Rosa Güell Rous

Benefits of a Home-Based Pulmonary Rehabilitation Program for Patients With Severe Chronic Obstructive Pulmonary Disease

OBJECTIVE The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease (COPD) are uncertain. We aimed to assess the short- and medium-term efficacy of such a program in this clinical setting. PATIENTS AND METHODS Patients with severe COPD (stages III-IV, classification of the Global Initiative for Chronic Obstructive Lung Disease) and incapacitating dyspnea (scores 3-5, Medical Research Council [MRC] scale) were randomized to a control or domiciliary rehabilitation group. The 9-week supervised pulmonary rehabilitation program included educational sessions, respiratory physiotherapy, and muscle training in weekly sessions in the patients home. We assessed the following variables at baseline, 9 weeks, and 6 months: lung function, exercise tolerance (3-minute walk test), dyspnea (MRC score), and health-related quality of life with the Chronic Respiratory Questionnaire (CRQ). RESULTS Thirty-eight patients with a mean (SD) age of 68 (6) years were enrolled. The mean MRC score was 4 (0.8) and mean forced expiratory volume in 1 second was 29% of reference. Twenty-nine patients completed the study (6 months). Distance covered on the walk test increased significantly in the rehabilitation group (P=.001) and the difference was maintained at 6 months. Dyspnea also improved significantly with rehabilitation (P<.05), but the reduction was not evident at 6 months. Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks: dyspnea (3.1 [0.8] vs 3.6 [0.7]; P=.02) and fatigue (3.7 [0.8] vs 4.2 [0.9]; P=.002). A clinically relevant but not statistically significant change in mastery over disease was detected (from 4.3 to 4.9). All improvements were maintained at 6 months. CONCLUSIONS Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months.

Oxigenoterapia continua domiciliaria

Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.

Influencia de un programa de rescate en la decisión quirúrgica en pacientes con carcinoma broncogénico y EPOC

Objetivo: La asociacion entre carcinoma broncogenico y enfermedad pulmonar obstructiva cronica (EPOC) se situa en torno al 70% en nuestro medio. Aproximadamente un 60% de los pacientes con dichos diagnosticos son rechazados para cirugia de reseccion del carcinoma broncogenico debido a la intensa alteracion de su funcion pulmonar. El objetivo del presente trabajo es evaluar el efecto de un programa de rescate en la mejoria de la funcion pulmonar de pacientes con EPOC y previamente descartados para cirugia por la alteracion de su funcion pulmonar. Pacientes y metodos: Se incluyo en el estudio a pacientes con EPOC descartados inicialmente porque se habia calculado que su volumen espiratorio forzado en el primer segundo (FEV1) tras la intervencion quirurgica seria menor de 1 l. Todos ellos participaron en un programa de rescate de 2 semanas de duracion que incluia: optimizacion del tratamiento farmacologico (broncodilatadores inhalados y/o corticoides) y fisioterapia respiratoria intensiva. Se analizo la funcion pulmonar antes y despues del programa. Resultados: Se evaluo a 30 pacientes (26 varones y 4 mujeres) con una edad media ± desviacion estandar de 66,7 ± 8,15 anos y FEV1 inicial de 1,497 ± 0,27 ml (FEV1%: 55,7 ± 20,14 l), que no presentaban insuficiencia respiratoria (presion arterial de oxigeno: 77,0 ± 9,4 mmHg; presion arterial de anhidrido carbonico: 41,6 ± 2,4 mmHg). Tras el programa 24 pacientes (80%) pudieron ser aceptados para la reseccion propuesta al objetivarse una mejoria significativa en la funcion pulmonar (p < 0,001). Se realizaron 2 resecciones en cuna, 18 lobectomias, 2 neumonectomias y 2 toracotomias exploradoras (por criterios oncologicos). De los 24 pacientes a los que se intervino, en 19 no hubo complicaciones, 2 presentaron fugas aereas mantenidas, hubo un caso de empiema pleural y otro de hemotorax. Un paciente fallecio por sepsis. Conclusiones: El diseno de un programa intensivo farmacologico y de fisioterapia respiratoria permite rescatar para cirugia a un numero alto (80%) de los pacientes con EPOC a los que inicialmente se descarta por una alteracion importante de la funcion pulmonar.

Impact of a Rescue Program on the Operability of Patients With Bronchogenic Carcinoma and Chronic Obstructive Pulmonary Disease

Objective Bronchogenic carcinoma and chronic obstructive pulmonary disease (COPD) are strongly associated in our setting, occurring together in around 70% of cases. Approximately 60% of COPD patients who require resection for bronchogenic carcinoma are considered unfit for surgery because of seriously impaired lung function. The purpose of this study was to evaluate the extent to which a rescue program could improve lung function in COPD patients who had previously been considered unfit for surgery because of poor lung function. Patients and methods The study enrolled COPD patients who had not been considered for surgical resection because they had a predicted postoperative forced expiratory volume in 1 second (FEV1) of less than 1 L. All of the patients participated in a 2-week rescue program that involved optimization of drug treatment (inhaled bronchodilators and/or corticosteroids) and intensive respiratory physiotherapy. Lung function was analyzed before and after the program. Results We evaluated 30 patients (26 men and 4 women) with a mean (SD) age of 66.7 (8.15) years and an initial FEV1 of 1.497 (0.27) mL (FEV1 % of 55.7% [20.14%]). None of the patients had respiratory failure (PaO2 of 77.0 [9.4] mm Hg and PaCO 2 of 41.6 [2.4] mm Hg). Twenty-four patients (80%) showed significant improvement in lung function (P Two wedge resections, 18 lobectomies, 2 pneumonectomies, and 2 exploratory thoracotomies were performed (based on oncologic indications). Nineteen of the 24 patients who underwent surgery had no complications. Two patients had prolonged air leaks, 1 empyema, and 1 hemothorax. One patient died from sepsis. Conclusions A large number (80%) of COPD patients previously considered unfit for surgical resection because of seriously impaired lung function can be admitted for surgery following an intensive drug and respiratory physiotherapy rescue program.

Entrenamiento de los músculos periféricos en pacientes con EPOC

La disnea es el síntoma más común en la enfermedad pulmonar obstructiva crónica (EPOC). Ésta provoca una disminución progresiva de la capacidad funcional del individuo hasta limitarlo en las actividades más simples de la vida cotidiana. Esto conduce a una pérdida de la autonomía desarrollándose un severo grado de invalidez. Esta situación provoca una alteración intensa en la calidad de vida del individuo y una transformación lenta y progresiva de su relación con el entorno sociofamiliar, además de favorecer una fuerte dependencia de las estructuras sanitarias. En estas situaciones de enfermedad respiratoria invalidante el paciente entra en un círculo vicioso en el cual cuanto más disnea menos movilidad y cuanto menor movilidad mayor disnea. La única posibilidad de romper este círculo vicioso es realizando ejercicio físico de forma controlada y sistematizada. Parece claro que el ejercicio físico mejora la calidad de vida de las personas sanas e incluso puede influir en la supervivencia1. Bajo esta premisa podríamos suponer que el ejercicio físico en los pacientes con EPOC tiene que producir los mismos beneficios. A finales del siglo XIX se publicó por primera vez un programa sistematizado de ejercicio para pacientes con limitación funcional debido a secuelas de tuberculosis pulmonar. En este programa se aceptaba que el ejercicio, además de una adecuada alimentación, conseguía mejorar al paciente de forma importante. Sin embargo, hasta la aparición de los trabajos de Barach et al, los médicos consideraban que la mejor terapia para los pacientes con disnea era el reposo. Alvan Barach y Albert Hass, fueron dos pioneros de la rehabilitación respiratoria. Ambos contribuyeron, con sus estudios y opiniones, al nacimiento de la fisioterapia respiratoria y del ejercicio físico como estrategias terapéuticas en las enfermedades respiratorias disneizantes. Aún hoy día, sus opiniones y consejos son una fuente de gran valor en rehabilitación respiratoria2,3. Factores limitantes al esfuerzo en la EPOC

Normativa SEPAROxigenoterapia continua domiciliariaContinuous Home Oxygen Therapy

Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.