Efficacy of pulmonary rehabilitation in chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD): The Maugeri Study.

Unlabelled: While the effectiveness of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) is well established, its effectiveness in the most severe category of COPD, i.e. patients with chronic respiratory failure (CRF), is less well known.

Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing.

The helmet, a transparent latex-free polyvinyl chloride cylinder linked by a metallic ring to a soft collar that seals the helmet around the neck, has been recently proposed as an effective alternative to conventional face mask to deliver pressure support ventilation (PSV) during noninvasive ventilation in patients with acute respiratory failure. We tested the hypothesis that mechanical characteristics of the helmet (large internal volume and high compliance) might impair patient-ventilator interactions compared with standard face mask. Breathing pattern, CO(2) clearance, indexes of inspiratory muscle effort and patient-ventilator asynchrony, and dyspnea were measured at different levels of PSV delivered by face mask and helmet in six healthy volunteers before (load-off) and after (load-on) application of a linear resistor.

Diaphragm fatigue during exercise at high altitude: the role of hypoxia and workload.

The effect of high altitude (HA) on exercise-induced diaphragm fatigue in normal subjects was examined. Eight normal subjects completed an incremental exercise test at sea level (SL) and at 3,325 m. Before (baseline), during, and after exercise (recovery), maximal transdiaphragm pressure (Pdi,sniff), breathing pattern, and diaphragmatic effort (PTPdi) were measured.

Physiologic response of ventilator-dependent patients with chronic obstructive pulmonary disease to proportional assist ventilation and continuous positive airway pressure.

To investigate the physiologic effects of proportional assist ventilation (PAV) in difficult-to-wean, mechanically ventilated patients with advanced COPD, we measured in eight ICU patients the breathing pattern, neuromuscular drive (P0.1), lung mechanics, and inspiratory muscle effort (PTPdi and PTPpl) during both spontaneous breathing (SB) and ventilatory support with PAV, CPAP, and CPAP + PAV (in random sequence). PAV (volume assist [VA] and flow assist [FA]) was set as follows: dynamic lung elastance and inspiratory pulmonary resistance were measured during SB; then VA and FA were set to counterbalance the elastic and resistive loads exceeding the normal values, respectively, the inspiratory muscles bearing a normal elastic and resistive workload.

Static intrinsic PEEP in COPD patients during spontaneous breathing.

Intrinsic positive end-expiratory pressure (PEEPi) is routinely determined under static conditions by occluding the airway at end-expiration (PEEPi,st). This procedure may be difficult in patients with chronic obstructive pulmonary disease (COPD) during spontaneous breathing, as both expiratory muscle activity and increased respiratory frequency often occur. To overcome these problems, we tested the hypothesis that the difference between maximum airway opening (MIP) and maximum esophageal (Ppl max) pressures, obtained with a Mueller maneuver from the end-expiratory lung volume (EELV), can accurately measure PEEPi,st.

Comparison of invasive and noninvasive saturation monitoring in prescribing oxygen during exercise in COPD patients.

The aim of this study was to determine whether it is possible using ear-oximetry to prescribe the correct oxygen flow rates during exercise in chronic obstructive pulmonary disease (COPD) patients on long-term oxygen therapy (LTOT). Twenty COPD patients on LTOT, with exercise desaturation breathing oxygen at resting flow rates, performed a series of 6-min treadmill walking tests, with a progressive increase in oxygen flows until oxygen saturation measured by ear- or pulse-oximetry (Sp,O2) was above 90%. The exercise studies were repeated the next day, saturation being measured both noninvasively by ear-oximetry (Sp,O2) and invasively by CO-oximeter (Sa,O2).

Partitioning of inspiratory muscle workload and pressure assistance in ventilator-dependent COPD patients.

To investigate the mechanisms underlying ventilator-dependence in patients with chronic obstructive pulmonary disease (COPD), and to assess the effects of the combination of positive end-expiratory pressure (PEEP) and pressure-support ventilation (PSV) on inspiratory muscle effort, we investigated respiratory mechanics in eight ventilator-dependent COPD patients. The patients' breathing pattern, lung mechanics, diaphragmatic effort (PTPdi), diaphragmatic tension-time index (TTdi), and arterial blood gases were measured during both spontaneous breathing (SB) and ventilatory assistance consisting of PSV alone (15, 20, and 25 cm H2O) and PSV combined with a PEEP of 5 cm H2O (reducing PSV to 10, 15, and 20 cm H2O, respectively, to maintain equivalent inspiratory pressure). The different levels of ventilatory support were delivered in a randomized sequence.

Intermediate respiratory care unit: admission criteria.

Intensive care unit (ICU) management of patients on partial ventilatory support is very costly. We opened an intermediate respiratory care unit (RCU), with the aim of providing cost beneficial in-hospital and home care for patients who require mechanical ventilation for at least 8 h.day-1.

Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease.

To assess physiologic effects of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) during noninvasive pressure support ventilation (PSV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), we measured in seven patients the breathing pattern, lung mechanics, diaphragmatic effort (PTPdi), and arterial blood gases under four conditions: (1) spontaneous breathing (SB); (2) CPAP; (3) PSV of 10 cm H2O; and (4) PSV plus PEEP (PEEP + PSV). CPAP and PEEP were set between 80 and 90% of dynamic intrinsic PEEP (PEEPidyn) measured during SB and PSV, respectively. PEEPidyn was obtained (1) from the decrease in pleural pressure (delta Ppl) preceding inspiration, and (2) subtracting the fall in gastric pressure (delta Pga) caused by relaxation of the abdominal muscles from the delta Ppl decrease.

Cardiopulmonary exercise testing in interstitial lung disease.

Interstitial lung disease (ILD) can determine severe lung function impairment both at rest and during exercise. Usually, resting measurements of lung and cardiac function give enough information on the degree of the disease. Thus, exercise testing should be reserved only for particular situations such as presence at the same time of cardiac and respiratory involvement, symptomatic patients with normal spirometry, and to check the response to therapy.

Selection criteria for exercise training in patients with COPD.

The physical performance of patients with chronic obstructive pulmonary disease (COPD) is limited mainly by pathophysiological derangements of the ventilatory system. Thus, the exercise performance can be ameliorated by increasing the level of ventilation that they can sustain, or by reducing the ventilatory requirement for a given level of activity. Almost all studies have yielded negative results in COPD patients, in terms of exercise training having the ability to improve VEmax.

Comparison of gas exchange, lactate, and lactic acidosis thresholds in patients with chronic obstructive pulmonary disease.

During an incremental exercise test, three consequences of the onset of anaerobic metabolism can be observed: rise in blood lactate (lactate threshold, LT); fall in standard bicarbonate (lactic acidosis threshold, LAT); nonlinear increase in CO2 output (V-slope gas exchange threshold, GET). We compared these thresholds in 31 patients with COPD. We found that the GET and LAT overestimated the LT.

Home mechanical ventilation in kyphoscoliosis.

The aim of the study was to determine whether intermittent positive pressure ventilation (IPPV), delivered either by nasal mask or by tracheostomy, is able to improve alveolar gas exchange in kyphoscoliotic patients with respiratory failure. We evaluated 17 patients, 10 females and 7 males, aged 52 +/- 12 (mean +/- SD) yrs. Eight had severe respiratory failure (arterial oxygen tension (PaO2) 53.

Ventilatory and metabolic changes as a result of exercise training in COPD patients.

Patients with COPD feel better and are able to sustain a given level of activity longer after a program of exercise training, but the underlying physiologic mechanisms have not been completely elucidated. Since the physical performance of patients with COPD is limited mainly by pathophysiologic derangements of the ventilatory system, the exercise performance can be ameliorated by increasing the level of ventilation that they can sustain or by reducing the ventilatory requirement for a given level of activity. Almost all studies have yielded negative results in patients with COPD in terms of exercise training having the ability to improve VEmax.

Can long-term oxygen therapy improve exercise capacity and prognosis?

The lack of studies as to whether the correction of desaturations during exercise can play a role in improving survival still leaves many problems usually met in the common practice open. (1) Why prescribe long-term oxygen therapy (LTOT) on exercise? Up to now, supplemental oxygen during exercise seems more an approach to the 'dyspnea symptom' than a pivotal component of a comprehensive strategy for long-term management of severe chronic airway obstruction. (2) Who needs LTOT on exercise? It seems reasonable to correct desaturations if this leads to a substantial improvement in exercise tolerance.

Protective effect and duration of action of formoterol aerosol on exercise-induced asthma.

The short-term protective effect on exercise-induced asthma (EIA) and the duration of action of formoterol, given by metered dose aerosol at a dose of 24 micrograms, were compared with salbutamol (200 micrograms) and placebo in twelve asthmatic EIA-positive patients in a double-blind, placebo-controlled, three period cross-over study. On each treatment day the patients were given one of the drugs or placebo and two exercise tests were performed at the second and at the eighth hour after dosing. Using a standard procedure, exercise was performed by treadmill in well-controlled environmental conditions.

Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease.

Though exercise training is part of most pulmonary rehabilitation programs, whether there is a physiologic basis for increased exercise tolerance is unclear. We sought to determine whether patients with chronic obstructive pulmonary disease (COPD) are capable of obtaining a physiologic training effect, as manifested by a reduction in blood lactate and ventilation (VE) at a given level of exercise. We also sought to determine whether training work rate determines the size of the training effect.

[Indications and results of exercise rehabilitation in patients with chronic obstructive lung diseases].

The aim of physical exercise retraining in patients with chronic obstructive lung disease undergoing rehabilitation is to increase the anaerobic work capacity with a rise in VO2 max. Exercise programmes must take into account the duration, frequency and intensity of exercise. In these patients, numerous factors limit physical exercise, including (a) decreased ventilatory capacity and respiratory muscles fatigue; (b) decreased efficacy of the pulmonary gas exchanges; (c) altered pulmonary vascular bed with altered cardiovascular response.

A new perspective in pulmonary rehabilitation: anaerobic threshold as a discriminant in training.

Exercise training is a mainstay of many pulmonary rehabilitation programmes. However, the physiologic basis for improved exercise tolerance is unclear. We hypothesized that since endurance training is known to reduce blood lactate at levels of work above the anaerobic threshold (AT), minute ventilation (VE) would also be lower.

Relationship between the perception of breathlessness and inspiratory resistive loading: report on a clinical trial.

We investigated the relationship between the sensation of breathlessness and progressively higher resistive inspiratory loadings in nine normal subjects (31 +/- 17 yr; forced expiratory volume in one second (FEV1) = 105 +/- 9% of predicted) and in eighteen chronic obstructive pulmonary disease (COPD) patients (63 +/- 7 yr; FEV1 = 43 +/- 17% of predicted). The sensation of breathlessness correlated with mouth pressure both in normals (r = 0.94) and in COPD patients (r = 0.

A new bronchodilating agent, procaterol, in preventing exercise-induced asthma.

The aim of the present study was to verify the effectiveness of procaterol, a recent and specific beta-2-adrenoceptor stimulant, in preventing exercise-induced asthma (EIA). Twelve asthmatic patients were selected aged 18.6 +/- 5.

[Functional recovery in pulmonary tuberculosis].

At first Authors explain the stages of tubercular disease in which a programme of functional respiratory rehabilitation can be advised. Then they deal with the main aspects of rehabilitating treatment in some tubercular manifestations, as sero-fibrinous pleural effusion, tubercular empyema, parenchymal fibrosis and surgical reliquates. With regard to surgical reliquates, we mostly consider pulmonary resections and pleural skinning.