Respirology : official journal of the Asian Pacific Society of Respirology
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Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health-related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost-effective. ⋯ Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and individual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.
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During wakefulness, the electromyography (EMG) activities of upper airway dilator muscles are higher in OSA syndrome (OSAS) patients than those in normal subjects. This is believed to be related to central compensatory mechanisms. This study aimed to assess the central motor conductivity of genioglossus (GG) during wakefulness and to evaluate the compensatory site in OSAS patients. ⋯ OSAS patients have an increased central motor conductivity of GG than normal subjects. Furthermore, this increased central motor conductivity of GG is related to the severity of OSAS.
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The six-minute walk test (6MWT) is widely used as an outcome measure in pulmonary rehabilitation programs (PRP). A learning effect for the test has been reported in COPD; however, limited data exist in patients with other respiratory diagnoses. The objectives of this study were to: (i) report the magnitude of change in 6MWD with test repetition in patients referred to an outpatient PRP, and (ii) compare the magnitude of change in 6MWD with test repetition in patients with COPD, interstitial lung disease (ILD), bronchiectasis and asthma. ⋯ Respiratory diagnosis influences the magnitude of the learning effect for the 6MWT. The findings support the recommendation of a practice 6MWT at baseline assessment in order to provide an accurate measure of the effects of rehabilitation on 6MWD.
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The past decade has seen a dramatic rise in clinical and research interests in pleural disease in parallel with rising incidences of pleural cancers and infection worldwide. Development of specialist pleural services can streamline patient diagnosis and therapy, reduce health-care resource consumption, improve procedural training and safety and facilitate clinical research. ⋯ Establishing funding support and referral sources are the common initial hurdles. This article provides an overview of the need for specialist pleural disease units, the essential elements required and the likely challenges encountered in setting a service up.
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Little is known about long-term survival of patients surviving the first episode of type II respiratory failure requiring non-invasive ventilation (NIV). We aimed to determine the 1-, 2- and 5-year survival, cause of death and potential prognostic indicators in this patient cohort. ⋯ The 2- and 5-year mortality rates for patients with COPD surviving their first episode of respiratory failure requiring NIV are high. Physiological measures of the severity of respiratory failure at presentation do not predict subsequent survival and nor does the time interval between first and second admissions requiring NIV. Age, BMI and prior need for domiciliary oxygen are the main predictors of mortality at 5 years.