Clinics in chest medicine
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Exercise training remains a cornerstone of pulmonary rehabilitation (PR) in patients with chronic respiratory disease. The choice of type of exercise training depends on the physiologic requirements and goals of the individual patient as well as the available equipment at the PR center. Current evidence suggests that, at ground walking exercise training, Nordic walking exercise training, resistance training, water-based exercise training, tai chi, and nonlinear periodized exercise are all feasible and effective in (subgroups) of patients with chronic obstructive pulmonary disease. In turn, these exercise training modalities can be considered as part of a comprehensive, interdisciplinary PR program.
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Pulmonary rehabilitation is now an established standard of care for patients with chronic obstructive pulmonary disease (COPD). Although pulmonary rehabilitation has no appreciable direct effect on static measurements of lung function, it arguably provides the greatest benefit of any available therapy across multiple outcome areas important to the patient with respiratory disease, including dyspnea, exercise performance, and health-related quality of life. It also appears to be a potent intervention that reduces COPD hospitalizations, especially when given in the periexacerbation period. The role of pulmonary rehabilitation within the larger schema of integrated care represents a fruitful area for further research.
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Clinics in chest medicine · Mar 2014
ReviewEpidemiology and prevalence of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) represents one of the main causes of morbidity and mortality worldwide. According to the World Health Organization, approximately 3 million people in the world die as a consequence of COPD every year. Tobacco use remains the main factor associated with development of disease in the industrialized world, but other risk factors are important and preventable causes of COPD, particularly in the developing world. The purpose of this review is to summarize the literature on the subject and to provide an update of the most recent advances in the field.
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As parenchymal lung disease in chronic obstructive pulmonary disease becomes increasingly severe there is a diminishing prospect of drug therapies conferring clinically useful benefit. Lung volume reduction surgery is effective in patients with heterogenous upper zone emphysema and reduced exercise tolerance, and is probably underused. Rapid progress is being made in nonsurgical approaches to lung volume reduction, but use outside specialized centers cannot be recommended presently. Noninvasive ventilation given to patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease reduces mortality and morbidity, but the place of chronic non-invasive ventilatory support remains more controversial.
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Clinics in chest medicine · Mar 2014
ReviewChronic obstructive pulmonary disease: clinical integrative physiology.
Peripheral airway dysfunction, inhomogeneous ventilation distribution, gas trapping, and impaired pulmonary gas exchange are variably present in all stages of chronic obstructive pulmonary disease (COPD). This article provides a cogent physiologic explanation for the relentless progression of activity-related dyspnea and exercise intolerance that all too commonly characterizes COPD. ⋯ Also explored are the perceptual and physiologic consequences of progressive erosion of the resting inspiratory capacity. Finally, emerging information on the role of cardiocirculatory impairment in contributing to exercise intolerance in patients with varying degrees of airway obstruction is reviewed.