Search

Résumé: La réhabilitation pulmonaire est une intervention transdisciplinaire et structurée destinée aux patients atteints de bronchopneumopathie chronique obstructive (BPCO), qui peut réduire la dyspnée et améliorer l''intolérance à l''exercice et la qualité de vie. Cette intervention présente un rapport de coût/efficacité favorable; elle diminue en effet l''utilisation des soins de santé. Le réentraînement à l''effort est un élément essentiel dans tout programme de réhabilitation pulmonaire. Pour obtenir des effets substantiels, on recommande de prescrire un réentraînement supervisé, à haute intensité, trois à cinq fois par semaine, avec des sessions ayant une durée de 30 à 45 minutes. Un minimum de 20 sessions est recommandé. Des programmes comprenant un nombre plus important de sessions mènent à des effets plus prononcés et prolongés. Un programme d''éducation visant une meilleure connaissance de la maladie et de la prise en charge par le patient même d''une exacerbation de BPCO, peut diminuer le nombre d''hospitalisations. Une intervention nutritionnelle doit être prise en considération chez les patients présentant une dénutrition ou une diminution de la masse musculaire. Les patients anxieux peuvent bénéficier d''un support psychosocial, tandis que l''intégration d''une prise en charge ergothérapeutique peut promouvoir l''autonomie du patient dans ses activités quotidiennes et réduire son isolement. Tout programme de réhabilitation pulmonaire devrait être de préférence ambulatoire. Les programmes en hospitalisation doivent être réservés aux patients présentant des problèmes de transports ou un déconditionnement sévère. Les effets les plus convaincants d''un programme de réhabilitation pulmonaire organisé au domicile du patient ont été observés dans le contexte d''une maintenance des bénéfices obtenus après un programme ambulatoire. [Copyright 2007 Elsevier]

Abstract: Pulmonary rehabilitation, a multidisciplinary and structured intervention for patients with chronic pulmonary diseases, has been shown to improve exercise tolerance, reduce dyspnea and improve health-related quality of life. Pulmonary rehabilitation appears to be cost-effective, since it reduces health care utilization. Exercise training represents the cornerstone of every pulmonary rehabilitation program. To obtain clinically relevant effects, training should closely supervised, of high intensity, lasting 30–45 min for at least 3 days/week. Patients should undertake a minimum of 20 sessions, but longer programs result in larger and more long-lasting effects. Education and self-management programs have been shown to result in a substantial reduction in hospital admissions. Nutritional intervention should be considered for patients who are underweight or those with body composition abnormalities. Patients reporting fear and anxiety may benefit from psychosocial support, and the integration of occupational therapy in a pulmonary rehabilitation program can improve independence in activity. Multidisciplinary pulmonary rehabilitation is preferably implemented in an outpatient hospital- or community-based setting. Inpatient programs are suited for patients with limited transportation capabilities or severe deconditioning. The most convincing effects of home-based rehabilitation are in maintaining the improvements obtained in an outpatient setting. [Copyright &y& Elsevier]

The aim of the study was to characterize pharmacokinetics of tiotropium solution 5 µg compared to powder 18 µg and assess dose-dependency of tiotropium solution pharmacodynamics in comparison to placebo. In total 154 patients with chronic obstructive pulmonary disease (COPD) were included in this multicenter, randomized, double-blind within-solution (1.25, 2.5, 5 µg, and placebo), and open-label powder 18 µg, crossover study, including 4-week treatment periods. Primary end points were peak plasma concentration (Cmax,ss), and area under the plasma concentration-time profile (AUC0-6h,ss), both at steady state. The pharmacodynamic response was assessed by serial spirometry (forced expiratory volume in 1 second/forced vital capacity). Safety was evaluated as adverse events and by electrocardiogram/Holter. Tiotropium was rapidly absorbed with a median tmax,ss of 5-7 minutes postdosing for both devices. The gMean ratio of solution 5 µg over powder 18 µg was 81% (90% confidence interval, 73-89%) for Cmax,ss and 76% (70-82%) for AUC0-6h,ss, indicating that bioequivalence was not established. Dose ordering for bronchodilation was observed. Powder 18 µg and solution 5 µg were most effective, providing comparable bronchodilation. All treatments were well tolerated with no apparent relation to dose or device. Comparable bronchodilator efficacy to powder18 µg at lower systemic exposure supports tiotropium solution 5 µg for maintenance treatment of COPD. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Little is known about the impact of an oncological treatment on muscle mass and strength in patients with lung cancer and the impact of a subsequent rehabilitation program. This study investigates the effect of radical treatment and post-treatment pulmonary rehabilitation on muscle mass and strength in patients with lung cancer and the relationship between muscle mass and strength. Methods: Lung cancer patients, candidate for radical treatment, were randomly (2:1) allocated after radical treatment to either standard follow up (CON) or a 12-week rehabilitation training program (RT). Muscle mass was estimated by bioelectric impedance and CT-scan. Muscle strength was estimated by measuring quadriceps force (QF) with a hand held dynamometer. All variables were measured before (M1) and after radical treatment (M2), and at the earliest 12 weeks after randomization (M3). Data are presented as means with standard deviation. Results: 45 lung cancer patients (age: 65 years (9)) participated in the study. At M2, both muscle cross sectional area (MCSA) and QF were significantly decreased (p <0.05). 28 patients were randomized. 13/18 RT and 9/10 CON patients ended the trial. At M3, RT-patients improved significantly their MCSA compared to CON-patients (ΔMCSA: 6cm2 (6) (p =0.003) vs. 1cm2 (11) (p =0.8)). Conclusion: Muscle mass and strength: (1) are decreased at presentation in a substantial part of lung cancer patients; (2) are significantly negatively affected by radical treatment and (3) completely recover after a 12 week structured rehabilitation program, whereas a further decline was observed in CON-patients. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Recently performed long term trials have enhanced the insight into the assessment of progression of COPD. The present review focuses on the initial assessment of COPD in general practice and the assessment of disease progression. Several variables may be used to assess this progression, all of which are associated with significant methodological problems. Finding the appropriate mix of outcome measures to capture all aspects of disease progression is a significant challenge. [ABSTRACT FROM AUTHOR]