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Diseases associated with chronic respiratory failure have a negative impact on quality of life and life expectancy, notably through a reduction in patients' functional capacity. Assessing balance, coordination, muscular strength and endurance, as well as exercise tolerance, is therefore an important component of the evaluation of individuals with chronic respiratory failure. This evaluation can be made easier by using simple tools such as sit-to-stand tests. This review presents the main sit-to-stand tests that have been described and that can be used in everyday practice. The aim is to provide information to the clinician on the contribution of each test, and to identify the extent to which and the purpose for which these tests can be incorporated into a routine pulmonology and/or respiratory rehabilitation evaluation. Because of their inherently functional nature, these tests could help to identify the indications and/or the effects of respiratory rehabilitation., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Pulmonary rehabilitation (PR) for patients undergoing lung resection for cancer remains controversial. We studied the effects of PR, its impact on quality of life and the level of anxiety and depression., Methods: In 2011 and 2012, PR was offered to all patients referred to our institution after lung resection for cancer. Patients were evaluated between admission and discharge by a 6 minutes walking test (6MWD), a Visual Analogue Pain Intensity Scale, a quality of life questionnaire (EORTC QLQ C30) and by the Hospital Anxiety and Depression Scale (HAD). The same questionnaires were mailed 6 months after completing PR., Results: Between early 2011 and late 2012, 133 patients were admitted to our institution following lung resection for cancer. Of these, 59 (44%) patients completed PR and returned their questionnaires 6 months after discharge. During PR of these 59 patients, the mean quality of life score increased from 56.3 to 65.9 (P<0.05), the median anxiety score decreased from 5.5 to 4 (P<0.05) and that of depression from 3 to 2 (P<0.05). At 6 months post-discharge, the mean quality of life score remained stable at 66.3 (P=0.8), the median anxiety score reverted to 6 (P<0.05) and the median depression score reverted to 4.5 (P<0.05)., Conclusion: This observational study during PR, showed that quality of life and the levels of anxiety and depression were improved at the end of the course. After returning home, the average quality of life score remained stable but the level of anxiety and depression increased., (Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Scheduled and/or thoracic, abdominal surgeries increase the risk of respiratory postoperative complications. In patients with chronic respiratory failure, preoperative evaluation should be performed to evaluate respiratory function in aim to optimize perioperative management. Preoperative gas exchange abnormalities (hypoxemia or hypercapnia) are associated with respiratory postoperative complications. Respiratory physiotherapy and prophylactic non-invasive ventilation should be integrated in a global rehabilitation management for cardiothoracic or abdominal surgery procedures, which are at high risk of postoperative respiratory dysfunction. Stopping tobacco consummation should be benefit, but decease risk of postoperative complications is relevant only after a period for 6 to 8 weeks of cessation. Bronchodilatator aerosol therapy (beta-agonists and atropinics) and inhaled corticotherapy allow a rapid preparation for 24 to 48 h. Systematic preoperative antibiotherapy should not be recommended., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Patients who suffered from an exacerbation of a chronic respiratory disorder are often very limited in terms of their exercise capacity because of severe dyspnea and amyotrophy of peripheral muscles. Early implementation of pulmonary rehabilitation may help these patients to avoid the complications of a prolonged bedridden period, and increase more rapidly their mobility. Early rehabilitation has become more frequent, but requires special skills from the care givers (chest therapists). Techniques which enhance muscular performance and motility of patients who are recovering from an exacerbation such as electromoystimulation or mobilisation under non-invasive ventilation, give encouraging results; their impact on length of hospital stay requires further studies.

State of the Art: The IRAD2 trial is evaluating a 3-month home intervention which includes education, oral supplements, exercise and androgenic steroids in undernourished patients with chronic respiratory failure. The main objective is to increase the six-minute walking distance by more than 50 m with an improvement in health-related quality-of-life. Secondary end-points include a reduction in exacerbation rates by 25%, a reduction in health-related costs and an increase in survival during the year following intervention., Material and Methods: This interventional, multi-centre, prospective, two-armed parallel, controlled trial is being conducted in 200 patients. In both groups, "Control" and "Rehabilitation", 7 home visits are scheduled during the 3-month intervention for education purpose. In the "Rehabilitation" group, patients will receive 160 mg/d of oral testosterone undecanoate in men, 80 mg/d in women, oral dietary supplements (563 kcal/d) and exercises on an ergometric bicycle 3 to 5 times a week., Expected Results: In the event of significant responses to intervention, this trial would validate a comprehensive and global home-care for undernourished patients with chronic respiratory failure combining therapeutic education, oral supplements, androgenic substitution and physical activity.

In the absence of severe clinical signs requiring endotracheal intubation, non-invasive mechanical ventilation is the first-line treatment in patients with chronic respiratory insufficiency. For a patient with non-invasive support, the probability to avoid intubation is 2 or 3 times higher than for a patient initially treated by oxygen therapy alone. Oxygen therapy will remain the recommended approach for staff unfamiliar with non-invasive support. In chronic obstructive pulmonary disease (COPD) ventilated patients, keeping the intrinsic positive end-expiratory pressure to a minimum level decreases the risk of barotrauma. During exacerbation, in these patients, the 3 most often prescribed medications are inhaled bonchodilators, corticosteroids, and antibiotics. In addition to long term home oxygen therapy, the preventive measures include education of patients, pulmonary rehabilitation programs, and eventually routine use of ventilatory support in a home ventilatory setting.

In France, 65,000 patients with chronic respiratory failure are managed at home. This is made possible by the collaboration between prescribing physicians and other medical and social agents in the community. It consists in various medical, technical and social interventions, all aimed at improving both survival and quality of life. Patient and family education is a key-factor to increase the success of the various therapeutic interventions that are rehabilitation, long term oxygen therapy and home mechanical ventilation. Rehabilitation programmes include optimisation of pharmacological treatments, help in smoking cessation, social and psychological support, and exercise training. National alert procedure for medical devices, and evaluation of medical devices is part of the management of respiratory failure at home. Care networks facilitate the various interventions necessary to maintain the patient with chronic respiratory failure at home.

Respiratory rehabilitation is defined as a medical practice including a multidisciplinary medical program fitting each individual. Personalized retraining by means of exercises, is the master part of it, its aim is to improve the physical fitness in specialised institution then to maintain it when he becomes an out patient. In both cases, this retraining complies with strict rules concerning the mode of exercises (imposed power--duration of sessions--weekly frequency--progressiveness of overloading ...). This codification rests mainly on the recommendations of the American College of Sports Medicine. The choice of intensity at the beginning of the stay will be determined either by the maximal reserve of cardiac frequency or by the ventilatory threshold. This training has to involve extensive muscular mass and must not neglect the upper limbs. Ventilatory physiotherapy also plays an important part. The other components of rehabilitation concern optimisation of bronchodilator treatment, cessation of smoking, health education, physical education and relaxation, appraisal of nutritional status, assessment of therapeutic programs, of the quality of life and a long-term program for reinforcement of acquisitions. The therapeutic programs improve ventilatory performance, maximal oxygen intake, maximal tolerated power and quality of life. An adaptation of the St. George's Respiratory Questionnaire to patients hosted at the TOKI EDER Medical Center points out that the quality of life of patients with chronic respiratory failure is improved very highly significantly by this rehabilitation.

Pulmonary rehabilitation is directed at all patients with severe chronic respiratory insufficiency of any origin. Patients with chronic obstructive pulmonary disease clearly represent the majority. In a pulmonary rehabilitation programme, the patient must gain a better understanding of his disease and of the goals of the treatment. He benefits from permanent teaching on methods of independent self-treatment and follows a regular programme of exercise training and nutritional support aimed at increasing effort capacity. The ultimate goal of the programme is to send the patient home with improved quality of life and a higher degree of independence.

In view of the readaptation of patients with respiratory insufficiency, the interrogation should aim at a clinical synthesis and define the sociological, familial and psychological context. It can be done by two ways; both with their pros and cons: 1) directed or self interrogation; 2) free talk or open questions. The first way is more specific, scientific, but less personal while the second is more personal though less objective. The latter is to be prefered, but a certain neutrality should be kept.

The authors described an optical technique enabling patients with chronic respiratory insuffiency, at first to get used to assisted ventilation, then to control it, to obtain an active ventilation operated by machine corresponding to a particular shape of the pressure curve and to the lesser haemodynamic repercussion.

Two patients aged 69 and 75 respectively and suffering from chronic obstructive lung disease (Par CO2 7.8 and 9.2 kPa at rest) were trained on a treadmill for 6 months. Twice a week, they were asked to walk for an increasing length of time (up to 30 min) and with increasing work load under continuous heart rate (HR) monitoring. On the remaining days of the week, they had to walk on their own during 30 min. Examinations performed before and after 3 and 6 months of training showed no change in lung function tests at rest, an increase in maximal work load, VO2 max and maximum HR, and a delayed anaerobic threshold. The subjects claimed greater fitness. This study demonstrates that elderly patients with respiratory impairment can benefit from exercise training, the changes observed consisting of better cardiac and metabolic adaptation to exercise.

For a good respiratory re-education, the handicap must be analyzed together with its causes and mechanisms, in relation with the patient's social environment, his age and profession. The handicapping factors should be analyzed in a medico-social (pollution, weather) and medical context by detecting the affection involved and the functional analysis. The latter is deduced from the clinical signs and measurements defining the functional syndrome justifying an appropriate treatment. The importance of the handicap is drawn out of the clinical measures of maximum effort studied by ergometry. There are 2 levels of handicap (without alteration of blood gases at rest) and of respiratory insufficiency: simple or complicated by decompensation bouts enabling the choice of re-adapatation methods correlated with age an environment. Clinical and functional supervision as well as the study of the integration in the environment, form the basis of the analysis of results obtained in 2 comparable groups or in one homogeneous group subjected first to a simple medical treatment, then to re-adaptation.