Inpatient pulmonary rehabilitation: does it make sense?

Among the nonpharmacological therapies, pulmonary rehabilitation (PR) is particularly appropriate for patients with chronic respiratory impairment who, despite any optimal drug management, are still symptomatic and experience restriction in every day activities. Pulmonary rehabilitation performed in inpatient, outpatient, or home settings demonstrates short- and long-term clinical efficacy. Although disease severity does not inherently dictate candidacy for exercise training, the degree of physiological and functional impairment may influence setting in which the training should occur. Therefore, inpatient rehabilitation is generally best-suited for the most sick and most disabled patients. The overall results from the literature confirm that the inpatient setting for a PR program is a feasible option and does not necessarily result in higher direct costs when balanced against duration and effectiveness in terms of improved outcomes

Association therapy as a prognostic factor in deep fungal infection complicating oncohaematological diseases.

A group of 31 oncohaemopathic patients (17 male, mean age 44 +/- 6 years), diagnosed as having primary deep fungal infection involving the lungs, were retrospectively evaluated. When infection was suspected on a clinical basis the major associated risks for death were the duration of bone marrow aplasia (12 +/- 7 versus 21 +/- 6 days, P < 0.001), increase in white blood cells and, in particular, prolonged granulocytopenia (11 +/- 5 versus 24 +/- 8 days, P < 0.001) when survivors were compared with patients, who died. Our therapeutic empirical approach was based on the association of i.v. amphotericin B, 1 mg kg-1 day-1, with oral 5-fluorocytosine (5-FC) 150 mg kg-1 day-1. Only 9 subjects received combination therapy for more than 7 days. For majority of them, oral 5-FC was interrupted because of altered compliance or sustained liver damage. A chi 2 test for independent parameters showed (P = 0.0021) a concentration of deaths among patients who received amphotericin B alone (15/22); none of the patients treated with amphotericin B + 5-FC (9 cases) died. Results generally suggest that a more favourable outcome was statistically associated with empirical antifungal combination therapy in deep fungal infection, although both treatment regimens showed effectiveness in terms of survival. Nevertheless the low 5-FC compliance and the small sample do not indicate the safe use of this drug in a large population

Noninvasive mechanical ventilation with high pressure strategy remains a “double edged sword” ?

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La NIV nel paziente con insufficienza respiratoria cronica, la gestione domiciliare - Competenza specialistica nelle patologie pneumologiche pure

Questo capitolo ha lo scopo di revisionare la letteratura in merito ai meccanismi dell’insufficienza respiratoria cronica e gli effetti fisiologici e l’efficacia della ventilazione meccanica non invasiva nei pazienti affetti da BPCO in fase di stabilità clinica, cercando di dare indicazioni sulla selezione dei pazienti che potrebbero maggiormente beneficiare di questo trattamento

Hospital monitoring, setting and training for home non invasive ventilation.

Although in recent years guidelines have been published in order to define indications, applications and delivery of long-term home non invasive mechanical ventilation (HNMV), there is lack of information with regards to in-hospital assessment, planning and training to initiate and prescribe it. Discontinuation and lack of compliance versus HNMV may affect the follow-up of these patients adding a costly burden for care. The present review proposes an operative flow chart for optimisation of HNMV prescription from initial patient's selection to post discharge follow up including; 1. assessment of the correct choice of ventilator, interfaces, ventilation setting. 2. Timing for different physiological monitoring (arterial gases, mechanics, sleep) 3. Timing for clinical evaluation, machine adaptation, carer training and long term follow-up

Persistent asthma hospitalizations and deaths require a national asthma prevention plan.

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Rehabilitation in COPD patients admitted for exacerbation

Recovery of lung function is delayed up to 2 months following acute exacerbation (AE) of COPD patients. After AE, even with optimal medical therapy, it takes considerable time for COPD patients to recover to baseline ability to perform usual physical activity.Despite pulmonary rehabilitation (PR) has been so far considered a useful non-pharmacological therapy in stable COPD individuals, still few studies have examined the effect of rehabilitation during and/or early after AE.The present review updates the application of early PR and main physical therapies both during hospital acute care and following discharge of COPD patients undergoing exacerbation.Only recently, literature has shown feasibility and effectiveness of early PR in COPD patients undergoing AE. Notwithstanding, it clearly appears a treatment indicated just after or even during an acute episode in hospital.Future studies should be able to clarify the practical role and effects of a timely application of rehabilitation to acute COPD, as well as the preferred modalities, duration and techniques to apply in this condition

Rehabilitation in COPD patients admitted for exacerbation

Zaostrzenia mają poważny i niekorzystny wpływ na jakość życia i czynność płuc u chorych na POChP. Powrót do stanu wyjściowego po zaostrzeniu, jest opóźniony do 2 miesięcy, nawet przy zastosowaniu optymalnego leczenia. Potrzebny jest czas, aby chory powrócił do wykonywania zwykłych aktywności fizycznych, w takim zakresie, jak przed zaostrzeniem. Dotychczas, rehabilitacja oddechowa (PR, pulmonary rehabilitation) była postrzegana jako forma leczenia niefarmakologicznego, w stabilnej postaci POChP, ale w kilku opublikowanych pracach oceniano wpływ zastosowania rehabilitacji oddechowej w trakcie i / lub wkrótce po zaostrzeniu. W przedstawianej pracy dokonano przeglądu i aktualizacji wiedzy na temat korzyści, wynikających ze stosowania rehabilitacji oddechowej i ćwiczeń fizycznych, w zaostrzeniu POChP i to zarówno w trakcie hospitalizacji, jaki i po powrocie chorych do domu. Ostatnio, opublikowano wyniki badań, w których wykazano przydatność i efektywność zastosowania rehabilitacji oddechowej u chorych na POChP, leczonych z powodu zaostrzenia. Konieczne są dalsze badania, w oparciu o które, będzie można dokładniej określić warunki, czas trwania i rodzaj stosowanych technik rehabilitacji oddechowej u chorych z zaostrzeniem POChP. Pneumonol. Alergol. Pol. 2011; 79, 2: 116-120Recovery of lung function is delayed by up to two months following acute exacerbation (AE) of COPD patients. After AE, even with optimal medical therapy, it takes a considerable time for COPD patients to recover to baseline ability to perform routine physical activities. Although pulmonary rehabilitation (PR) has long been considered a useful non-pharmacological therapy in stable COPD individuals, there have been only a few studies into the effects of rehabilitation during and/or just after AE. This review updates the application of early PR and main physical therapies both during hospital acute care and following discharge of COPD patients who have experienced exacerbation. It is only recently that literature has demonstrated the feasibility and effectiveness of early PR in COPD patients undergoing AE. Nonetheless, early PR clearly appears to be a treatment indicated just after, or even during, an acute episode in hospital. Future studies should be able to clarify the practical role and effects of a timely application of rehabilitation to acute COPD, as well as the preferred modalities, duration and techniques to apply in this condition. Pneumonol. Alergol. Pol. 2011; 79, 2: 116-12

Chronic respiratory abnormalities in the multi-morbid frail elderly

Two-thirds of people aged 65 65 years have multi-morbidity, with people living in the most deprived areas developing multi-morbidity 10-15 years even earlier. Multi-morbidity is associated with higher mortality, polypharmacy and high treatment burden, higher rates of adverse drug events, and much greater health services use including emergency hospital admissions. Multi-morbidity includes both physical and mental health conditions, as anxiety and depression, that almost invariably affect patients with multiple symptomatic chronic diseases. The main message of the present paper is that the management of a patient with any of the chronic diseases that are part of multi-morbidity is not just the management of that single index disease, but must include the active search and proper treatment of concomitant chronic diseases. The presence of concomitant chronic diseases should not alter the management of the index disease (eg COPD), and concomitant chronic disease should be treated according to single diseases guidelines regardless of the presence of the index disease, obviously with careful consideration that this choice implies complex management, polypharmacy and potential adverse effects. Ongoing multidisciplinary hospital and home base management programmes suggest that an olistic integrated approach might improve quality of life and reduce hospital admissions and death in these multimorbid patients

Pulmonary fibrosis and lung carcinogenesis: do myofibroblasts and cancer-associated fibroblasts share a common identity?

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