Search

Basic Problem and Objective of the Study: Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and improve exercise tolerance in patients with severe lung emphysema. The aim of this study was to analyse changes of lung function, gas exchange, exercise tolerance and degree of dyspnoea one and 3 months after LVR., Patients and Methods: Seventeen patients (15 men and two women; mean age 53 [38-68] years) with severe emphysema (six with alpha 1-PI deficiency) underwent unilateral (n = 14) or bilateral (n = 3) LVR surgery. One week before and one and 3 months after surgery pulmonary function tests, arterial blood gas analysis at rest breathing room air, 6-minute walking distance and dyspnoea score (Medical Research Council Scale) were determined., Results: There was a significant increase in forced expiratory vital capacity after one second (FEV1, P < 0.001), and a significant decrease in total lung capacity (TLC, P < 0.0001) and residual volume (RV, P < 0.0001). The mean increase in FEV1 was 39% and in PaO2 9%. The mean decrease in TLC was 20%, in RV 26% (P < 0.001; both comparisons), and in paCO2 4% (not significant). The mean 6-minute walking distance increased by 96% from 229 to 405 meters (P < 0.0001). The mean dyspnoea score on a five point scale (0-4 points) decreased by 52% from 3.4 to 1.6. With the exception of the improved inspiratory vital capacity the postoperative results at one and 3 months after LVR did not differ significantly. All patients were alive 3 months postoperatively., Conclusions: In patients with severe emphysema surgical LVR shows significantly improved pulmonary function, gas exchange, dyspnoea and walking distance as assessed one and three months postoperatively. The early mortality seems to be low.

The protease-antiprotease concept has contributed substantially to the pathogenetic understanding of different internistic disease patterns including the generalised, histologically mostly panlobular pulmonary emphysema. Attention is presently focused on alpha-1-antitrypsin protease inhibitor deficiency for which substitute solutions are already available. We present a case report on a patient of 40 years of age suffering from a severe, basally located pulmonary emphysema (as was evident on x-ray examination) with respiratory global insufficiency and an obstructive component that was only partially reversible under medication. Laboratory chemistry revealed that this was associated with an alpha-2-macroglobulin deficiency. Possibly the deficiency in this protease inhibitor of low specificity but broad spectrum of action may contribute to a better understanding of some of the types of emphysema that had so far been subclassified as cryptogenic although bearing traits of "proteinase inhibitor deficiency".

As the third "pillar" in the treatment of chronic obstructive airway diseases after acute treatment and long-term drug treatment aimed at avoiding late sequelae of the disease, this article describes the "patient school". Its aims are, on the one hand to motivate the patient to develop better compliance, and, through the utilisation of non-medicamentous possibilities, to greatly improve the patient's quality of life and his long-term prognosis. The Bad Reichenhall model is characterized as an integrated concept with the following main thrusts: helping the patient to better cope with and accept his disease, to provide education and behavioral training with the aim of permitting the patient to adapt his activities to the constraints of his disease.

In a pilot evaluation study, 186 out of-so far-600 patients who underwent 40 "educational cycles" were submitted to a controlled interview to determine the learning effect, patient's views on educational matters and, at least in part, on the success of the latter in terms of improved quality of life, treatment and the social environment. For this purpose, questions that appeared similar while having the identical content, were asked prior to "schooling", immediately following such instruction and six months later. The return rate of the 6-month questionnaires achieved an astonishing almost 80%, which represents a very good figure. Sixteen questions were asked about the contents of instruction, which, in turn, divided up into six complexes.

The modern lung hospital offers favorable conditions for the rehabilitation of patients suffering from chronic obstructive pulmonary diseases. In the years from 1972 to 1976 2398 patients suffering from chronic bronchitis, bronchial asthma and pulmonary emphysema were subjected to a rehabilitation process at the central hospital for heart and lung diseases Bad Berka. A long-term therapy plan based on a most accurate investigation possible of all the factors which trigger off the complaint in each case was used as baseline. An account is given of the resulting diagnostic and therapeutic program carried out. In the case of chronic obstructive pulmonary diseases it is particularly difficult to assess the effectiveness of rehabilitation measures. One aspect dealt with is the restoration of working capacity. 56.7% of the men and 56.8% of the women were capable of working when they were dismissed. 31.6% of male and 26.4% of female patients were invalids, 11.7% and 16.8% respectively were old age pensioners. Rehabilitation success depended on variables such as age, degree of cardio-pulmonary limitation in performance, as well as on certain concomitant diseases and the patient's cooperation. A decisive factor in some cases was also whether suitable employment could be found for these patients whose age ranges between 40 and 60.

Geriatric rehabilitation is described according to the theory of Steinmann and is divided into three categories. Firstly, into the actual preventive rehabilitation of the outpatient with the aim of slowing down, possibly even stabilizing or retarding partly normal, partly pathological changes occurring as a function of the aging process. The old person who is not confined to an institution should thus be given an opportunity to lead an active life inspite of certain age related infirmities. Secondly, the general rehabilitation of the sick, comprising the treatment of age illnesses by means of medication and what could be described as "activating care or therapy". Thirdly, the specific rehabilitation which deals with these old age diseases through sophisticated and expensive team in a highly specialized clinic. The approach of the therapeutic team of a geriatric clinic ist described on the basis of the example of the treatment of hemiplegic patients.

Respiratory rehabilitation in patients with pulmonary emphysema should be focussed first on the prevention and elimination of harmful inhalative factors, e.g. smoking habits and environmental or occupational pollution. In addition, distinct therapeutical procedures are mostly effective in preventing a progressive course of the disease and interrupting the vicious circle of dyspnea, physical inactivity and overall disability as well. In patients with advanced disease, mostly complicated by features of chronic respiratory insufficiency and cor pulmonale, long-term administration of oxygen often relieves symptoms, increases physical performance and may even reduce hospital admissions for a longer period. As a consequence, most patients with severe disability also suffer from severe psychological and social problems which should be considered more attentively within the concept of the overall rehabilitation program.

Report on 14 years experience with the day sanatorium belonging to the 4th pulmonary department of the János-Hospital in Budapest. Therapeutic results correspond to those of the hospital department. The day department has proved a success for examination and treatment of patients with pulmonary disease. In the recent years its importance of treatment of patients with non-specific pulmonary diseases has significantly increased. The day sanatorium is enjoying great popularity as well with the patients as in the Chest Clinics.