Current clinical management of smoke inhalation injuries: a reality check

Smoke inhalation injury is a complex clinical condition and respiratory clinicians need to have a good understanding of its current clinical management. However, evidence derives mostly from retrospective cohorts and case series. Is this enough

Interval training induces clinically meaningful effects in daily activity levels in COPD

Mounting evidence suggests that daily activity levels (DAL) in patients with chronic obstructive pulmonary disease (COPD) are markedly low compared with healthy age-matched individuals and are associated with poorer health status and prognosis [1]. COPD severity negatively impacts on DAL since patients with low DAL experience greater ventilatory, central haemodynamic and peripheral muscle oxygenation constraints during activities of daily living when compared with more physically active counterparts [2, 3]. Although exercise training as part of pulmonary rehabilitation has shown to mitigate the aforementioned physiological constraints [4], there is no evidence of clinically meaningful improvements in DAL following pulmonary rehabilitation [5] as manifested by a mean increase of at least 1000 steps·day−1 [6]. This has been attributed to methodological shortfalls, such as lack of adequately controlled studies, small sample size, short duration of pulmonary rehabilitation programmes, application of activity monitors non-validated for COPD patients [5] and insufficient exercise intensities to induce true physiological training effects. Interval exercise training has been shown to allow application of intense loads to peripheral muscles that induce substantial physiological effects manifested by mitigation of respiratory and central haemodynamic limitations and partial restoration of peripheral muscle dysfunction in patients with diverse COPD severity [7, 8]. In this context, it is reasoned that application of this training modality would allow transfer of the aforementioned physiological benefits into clinically meaningful improvements in DAL [2, 3]. Accordingly, the purpose of this randomised controlled study was to investigate the effect of a 12-week high-intensity interval exercise training programme in DAL in addition to usual care in patients with COPD

Vascular endothelial growth factor and cysteinyl leukotrienes in sputum supernatant of patients with asthma

SummaryBackgroundVascular endothelial growth factor (VEGF) is considered to be the most important angiogenic factor in asthma. Cysteinyl leukotrienes (Cyst-LTs) have been implicated in vascular permeability in asthma. Cyst-LTs receptor antagonists modulate vascular permeability by reducing VEGF expression.ObjectiveWe aimed to determine the levels of VEGF and Cyst-LTs in sputum supernatants of patients with asthma and to investigate possible associations within them and with airway vascular permeability (AVP) index. Possible confounding factors were also assessed.MethodsOne hundred twenty one patients with asthma (38 with severe refractory asthma, 41 smokers) and 30 healthy subjects (15 smokers) were studied. All subjects underwent lung function tests, and sputum induction for cell count identification and VEGF, Cyst-LTs, measurement in supernatants. AVP index was also assessed.ResultsBoth VEGF & Cyst-LTs (pg/ml) levels were significantly elevated in patients with asthma compared to normal subjects (median, interquartile ranges 845 [487–1034] vs. 432 (327–654) and 209 [171–296] vs. 92 [75–114] respectively, p < 0.001 for both). Multivariate regression analysis in the whole group showed a significant association of Cyst-LTs levels in sputum supernatants with VEGF levels in sputum supernatants and AVP index. A similar positive association was observed between VEGF levels in sputum supernatants and AVP index. The presence of Severe asthma was a significant covariate for both associations.ConclusionOur results indicate that Cyst-LTs may modulate vascular permeability by up-regulating VEGF expression. The above effect seems to be affected by asthma severity

Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits

Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits. Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR. In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389–0.687, and IRR 0.635, 95% CI 0.473–0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100–0.358, and IRR 0.375, 95% CI 0.207–0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072–0.185). Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR

The effect of exercise on improving quality of life and self-esteem of inmates in Greek prisons

The purpose of the study was to examine the effect of an exercise program on the quality of life and self-esteem of inmates in Greek prisons. Sixty male inmates randomly assigned in two groups (control and experiment). The duration of the training program for the exercise group was 12 weeks. Control group individuals did not participate in the exercise program. SF-12 quality of life questionnaire and the Rosenberg self-esteem scale were administered to both groups prior and after exercise intervention. The findings of this study support the beneficial effect of exercise on quality of life and self-esteem of inmates in Greek prison settings.The research for this paper was financially supported by a PhD Research Fellowship from the General Secretariat for Research and Technology (GSRT) and Hellenic Foundation for Research and Innovation (HFRI)

The Impact of Reducing Hypertensive Left Ventricular Hypertrophy on Sudden Cardiac Death

It has been well recognized that the presence of left ventricular hypertrophy (LVH) is an adverse feature in hypertension, with such patients having a substantially higher risk of cardiovascular events, including mortality and morbidity from heart failure, ventricular arrhythmias, death from myocardial infarction, sudden cardiac death and cerebrovascular episodes. ECG may show findings suggestive of hypertrophy but echocardiography is the preferred test for the evaluation of the presence and extent of hypertrophy. The reduction of blood pressure via life style interventions and with the use of antihypertensive agents reduces cardiac mass in patients with LVH. This reduction is related both to the degree of antihypertensive response and to the specific therapy used. It appears that the degree of regression is more pronounced with angiotensin-converting enzyme inhibitors and calcium channel blockers, especially non-dihydropyridines. The regression of LVH is accompanied by a reduction in sudden death, acute myocardial infarction and heart failure

Interval versus constant-load exercise training in adults with Cystic Fibrosis

Background: The efficacy of interval exercise (IE) compared to constant-load exercise (CLE) training remains unsettled in adults with Cystic Fibrosis (CF). Methods: Twenty-four adults with CF were randomised to 30-min IE (100% peak work capacity (WRpeak) for 30-s alternated with 40% WRpeak for 30-s; n = 12) or 30-min CLE (70% WRpeak; n = 12) training, 3 times weekly, for 12 weeks. Isometric quadriceps muscle strength was assessed using a strain gauge Myometer. Results: The magnitude of improvement in quadriceps muscle strength was greater (p = 0.037) in the IE (by 32 ± 13 Nm) compared to the CLE (by 23 ± 12 Nm) groups. Maximum inspiratory and expiratory mouth pressures were significantly improved only in the IE group (by 30 ± 10 cmH2O; p = 0.009 and 13 ± 4 cmH2O; p = 0.007, respectively). Arterial oxygen saturation during training was higher (p = 0.002) for IE (94 ± 1%) compared to CLE (91 ± 1%), whereas dyspnoea scores were lower (p = 0.001) for IE (3.8 ± 0.7) compared to CLE (5.9 ± 0.8) Conclusions: IE is superior to CLE in improving peripheral and respiratory muscle strength and preferable to CLE because it is associated with lower exercise-induced arterial oxygen desaturation and breathlessness

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity &lt;0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 6580% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both