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ZusammenfassungIn Deutschland findet die Lungenrehabilitation (PR) traditionell in Rehabilitationskliniken statt. Nach der aktuellen deutschen Richtlinie „Diagnostik und Beurteilung asbestbedingter Berufskrankheiten“ kann PR auch als ambulantes Programm mit den wesentlichen Elementen der stationären PR (Kompakt-Rehabilitation [KR]) angeboten werden. Unser Projekt untersuchte die Auswirkungen der KR auf Akzeptanz, körperliche Leistungsfähigkeit und Lebensqualität bei Patienten mit berufsbedingten Lungenerkrankungen. KR umfasste 24 Einheiten à 90 Minuten mit Physiotherapie und Atemtherapie sowie gerätegestütztes Kraft- und Ausdauertraining. Ziel unserer Studie war es, die Auswirkungen der KR bei Patienten mit Berufskrankheiten der Atemwege und einem gesetzlich verankerten Recht auf PR zu untersuchen. Eine Randomisierung war daher nicht geplant. 148 versicherte Personen mit einer bestätigten beruflichen Erkrankung der Lunge wurden von den Berufsgenossenschaften zur Teilnahme eingeladen. 126 Patienten (85 %) nahmen die Einladung an, und 78 Teilnehmer (Durchschnittsalter 71 Jahre) schlossen das gesamte Programm ab (53 %). Gutartige asbestbedingte Erkrankungen (Plaques, Pleuraverdickungen, Asbestose) dominierten mit rund 80 %. Gebrechlichkeit, Depression und Demenz sind typische Hindernisse. Unter strikter Einhaltung der gewählten Einschluss- und Ausschlusskriterien und Trainingsbedingungen traten keine unerwünschten Ereignisse auf. Die Messergebnisse am Beginn der KR wurden mit denen bei Beendigung verglichen. KR führte zu einer signifikanten (p

In Germany, pulmonary rehabilitation (PR) traditionally takes place in rehabilitation clinics. According to the current German guideline "Diagnostics and assessment of asbestos-related occupational diseases", PR can also be offered as outpatient program with the essential elements of inpatient PR (compact rehabilitation [CR]). Our project investigated the effects of CR regarding acceptance, physical performance, and quality of life of patients with occupational lung diseases. CR included 24 units of 90 minutes each with physiotherapy and breathing therapy as well as device-supported strength and endurance training. The aim of our study was to investigate the effects of CR in subjects with occupational diseases of the respiratory system and a legally anchored right to PR. Randomization was therefore not planned. A total of 148 insured persons with a confirmed occupational disease of the respiratory system were invited to participate by the employers' liability insurance association; 126 patients (85 %) accepted the invitation, and 78 participants (mean age: 71 years) completed the entire program (53 %). Benign asbestos-related diseases (plaques, pleural thickening, asbestosis) dominated with around 80 %. Ailments, depression, and dementia were typical obstacles. No adverse events occurred with strict observance of the chosen inclusion and exclusion criteria and training conditions. The measurement results at enrolment were compared with those at completion of the CR. CR led to a significant (p 0.01) improvement in all parameters of physical performance: 6-minute walking test: + 36 m, ergometer test: + 9 watts, hand dynamometry: + 29 N, quadriceps strength test: + 84 MKI. The inspiratory capacity of the respiratory muscles (PiIn Deutschland findet die Lungenrehabilitation (PR) traditionell in Rehabilitationskliniken statt. Nach der aktuellen deutschen Richtlinie „Diagnostik und Beurteilung asbestbedingter Berufskrankheiten“ kann PR auch als ambulantes Programm mit den wesentlichen Elementen der stationären PR (Kompakt-Rehabilitation [KR]) angeboten werden. Unser Projekt untersuchte die Auswirkungen der KR auf Akzeptanz, körperliche Leistungsfähigkeit und Lebensqualität bei Patienten mit berufsbedingten Lungenerkrankungen. KR umfasste 24 Einheiten à 90 Minuten mit Physiotherapie und Atemtherapie sowie gerätegestütztes Kraft- und Ausdauertraining. Ziel unserer Studie war es, die Auswirkungen der KR bei Patienten mit Berufskrankheiten der Atemwege und einem gesetzlich verankerten Recht auf PR zu untersuchen. Eine Randomisierung war daher nicht geplant. 148 versicherte Personen mit einer bestätigten beruflichen Erkrankung der Lunge wurden von den Berufsgenossenschaften zur Teilnahme eingeladen. 126 Patienten (85 %) nahmen die Einladung an, und 78 Teilnehmer (Durchschnittsalter 71 Jahre) schlossen das gesamte Programm ab (53 %). Gutartige asbestbedingte Erkrankungen (Plaques, Pleuraverdickungen, Asbestose) dominierten mit rund 80 %. Gebrechlichkeit, Depression und Demenz sind typische Hindernisse. Unter strikter Einhaltung der gewählten Einschluss- und Ausschlusskriterien und Trainingsbedingungen traten keine unerwünschten Ereignisse auf. Die Messergebnisse am Beginn der KR wurden mit denen bei Beendigung verglichen. KR führte zu einer signifikanten (p 0,01) Verbesserung aller Parameter der körperlichen Leistung: 6-Minuten-Gehtest: + 36 m, Ergometertest: + 9 Watt, Handdynamometrie: + 29 N, Quadriceps-Krafttest: + 84 MKI. Die Inspirationskapazität der Atemmuskulatur (Pi

The two-minute walk test (2MWT) is less well validated than the well-known six-minute walk test (6MWT) as a field walking test in patients with chronic obstructive pulmonary disease (COPD). The primary objective of this study was to compare the accuracy of the 2MWT to the 6MWT in detecting exercise-induced oxygen desaturation in patients with severe COPD. Twenty-six patients with COPD (age: 61 ± 10 years, forced expired volume in one second: 37 ± 10%) that were normoxemic at rest performed a 2MWT and a 6MWT under normal ambient conditions on two consecutive days in random order. Oxygen saturation, total walking distance, heart rate, breathing frequency, dyspnea, and leg fatigue were evaluated. Average walking distances were 150 m (95% confidence interval (95% CI): 134–165 m) and 397 m (95% CI: 347–447 m) for the 2MWT and 6MWT, respectively ( r = 0.80, p < 0.0001). The difference in minimum oxygen saturation during the 2MWT (83%, 95% CI: 81–86%) and 6MWT (mean 82%, 95% CI: 80–84%) was not statistically different and the data strongly correlated between the groups ( r = 0.81, p < 0.0001). Other measurements from the 6MWT, including heart rate, breathing rate, and levels of perceived exertion were also comparable in 2MWT. The 2MWT showed comparable validity in detecting exercise-induced oxygen desaturation in patients with severe COPD compared to the 6MWT.

Background and objective: COPD is associated with impaired health-related quality of life (HRQL) and cardiac autonomic dysfunction. Data describing the association between these factors in patients with COPD are mostly lacking. The objective of this study was to evaluate whether there is an association between cardiac autonomic dysfunction and HRQL in COPD. Methods: We studied 60 patients with COPD (37 women, mean (SD) age 65.20 (7.73) years, FEV1 % pred. 46.58 (18.53) %) and measured HRQL, as assessed by the Chronic Respiratory Disease Questionnaire, and cardiac autonomic dysfunction, as assessed by heart rate variability (HRV). Analysis of HRV was performed using a Holter-ECG device during a recording period of 5 min. To evaluate a possible association between these factors, univariate and multivariate analyses were used. Results: There was a significant correlation between Chronic Respiratory Disease Questionnaire total score and both variables of HRV reflecting parasympathetic tone; root mean square successive difference of RR intervals (rMSSD) (r = 0.34, P = 0.012) and the density of the beat-to-beat oscillation in the N-N interval of HRV in the high-frequency band (HF power) (r = 0.35, P = 0.01). In a multivariate analysis rMSSD was found to be independently associated with HRQL after correcting for FEV1, carbon monoxide transfer coefficient (DLCO), 6MWD and CRP. Conclusions: Resting parasympathetic tone, as measured by HRV, is independently associated with HRQL, which emphasizes the role of cardiac autonomic dysfunction on HRQL in patients with COPD.

Krafttraining in der pulmonalen Rehabilitation ist etabliert. Gangige Krafttests der peripheren Muskulatur werden in diesem Kapitel besprochen. Wie bei Patienten mit chronischem Herzversagen fuhren die krankheitsbedingten degenerativen Prozesse bei COPD-Patienten zu funktionellen Anpassungen und strukturellen Veranderungen der biochemischen und metabolischen Versorgung der peripheren Muskulatur. Hypertrophietraining geniest bei der Behandlung von COPD-Patienten einen Mehrwert, da diese Patienten u.a. durch eine verminderte periphere Muskelkraft in ihrer korperlichen Leistungsfahigkeit eingeschrankt sind. Ein Hypertrophietraining scheint deutlichere Effekte auf die krankheitsbezogene Lebensqualitat zu haben als ein Ausdauertraining. Das Hypertrophietraining ist auf grose Muskelgruppen wie Beinmuskulatur bzw. komplexe Ubungen der kinetischen Ketten ausgerichtet, da es dem katabolen Stoffwechsel entgegenwirkt und die Aktivitat signifikante Anderungen des peripheren Metabolismus induziert.

Background: Conventional pulmonary rehabilitation programs improve exercise tolerance but have no effect on pulmonary function in patients with chronic obstructive pulmonary disease (COPD). The role of controlled breathing using respiratory biofeedback during rehabilitation of patients with COPD remains unclear. Objectives: To compare the effects of a conventional 4-week pulmonary rehabilitation program with those of rehabilitation plus controlled breathing interventions. Methods: A randomized controlled trial was performed. Pulmonary function (FEV1), exercise capacity (6-min walking distance, 6MWD), health-related quality of life (chronic respiratory questionnaire, CRQ) and cardiac autonomic function (rMSSD) were evaluated. Results: Forty COPD patients (mean ± SD age 66.1 ± 6.4, FEV1 45.9 ± 17.4% predicted) were randomized to rehabilitation (n = 20) or rehabilitation plus controlled breathing (n = 20). There were no statistically significant differences between the two groups regarding the change in FEV1 (mean difference –0.8% predicted, 95% CI –4.4 to 2.9% predicted, p = 0.33), 6MWD (mean difference 12.2 m, 95% CI –37.4 to 12.2 m, p = 0.16), CRQ (mean difference in total score 0.2, 95% CI –0.1 to 0.4, p = 0.11) and rMSSD (mean difference 2.2 ms, 95% CI –20.8 to 25.1 ms, p = 0.51). Conclusions: In patients with COPD undergoing a pulmonary rehabilitation program, controlled breathing using respiratory biofeedback has no effect on exercise capacity, pulmonary function, quality of life or cardiac autonomic function.

Chronic obstructive pulmonary disease (COPD) is associated with impaired exercise tolerance, but it has not been established to what extent cardiac autonomic function impacts on exercise capacity.To evaluate whether there is an association between airflow limitation and cardiac autonomic function and whether cardiac autonomic function plays a role in exercise intolerance and daily physical activity (PA) in patients with COPD.Univariate and multivariate analyses were performed to evaluate the association between both 6-minute walking test (6MWT) and PA (steps per day) and pulmonary function, cardiac autonomic function (HR at rest, HRR and heart rate variability, HRV) in patients with COPD.In 154 COPD patients (87 females, mean [SD]: age 62.5 [10.7] years, FEV(1) %predicted (43.0 [19.2]%), mean HR at rest was elevated (86.4 [16.4] beats/min) and HRV was reduced (33.69 [28.96] ms) compared to published control data. There was a significant correlation between FEV(1) and HR at rest (r = -0.32, p0.001), between HR at rest and 6MWD (r = -0.26, p = 0.001) and between HR at rest and PA (r = -0.29, p = 0.010). No correlation was found between HRV and 6MWD (r = 0.089, p = 0.262) and PA (r = 0.075, p = 0.322). In multivariate analysis both HR and FEV(1) were independent predictors of exercise capacity in patients with COPD.In patients with COPD the degree of airflow limitation is associated with HR at rest. The degree of airflow limitation and cardiac autonomic function, as quantified by HR at rest, are independently associated with exercise capacity in patients with COPD.

Background: Previous studies with small sample sizes reported contradicting findings as to whether pulmonary function tests can predict exercise-induced oxygen desaturation (EID). Objective: To evaluate whether forced expiratory volume in one second (FEV1), resting oxygen saturation (Spo2) and diffusion capacity for carbon monoxide (Dlco) are predictors of EID in chronic obstructive pulmonary disease (COPD). Methods: We measured FEV1, Dlco, Spo2 at rest and during a 6-min walking test as well as physical activity by an accelerometer. A drop in Spo2 of >4 to Results: We included 154 patients with COPD (87 females). The mean FEV1 was 43.0% (19.2) predicted and the prevalence of EID was 61.7%. The only independent predictor of EID was FEV1 and the optimal cutoff value of FEV1 was at 50% predicted (area under ROC curve, 0.85; p < 0.001). The positive predictive value of a threshold of FEV1 1 ≥80% was 1.0. The severity of EID was correlated with daily physical activity (r = –0.31, p = 0.008). Conclusions: EID is highly prevalent among patients with COPD and can be predicted by FEV1. EID seems to be associated with impaired daily physical activity which supports its clinical importance.

Das Hypertrophietraining der peripheren Muskulatur beinhaltet standardisierte Ubungen der medizinischen Trainingstherapie zum Muskelaufbau der oberen und unteren Extremitaten sowie des Rumpfes. In diesem Kapitel werden die Evidenzlage zum Hypertrophietraining beschrieben und Grundlagen der Durchfuhrung erklart. Das Hypertrophietraining geniest innerhalb der Behandlung von COPD-Patienten einen Mehrwert, da die Patienten u.a. durch eine verminderte periphere Muskelkraft in ihrer korperlichen Leistungsfahigkeit eingeschrankt sind. Der positive Effekt eines Krafttrainings bei COPD ist ebenfalls in der Literatur gut belegt. Vor allem die Muskelmasse und die Muskelkraft nehmen starker zu als bei einem Ausdauertraining. Spruit et al. verglichen bei 48 COPD-Patienten die Effekte eines Hypertrophie- und eines kardiopulmonalen Ausdauerkapazitatstrainings auf die periphere und respiratorische Kraft; dabei untersuchten sie die Unterschiede der Ausdauerkapazitat und der Gehstrecke beim 6-Minuten-Gehtest

Due to the unattended design screening of sleep-disordered breathing (SDB) has a significant error rate. Possible reasons for the screening failure are off-centered or unfixed sensors. Therefore often another screening is mandatory which is both expensive and impeding for the patient. In order to minimise screening failure it is desirable to develop contactless screening devices. In 7 patients with a total of 477 central apneas we studied the diagnostic accuracy of Sleep-Minder (Biancamed, Dublin, Ireland) that was placed approx. 1m from the patient. Sleep-Minder emitted a very weak radio wave (factor 10-100 less compared to common household devices) and detected thorax and abdomen movement by measuring the Doppler effect. SleepMinder could detect 431 central apneas. This study showed the utility of SleepMinder, a contactless screening device, for detecting central apneas. Thus, SleepMinder can be used as an unattended screening method minimising screening failure.

BACKGROUND: Although many different types of physical therapy are commonly applied in the treatment of respiratory disease, there is no good evidence for all of them. Pursed-lips-breathing (PLB) is an easy and commonly used method to help patients with obstructive ventilatory disease to breathe under physical stress. Not each patient with chronic obstructive pulmonary disease (COPD) performs PLB spontaneously. OBJECTIVE: Verification of the null hypothesis that PLB has no benefit for patients with severe COPD. METHODS: A prospective randomised cross-over trial was carried out to test whether PLB can improve functional performance in patients with severe COPD. Patients performed a 6-minute-walk-test (6-MWT) with and without PLB (prevented by a mouthpiece). Heart-rate, O 2 -saturation (pulse oximeter), dyspnoea (modified Borg scale) before and after 6-MWT as well as the walking distance and breaks were measured. RESULTS: The evaluation of 14 patients showed that PLB improved saturation decrease and heart rate acceleration under physical stress. The patients had less subjective dyspnoea and achieved a longer distance in the 6-MWT. CONCLUSIONS: Functional performance of patients with severe COPD can be improved by PLB. Breathlessness and stress on the respiratory system are beneficially modified. Because of the progressive nature of the disease, all COPD patients should be taught PLB.