Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis

Background. Treatment of bronchiectasis includes drugs, oxygen therapy and bronchial clearance maneuvers. The aim of the current study was to assess safety and efficacy of IntrapulmonaryPercussive Ventilation when compared with usual Chest Physical Therapy in patients with bronchiectasis Methods. In two consecutive days, 22 patients underwent both Intrapulmonary Percussive Ventilation and Chest Physical Therapy following a randomized cross-over design. At inclusion (T0), at the end of 30-min session (T1), and after 30 min (T2) and 4 hrs (T3), side effects, heart rate, oxygen saturation rate, respiratory rate, sensation of phlegm encumbrance and dyspneameasured by visual analogue scales, were recorded. At T1, discomfort measured by visual analogue scales was also recorded. At T3, we evaluated efficacy in terms of volume (ml), and wet and dry weight (g) of sputum. Results. Side effects were not so severe as to determine study discontinuation and were similar (27%) between the two treatments. Heart rate (p<.001) and respiratory rate (p=0.047) decreased over time while sensation of phlegm encumbrance improved (p=0.026) withboth treatments. Only Intrapulmonary Percussive Ventilation improved (p=0.004) sensation of dyspnea and resulted more comfortable than Chest Physical Therapy (p=0.032). The two treatments caused important phlegm production without differences in total volume, and both wet and dry weight. Conclusions. In patients with bronchiectasis and productive cough, short-term application of Intrapulmonary Percussive Ventilation is similarly safe and effective than traditional chestPhysical Therapy with less discomfort. Further studies on cost-effectiveness of using IPV is recommended

Effectiveness of a Pulmonary Rehabilitation Program on Persistent Asthma Stratified for Severity

BACKGROUND: Asthma is defined by airway inflammation associated with various respiratory symptoms, and pharmacologic treatment is based on inhaled corticosteroids and bronchodilators. Physical activity, educational training, nutritional support, and psychological counseling are considered part of non-pharmacologic treatment; however, studies so far have investigated the effect of single non-pharmacologic treatment. There are few studies that demonstrate the effect of comprehensive pulmonary rehabilitation, but no clear data are available regarding factors that can predict who could benefit the most. Our study aimed to assess the effect of a comprehensive 3-week pulmonary rehabilitation program on exercise tolerance and to identify baseline subject characteristics that may predict a better response to treatment. METHODS: This was a retrospective study. A team planned a pulmonary rehabilitation program: educational support; endurance training; and optional components, such as respiratory exercises and airway clearance techniques. The following data were collected before and after pulmonary rehabilitation: subject characteristics, smoking history, asthma severity, respiratory function and 6-min walk test (6MWT). RESULTS: We collected data on 515 subjects (202 males 39.2%), age, mean \ub1 SD 63.9 \ub1 10.4 y), with 413 (80.2%) having moderate-to-severe disease; and 455 (88.4%) with stable respiratory symptoms 455 (88.35%). At baseline, the percentage of predicted 6MWT in all subjects categorized by the Global Initiative for Asthma (GINA) steps was in the normal range, except for the subjects at step 5, for which it was significantly lower (P = .01). All subjects showed a significant improvement in exercise tolerance and oxygen saturation, together with a decrease in baseline dyspnea, muscle fatigue, and heart rate after pulmonary rehabilitation. Improvement of 6MWT was statistically significant, irrespective of the GINA categorization. The variables related to the improvement in 6MWT were age (P &lt; .001), smoking habit (P = .034), and baseline 6MWT (P &lt; .001). CONCLUSIONS: Subjects with asthma at any GINA step seemed to benefit from a pulmonary rehabilitation program; analysis of our data highlighted that pulmonary rehabilitation was more beneficial in younger subjects with a smoking history and worse baseline exercise tolerance

Clusters of individuals recovering from an exacerbation of chronic obstructive pulmonary disease and response to in-hospital pulmonary rehabilitation

Introduction and objectives: Due to the present low availability of pulmonary rehabilitation (PR) for individuals recovering from a COPD exacerbation (ECOPD), we need admission priority criteria. We tested the hypothesis that these individuals might be clustered according to baseline characteristics to identify subpopulations with different responses to PR. Methods: Multicentric retrospective analysis of individuals undergone in-hospital PR. Baseline characteristics and outcome measures (six-minute walking test - 6MWT, Medical Research Council scale for dyspnoea -MRC, COPD assessment test -CAT) were used for clustering analysis. Results: Data analysis of 1159 individuals showed that after program, the proportion of individuals reaching the minimal clinically important difference (MCID) was 85.0%, 86.3%, and 65.6% for CAT, MRC, and 6MWT respectively. Three clusters were found (C1-severe: 10.9%; C2-intermediate: 74.4%; C3-mild: 14.7% of cases respectively). Cluster C1-severe showed the worst conditions with the largest post PR improvements in outcome measures; C3-mild showed the least severe baseline conditions, but the smallest improvements. The proportion of participants reaching the MCID in ALL three outcome measures was significantly different among clusters, with C1-severe having the highest proportion of full success (69.0%) as compared to C2-intermediate (48.3%) and C3-mild (37.4%). Participants in C2-intermediate and C1-severe had 1.7- and 4.6-fold increases in the probability to reach the MCID in all three outcomes as compared to those in C3-mild (OR&nbsp;=&nbsp;1.72, 95% confidence interval [95% CI]&nbsp;=&nbsp;1.2 - 2.49, p&nbsp;=&nbsp;0.0035 and OR&nbsp;=&nbsp;4.57, 95% CI&nbsp;=&nbsp;2.68 - 7.91, p &lt; 0.0001 respectively). Conclusions: Clustering analysis can identify subpopulations of individuals recovering from ECOPD associated with different responses to PR. Our results may help in defining priority criteria based on the probability of success of PR

Minimal clinically important difference in barthel index dyspnea in patients with COPD

Background: The Barthel Index dyspnea (BId) is responsive to physiological changes and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). However, the minimum clinically important difference (MCID) has not been established yet. Aim: To identify the MCID of BId in patients with COPD stratified according to the presence of chronic respiratory failure (CRF) or not. Materials and Methods: Using the Medical Research Council (MRC) score as an anchor, receiver operating characteristic curves and quantile regression were retrospectively evaluated before and after pulmonary rehabilitation in 2327 patients with COPD (1151 of them with CRF). Results: The median post-rehabilitation changes in BId for all patients were −10 (interquartile range = −17 to −3, p&lt;0.001), correlating significantly with changes in MRC (r = 0.57, 95% CI = 0.53 to 0.59, p&lt;0.001). Comparing different methods of assessment, the MCID ranged from −6.5 to −9 points for patients without and −7.5 to −12 points for patients with CRF. Conclusion: The most conservative estimate of the MCID is −9 points in patients with COPD, without and −12 in those with CRF. This estimate may be useful in the clinical interpretation of data, particularly in response to intervention studies

Adapted physical activity in subjects and athletes recovering from covid-19: a position statement of the Società Italiana Scienze Motorie e Sportive

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic illness that is impacting the cardiovascular, pulmonary, musculoskeletal, and cognitive function of a large spectrum of the worldwide population. The available pharmacological countermeasures of these long-term effects of COVID-19 are minimal, while myriads of non-specific non-pharmacological treatments are emerging in the literature. In this complicated scenario, particular emphasis should be dedicated to specific exercise interventions tailored for subjects and athletes recovering from COVID-19. Specific guidelines on adapted physical activity in this critical population are unavailable so far, therefore, in this position statement of the Società Italiana di Scienze Motorie e Sportive (SISMeS) the members of the steering committee of the research group Attività Motoria Adattata, Alimentazione, Salute e Fitness have indicated the adapted physical activity approaches to counteract the long-term effects of the COVID-19, both in good health people and athletes

Intermittent versus equivalent constant-load cycle training in COVID-19 patients

[no abstract available

Inhaler technique knowledge and skills before and after an educational program in obstructive respiratory disease patients: A real-life pilot study

Patients present poor knowledge and skills about their respiratory disease and inhaler device. We aimed to: (1) evaluate COPD and asthmatic patients' ability to manage inhaled drugs (2) identify differences among devices and (3) correlate clinical data with patient ability.Patients (n=134) admitted for pulmonary rehabilitation (PR) were given an ad-hoc questionnaire covering 0% as the worst and 100% the best value of global ability (indicating the sum of knowledge and skills in managing inhaled drugs) at baseline (T0) and discharge (T1). Educational program was provided during PR. Setting of rehabilitation, age, sex, diagnosis, spirometry, CIRS score, level of autonomy to use medications, if naïve about PR, educational level, and number/type of prescribed inhaled drugs were recorded.Most patients used 1 drug while 37% used 2 drugs. DPIs were the main device prescribed. At baseline, patients' mean level of knowledge and skills were 73% and 58%, respectively. There was a significant difference in level of skills (p=0.046) among device families, DPIs resulting worst and pMDIs best. Global ability, skills and knowledge improved after educational support (p0.001) but did not reach the optimal level, 88%, 87% and 89%, respectively. Baseline global ability was positively correlated to female gender, younger age, previous PR access, outpatient status, higher education level and GOLD D class.At hospital admission, global ability was not optimal. Education may improve this, irrespective of the type of device used, in particular in male, elderly, naïve to PR, low educational level patients

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 cor-related 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