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4. COPD: Providing the right treatment for the right patient at the right time

Author

Agusti, Alvar, Ambrosino, Nicolino, Blackstock, Felicity, Bourbeau, Jean, Casaburi, Richard, Celli, Bartolome, Criner, Gerard J., Crouch, Rebecca, Negro, Roberto W. Dal, Dreher, Michael, Garvey, Chris, Gerardi, Daniel A., Goldstein, Roger, Hanania, Nicola A., Holland, Anne E., Kaur, Antarpreet, Lareau, Suzanne, Lindenauer, Peter K., Mannino, David, Make, Barry, Maltais, François, Marciniuk, Jeffrey D., Meek, Paula, Morgan, Mike, Pepin, Jean-Louis, Reardon, Jane Z., Rochester, Carolyn L., Singh, Sally, Spruit, Martijn A., Steiner, Michael C., Troosters, Thierry, Vitacca, Michele, Clini, Enico, Jardim, Jose, Nici, Linda, Raskin, Jonathan, and ZuWallack, Richard

Published
2023
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24. High-Flow Oxygen Therapy During Exercise Training in Patients With Chronic Obstructive Pulmonary Disease and Chronic Hypoxemia: A Multicenter Randomized Controlled Trial

Author

Vitacca, Michele, Paneroni, Mara, Zampogna, Elisabetta, Visca, Dina, Carlucci, Annalisa, Cirio, Serena, Banf, Paolo, Pappacoda, Gabriele, Trianni, Ludovico, Brogneri, Antonio, Belli, Stefano, Paracchini, Elena, Aliani, Maria, Spinelli, Vito, Gigliotti, Francesco, Lanini, Barbara, Lazzeri, Marta, Clini, Enrico M., Malovini, Alberto, and Ambrosino, Nicolino

Subjects
Anoxemia -- Analysis, Chronic obstructive lung disease -- Analysis, Patient satisfaction -- Analysis, Health
Abstract

Objective. The study aimed to evaluate whether high-flow oxygen therapy (HFOT) during training was more effective than oxygen in improving exercise capacity in hypoxemic chronic obstructive pulmonary disease (COPD). Methods. A total of 171 patients with COPD and chronic hypoxemia were consecutively recruited in 8 rehabilitation hospitals in a randomized controlled trial. Cycle-ergometer exercise training was used in 20 supervised sessions at iso inspiratory oxygen fraction in both groups. Pre- and post-training endurance time (Tlim), 6-minute walking distance (6MWD), respiratory and limb muscle strength, arterial blood gases, Barthel Index, Barthel Dyspnea Index, COPD Assessment Test, Maugeri Respiratory Failure questionnaire, and patient satisfaction were evaluated. Results. Due to 15.4% and 24.1% dropout rates, 71 and 66 patients were analyzed in HFOT and Venturi mask (V-mask) groups, respectively. Exercise capacity significantly improved after training in both groups with similar patient satisfaction. Between-group difference in post-training improvement in 6MWD (mean: 17.14 m; 95% CI = 0.87 to 33.43 m) but not in Tlim (mean: 141.85 seconds; 95% CI = -18.72 to 302.42 seconds) was significantly higher in HFOT. The minimal clinically important difference of Tlim was reached by 47% of patients in the V-mask group and 56% of patients in the HFOT group, whereas the minimal clinically important difference of 6MWD was reached by 51% of patients in the V-mask group and 69% of patients in the HFOT group, respectively. Conclusion. In patients with hypoxemic COPD, exercise training is effective in improving exercise capacity. Impact Statement. The addition of HFOT during exercise training is not more effective than oxygen through V-mask in improving endurance time, the primary outcome, whereas it is more effective in improving walking distance., Pulmonary rehabilitation, including aerobic exercise training, has stronger evidence of effectiveness to improve exercise capacity, dyspnea, and health-related quality of life (HRQL) than almost all other therapies in patients with [...]

Published
2020
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25. Incorporating telemedicine into the integrated care of the COPD patient a summary of an interdisciplinary workshop held in Stresa, Italy, 7–8 September 2017

Author

Donner, Claudio F., Raskin, Jonathan, ZuWallack, Richard, Nici, Linda, Ambrosino, Nicolino, Balbi, Bruno, Blackstock, Felicity, Casaburi, Richard, Dreher, Michael, Effing, Tanja, Goldstein, Roger, Krishnan, Jerry, Lareau, Suzanne C., Make, Barry J., Maltais, Francois, Meek, Paula, Morgan, Michael, Pépin, Jean-Louis, Rabbito, Chiara, Rochester, Carolyn L., Silverman, Adam R., Singh, Sally, Spruit, Martijn A., Vitacca, Michele, and Williams, Loreen

Published
2018
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44. Effect of Pulmonary Rehabilitation on COPD Assessment Test Items in Individuals Classified as GOLD Group E.

Author

Vitacca, Michele, Paneroni, Mara, Spanevello, Antonio, Maniscalco, Mauro, Diasparra, Aldo, Aliani, Maria, and Ambrosino, Nicolino

Subjects
OBSTRUCTIVE lung disease diagnosis, MEDICAL rehabilitation, RESEARCH, LUNG diseases, FUNCTIONAL status, RETROSPECTIVE studies, HEALTH outcome assessment, TREATMENT effectiveness, DYSPNEA, SEX distribution, PRE-tests & post-tests, OBSTRUCTIVE lung diseases, RESEARCH funding, EXERCISE therapy, DISEASE exacerbation
Abstract

Background: A new Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification has been proposed, based also on COPD Assessment Test (CAT). Objectives: The aim of this large, multicenter, retrospective study was to determine the impact of pulmonary rehabilitation (PR) on CAT items in individuals with COPD, GOLD group E, recovering from an exacerbation (ECOPD). As secondary aims, we evaluated whether gender, associated chronic respiratory failure (CRF), and age might influence results. Methods: Data of 2,213 individuals with available paired pre- and post-PR CAT were analyzed. Other common outcome measures were also assessed. Results: After PR, total CAT improved from 20.8 ± 7.8 to 12.4 ± 6.9 (p = 0.000), and 1,911 individuals (86.4%) reached the minimal clinically important difference (MCID). All CAT items improved significantly without any significant difference among them. However, item "confidence with disease" improved significantly more in males than in females (p = 0.009). Total CAT and six out of eight items improved significantly more in individuals with CRF than in those without (all p < 0.001). Total CAT and three items improved significantly more in younger than in older individuals (p = 0.023). Only presence of CRF was significantly associated with the probability of improving total CAT more than the MCID. Conclusion: In individuals with COPD, GOLD group E, recovering from ECOPD, PR improves all CAT items; however, gender, associated CRF and age may influence the effect size, suggesting the need to evaluate all items in addition to total CAT score. [ABSTRACT FROM AUTHOR]

Published
2023
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