Efficacy of pulmonary rehabilitation for bronchiectasis and related factors: which patients should receive the most treatment?

Introduction: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis.Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program.Results: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = -0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = -0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = -0.563) and ΔSGRQ (p < 0.001, r = -0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = -0.176) and Δanxiety (p = 0.007, r = -0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = -0.267) and ΔSGRQ (p < 0.001, r = -0.648). Conclusions: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program

Remembering the Occam’s Razor: Could simple electrocardiographic findings provide relevant predictions for current hemodynamic criteria of pulmonary hypertension?

Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH

The Reasons for Non-Adherence in Pulmonary Rehabilitation Programs

Objective: Pulmonary Rehabilitation (PR), a multidisciplinary treatment modality, is recommended in management of COPD. Structure, experience of units /centers, contents of the program are as important as patient-specific factors.To our knowledge, there is no data regarding the success of PR in Turkey. This study was performed in order to determine the reasons for nonadherence in patients who underwent PR programs in Turkey. Methods: Demographic data, initial assessment parameters of 143 patients were collected retrospectively, examined. Age, smoking history, FEV1%, health related quality of life, dyspnea score, body composition and psychological status of all patients who were divided into two group according to completion of PR were compared. The reasons of non-completion were asked from patients who did not complete PR by phone, their answers were recorded. Results: Thirty two patients did not complete (22.3%) multidisciplinary, comprehensive, an individualized outpatient PR program.The most common reason for non-adherence except all medical conditions including exacerbations was inability to comprehend efficacy and contents of PR program. While mean walking distance of patients who completed PR was 241±128.9, other group’s distance was 183.4±119.9 m, endurance time was 7.03±6.32, 4.89±5.3 min (respectively, p=0.02). Although total SGRQ and all domains’ scores of patients who did not complete PR were higher, only impact domain scores, MRC scores were significantly higher (p=0.045, 0.01 respectively). Body composition, psychosocial status of patients did not differ significantly. Conclusion: Patients with advanced dyspnea, decreased exercise capacity should be continuously, vigorously informed of possible gains in order to increase success rate of programs, adherence to programs should be reinforced by patient-specific individualized PR programs

Influenza and pneumonia vaccination rates in patients hospitalized with acute respiratory failure

Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded. Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations. Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients

Efficacy of Pulmonary Rehabilitation for Bronchiectasis and Related Factors: Which Patients Should Receive the Most Treatment?

Introduction: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. Results: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = −0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = −0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = −0.563) and ΔSGRQ (p < 0.001, r = −0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = −0.176) and Δanxiety (p = 0.007, r = −0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = −0.267) and ΔSGRQ (p < 0.001, r = −0.648). Conclusions: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program

The Efficacy of Supervised Home-based Pulmonary Rehabilitation in Patients with Chronic Respiratory Disorders

Objective: Pulmonary rehabilitation (PR) programs can be carried out in hospital or home basis with a different organizational aspect and program content. This study aimed to evaluate the efficacy of a multidisciplinary supervised home-based PR program in patients with chronic respiratory disorders. Methods: Forty patients with chronic respiratory disorders who admitted to our center between September 2007 and May 2012 were enrolled. In all patients before and after PR, dyspnea was assessed with Medical Research Council (MRC) dyspnea scale, exercise capacity with Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT), health related quality of life with St. Geoerge Respiratory Questionnaire (SGRQ), psychosocial evaluation with hospital anxiety and depression scale (HAD), the body composition with bioelectrical impedance method. Ten patients did not complete home-based PR for various reasons. Results: In patients with Chronic Obstructive Pulmonary Disease (COPD), dyspnea sensation (p=0.026), exercise capacity (p=0.001), quality of life (p=0.001), body composition (p=0.012), anxiety and depression score (p=0.001) improvements were statistically significant. In all patients with COPD and non-COPD perception of dyspnea, exercise capacity, quality of life, anxiety and depression score improvements were above minimal clinically important differences. Conclusion: In this study supervised home-based pulmonary rehabilitation has been shown as an effective and safe modality when applied by an experiencied and multidisciplinary team in selected severe COPD or non-COPD patients

Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support: A randomized controlled trial

The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone

A Cause of Fever of Unknown Origin: A Case of Adult Onset Still’s Disease

Adult onset Still’s disease is rare syndrome consisting of recurrent fever, rash, artralgia or arthritis. A sixty-five years old female was admitted to the hospital for high fever with one month duration, accompanied with fatique and lack of appetite. Findings of physical examination, laboratory test results and radioghraphic evaluations were negative for infectious diseases, malignancy and immunological disorders. The diagnosis of Still’s disease was made on the clinical findings and exclusion of other possible diseases. High serum ferritin value was a key factor in making the diagnosis. The patients with Still’s disease can apply to the infectious diseases department because of the fever of unknown origin (FUO) and this disorder can be the cause of FUO in the elderly as well as in the younger population

Comprehensive out-patient pulmonary rehabilitation: Treatment outcomes in early and late stages of chronic obstructive pulmonary disease

Background : The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) and to establish whether in early disease stage PR is as effective as in late stages of disease. Methods : A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To eluciate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council (MRC)], body composition [body mass index (BMI), fat free mass (FFM), fat free mass index (FFMI)], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life (HRQoL) with St. George Respiratory Disease Questionnaire, psycohological status (Hospital anxiety-depression (HAD) scale) were evaluated before and after PR. Results : At the end of PR in the early disease stage group, the improvement in forced vital capacity (FVC) reached a statistically significant level (P < 0.05). In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements (P < 0.001). HRQoL and exercise capacity were significantly improved for the two groups (P < 0.001). Psychological status evaluated with the HAD scale improved after PR (P < 0.001) both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages. Conclusions : These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program