Telerehabilitation Programme as a Maintenance Strategy for COPD Patients: A 12-Month Randomized Clinical Trial.

Background: There is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR).

Research Question: To determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR.

Study Design And Methods: A multicentre open-label pragmatic parallel-group randomized clinical trial was conducted.

Heart failure induced by itraconazole.

Introduction And Objective: Itraconazole is an antifungal imidazole used for the treatment of aspergillosis. Evidence supporting the association between itraconazole and the onset of congestive heart failure (CHF) is limited and is based on cases reported after drug market release.

Case Report: We report the case of a 76-year-old man with hypertension and COPD GOLD D who experienced heart failure after receiving a new line of treatment with itraconazole.

Ambulatory adaptation to noninvasive ventilation in restrictive pulmonary disease: a randomized trial with cost assessment.

Background: Home mechanical ventilation is usually initiated in hospital. However, cost-effectiveness of inpatient set up has never been compared to outpatient adaptation in a randomized design. A Prospective, multicenter, non-inferiority trial was conducted comparing the effectiveness of adaptation to noninvasive mechanical ventilation (NIMV) performed in the ambulatory or hospital setting in patients with chronic respiratory failure secondary to restrictive thoracic disease, obesity-hypoventilation syndrome or neuromuscular disease.

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial.

Pulmonary hypertension is a serious complication of chronic obstructive pulmonary disease (COPD) that currently has no established pharmacological treatment. This study aimed to assess whether concomitant treatment with sildenafil would enhance the results of pulmonary rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP). In this double-blind, randomised controlled trial patients received 20 mg sildenafil or placebo three times daily and underwent pulmonary rehabilitation for 3 months.

Predicting nocturnal hypoventilation in hypercapnic chronic obstructive pulmonary disease patients undergoing long-term oxygen therapy.

Background: Chronic obstructive pulmonary disease (COPD) patients are very sensitive to changes in pulmonary mechanics and central ventilation control during sleep and may develop significant gas exchange alterations with increased hypoxemia and hypercapnia. Oxygen therapy improves nocturnal desaturation but can worsen hypoventilation.

Objectives: To analyze the prevalence of nocturnal hypoventilation (NHV) in hypercapnic COPD patients and to determine predictive factors for this phenomenon.

Sleep hypoventilation due to increased nocturnal oxygen flow in hypercapnic COPD patients.

Unlabelled: This study shows the risks and benefits of increasing the nocturnal oxygen flow in hypercapnic COPD patients undergoing LTOT, as recommended by some COPD treatment guidelines to avoid nocturnal desaturation.

Background And Objective: Several COPD treatment guidelines recommend increasing oxygen flow during sleep to avoid nocturnal desaturation. However, such an increase could have deleterious clinical and gas exchange effects.

[Relationship between expiratory muscle dysfunction and dynamic hyperinflation in advanced chronic obstructive pulmonary disease].

Background And Objectives: Dynamic hyperinflation (DH) and expiratory flow limitation (EFL) are physiologically linked and seem to be involved in the genesis of dyspnea and the quality of life (QL) impairment in chronic obstructive pulmonary disease (COPD). Advanced COPD patients often show expiratory muscles dysfunction that could be involved in DH development.

Aim: Study the relationships between expiratory muscle dysfunction and DH, and their association with dyspnea and QL, in advanced COPD.

Duration of pulmonary rehabilitation to achieve a plateau in quality of life and walk test in COPD.

Objective: To address the minimum duration of pulmonary rehabilitation necessary for patients with chronic obstructive pulmonary disease (COPD) to achieve a plateau in Health-Related Quality of Life (HRQL) and exercise tolerance.

Methods: COPD patients with a dyspnea rating of at least 2 on the Medical Research Council scale participated in an outpatient rehabilitation program of 3 weekly sessions for 12 weeks. Measurements included HRQL and exercise tolerance 2 weeks before the program started and every 2 weeks thereafter.

Carbon dioxide rebreathing in non-invasive ventilation. Analysis of masks, expiratory ports and ventilatory modes.

Background And Aim: Carbon dioxide (CO2) rebreathing is a complication of non-invasive ventilation (NIV). Our objectives were to evaluate the ability of masks with exhaust vents (EV) to avoid rebreathing while using positive pressure (PP) NIV with different levels of expiratory pressure (EPAP). Concerning volume-cycled NIV, we aimed to determine whether cylindrical spacers located in the circuit generate rebreathing.

Sensitive and stable monitoring of lead and cadmium in seawater using screen-printed electrode and electrochemical stripping analysis.

Sensitive and stable monitoring of heavy metals in seawater using screen-printed electrodes (SPE) is presented. The analytical performance of SPE coupled with square wave anodic stripping voltammetry (SWASV) for the simultaneous determination of Pb and Cd in seawater samples, in the low microgL(-1) range, is evaluated. The stripping response for the heavy metals following 2min deposition was linear over the concentration range examined (10-2000microgL(-1)) with detection limits of 1.

[Risk factors for mortality in chronic obstructive pulmonary disease].

Objective: Although the factors predictive of survival in patients with chronic obstructive pulmonary disease (COPD) have been widely studied, full consensus has yet to be reached. The objective of this study was to further clarify how lung function parameters, exercise tolerance, and quality of life influence survival in patients with COPD.

Patients And Methods: This prospective study included 60 patients diagnosed with COPD.

Development of a selective optical sensor for Cr(VI) monitoring in polluted waters.

An optical sensor is described for the sensitive and selective determination of the Cr(VI) ion in aqueous solutions. The optode membrane is prepared by incorporating Aliquat 336 as an ionophore and a chromoionophore (4',5'-dibromofluorescein octadecyl ester) in a poly(vinyl chloride) (PVC) membrane containing ortho-nitrophenyloctyl ether (o-NPOE) as a plasticizer. The response to Cr(VI) is indicated by co-extraction of the target species and of hydrogen ions into the bulk of the membrane yielding large absorbance changes which can easily be measured in the visible spectral range.

[Oxygen-conserving devices: a forgotten resource].

Oxygen-conserving devices include transtracheal catheters, reservoir cannulas, and demand oxygen delivery systems. They are designed to extend the amount of time portable oxygen cylinders will last and correct hypoxemia with a lower flow of oxygen. Transtracheal catheters increase the fraction of inspired oxygen by delivering oxygen directly to the trachea, bypassing the dead space of the oropharynx and improving the efficiency of the upper airway as a reservoir.

Primary alveolar hypoventilation and XXXXY chromosopathy.

The association of primary alveolar hypoventilation (PAH) and chromosomic diseases has not been described previously. A 19 year-old man with Fraccaro's syndrome (XXXXY karyotype) was admitted to evaluate chronic hypercapnic respiratory failure, pulmonary arterial hypertension and cor pulmonale. PAH was diagnosed.

Clinical outcomes of expiratory muscle training in severe COPD patients.

Unlabelled: The most common symptoms in chronic obstructive pulmonary disease (COPD) patients are breathlessness and exercise limitation. Although both general and inspiratory muscle training have shown clinical benefits, the effects of specific expiratory muscle training remain controversial.

Objective: To investigate the effects of expiratory training on lung function, exercise tolerance, symptoms and health-related quality of life in severe COPD patients.

Impact of pulmonary rehabilitation on psychosocial morbidity in patients with severe COPD.

Study Objective: To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe COPD.

Design: A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis.

Setting: A tertiary-care respiratory service.

Performance of mechanical ventilators at the patient's home: a multicentre quality control study.

Background: Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV).

Methods: A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator control panel, and the actual performance of the ventilator measured at home were compared; (2) the different ventilator alarms were tested; and (3) the effect of differences between the prescribed settings and the actual performance of the ventilator on non-programmed readmissions of the patient was determined.

Inspired oxygen fraction achieved with a portable ventilator: determinant factors.

Introduction: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment in respiratory failure. Continuous positive pressure (CPAP) may also be useful in acute hypoxaemic patients. Supplementary oxygen is usually necessary in both systems.

[Efficacy of the 6-minute walk test in evaluating ambulatory oxygen therapy].

Objective: To compare oxyhemoglobin saturation (SpO2) observed during the 6-minute walk test with that of pulse oximetry carried out during activities of daily living (ADLs). The efficacy of the 6-minute walk test for determining adequate oxygen flow to prevent arterial desaturation during ADLs was also analyzed.

Patients And Methods: We studied 37 patients diagnosed with chronic obstructive pulmonary disease (COPD)--mean (SD) forced expiratory volume in 1 second, 26% (9%) of predicted--and compared SpO2 values obtained in the 6-minute walk test with those obtained with ambulatory pulse oximetry during ADLs.

Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis.

Study Objective: To assess the effect of interval-based inspiratory muscle training (IMT) combined with breathing retraining (BR) in patients with generalized myasthenia gravis (MG) in a partial home program.

Design: A randomized controlled trial with blinding of outcome assessment.

Setting: A secondary-care respiratory clinic.

[Acute confusional syndrome associated with obstructive sleep apnea aggravated by acidosis secondary to oral acetazolamide treatment].

Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn.

Acute physiologic effects of nasal and full-face masks during noninvasive positive-pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease.

Objective: To assess the efficacy of and patient tolerance for nasal and full-face masks during noninvasive positive-pressure ventilation (NPPV) with patients suffering acute exacerbations of chronic obstructive pulmonary disease.

Setting: A respiratory medicine ward of a referral hospital.

Methods: Fourteen patients were randomized to 2 groups.

Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes.

The present study was aimed at evaluating the effects of a specific inspiratory muscle training protocol on the structure of inspiratory muscles in patients with chronic obstructive pulmonary disease. Fourteen patients (males, FEV1, 24 +/- 7% predicted) were randomized to either inspiratory muscle or sham training groups. Supervised breathing using a threshold inspiratory device was performed 30 minutes per day, five times a week, for 5 consecutive weeks.