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Di Chiara C, Sartori G, Fantin A, Castaldo N, Crisafulli E. Reducing Hospital Readmissions in Chronic Obstructive Pulmonary Disease Patients: Current Treatments and Preventive Strategies. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:97. [PMID: 39859079 PMCID: PMC11766895 DOI: 10.3390/medicina61010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 12/27/2024] [Accepted: 01/08/2025] [Indexed: 01/27/2025]
Abstract
COPD is one of the leading causes of death worldwide, so it represents a significant public health challenge. Over the years, new effective therapies have been proposed. However, the burden of COPD is still conditioned by frequent acute events defined as exacerbations (exacerbation of COPD-ECOPD), which have a significant impact not only on the patient's quality of life but also on the progression of the disease, morbidity, and mortality. Related to the severity of the condition, ECOPD may require hospital admission and often repeatedly more admissions (readmission). The phenomenon of readmissions is a significant problem, contributing substantially to the utilisation of healthcare resources and the economic burden of COPD. Related contributing factors are still poorly understood, and managing the patients readmitted to the hospital with ECOPD may be challenging. Hospital readmissions should be optimally managed, including supporting and preventive strategies. Although early readmissions (30 days from discharge) are a marker of the quality of the patient's care, we need to consider COPD patients globally. It is not sufficient to address just the acute events, so multidimensional management is necessary, able to follow the patient over time to identify, by a personalised approach, the correct treatment during and post hospitalisation and intercept any factor affecting the natural history of the disease, comprising the risk of hospital readmissions. In the context of the literature concerning respiratory medicine, particularly COPD patients, our narrative review analyses recent evidence regarding the current management of COPD hospital readmissions, aiming to propose preventive strategies helpful in clinical practice. The proposed strategies can potentially improve clinical outcomes and reduce healthcare costs when effectively implemented in practice.
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Affiliation(s)
- Claudia Di Chiara
- Respiratory Medicine Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.D.C.); (G.S.)
| | - Giulia Sartori
- Respiratory Medicine Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.D.C.); (G.S.)
| | - Alberto Fantin
- Respiratory Medicine Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.D.C.); (G.S.)
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Nadia Castaldo
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.D.C.); (G.S.)
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Genç A, Sonel Tur B. Rehabilitation in children with home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2203-2209. [PMID: 38265147 DOI: 10.1002/ppul.26872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
Children with home invasive mechanical ventilation need special health care and rehabilitation services due to complications caused by both the pulmonary system and physical inactivity. Children who are dependent on invasive mechanical ventilators due to breathing difficulties and lung problems can benefit from rehabilitation programs. Rehabilitation requires a close relationship between the child, parents and/or caregivers, and healthcare professionals. The main goal of rehabilitation is to improve breathing, lung function and overall quality of life. In this review, although full standard approaches have not been determined yet, rehabilitation approaches for children dependent on home-type invasive mechanical ventilator will be discussed.
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Affiliation(s)
- Aysun Genç
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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Spitzer KA, Stefan MS, Priya A, Pack QR, Pekow PS, Lagu T, Mazor K, Pinto-Plata VM, Bradley K, Heineman B, ZuWallack RL, Lindenauer PK. Promoting Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease, Strategies of Top-performing Systems: A Qualitative Study. Ann Am Thorac Soc 2023; 20:532-538. [PMID: 36449407 PMCID: PMC10112402 DOI: 10.1513/annalsats.202203-237oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Rationale: Pulmonary rehabilitation (PR) after hospitalization for chronic obstructive pulmonary disease (COPD) is recommended by guidelines; however, few patients participate, and rates vary between hospitals. Objectives: To identify contextual factors and strategies that may promote participation in PR after hospitalization for COPD. Methods: Using a positive-deviance approach, we calculated hospital-specific rates of PR after hospitalization for COPD among a cohort of Medicare beneficiaries. At a purposive sample of high-performing and innovative hospitals in the United States, we conducted in-depth interviews with key stakeholders. We defined high-performing hospitals as having a PR rate above the 95th percentile, at least 6.58%. To learn from hospitals that demonstrated a commitment to improving rates of PR, regardless of PR rates after discharge, we identified innovative hospitals on the basis of a review of American Thoracic Society conference research presentations from prior years. Interviews were audio-recorded and transcribed verbatim. Using a directed content analysis approach, transcripts were coded iteratively to identify themes. Results: Interviews were conducted with 38 stakeholders at nine hospitals (seven high-performers and two innovators). Hospitals were diverse regarding size, teaching status, PR program characteristics, and geographic location. Participants included PR medical directors, PR managers, respiratory therapists, inpatient and outpatient providers, and others. We found that high-performing hospitals were broadly focused on improving care for patients with COPD, and several had recently implemented new initiatives to reduce rehospitalizations after admission for COPD in response to the Centers for Medicare and Medicaid Services/Medicare's Hospital Readmission Reduction Program. Innovative and high-performing hospitals had systems in place to identify patients with COPD that enabled them to provide patient education and targeted discharge planning. Strategies took several forms, including the use of a COPD navigator or educator. In addition, we found that high-performing hospitals reported effective interprofessional and patient communication, had clinical champions or external change agents, and received support from hospital leadership. Specific strategies to promote PR included education of referring providers, education of patients to increase awareness of PR and its benefits, and direct assistance in overcoming barriers. Conclusions: Our findings suggest that successful efforts to increase participation in PR may be most effective when part of a larger strategy to improve outcomes for patients with COPD. Further research is necessary to test the generalizability of our findings.
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Affiliation(s)
| | - Mihaela S. Stefan
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Aruna Priya
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
- Department of Healthcare Delivery and Population Sciences and
| | - Quinn R. Pack
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
- Division of Cardiovascular Medicine and
| | - Penelope S. Pekow
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
- Department of Healthcare Delivery and Population Sciences and
| | - Tara Lagu
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Kathy Mazor
- Meyers Primary Care Institute, Worcester, Massachusetts
- Department of Medicine and
| | | | - Kolbi Bradley
- Department of Healthcare Delivery and Population Sciences and
| | - Brent Heineman
- Department of Healthcare Delivery and Population Sciences and
| | | | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts; and
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Chen YH, Hsin YF, Chen SH, Yu TJ, Huang CC. Effects of transcutaneous electrical diaphragmatic stimulation on respiratory function in patients with prolonged mechanical ventilation. Ann Thorac Med 2022; 17:14-20. [PMID: 35198044 PMCID: PMC8809123 DOI: 10.4103/atm.atm_158_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: Muscle atrophy and diaphragm dysfunction are common with prolonged mechanical ventilation (PMV). Electrical stimulation on peripheral muscles has been shown to be beneficial in the improvement of muscle function. This study examined the effects of transcutaneous electrical diaphragmatic stimulation (TEDS) on respiratory muscle strength and weaning outcomes in patients with PMV. METHODS: Participants on ventilation for ≥21 days were randomly assigned to TEDS (n = 29) and control (n = 30) groups. The TEDS group received muscle electrical stimulation for 30 min/session/day throughout the intervention. Pulmonary function parameters (tidal volume, respiratory rate, and rapid shallow breathing index), and respiratory muscle strength (Pimax, Pemax) were assessed. The hospitalization outcome, including weaning rate and length of stay, was followed up until discharge. RESULTS: After TEDS, there was a significant increase in Pemax (10 [8–20] vs. 20 [10–22] cmH2O, P = 0.034) in the intervention group. At the end of the study, the improvement of minute volume in the TEDS group (0.64 (−0.67) was significantly higher than the control group (−0.64 (−2.5–0.78) (P = 0.008). In the control group, there was no significant difference between pre- and post-measurement of weaning parameters. There was a significant difference between groups in the weaning rate, with a higher rate in the TEDS group (90%) when compared with that in the control group (66.7%) (P =0.021). CONCLUSION: TEDS was significantly associated with increased respiratory muscle strength in patients with PMV. TEDS may be useful to facilitate weaning in this population.
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Stefan MS, Pekow PS, Priya A, ZuWallack R, Spitzer KA, Lagu TC, Pack QR, Pinto-Plata VM, Mazor KM, Lindenauer PK. Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 204:1015-1023. [PMID: 34283694 PMCID: PMC8663014 DOI: 10.1164/rccm.202012-4389oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, less is known about PR's impact in routine clinical practice. Objectives: To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s). Methods: We analyzed a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. Measurements and Main Results: We used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death. Of 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within 1 year of discharge. In the propensity-score-matched analysis, PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83; 95% confidence interval, 0.77-0.90). The mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not (P < 0.001). Conclusions: After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.
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Affiliation(s)
- Mihaela S. Stefan
- Institute for Healthcare Delivery and Population Science
- Department of Medicine
| | - Penelope S. Pekow
- Institute for Healthcare Delivery and Population Science
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Aruna Priya
- Institute for Healthcare Delivery and Population Science
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Richard ZuWallack
- Pulmonary and Critical Care Division, Saint Francis Hospital and Medical Center, Hartford, Connecticut
| | | | - Tara C. Lagu
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine and
- Division of Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and
| | - Quinn R. Pack
- Institute for Healthcare Delivery and Population Science
- Department of Medicine
- Division of Cardiovascular Medicine, and
| | - Victor M. Pinto-Plata
- Department of Medicine
- Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
| | | | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science
- Department of Medicine
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Lindenauer PK, Stefan MS, Pekow PS, Mazor KM, Priya A, Spitzer KA, Lagu TC, Pack QR, Pinto-Plata VM, ZuWallack R. Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries. JAMA 2020; 323:1813-1823. [PMID: 32396181 PMCID: PMC7218499 DOI: 10.1001/jama.2020.4437] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge. OBJECTIVE To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival. DESIGN, SETTING, AND PATIENTS This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015. EXPOSURES Initiation of pulmonary rehabilitation within 90 days of hospital discharge. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality. RESULTS Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD], -6.7% [95% CI, -7.9% to -5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD, -4.6% [95% CI, -5.9% to -3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD, -11.1% [95% CI, -13.2% to -8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01). CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.
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Affiliation(s)
- Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Mihaela S. Stefan
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Penelope S. Pekow
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- University of Massachusetts School of Public Health and Health Sciences, Amherst
| | - Kathleen M. Mazor
- The Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
| | - Aruna Priya
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- University of Massachusetts School of Public Health and Health Sciences, Amherst
| | - Kerry A. Spitzer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
| | - Tara C. Lagu
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Quinn R. Pack
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School—Baystate, Springfield
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
- Division of Cardiovascular Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Victor M. Pinto-Plata
- Department of Medicine, University of Massachusetts Medical School—Baystate, Springfield
- Divsion of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School—Baystate, Springfield
| | - Richard ZuWallack
- Pulmonary and Critical Care Division, Saint Francis Hospital and Medical Center, Hartford, Connecticut
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Carlin BW. The Journal of Cardiopulmonary Rehabilitation and Prevention at 40 Years and Its Role in the Evolution of Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2020; 40:65-69. [DOI: 10.1097/hcr.0000000000000508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnston CL, Maxwell LJ, Alison JA. Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals. Aust J Rural Health 2015; 24:106-14. [PMID: 26010050 DOI: 10.1111/ajr.12202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation. SETTING Rural (NSW) and remote (NT) Australian healthcare settings. PARTICIPANTS Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation. MAIN OUTCOME MEASURE(S) Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation. RESULTS Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised. CONCLUSIONS Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.
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Affiliation(s)
- Catherine L Johnston
- Discipline of Physiotherapy, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal J Maxwell
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Jennifer A Alison
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Donesky D, Nguyen HQ, Paul SM, Carrieri-Kohlman V. The affective dimension of dyspnea improves in a dyspnea self-management program with exercise training. J Pain Symptom Manage 2014; 47:757-71. [PMID: 23954497 DOI: 10.1016/j.jpainsymman.2013.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022]
Abstract
CONTEXT The perception of dyspnea includes both sensory and affective dimensions that are shaped by emotions and psychological, social, and environmental experiences. Previous investigators have studied either measurement or strategies to decrease the affective dimension with laboratory-induced dyspnea. Few have reported the effect of a therapeutic clinical intervention on the affective dimension of dyspnea. OBJECTIVES (1) To evaluate the effects of three different versions of a dyspnea self-management program (DM) on the affective dimension of dyspnea, measured by dyspnea-related anxiety (DA) and dyspnea-related distress (DD); and (2) to determine the stability of DA and DD over two baseline incremental treadmill tests (ITTs). METHODS Participants with chronic obstructive pulmonary disease were randomly assigned to three 12 month DMs with varying doses of supervised exercise (DM, DM-Exposure, and DM-Training). The measurements of the affective dimension, DA and DD, were rated during ITTs on two baseline days and at two, six, and 12 months. Changes over time in DA and DD were analyzed using linear mixed-effects models. RESULTS Participants in the DM-Training group who received 24 nurse-coached exercise sessions had significantly greater reductions in DA and DD compared with those who had four exercise sessions (DM-Exposure) or only received a home-walking program (DM). Reductions in DA and DD in the DM-Training group were only maintained through six months. There were no significant differences in ratings of DA and DD at end between the two baseline ITTs. CONCLUSION These findings provide initial support for the positive impact of a self-management program with nurse-coached exercise on the affective dimension of dyspnea. Further investigation of interventions that target the affective dimension in addition to the sensory dimension of dyspnea should be encouraged.
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Affiliation(s)
- Doranne Donesky
- University of California, San Francisco, San Francisco, California, USA.
| | - Huong Q Nguyen
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Steven M Paul
- University of California, San Francisco, San Francisco, California, USA
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Breunig IM, Shaya FT, Scharf SM. Delivering cost–effective care for COPD in the USA: recent progress and current challenges. Expert Rev Pharmacoecon Outcomes Res 2014; 12:725-31. [DOI: 10.1586/erp.12.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hogg L, Garrod R, Thornton H, McDonnell L, Bellas H, White P. Effectiveness, attendance, and completion of an integrated, system-wide pulmonary rehabilitation service for COPD: prospective observational study. COPD 2013; 9:546-54. [PMID: 23030586 DOI: 10.3109/15412555.2012.707258] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pulmonary rehabilitation (PR) is one of the most effective treatments for COPD but not widely available. Uptake is poor and completion rates are low. In this integrated PR service we report on effectiveness, attendance, and completion of twice weekly rolling recruitment and once weekly cohort recruitment programmes in two hospital and five community PR sites. The hospital and two of the community programmes were 'rolling' recruitment twice weekly for 8 weeks. Three community programmes ran in once weekly cohorts for 8 weeks. Predictors of attendance, completion and effectiveness were sought. 1114 eligible COPD patients were referred. 812 (73%) attended assessment, 656 (59%) started and 441 (40%) completed. Significant improvements were seen in incremental shuttle walk test (ISWT) (mean 68.3 m; 95%CI 59.3-77.4), Chronic Respiratory Questionnaire self-report dyspnoea scale (CRQ-SR) (0.94; 0.80-1.07), Hospital Anxiety and Depression Scale anxiety (0.9; 0.5-1.2) and depression (1.1; 0.8-1.4) components, exceeding the minimum clinically important difference for ISWT and CRQ-SR. Twice weekly compared with once weekly programmes showed similar improvement. Patients were less likely to complete if they were deprived (4(th) quintile of deprivation 0.56; 0.33-0.94, 5(th) quintile 0.57; 0.34-0.85), reported MRC dyspnoea scale 4 (0.61; 0.37-0.97) or 5 (0.39; 0.16-0.93), or had been referred by their general practitioner (0.42; 0.24-0.74) (pseudo R(2) 0.103). PR is effective for COPD in real-world practice achieving results comparable to trials. Low rates of attendance and completion of PR were not explained by demographic characteristics, disease severity, psychological morbidity and source of referral despite the large number of participants.
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Affiliation(s)
- Lauren Hogg
- Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, United Kingdom
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Soler X, Diaz-Piedra C, Ries AL. Pulmonary rehabilitation improves sleep quality in chronic lung disease. COPD 2013; 10:156-63. [PMID: 23514215 DOI: 10.3109/15412555.2012.729622] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sleep-related disorders are common in patients with chronic obstructive pulmonary disease (COPD) and, possibily, other lung disorders. Exercise has been shown to improve sleep disturbances. In patients with COPD, pulmonary rehabilitation (PR) produces important health benefits with improvement in symptoms, exercise tolerance, and quality of life. However, the effect of PR on sleep quality remains unknown. The aim of this observational study was to evaluate sleep quality in patients with chronic lung disease and the role of PR as a non-pharmacologic treatment to improve sleep. Sixty-four patients with chronic lung disease enrolled in an 8-week comprehensive PR program, and completed the study (48% male; obstructive [72%], restrictive [20%], mixed [8%]; 44% on supplemental oxygen). Baseline spirometry [mean (SD)]: FEV1% pred = 48.9 (17.4), FVC% pred = 72.5 (18.1), and FEV1/FVC% = 53.1 (18.9). Exercise tolerance and questionnaires related to symptoms, health-related quality of life (HRQL), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) were obtained before and after PR. 58% reported poor sleep quality (PSQI > 5) at baseline. Sleep quality improved by 19% (p = 0.017) after PR, along with significant improvements in dyspnea, exercise tolerance, self-efficacy, and HRQL. Sleep quality in patients with chronic lung disease was poor. In addition to expected improvements in symptoms, exercise tolerance, and HRQL after PR, the subgroup of patients with COPD had a significant improvement in sleep quality. These findings suggest that PR may be an effective, non-pharmacologic treatment option for sleep problems in patients with COPD.
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Affiliation(s)
- Xavier Soler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego (UCSD), San Diego, CA, USA.
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JOHNSTON CATHERINEL, MAXWELL LYNDALJ, BOYLE EILEEN, MAGUIRE GRAEMEP, ALISON JENNIFERA. Improving chronic lung disease management in rural and remote Australia: The Breathe Easy Walk Easy programme. Respirology 2012; 18:161-9. [DOI: 10.1111/j.1440-1843.2012.02269.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Short term and long term effects of pulmonary rehabilitation on physical activity in COPD. Respir Med 2012; 106:1671-9. [DOI: 10.1016/j.rmed.2012.08.016] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 11/23/2022]
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16
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Johnston CL, Maxwell LJ, Maguire GP, Alison JA. How prepared are rural and remote health care practitioners to provide evidence-based management for people with chronic lung disease? Aust J Rural Health 2012; 20:200-7. [PMID: 22827428 DOI: 10.1111/j.1440-1584.2012.01288.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the existing experience, training, confidence and knowledge of rural/remote health care practitioners in providing management for people with chronic obstructive pulmonary disease (COPD). DESIGN Descriptive cross-sectional, observational survey design using a written anonymous questionnaire. This study formed part of a larger project evaluating the impact of breathe easy walk easy (BEWE), an interactive education and training program for rural and remote health care practitioners. SETTING Rural (n = 1, New South Wales) and remote (n = 1, Northern Territory) Australian health care services. PARTICIPANTS Health care practitioners who registered to attend the BEWE training program (n = 31). MAIN OUTCOME MEASURES Participant attitudes, objective knowledge and self-rated experience, training and confidence related to providing components of management for people with COPD. RESULTS Participants were from a variety of professional backgrounds (medical, nursing, allied health) but were predominantly nurses (n = 13) or physiotherapists (n = 9). Most participants reported that they had minimal or no experience or training in providing components of management for people with COPD. Confidence was also commonly rated by participants as low. Mean knowledge score (number of correct answers out of 19) was 8.5 (SD = 4.5). Questions relating to disease pathophysiology and diagnosis had higher correct response rates than those relating more specifically to pulmonary rehabilitation. CONCLUSION The results of this study indicate that some rural and remote health care practitioners have low levels of experience, knowledge and confidence related to providing components of management for people with COPD and that education and training with an emphasis on pulmonary rehabilitation would be beneficial.
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Affiliation(s)
- Catherine Louise Johnston
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, Australia.
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17
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Tang J, Mandrusiak A, Russell T. The feasibility and validity of a remote pulse oximetry system for pulmonary rehabilitation: a pilot study. Int J Telemed Appl 2012; 2012:798791. [PMID: 23049549 PMCID: PMC3462379 DOI: 10.1155/2012/798791] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/09/2012] [Accepted: 08/23/2012] [Indexed: 01/17/2023] Open
Abstract
Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease. However, access to these services is limited especially in rural and remote areas. Telerehabilitation has the potential to deliver pulmonary rehabilitation programs to these communities. The aim of this study was threefold: to establish the technical feasibility of transmitting real-time pulse oximetry data, determine the validity of remote measurements compared to conventional face-to-face measures, and evaluate the participants' perception of the usability of the technology. Thirty-seven healthy individuals participated in a single remote pulmonary rehabilitation exercise session, conducted using the eHAB telerehabilitation system. Validity was assessed by comparing the participant's oxygen saturation and heart rate with the data set received at the therapist's remote location. There was an 80% exact agreement between participant and therapist data sets. The mean absolute difference and Bland and Altman's limits of agreement fell within the minimum clinically important difference for both oxygen saturation and heart rate values. Participants found the system easy to use and felt confident that they would be able to use it at home. Remote measurement of pulse oximetry data for a pulmonary rehabilitation exercise session was feasible and valid when compared to conventional face-to-face methods.
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Affiliation(s)
- Jonathan Tang
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia 4072, Brisbane, QLD 4072, Australia
| | - Allison Mandrusiak
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia 4072, Brisbane, QLD 4072, Australia
| | - Trevor Russell
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia 4072, Brisbane, QLD 4072, Australia
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18
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Bratås O, Espnes GA, Rannestad T, Walstad R. Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation. Scand J Caring Sci 2011; 26:219-27. [PMID: 21895731 DOI: 10.1111/j.1471-6712.2011.00921.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS This study aimed to evaluate the short- and long-term effects of 4-week inpatient rehabilitation on health-related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio-demographical factors on unaltered or improved HRQL after discharge. METHODS A total of 111 consecutive cases with mild-to-very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6-month follow-up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George's Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio-demography and co-morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow-up were analysed by paired-sample t-test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge. RESULTS Health-related quality of life and depression improved between t1 and t2: a change of -3.6 for the SGRQ impact score (p = 0.009), -2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of -4.0 for the SGRQ symptom score (p = 0.012) and a reduction of -0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1-7.8, p = 0.039). CONCLUSION Short-term benefits on HRQL and depression after rehabilitation relapsed at 6-month follow-up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.
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Affiliation(s)
- Ola Bratås
- Department of Nursing, Sør-Trøndelag University College, Trondheim, Norway.
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19
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Abstract
People who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after PR. The research was inspired by interpretive phenomenology. Thirty-three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well-being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time-limited PR and support the current trends towards patient-centred rehabilitation efforts that incorporate user involvement and self-management education.
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Affiliation(s)
- Anne-Grethe Halding
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway.
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20
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Hellem E, Bruusgaard KA, Bergland A. Exercise maintenance: COPD patients' perception and perspectives on elements of success in sustaining long-term exercise. Physiother Theory Pract 2011; 28:206-20. [PMID: 21823993 DOI: 10.3109/09593985.2011.587502] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our goal was to elucidate how patients with COPD who successfully maintain a long-term exercise programme understand concordance with maintenance exercise and see potential solutions. The information, collected from 11 individuals through six in-depth interviews and one focus-group interview, was analysed by means of qualitative content analysis. Four themes were identified: (1) perception and acknowledgement of the disease; (2) the personal manner and empowering skills of the therapist; (3) perception of the exercise programme; and (4) left to myself-a pitfall in maintenance. Motivation to continue long-term exercise was related to how the patient is empowered to come to terms with the situation, the relational skills and expert competence of the physiotherapist, the patient's perceived mastery of the intensity of the exercise programme, and the physiotherapist's ability to individualize the exercise, peer support, and the availability and continuity of the programme. More attention should be paid to the link between PR programs and follow-up programmes. Crucial factors in this context are guidance of a municipal physiotherapist or instructor with extensive knowledge of exercise for patients with COPD, social interaction with peers in the exercise setting, enthusiasm, support, and ongoing communication between patients and practitioners across an entire continuum of care.
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Affiliation(s)
- Elisabet Hellem
- Oslo University College, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
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21
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Katz P, Chen H, Omachi TA, Gregorich SE, Julian L, Cisternas M, Balmes J, Blanc PD. The role of physical inactivity in increasing disability among older adults with obstructive airway disease. J Cardiopulm Rehabil Prev 2011; 31:193-7. [PMID: 21124233 PMCID: PMC3134630 DOI: 10.1097/hcr.0b013e3181fc09b7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE : The independent contribution of physical inactivity to disability in obstructive lung disease (OLD) is difficult to study, partly because inactivity may reflect disease severity. We examined the relationship of physical inactivity to disability progression over a 1-year period among a group of older adults with OLD. METHODS : A population-based cohort with self-reported physician-diagnosed emphysema, chronic obstructive pulmonary disease, or chronic bronchitis (n = 206) completed baseline interviews and in-person spirometry, with 1-year followup interviews. The Community Health Activities Model Program for Seniors physical activity questionnaire provided estimates of energy expenditure; we defined inactivity as no expenditure in moderate- or vigorous-intensity activities. Disability was measured with the Valued Life Activity (VLA) disability scale; increased disability was defined as a 10% or greater increase in VLA disability score over 1-year followup. Logistic regression tested the relationship between baseline inactivity and disability increase, controlling for age, sex, baseline VLA disability, comorbidities, smoking, and pulmonary function (forced expiratory volume in 1 second, % predicted). RESULTS : Of 206 subjects, 48 (27%) were physically inactive at baseline; 42.9% of individuals whose disability increased were inactive at baseline compared with 23.4% of those who did not experience a disability increase. With adjustment for covariates, increased disability after 1 year was significantly (P = .04) more likely among individuals who were inactive at baseline (Odds Ratio =2.4; 95% confidence interval, 1.02-5.9). CONCLUSIONS : Physically inactive individuals with OLD had more than double the odds of an increase in disability, even after controlling for baseline disability, lung function, and other covariates. These results provide strong support for the importance of maintaining physical activity among individuals with OLD.
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Affiliation(s)
- Patricia Katz
- Department of Medicine, University of California, San Francisco, USA.
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22
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van Helvoort HA, de Boer RC, van de Broek L, Dekhuijzen R, Heijdra YF. Exercises commonly used in rehabilitation of patients with chronic obstructive pulmonary disease: cardiopulmonary responses and effect over time. Arch Phys Med Rehabil 2010; 92:111-7. [PMID: 21092932 DOI: 10.1016/j.apmr.2010.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare conventional exercise-based assessment of pulmonary rehabilitation (PR) with improvement in training exercises employed during a PR program, and to describe the cardiopulmonary response of different training exercises during PR of patients with chronic obstructive pulmonary disease (COPD). DESIGN Observational study. SETTING Inpatient PR. PARTICIPANTS Patients with moderate to very severe COPD (N=18). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Cardiopulmonary responses to interval cycling, arm exercise, and a test of functional activities of daily living (ADLs) were evaluated during the PR training program using a mobile telemetric breath-by-breath system. The effects of PR were evaluated by comparing pre-PR and post-PR training activities, incremental and constant work-rate cycling, and a 6-minute walk test. RESULTS Interval cycling and the ADLs test were moderate-intensity to heavy-intensity exercises (70%-80% of maximal oxygen consumption), while the arm exercise was a low-intensity activity (40% of maximal oxygen consumption). After 12 weeks of PR, cycle load, arm weights, and walking distances during training activities had increased alongside increased muscle mass. At iso-intensities, no cardiopulmonary changes in the training exercises were observed. Exercise duration of constant work-rate cycling and 6-minute walk distance increased by 160% and 14%, respectively, after PR, with concurrent right-shifts of anaerobic threshold and a decrease in heart rate. CONCLUSIONS Supervised increases in weight, load, and walking distance during training activities were useful clinical outcomes for patients, demonstrating the beneficial effects of progressive training on physical performance. However, for physiologic evaluation of PR, conventional tests, such as maximal incremental cycling, endurance cycling, and a 6-minute walk test, had greater validity. Physiologic evaluation of the training exercises showed that the training program complied with the training recommendations for PR.
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Affiliation(s)
- Hanneke A van Helvoort
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, The Netherlands.
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23
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Chang AB, Bell SC, Byrnes CA, Grimwood K, Holmes PW, King PT, Kolbe J, Landau LI, Maguire GP, McDonald MI, Reid DW, Thien FC, Torzillo PJ. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. Med J Aust 2010; 193:356-65. [PMID: 20854242 DOI: 10.5694/j.1326-5377.2010.tb03949.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 07/15/2010] [Indexed: 11/17/2022]
Abstract
Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop. The diagnosis of bronchiectasis requires a high-resolution computed tomography scan of the chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis. CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules. Individualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely.
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Affiliation(s)
- Anne B Chang
- Royal Children's Hospital and Queensland Children's Medical Research Institute, Brisbane, QLD, Australia.
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Johnston K, Grimmer-Somers K. Pulmonary rehabilitation: overwhelming evidence but lost in translation? Physiother Can 2010; 62:368-73. [PMID: 21886377 DOI: 10.3138/physio.62.4.368] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE This report highlights the current international gap between the availability of high-quality evidence for pulmonary rehabilitation (PR) and its low level of implementation. Key barriers are outlined, and potentially effective strategies to improve implementation are presented. SUMMARY OF KEY POINTS Although pulmonary rehabilitation (PR) is recommended by international guidelines as part of the management of patients with chronic obstructive pulmonary disease (COPD), participation in PR remains low. Physician referral to PR ranges from 3% to 16% of suitable patients. Barriers to participation include limited availability of suitable programmes and interrelated issues of referral and access. Individual patient barriers, including factors relating to comorbidities and exacerbations, perceptions of benefit, and ease of access, contribute less overall to low participation rates. Chronic care programmes that incorporate self-management support have some benefit in patients with COPD. However, the demonstrated cost-effectiveness of PR is substantial, and efforts to improve its implementation are urgently indicated. CONCLUSION To improve implementation, a holistic examination of the key issues influencing a patient's participation in PR is needed. Such an examination should consider the relative influences of environmental (e.g., health-service-related) factors, organizational factors (e.g., referral and intake procedures), and individual factors (e.g., patient barriers) for all participants. On the basis of these findings, policy, funding, service delivery, and other interventions to improve participation in PR can be developed and evaluated.
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Affiliation(s)
- Kylie Johnston
- Kylie Johnston, PhD, BAppSc (Physiotherapy): Research Officer, International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide, Australia
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25
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Eastwood PR, Maher TM, Wells AU, Lam B. Year in review 2009: Interstitial lung diseases, acute injury, sleep, physiology, imaging and bronchoscopic intervention. Respirology 2010; 15:172-81. [PMID: 20199638 DOI: 10.1111/j.1440-1843.2009.01696.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Peter R Eastwood
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia.
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26
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Current World Literature. Curr Opin Pulm Med 2010; 16:162-7. [DOI: 10.1097/mcp.0b013e32833723f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Surpas P. [Why is pulmonary rehabilitation so underused? How can this situation be improved?]. Rev Mal Respir 2010; 27:5-7. [PMID: 20146945 DOI: 10.1016/j.rmr.2009.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 11/21/2009] [Indexed: 11/17/2022]
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