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Telerehabilitation brings together a set of rehabilitation practices applied remotely by means of information and communication technologies. Even though it has been taking on increasing importance in many health fields over 10 years, telerehabilitation had yet to find its place in pulmonary rehabilitation before 2020, when the pandemic situation impelled numerous teams to put it to work. Pilot studies on respiratory diseases, primarily COPD, along with recent data from randomized or non-randomized studies, have enhanced our understanding of "remote" practice. In this review of the literature, we will show that pulmonary telerehabilitation is feasible, safe and likely to yield short-term (and possibly longer term) effects generally similar to those achieved in the pulmonary rehabilitation programs of specialized centers, especially as regards some indicators of exercise tolerance, dyspnea or patient quality of life. However, the number of studies and patients included in these programs remains too limited in terms of modalities, duration, long-term effects, or adaptations in case of exacerbation to be the subject of recommendations. The potential of respiratory telerehabilitation justifies continuing clinical trials and experiments, which need to be coordinated with the interventions characterizing a conventional program., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

In ancient times Hippocrates described a disease, the 3rd phthisis, which seems to correspond to COPD and is mainly treated by walking, gradually increasing the number of steps until reaching 10,000 steps a day at the end of the initial period of treatment. The recent era began in the second half of the 20th century and ended in 2015, with an unusual Cochrane Library editorial in which it was stated that the accumulated evidence (statistically significant and clinically relevant improvements in clinical signs, tolerance to exercise, quality of life, days hospitalization…) on the effects of rehabilitation programs suffice to suspend research on the subject and to justify focus on new elements in the programs. It is essential, in fact, to establish uniform practical recommendations for the prescription of routine rehabilitation (number and duration of physical activity sessions, therapeutic education, re-training intensity…). In addition, studies should be carried out on new practices: community or home rehabilitation, long-term rehabilitation, tele-rehabilitation., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Physical activity in daily life (PA) in patients with chronic respiratory disease is reduced. Inactivity is associated with an increased risk of hospitalisation and mortality. Even though pulmonary rehabilitation (PR) is associated with improved quality of life (fewer symptoms, greater exercise capacity…), its benefits with regard to PA remain unclear., State of the Art: For each patient, it is important during a respiratory rehabilitation (RR) programme to evaluate PA and its determinants. Only programs aimed at improved self-management and including educational therapy (ETP) have shown a short-term increase of PA following PR. Several studies have reported better long-term adherence when professionals help the patient to construct a personalised PA project, with regular follow-up and an array of activities (local facilities, urban walking…) chosen by the patient and adapted to the environment., Perspectives: The ongoing SARS-CoV2 pandemic has highlighted the importance of human interaction, even at a distance using information and communication technologies, as a means of sustaining patient motivation. Future controlled and randomized studies should focus on the long-term impact on PA of innovative strategies in patients with chronic respiratory diseases. Moreover, it would be interesting to quantify the socioeconomic impact as well as the sustainable health benefits of the different strategies outlined in this review., Conclusion: It is not possible to offer a single solution likely to maintain RR benefits over an extended lapse of time. However, follow-up with an ETP and/or regular and customized support during the post-training period facilitates the long-term adoption of active behavior., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

As chronic respiratory symptoms and the presence of expiratory flow limitation (EFL) are commonly reported in the elderly, we investigated whether they were associated in a population of 75 years old volunteers. We analyzed the results of a prevalence survey of chronic respiratory symptoms and respiratory infections, and performed spirometry and measured EFL after application of a negative expiratory pressure at the mouth (NEP). EFL was present in 170 (46%) subjects, a chronic cough in 49 (13%), chronic sputum in 58 (29%) and a history of respiratory infection in 62 (17%). Chronic cough and the composite outcome "chronic cough or sputum" were significantly associated with the presence of EFL (respectively 60% vs. 43%, OR=2.04 [1.09 to 3.78], P=0.023, and 56% vs. 43%, OR=1.74 [1.05 to 2.87], P=0.04), after controlling for smoking or airway obstruction. History of respiratory infections were not associated with an increased prevalence of EFL. We concluded that the presence of a LED could be an interesting indicator of respiratory aging. Its detection could be advocated in elderly subjects presenting with respiratory symptoms., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: We report the case of a young woman presenting with dyspnoea of effort. Her records noted that correction of a double aortic arch had been performed in the neonatal period. At rest her flow/volume loop showed a moderate reduction of peak flow without an expiratory plateau. Exercise capacity was limited by sudden onset, during the last 2 stages of the test, of inspiratory dyspnea and tachypnea. During recovery there was no evidence of bronchospasm., Case Report: With this picture we suspected upper airway obstruction and bronchoscopy revealed tracheal compression to 50% of normal. CT scan with 3 dimensional reconstruction showed the trachea compressed between 2 aortic branches. In order to confirm that the tracheal compression increased during exercise we induced sympathetic stimulation by a "handgrip" test that reproduced the inspiratory dyspnea and lead to a reduction in inspiratory flows., Conclusion: We have thus demonstrated that the increase in tracheal compression leading to limitation of airflow on exercise was due to an increase in aortic pressure and not to an increase in ventilatory flows.

The decrease in pulmonary function tests (PFTs) in retired coal miners who complain of increased exercise dyspnoea does not precisely reflect exercise tolerance. PFTs and a maximal cardiopulmonary exercise test in order to determine peak were performed in thirty-eight patients (69.7 +/- 6.7 years old). They also completed a six-minute walk test (6MWD) in order to evaluate its sensibility to detect a limitation of peak. Quality of life was assessed by the Saint George's Hospital Respiratory Questionnaire (SGRQ). PFTs were within normal values in 21 patients whereas 8 patients showed an obstructive pattern, 4 a restrictive one and 5 gas exchange abnormalities only. We found a mild decrease in peak at 70.4 +/- 15.9% of reference value. Exercise limitation was explained by a poor ventilatory adaptation in 36.8% of cases, cardiac abnormalities in 23.7% and both in 7.7%. 6MWD was within normal at 83.7 +/- 15.6% of reference value. Neither peak, maximal workload nor 6MWD correlated with the results of PFTs. In patients with normal pulmonary function, the 6MWD had an 80% sensitivity at predicting a decrease in peak. The total SGRQ index of 51% represents the effect of dyspnoea on quality of life. We conclude that there is moderate impairment of maximal exercise capacity in one third of retired coal miners complaining of exercise dyspnoea, irrespective of PFTs results. We suggest that 6MWD could be used to detect a decreased exercise tolerance in these patients with normal PFTs, but should be followed up with a maximal cardiopulmonary exercise test if found to be abnormal.

We performed polysomnography and measured hypoxic ventilatory (HVR), hypercapnic ventilatory responses (HCVR) in 42 patients (60 +/- 11 years) with obesity and a clinical suspicion of sleep apnea syndrome (SAS) in order to determine whether an altered chemosensitivity was associated with SAS. The apnea/hypopnea index was 38 +/- 20 events per hour of sleep in 28 patients (SAS+ group) and less than 10 in the 14 others (SAS- group). The 2 groups differed only by a lower waking PaO2 in SAS+ as compared to SAS- (71.0 +/- 9 vs 77.4 +/- 8 mmHg, p < 0.05). HVR and HCVR were not significantly different in the 2 groups (0.82 +/- 0.58 vs 0.86 +/- 0.37 l.min-1.%-1; 1.41 +/- 0.81 vs 1.40 +/- 0.67 l.min-1.mmHg-1, respectively). In SAS+ group, HVR or HCVR did not change 3 or 12 months after continuous positive airway pressure (CPAP) therapy while both polysomnography and PaO2 returned to normal. We conclude that in patients with mild obesity and SAS there is no difference in chemosensitivity due to the presence of sleep apnea and that CPAP therapy does not alter these measurements. These results suggest no direct effect of SAS on chemosensitivity in the population studied.