The Maugeri daily activity profile: a tool to assess physical activity in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) report reduced physical activity (PA). There are only few tools available to assess PA and sedentary behavior in these patients, and none of them aims to differentiate between sedentary and active patterns. The aim of the study was to evaluate an easy tool to profile daily activity time in a cohort of patients with COPD, compared to healthy subjects; the study was set at the Istituti Clinici Scientifici Maugeri (ICS), IRCCS of Tradate and Lumezzane, Italy, and at the Ente Ospedaliero Cantonale Novaggio, Switzerland (Italian Speaking). The populations were inpatients with COPD, healthy subjects. The items of the Maugeri Daily Activity (MaDA) profile were chosen based on literature, interviews with patients and health professionals. Time spent during sleep (ST), when awake (AT), active (ACT) or in sedentary behavior (SET) were recorded. Lung function tests, arterial blood gases, the modified Medical Research Council (mMRC), the six-minute walking distance test (6MWD), the COPD Assessment Test (CAT), and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index were also assessed in patients. Sixty patients with COPD and 60 healthy controls filled in the questionnaire. As compared to controls, patients showed longer AT and SET. Active time of patients was significantly correlated with mMRC, CAT, Bode Index and 6MWD, but not with demographics, anthropometrics or stages of disease. Using this tool, we found that patients with COPD spent longer time awake and in sedentary behavior. The MaDA may be useful to evaluate PA in patients with COPD

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR)

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units

May an early integrated care program with NIV adaptation delay NIV failure in patients with ALS?

The most recent European Guidelines propose the start of non invasive ventilation (NIV) when the amyotrophic lateral sclerosis (ALS) patient\u2019s sitting Forced Vital Capacity (FVC% prd) is less than the value of 80%. The aim of our study was to assess whether an early integrated care program with adaptation to NIV (patient with FVC%> 80) can lengthen free interval of NIV failure (tracheostomy and/or death). This retrospective study was conducted in 3 italian facilities on a cohort of 213 subjects with ALS with at least 36 months of follow-up from the NIV start. The subjects were then divided into two groups according to the sitting FVC% value prd (Late group = LG with FVC <80% and Early group = EG with FVC> 80%) at the time of NIV prescription. For each group we analyzed clinical and respiratory functional data, time free from \u201cfailure of NIV " (tracheotomy need/death) starting from the first symptoms, the ALS diagnosis and the NIV prescription. 167 patients failed NIV after 36 months of follow-up (in LG 125 and 42 in the EG). After one year from the NIV prescription, the % of failure rate was 50% in LG and about 10% in the EG while after three years by NIV prescription % of failure in the LG was 86% compared to 62% in the EG. When compared with the LG, the EG showed a lower probability of NIV failure starting from a) the time of NIV prescription (p = 0.0000) b) first symptoms (p = 0.001) (figure 1) c) diagnosis (p = 0.0003). An early integrated care with NIV prescription seems to prolong free interval to the some NIV failure (tracheotomy and/or death). Only robust randomized controlled trials will confirm our working hypothesis

Efficacy of Temporary Positive Expiratory Pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO project: a multicentre randomised controlled trial.

Objective: To evaluate whether Temporary Positive Expiratory Pressure provides benefit in patients with lung diseases and chronic hypersecretion.Design: Single blind multicentre randomised trial.Setting: 5 Italian rehabilitation centres.Participants: 98 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 in two treatment groups. Interventions: For 10 consecutive days, Active group performed twice a day 20-min cycles of Manually Assisted Breathing Techniques in sequence with the addition of 15-min of Temporary Positive Expiratory Pressure, while 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, after 3, and 10 treatment sessions. Pre-to-post treatment change of sputum volume and bronchial encumbrance (Δ-VAS), 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 Active group. The group comparison analysis of the pre-to-post change showed that Inspiratory Capacity was significantly higher in Active than in Control group (+19.5% and +2.2%, p=0.044) at day 10. A greater improvement in Δ-VAS was recorded in 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

Efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO\uae 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 (\uc4-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 \uc4-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. \ua9 The Author(s) 2012

An Italian consensus on pulmonary rehabilitation in COVID-19 patients recovering from acute respiratory failure: results of a Delphi process

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts\u2019 opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was &gt;7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was &gt;95%. Twenty-three questions from 4 areas: personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions