Increasing Implementation and Delivery of Pulmonary Rehabilitation: Key Messages from the New ATS/ERS Policy Statement.

In December 2015 the Official ATS/ERS Policy Statement on Enhancing Implementation, Use and Delivery of Pulmonary Rehabilitation (PR) was published [1] with the aim of providing policy recommendations to increase implementation and delivery of PR worldwide. Major areas addressed included increasing healthcare professional, payer and patient awareness and knowledge of PR, increasing patient access to PR, improving quality of PR programs and future research directions to advance evidence-based policy in PR. This ATS/ERS document was developed via an iterative consensus process by an ad hoc Task Force on Policy in PR comprised of experts from the ATS Pulmonary Rehabilitation Assembly, the ERS Rehabilitation and Chronic Care Group, the ATS and ERS Documents Development and Implementation Committees, representatives from the European Lung Foundation (ELF) and primary care representatives from the USA and Europe between May 2013 and January 2015. Input was obtained via informal surveys from patients, patient advocacy groups, (including the ATS Public Advisory Roundtable and ELF), insurance payers, as well as primary and pulmonary specialty healthcare providers. The Policy Statement was approved by the Board of Directors of the ATS and the Science Council and Executive Committee of the ERS. This editorial provides ERJ readers with a concise reflection on the key issues addressed and summarizes the policy recommendations made in the ATS/ERS Policy Statement[1] to enhance implementation, use and delivery of PR

Treatment of isoniazid-resistant pulmonary tuberculosis

<p>Abstract</p> <p>Background</p> <p>Although resistance to isoniazid (INH) is the most common form of drug resistance seen among <it>Mycobacterium tuberculosis </it>isolates, there have been few studies on the efficacy and optimal duration of treatment for patients with INH-resistant tuberculosis (TB).</p> <p>Methods</p> <p>We evaluated retrospectively the treatment outcomes of 39 patients who were treated for INH-resistant pulmonary TB. The treatment regimens consisted of a 12-month regimen of rifampin (RIF) and ethambutol (EMB), with pyrazinamide (PZA) given during the first 2 months (2HREZ/10RE) (<it>n </it>= 21), a 9-month regimen of RIF and EMB with PZA during the first 2 months (2HREZ/7RE) (<it>n </it>= 5), and a 6-month regimen of RIF, EMB, and PZA (2HREZ/4REZ) (<it>n </it>= 13). After drug susceptibility testing confirmed the INH-resistance of the isolated <it>M. tuberculosis </it>strains, INH was discontinued for all the patients.</p> <p>Results</p> <p>Among the 39 patients, treatment was successfully completed by 36 patients (92%). However, treatment failure occurred, and acquired resistance to other first-line drugs, such as RIF, developed in three patients (8%). Cavitary and bilateral extensive lesions were commonly found in the chest radiographs of the patients who exhibited treatment failure.</p> <p>Conclusion</p> <p>These findings underline the seriousness of concerns regarding treatment failure and the development of multidrug-resistant TB in patients with INH-resistant TB following treatment with recommended regimens.</p

Psycho-educational interventions for adults with severe or difficult asthma: a systematic review.

types: Journal Article; Research Support, Non-U.S. Gov't; ReviewThis is the author's version of the work that was accepted for publication in the Journal of Asthma. The final version can be accessed via the DOI in this record.Research highlights psychosocial factors associated with adverse asthma events. This systematic review therefore examined whether psycho-educational interventions improve health and self-management outcomes in adults with severe or difficult asthma. Seventeen controlled studies were included. Characteristics and content of interventions varied even within broad types. Study quality was generally poor and several studies were small. Any positive effects observed from qualitative and quantitative syntheses were mainly short term and, in planned subgroup analyses (involving < 5 trials), effects on hospitalizations, quality of life, and psychological morbidity in patients with severe asthma did not extend to those in whom multiple factors complicate management.UK NHS Health Technology Assessment Programm