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Paneroni M, Vitacca M, Salvi B, Simonelli C, Arici M, Ambrosino N. Is there any physiological reason to train expiratory muscles in people with mild COPD? Pulmonology 2024:S2531-0437(24)00049-7. [PMID: 38704310 DOI: 10.1016/j.pulmoe.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024] Open
Affiliation(s)
- M Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy.
| | - M Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - B Salvi
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - C Simonelli
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - M Arici
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - N Ambrosino
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Carlucci A, Paneroni M, Carotenuto M, Bertella E, Cirio S, Gandolfo A, Simonelli C, Vigna M, Lastoria C, Malovini A, Fusar Poli B, Vitacca M. Prevalence of exercise-induced oxygen desaturation after recovery from SARS-CoV-2 pneumonia and use of lung ultrasound to predict need for pulmonary rehabilitation. Pulmonology 2023; 29 Suppl 4:S4-S8. [PMID: 34247995 PMCID: PMC8175480 DOI: 10.1016/j.pulmoe.2021.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Persistence of breathlessness after recovery from SARS-CoV-2 pneumonia is frequent. Recovery from acute respiratory failure (ARF) is usually determined by normalized arterial blood gases (ABGs), but the prevalence of persistent exercise-induced desaturation (EID) and dyspnea is still unknown. METHODS We investigated the prevalence of EID in 70 patients with normal arterial oxygen at rest after recovery from ARF due to COVID-19 pneumonia. Patients underwent a 6-min walking test (6MWT) before discharge from hospital. We recorded dyspnea score and heart rate during 6MWT. We also investigated the possible role of lung ultrasound (LU) in predicting EID. Patients underwent a LU scan and scores for each explored area were summed to give a total LU score. RESULTS In 30 patients (43%), oxygen desaturation was >4% during 6MWT. These patients had significantly higher dyspnea and heart rate compared to non-desaturators. LU score >8.5 was significantly able to discriminate patients with EID. CONCLUSION In SARS-CoV-2 pneumonia, ABGs at discharge cannot predict the persistence of EID, which is frequent. LU may be useful to identify patients at risk who could benefit from a rehabilitation program.
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Affiliation(s)
- A Carlucci
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy; Dipartimento di Medicina e Chirurgia, Università Insubria-Varese e Como, Italy.
| | - M Paneroni
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Lumezzane (Brescia), Italy
| | - M Carotenuto
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - E Bertella
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Lumezzane (Brescia), Italy
| | - S Cirio
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - A Gandolfo
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - C Simonelli
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Lumezzane (Brescia), Italy
| | - M Vigna
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - C Lastoria
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - A Malovini
- Laboratorio di Informatica e Sistemistica per la Ricerca Clinica, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - B Fusar Poli
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Pavia, Italy
| | - M Vitacca
- U.O. Pneumologia Riabilitativa, IRCCS Istituti Clinici Scientifici Salvatore Maugeri, Lumezzane (Brescia), Italy
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Vitacca M, Paneroni M, Fracassi M, Mandora E, Cerqui L, Benedetti G, Zanoni C, Pluda A, Bertacchini L, Fiorenza D. Inhaler technique knowledge and skills before and after an educational program in obstructive respiratory disease patients: A real-life pilot study. Pulmonology 2023; 29:130-137. [PMID: 33268032 DOI: 10.1016/j.pulmoe.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Patients present poor knowledge and skills about their respiratory disease and inhaler device. We aimed to: (1) evaluate COPD and asthmatic patients... ability to manage inhaled drugs (2) identify differences among devices and (3) correlate clinical data with patient ability. MATERIAL AND METHODS Patients (n=134) admitted for pulmonary rehabilitation (PR) were given an ad-hoc questionnaire covering 0% as the worst and 100% the best value of global ability (indicating the sum of knowledge and skills in managing inhaled drugs) at baseline (T0) and discharge (T1). Educational program was provided during PR. Setting of rehabilitation, age, sex, diagnosis, spirometry, CIRS score, level of autonomy to use medications, if na..ve about PR, educational level, and number/type of prescribed inhaled drugs were recorded. RESULTS Most patients used 1 drug while 37% used 2 drugs. DPIs were the main device prescribed. At baseline, patients... mean level of knowledge and skills were 73% and 58%, respectively. There was a significant difference in level of skills (p=0.046) among device families, DPIs resulting worst and pMDIs best. Global ability, skills and knowledge improved after educational support (p<0.001) but did not reach the optimal level, 88%, 87% and 89%, respectively. Baseline global ability was positively correlated to female gender, younger age, previous PR access, outpatient status, higher education level and GOLD D class. CONCLUSIONS At hospital admission, global ability was not optimal. Education may improve this, irrespective of the type of device used, in particular in male, elderly, na..ve to PR, low educational level patients.
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Affiliation(s)
- M Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy.
| | - M Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - M Fracassi
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - E Mandora
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - L Cerqui
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - G Benedetti
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - C Zanoni
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - A Pluda
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - L Bertacchini
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - D Fiorenza
- Respiratory Rehabilitation of the Institute of Lumezzane. Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
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Vitacca M, Malovini A, Spanevello A, Ceriana P, Paneroni M, Maniscalco M, Balbi B, Rizzello L, Murgia R, Bellazzi R, Ambrosino N. Clusters of individuals recovering from an exacerbation of chronic obstructive pulmonary disease and response to in-hospital pulmonary rehabilitation. Pulmonology 2023; 29:230-239. [PMID: 36717292 DOI: 10.1016/j.pulmoe.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Due to the present low availability of pulmonary rehabilitation (PR) for individuals recovering from a COPD exacerbation (ECOPD), we need admission priority criteria. We tested the hypothesis that these individuals might be clustered according to baseline characteristics to identify subpopulations with different responses to PR. METHODS Multicentric retrospective analysis of individuals undergone in-hospital PR. Baseline characteristics and outcome measures (six-minute walking test - 6MWT, Medical Research Council scale for dyspnoea -MRC, COPD assessment test -CAT) were used for clustering analysis. RESULTS Data analysis of 1159 individuals showed that after program, the proportion of individuals reaching the minimal clinically important difference (MCID) was 85.0%, 86.3%, and 65.6% for CAT, MRC, and 6MWT respectively. Three clusters were found (C1-severe: 10.9%; C2-intermediate: 74.4%; C3-mild: 14.7% of cases respectively). Cluster C1-severe showed the worst conditions with the largest post PR improvements in outcome measures; C3-mild showed the least severe baseline conditions, but the smallest improvements. The proportion of participants reaching the MCID in ALL three outcome measures was significantly different among clusters, with C1-severe having the highest proportion of full success (69.0%) as compared to C2-intermediate (48.3%) and C3-mild (37.4%). Participants in C2-intermediate and C1-severe had 1.7- and 4.6-fold increases in the probability to reach the MCID in all three outcomes as compared to those in C3-mild (OR = 1.72, 95% confidence interval [95% CI] = 1.2 - 2.49, p = 0.0035 and OR = 4.57, 95% CI = 2.68 - 7.91, p < 0.0001 respectively). CONCLUSIONS Clustering analysis can identify subpopulations of individuals recovering from ECOPD associated with different responses to PR. Our results may help in defining priority criteria based on the probability of success of PR.
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Affiliation(s)
- M Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy.
| | - A Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - A Spanevello
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - P Ceriana
- Respiratory Rehabilitation of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - M Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - M Maniscalco
- Respiratory Rehabilitation of the Institute of Telese, Istituti Clinici Scientifici Maugeri IRCCS, Benevento, Italy
| | - B Balbi
- Respiratory Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - L Rizzello
- Respiratory Rehabilitation of the Institute of Milano Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | - R Murgia
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - R Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy; Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - N Ambrosino
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Mapelli M, Salvioni E, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, La Rovere M, Agostoni P. P244 BRISK WALKING CAN BE A MAXIMAL EFFORT IN HEART FAILURE PATIENTS. A COMPARISON OF CARDIOPULMONARY EXERCISE AND SIX–MINUTE WALKING TEST CARDIORESPIRATORY DATA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiopulmonary exercise test (CPET) and six–minute walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self–selected constant load test usually considered a submaximal, and therefore safer, exercise but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.
Methods and Results
Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath–by–breath measurement of cardiorespiratory parameters. HF Patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One–hundred and fifty–five subjects were enrolled, of whom 40 were healthy (59±8 years; male 67%) and 115 were HF patients (69±10 years; male 80%; left ventricular ejection fraction 34.6±12.0%). CPET peakV̇O2 was 13.5±3.5 ml/kg/min in HF patients and 28.1±7.4 ml/kg/min in healthy (p < 0.001). 6MWT–V̇O2 was 98±20% of the CPET peakV̇O2 values in HF patients, while 72±20% in healthy subjects (p < 0.001). 6MWT–V̇O2 was >110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2<12ml/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as absolute value, progressively increased as exercise limitation did.
Conclusions
6MWT must be perceived as a maximal or even supra–maximal exercise activity at least in patients with severe exercise limitation from HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - E Salvioni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - M Paneroni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - P Gugliandolo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - A Bonomi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - S Scalvini
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - R Raimondo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - S Sciomer
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - M La Rovere
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
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Paneroni M, Vitacca M, Bernocchi P, Bertacchini L, Scalvini S. Feasibility of tele-rehabilitation in survivors of COVID-19 pneumonia. Pulmonology 2021; 28:152-154. [PMID: 33893061 PMCID: PMC8045455 DOI: 10.1016/j.pulmoe.2021.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - M Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - P Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy.
| | - L Bertacchini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - S Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
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Paneroni M, Scalvini S, Simonelli C, Rivadossi F, Pavesi C, Rainoldi F, Lovagnini M, La Rovere MT, Ambrosetti M, Pedretti R. P2261The impact of a short-term cardiac rehabilitation program on activities of daily living in elderly patients with chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
A high proportion of elderly patients with Chronic Heart Failure (CHF) experience dyspnea and fatigue during the activities of daily living (ADLs).
Purpose
We aimed to determine 1) the VO2 peak of some basic ADLs comparing it to VO2 peak at CardioPulmonary Exercise Test (CPET) and 2) the effects of 3-week inpatient cardiac rehabilitation program on ADLs' performance.
Methods
At entry and at the end of a 20-day cardiac rehabilitation program patients performed an ADL-test consisting of five task-related ADL activities and two time-related ADL activities while wearing a metabolimeter mobile device (K5, Cosmed). Task-related activities were: 1) to put on and take off socks, shoes and jacket (ADL 1); 2) to fold eight towels (ADL 2); 3) to put 6 bottles on a shelve (ADL 3); 4) to make a bed (ADL 4); 5) to go up and down 1-floor stairs (ADL 5). Time-related ADL activities were: 1) to sweep the floor for 4 minutes (ADL 6) and 2) to walk for six minute (6MWT). Metabolic load, oxygen uptake, ventilation, heart rate and symptom of dyspnea were computed for each ADL. During the program, patients performed a CPET.
Results
Fifty-six CHF patients [89% men; age 72±6 years; Ejection Fraction (EF) 38±12%; 66% with EF<40%] were enrolled. At entry, the least demanding ADL [expressed as proportion of peak oxygen uptake (VO2 peak) reached at CPET] was ADL 3 with 53,14±18.53%, while the most challenging was the 6MWT with 116.81±34.48%. Forty-two (75%) patients reached the VO2peak of CPET during 6MWT. After rehabilitation, there was a significant decrease in the time required to perform the task-related activities (ADL 1–5) [from 382.25±114.90 to 354.48±116.92 seconds, p=0.0175] and a significant increase in the distance covered during 6MWT [from 421.35±81.64 to 448.84±89.69 meters, p=0.000]. Moreover, following rehabilitation a significant decrease of heart rate in ADL1, ADL 3 and ADL 5 and a significant decrease of dyspnea in ADL 5, ADL 6 and 6MWT was recorded.
Conclusion
A comprehensive cardiac rehabilitation program can improve ADL performance due to the change of some physiological variables during effort. Further studies about the role of dedicated rehabilitation program (i.e. occupational rehab) are necessary.
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Simonelli C, Vitacca M, Vignoni M, Ambrosino N, Paneroni M. Effectiveness of manual therapy in COPD: A systematic review of randomised controlled trials. Pulmonology 2019; 25:236-247. [PMID: 30738792 DOI: 10.1016/j.pulmoe.2018.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/20/2018] [Accepted: 12/15/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Manual therapy (MT) has been proposed in pulmonary rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD), but an updated systematic review of the evidence is lacking. We aimed to systematically review the effectiveness of MT interventions, alone or added to exercise, on lung function, exercise capacity and quality of life in COPD patients, compared to other therapies (e.g. exercise alone) or no treatment. MATERIALS AND METHODS We searched MEDLINE, EMBASE, Physiotherapy Evidence Database, and Cochrane Central Register of Controlled Trials databases, using the terms: COPD, manual therapy, manipulation, joint mobilisation, osteopathic manipulation. Only randomised controlled trials (RCT) were considered. RESULTS Out of 555 articles screened, 6 fulfilled the inclusion criteria. The study designs were heterogeneous (with different intervention schedules) and there was a high risk of bias. No effect on lung function was found, while results on exercise capacity were contrasting. MT had no effect on quality of life, although valid measures were available only in one study. Only mild adverse events were reported. CONCLUSIONS Few RCTs of poor methodological quality are available on the effects of MT in COPD. More and better quality RCTs are needed before this technique can be included in rehabilitation programmes for these patients.
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Affiliation(s)
- C Simonelli
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane (BS), Italy.
| | - M Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
| | - M Vignoni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano (PV), Italy
| | - N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano (PV), Italy
| | - M Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
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Vitacca M, Montini A, Lunetta C, Banfi P, Bertella E, De Mattia E, Lizio A, Volpato E, Lax A, Morini R, Paneroni M. Impact of an early respiratory care programme with non-invasive ventilation adaptation in patients with amyotrophic lateral sclerosis. Eur J Neurol 2018; 25:556-e33. [PMID: 29266547 DOI: 10.1111/ene.13547] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Forced vital capacity (FVC) <80% is one of the key indications for starting non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS). It was hypothesized that a very early start of NIV could lengthen the free interval before death compared to later-start NIV; as a secondary outcome, the survival rate of patients on NIV without tracheotomy was also evaluated. METHODS This retrospective study was conducted on 194 ALS patients, divided into a later group (LG) with FVC <80% at NIV prescription (n = 129) and a very early group (VEG) with FVC ≥80% at NIV prescription (n = 65). Clinical and respiratory functional data and time free to death between groups over a 3-year follow-up were compared. RESULT At 36 months from diagnosis, mortality was 35% for the VEG versus 52.7% for the LG (P = 0.022). Kaplan-Meier survival curves adjusted for tracheotomy showed a lower probability of death (P = 0.001) for the VEG as a whole (P = 0.001) and for the non-bulbar (NB) subgroup (P = 0.007). Very early NIV was protective of survival for all patients [hazard ratio (HR) 0.45; 95% confidence interval (CI) 0.28-0.74; P = 0.001] and for the NB subgroup (HR 0.43; 95% CI 0.23-0.79; P = 0.007), whilst a tracheotomy was protective for all patients (HR 0.27; 95% CI 0.15-0.50; P = 0.000) and both NB (HR 0.26; 95% CI 0.12-0.56; P = 0.001) and bulbar subgroups (HR 0.29; 95% CI 0.11-0.77; P = 0.013). Survival in VEG patients on NIV without tracheotomy was three times that for the LG (43.1% vs. 14.7%). CONCLUSION Very early NIV prescription prolongs the free time from diagnosis to death in NB ALS patients whilst tracheotomy reduces the mortality risk in all patients.
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Affiliation(s)
- M Vitacca
- Respiratory Rehabilitation Division, ICS Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - A Montini
- Respiratory Rehabilitation Division, ICS Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - C Lunetta
- NEMO Clinical Centre, Fondazione Serena Onlus, Milano, Italy
| | - P Banfi
- Don Gnocchi Foundation IRCCS - Onlus, Milano, Italy
| | - E Bertella
- Respiratory Rehabilitation Division, ICS Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - E De Mattia
- NEMO Clinical Centre, Fondazione Serena Onlus, Milano, Italy
| | - A Lizio
- NEMO Clinical Centre, Fondazione Serena Onlus, Milano, Italy
| | - E Volpato
- Don Gnocchi Foundation IRCCS - Onlus, Milano, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - A Lax
- Don Gnocchi Foundation IRCCS - Onlus, Milano, Italy
| | - R Morini
- Neurorehabilitation Division, ICS Maugeri IRCCS, Lumezzane, Brescia, Italy
| | - M Paneroni
- Respiratory Rehabilitation Division, ICS Maugeri IRCCS, Lumezzane, Brescia, Italy
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Comini L, Rocchi S, Bruletti G, Paneroni M, Bertolotti G, Vitacca M. Impact of Clinical and Quality of Life Outcomes of Long-Stay ICU Survivors Recovering From Rehabilitation on Caregivers' Burden. Respir Care 2016; 61:405-15. [DOI: 10.4187/respcare.04079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vitacca M, Scalvini S, Volterrani M, Paneroni M, Giordano A, Ambrosino N. Physiological and symptom effects of changing posture from sitting to supine, and vice versa, in stable chronic heart failure. Acta Cardiol 2016; 71:543-548. [PMID: 27695011 DOI: 10.2143/ac.71.5.3167497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Vitacca M, Paneroni M, Peroni R, Barbano L, Dodaj V, Piaggi G, Vanoglio F, Luisa A, Giordano A, Ceriana P. Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility. Respir Care 2014; 59:1863-71. [DOI: 10.4187/respcare.03030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Paneroni M, Clini E, Crisafulli E, Guffanti E, Fumagalli A, Bernasconi A, Cabiaglia A, Nicolini A, Brogi S, Ambrosino N, Peroni R, Bianchi L, Vitacca M. Feasibility and Effectiveness of an Educational Program in Italian COPD Patients Undergoing Rehabilitation. Respir Care 2013; 58:327-33. [DOI: 10.4187/respcare.01697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vitacca M, Paneroni M. [Mechanical ventilation weaning: dedicated protocols]. G Ital Med Lav Ergon 2007; 29:65-71. [PMID: 17569422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- M Vitacca
- Divisione di Pneumologia Riabilitativa, Centro di svezzamento prolungato, Fondazione S. Maugeri IRCCS, Centro medico Gussago/Lumezzane (BS), Italy.
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Vitacca M, Paneroni M, Bianchi L, Clini E, Vianello A, Ceriana P, Barbano L, Balbi B, Nava S. Maximal inspiratory and expiratory pressure measurement in tracheotomised patients. Eur Respir J 2006; 27:343-9. [PMID: 16452590 DOI: 10.1183/09031936.06.00002705] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present study compared four different sites and conditions for the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in 38 spontaneous breathing tracheotomised patients. Of the patients, 28 had chronic obstructive pulmonary disease (COPD). The four different conditions were: 1) through a cuff inflated cannula (condition A); 2) through the mouth with a deflated cannula (condition B); 3) through the mouth with a phonetic uncuffed cannula (condition C); and 4) through the mouth after stoma closure (condition D). Five trials in each condition were performed using a standardised method. The measurement of both MIP and MEP differed significantly depending on the condition of measurement. MIP taken in condition A was significantly higher when compared with conditions B, C and D. MEP in condition A was significantly higher when compared with condition B and D. In condition A the highest frequency of the best measurement of MIP and MEP was observed at the fourth and fifth effort, respectively. The same results were obtained after the selection of only COPD patients. In conclusion, respiratory muscle assessment differs significantly depending on measurement condition. Measurement through inflated cannula tracheotomy yields higher values of both maximal inspiratory and maximal expiratory pressure.
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Affiliation(s)
- M Vitacca
- Fondazione S. Maugeri IRCCS, Pavia, Italy.
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