pneumonol. Alergol. Pol. 2011; 79, 3: 184&#8211;188Background: Interleukin-8 (IL-8, CXCL8), chemokine produced by macrophages and epithelium cells, plays a major role in activating neutrophils and eosinophils in the airways of patients with COPD and might act as a stimulator of inflammatory process. The aim of the research was to assess whether pulmonary physiotherapy influences the concentration of IL-8 in the induced sputum of patients with COPD. Material and methods: The study included 44 patients (21 males, 23 females, average age 56.47 &#177; 9.52) with COPD treated in Physiotherapy Department of MSWiA Hospital in Glucholazy, with unchanged pharmacological treatment for the duration of the therapy. Before treatment, efficiency treadmill test by Bruce modified protocol and dyspnea assessment with the modified 20-point Borg scale was given to qualify each patient for physiotherapy. All patients participated in a 3-week multi-treatment pulmonary physiotherapy programme based on efficiency training on a cycloergometer. The physical workload was determined individually for each patient based on the assessment of individual exercise tolerance. Standard physiotherapy programme also included respiratory muscles&#8217; training with particular emphasis on training of abdominal muscles and diaphragm, inhalations with isotonic saline, drainage, chest clapping, relaxations and walking. IL-8 concentration in each patient&#8217;s induced sputum was collected prior to complex physiotherapy, and after it has been completed. IL-8 concentration was determined with the use of the ELISA test. Results: It was found that the concentration of IL-8 was significantly lower in patients with COPD after a 3-week physiotherapy programme. It fell from 18.91 &#177; 25.2 to 9.69 &#177; 14.06 ng/ml (p = 0.0215). The most significant IL-8 concentration decrease was observed in patients with the highest initial level of IL-8. Conclusions: The study shows that multi-treatment pulmonary physiotherapy causes decrease of IL-8 level in the induced sputum in patients with COPD, what can suggest decrease activity of neutrophils, which may be one of the factors leading to the improvement in patients&#8217; clinical condition. Pneumonol. Alergol. Pol. 2011; 79, 3: 184-18

Proprietary Model of Qualification for In-Hospital Rehabilitation after COVID-19

Background: Since the beginning of the SARS-CoV-2 epidemic in Poland, 6,128,006 people have been diagnosed, of which 116,798 died. Patients who recovered from COVID-19 and require rehabilitation due to varied impairments should be provided an opportunity to participate in an individualized, complex rehabilitation program starting from acute care and being continued in the post-acute and long-term rehabilitation phase. It is recommended to offer out-patient and in-hospital rehabilitation procedures depending on the type and persistence of symptoms and dysfunctions. The aim of this paper is to present the qualification process of post-COVID19 patients for an in-hospital complex rehabilitation program developed on the basis of pulmonary physical therapy. Methods: The presented qualification program was developed on the basis of clinical experience of over 2000 patients participating in the pilot program of in-hospital rehabilitation launched in September 2020 and based on the Regulation of the Polish Minister of Health of 13 July 2020. Results: The proposed model of patients&rsquo; qualification rests on well-known and validated tools for functional assessment: exercise tolerance assessment, dyspnea intensity assessment, functional fitness assessment, assessment of arterial blood saturation, lung ventilation function assessment, assessment of long-lasting COVID-19 symptoms, and patient&rsquo;s basic mental health condition. Conclusions: The proposed qualification model for the post-COVID rehabilitation program allows us to introduce adequate qualifications followed by much needed assessment of the health effects

Post-COVID-19 rehabilitation – a Polish pilot program

The current spread of SARS-CoV-2 indicates a long-term fight against the widespread and exponential increase in morbidity and mortality across the globe. A variety of non-pharmacological strategies to mitigate and suppress virus transmission have been investigated and introduced. Currently, emerging studies focus mostly on the management of hospital-treated patients in the acute phase of the disease, including the legitimacy of using physiotherapeutic procedures. However, current literature lacks guidelines for rehabilitation related to maintaining continuity and universality of the therapy after the end of the acute phase of the disease and discharge from hospital. The authors suggest implementing an immediate rehabilitation program in post-infection patients as data from previous epidemics of respiratory-related viral diseases shows that COVID-19 survivors should be expected to have impaired lung ventilation function, and reduced exercise tolerance and muscular weakness, and prolonged return to work and participation. It should be assumed that only the introduction of immediate recommendations for the implementation of rehabilitation procedures based on simple and well-known tests, as well as their obligatory regime, can contribute to the reduction of respiratory disability leading, in a short time, to infections recurrence and, in the long run, to a lower quality of life and socioeconomic burden on the population. This article presents a respiratory rehabilitation program for COVID-19 survivors, recommended by the Polish Society of Physiotherapy. This program was approved by the Polish Minister of Health and implemented as a pilot program at the Hospital of the Ministry of the Interior and Administration in Głuchołazy, Poland. Med Pr. 2021;72(5):611–

The Effect of Physiotherapy on Interleukin-8 Levels in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Interleukin-8 (IL-8), a chemokine formed by macrophages and epithelial cells and a potent chemoattractant for neutrophils, plays the principal role in the activation of neutrophils and eosinophils in the airways of patients with chronic obstructive pulmonary disease (COPD) and may be used as a marker of inflammation. The inflammation in the course of COPD may be characterised by an increased neutrophil count in the sputum and elevated IL-8 levels. The aim of the study was to assess the effect of physiotherapy on IL-8 levels in induced sputum in patients with COPD. Material and methods: The study included 44 patients (21 men and 23 women, mean age 56.47 ± 9.52) managed at the Ministry of Internal Affairs and Administration Specialist Hospital in Głuchołazy, Poland, and undergoing rehabilitation at the Therapeutic Rehabilitation Facility, with the diagnosis of COPD (FEV1/VC &lt; 65%), receiving stable drug treatment during physiotherapy. Before physiotherapy all the patients underwent treadmill exercise testing according to the Bruce protocol and had their dyspnoea assessed on the 20-point Borg scale as part of qualification for physiotherapy. All the patients participated a multidirectional three-week respiratory physiotherapy programme based on aerobic training performed on a cycloergometer. The training loads were selected on an individual basis depending on exercise tolerance. The standard physiotherapy programme also included respiratory muscle exercises with a particular emphasis on the abdominal muscles and the diaphragm, saline inhalations, postural drainage and percussion, relaxation and walks. Results: IL-8 levels were significantly lower after completion of the three-week physiotherapy. IL-8 levels in the sputum decreased from 18.91 ± 25.2 to 9.69 ± 14.06 ng/ml (p = 0.0215). The highest reduction of IL-8 levels was observed in patients with the highest baseline values. Conclusions: The decrease of IL-8 levels in induced sputum following comprehensive physiotherapy in patients with COPD suggests suppression of neutrophil activity, which may be one of the reasons for the improved clinical condition of the patients

Excessive Facial Wrinkling Is Associated with COPD Occurrence&mdash;Does COPD Damage Skin Beauty and Quality?

The aim of this study was to investigate facial wrinkling in COPD patients, its relationship with lung function parameters, and the differences in wrinkling between COPD patients and smokers without COPD. The study included 56 patients with COPD with smoking history and 84 controls. Wrinkle intensity was measured and classified using Daniell&rsquo;s grading system, and the total length of wrinkles was also estimated. The predominant grades of Daniell&rsquo;s scale were IV&ndash;V for COPD patients (89.3% of current and 75.0% of former smokers), III&ndash;V for controls who currently smoke (89.2%), and II&ndash;III for former (92.9%) and never smokers (100%) controls. These distributions were statistically significantly different, but current and former smokers with COPD and COPD former smokers and control current smokers did not differ. In terms of the total length of wrinkles, the COPD patients possessed significantly longer wrinkles than the control subgroups (all p-values were &lt;0.004). Negative correlations between wrinkle length and lung parameters were found. This phenomenon seems to be independent of smoking, but the length of wrinkles is related to lung function parameters. It seems that not only smoking but also COPD damages skin beauty and quality

Modified cardiological physiotherapy model

According to the World health Organization (WHO), “physiotherapy is a comprehensive and coordinated use of medical, social, professional supplies and educational measures in order to adapt patients to new lifestyle and allow them to get better physical fitness.” In the case of patients who suffer from cardiovascular diseases it refers to complex cardiological rehabilitation (CRR). Constant elements of CRR: review of clinical status of patient, optimization of pharmacological treatment, rehabilitation — gradual and controlled exercises adapted to individual possibilities. At the time of CRR implementation, the period of early rehabilitation (stages I, II) and the period of late rehabilitation (stage III) are distinguished

Results of LOO CV for polynomial and piecewise linear models.

<p>Results of LOO CV for polynomial and piecewise linear models.</p

Data set <i>M</i> vs. <i>v</i>_6<i>M</i> (or 10⁻² <i>D</i>) and the model outputs for men patients’ population.

<p>Data set <i>M</i> vs. <i>v</i>_6<i>M</i> (or 10⁻² <i>D</i>) and the model outputs for men patients’ population.</p

A study on nonlinear estimation of submaximal effort tolerance based on the generalized MET concept and the 6MWT in pulmonary rehabilitation

<div><p>Background</p><p>The six-minute walk test (6MWT) is considered to be a simple and inexpensive tool for the assessment of functional tolerance of submaximal effort. The aim of this work was 1) to background the nonlinear nature of the energy expenditure process due to physical activity, 2) to compare the results/scores of the submaximal treadmill exercise test and those of 6MWT in pulmonary patients and 3) to develop nonlinear mathematical models relating the two.</p><p>Methods</p><p>The study group included patients with the COPD. All patients were subjected to a submaximal exercise test and a 6MWT. To develop an optimal mathematical solution and compare the results of the exercise test and the 6MWT, the least squares and genetic algorithms were employed to estimate parameters of polynomial expansion and piecewise linear models.</p><p>Results</p><p>Mathematical analysis enabled to construct nonlinear models for estimating the MET result of submaximal exercise test based on average walk velocity (or distance) in the 6MWT.</p><p>Conclusions</p><p>Submaximal effort tolerance in COPD patients can be effectively estimated from new, rehabilitation-oriented, nonlinear models based on the generalized MET concept and the 6MWT.</p></div

Data set <i>M</i> vs. <i>v</i>_6<i>M</i> (or 10⁻² <i>D</i>) and the model output for women patients’ population.

<p>Data set <i>M</i> vs. <i>v</i>_6<i>M</i> (or 10⁻² <i>D</i>) and the model output for women patients’ population.</p