Respiration; international review of thoracic diseases
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Clinically, the symptoms and limited exercise capabilities of patients with chronic obstructive pulmonary disease (COPD) correlate better with changes in lung volumes than with airflow measurements. The realization of the clinical importance of hyperinflation has been overshadowed for decades by the use of forced expiratory volume during 1 s (FEV(1)) and the ratio of the FEV(1) to the forced expiratory vital capacity (FEV(1)/FVC) to categorize the severity and progression of COPD. Hyperinflation is defined as an elevation in the end-expiratory lung volume or functional residual capacity. ⋯ Severe hyperinflation is the major physiologic cause of the resulting hypercarbic respiratory failure and patients' inability to transition (i.e. wean) from mechanical ventilatory support to spontaneous breathing. This paper reviews the basic physiologic principles of hyperinflation and its clinical manifestations as demonstrated by PEEPi. Also reviewed are the adverse effects of hyperinflation and PEEPi in critically ill patients with COPD, and methods for minimizing or counterbalancing these effects.
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Airway stenting is nowadays an established method for the palliative and/or curative treatment of central airways obstruction. However, complications related to the use of airway stents have been reported. ⋯ The accumulated and evaluated evidence suggests that SARTI probably involves 1 in 5 patients with airway stent. Although the possibility of SARTI should not discourage the interventional pneumologists from inserting airway stents, the data seem to underline the urgent need for establishing a consensus definition and diagnostic criteria for SARTI.
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Review
Relation of chronic obstructive pulmonary disease exacerbations to FEV(1)--an intricate tango.
This article provides a brief review of the complex interrelationships that surround chronic obstructive pulmonary disease exacerbations and lung function, particularly FEV(1). Areas of discussion include a consideration of baseline lung function as a risk factor for exacerbation, the magnitude and duration of lung function abnormalities after onset and during recovery from exacerbations, the relation between changes in lung function during an exacerbations and clinical outcomes, and the potential impact of recurrent exacerbations on long-term deterioration in lung function.
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Disabled patients with chronic respiratory disease and peripheral skeletal muscle disorders have limitations in their exercise capacity, which may be improved after specific training in a pulmonary rehabilitation (PR) program. Individual assessment of exercise capacity by clinically available exercise tests represents an important patient-centered outcome that should be embedded in the rehabilitation process. These measurements include laboratory (treadmill and/or cycle ergometer) and field (walking) tests. ⋯ These tests are inexpensive and provide information on an individual's functional abilities: the 6-min walking test has been shown to provide level of disability and functional status, whereas the shuttle walking test has been shown to be more suitable to detect change of physical performance following PR. Overall, several available physiologically targeted tests are useful to measure the patient's tolerance to exercise, and many are even sensitive to change once intervention has taken place. In particular, endurance modality tests seem to provide better measurement of changes after PR than incremental exercise tests.