Bihiyga Salhi

Effects of Pulmonary Rehabilitation in Patients With Restrictive Lung Diseases

BACKGROUNDnPulmonary rehabilitation programs improve exercise tolerance, muscle strength, and dyspnea in patients with COPD. The aim of the study was to assess prospectively the effectiveness and feasibility of pulmonary rehabilitation in patients with restrictive lung diseases.nnnMETHODSnIn a prospective, nonrandomized, noncontrolled study, patients with an established diagnosis of restrictive lung disease (RLD) participated in a 24-week outpatient multidisciplinary rehabilitation program. Pulmonary function, exercise capacity, muscle force, and dyspnea were measured at inclusion, after 12 and 24 weeks of rehabilitation. Primary outcome was the change in 6-min walk distance (6MWD) after 12 weeks of rehabilitation.nnnRESULTSnTwenty-nine patients out of 31 patients (57 +/- 17 years of age; 21 men; FEV(1): 1.4 +/- 0.7 L) completed the 12-week rehabilitation program and 26 patients the 24-week rehabilitation program. At inclusion, exercise tolerance (maximal oxygen consumption [V(O(2))max]: 63% +/- 27% predicted; 6MWD: 390 +/- 140 m) and quadriceps force ([QF] 61% +/- 21% predicted) were reduced, and dyspnea, assessed using the Chronic Respiratory Disease Questionnaire (CRDQ), was increased (CRDQ item dyspnea [CRDQd]: 16 +/- 6 points). Exercise capacity, muscle force, and CRDQd improved significantly after 12 weeks (6MWD: 445 +/- 142 m; V(O(2))max: 69% +/- 30% predicted; QF: 73% +/- 25% predicted; CRDQd: 20 +/- 6 points) (P < .05). Further improvements were noted after 24 weeks (6MWD: 463 +/- 146 m; CRDQd: 22 +/- 6 points).nnnCONCLUSIONSnPatients with RLD respond well after 12 weeks of pulmonary rehabilitation, and even better results were seen after 24 weeks. Clinically significant improvements were obtained in the majority of the patients after 24 weeks.

Genetic variation in three candidate genes and nicotine dependence, withdrawal and smoking cessation in hospitalized patients

AIMSnThis study evaluates the relationship of six polymorphisms found in the CHRNA3, DRD2 and COMT genes with nicotine dependence, the ability to quit smoking and the occurrence of withdrawal symptoms after short-term use of nicotine patch in hospitalized patients.nnnMATERIALS & METHODSnThe study included 233 participants from a double-blind, placebo-controlled trial of nicotine patch substitution with a 6-month follow-up period. Nicotine dependence was assessed by the Fagerström Test for Nicotine Dependence (FTND) questionnaire, withdrawal symptoms by the Minnesota Nicotine Withdrawal Scale questionnaire and smoking cessation by self-reported abstinence at 1 week, 1 month and 6 months after treatment.nnnRESULTSnAfter correcting for multiple testing, three polymorphisms in the DRD2 gene (Taq1A, Taq1B and Pro319Pro) were significantly associated with nicotine dependence (p = 0.018, p = 0.048 and p = 0.006, respectively). Using a cutoff point for the FTND score, the CHRNA3 Tyr215Tyr (rs1051730) polymorphism was also associated with nicotine dependence (p = 0.037 and p = 0.074 after correction for multiple testing). No association of any of the studied polymorphisms was observed with either smoking cessation or the occurrence of withdrawal symptoms.nnnCONCLUSIONnThis study confirms the reported association of the CHRNA3 locus with nicotine dependence and shows the involvement of two independent DRD2 polymorphisms in nicotine dependence.

Quantitative perfusion scintigraphy or anatomic segment method in lung cancer resection

BACKGROUNDnQuantitative Perfusion Scintigraphy (QPS) and Anatomic Segment Method (ASM) are two techniques for estimating postoperative pulmonary function. QPS is gold standard, but holds disadvantages.nnnAIMnCould ASM substitute QPS in the preoperative work-up of NSCLC?nnnMETHODSnRetrospective study in patients with NSCLC or mesothelioma undergoing resection. FEV1 and DL,CO were estimated by QPS and ASM and compared to pulmonary function measured 3 months after resection. Correlation tests and Bland-Altman analyses were performed.nnnRESULTSn40 patients (23 lobectomies, 14 pneumonectomies). Both methods correlated similarly with postoperative FEV(1) (QPSρ=0.69; ASMρ=0.75) and DL,CO (QPSρ=0.70; ASMρ=0.74). Correlation between both methods was high (ppoFEV(1)ρ=0.89; ppoDL,COρ=0.89). The same principles applied in a subgroup analysis of patients with COPD. Bland-Altman analyses showed that ASM underestimated postoperative FEV(1) and DL,CO more than QPS in all groups.nnnCONCLUSIONnQPS and ASM are remarkably similar in predicting postoperative pulmonary function. As ASM underestimates pulmonary function more, it could be a safe alternative from a cost-benefit point of view. Based on these results, it appears that QPS could be restricted to patients in whom ASM suggests functional inoperability, although further prospective studies are necessary.

Endurance and Resistance Training in Radically Treated Respiratory Cancer patients: A Pilot Study

Introduction. Respiratory cancer and its treatment are known to contribute to muscle weakness and functional impairment. Aim. To assess the effects of rehabilitation in patients with respiratory cancer. Methods. Radically treated respiratory cancer patients were included in a 12-week multidisciplinary rehabilitation program. Results. 16 patients (age: 61 ± 7 years; FEV1: 57 ± 16% pred.) showed a reduced exercise tolerance (VO2max: 56 ± 15% pred.; 6 MWD: 67 ± 11% pred.), muscle force (PImax: 54 ± 22% pred.; QF: 67 ± 16% pred.), and quality of life (CRDQd: 17 ± 5 points; CRDQf: 16 ± 5 points). Exercise tolerance, muscle force, and quality of life improved significantly after rehabilitation. Conclusion. Radically treated patients with respiratory cancer have a decreased exercise capacity, muscle force, and quality of life. 12 weeks of rehabilitation leads to a significant improvement in exercise capacity, respiratory muscle force, and quality of life.