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Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease.

The aim of this study was to assess the effects of preoperative pulmonary rehabilitation (PPR) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC), and net effects of PPR and cancer resection on residual pulmonary function and functional capacity.

MATERIAL AND METHODS: This prospective single group study included 83 COPD patients (62 ±8 years, 85% males, FEV1 = 1844 ±618 ml, Tiffeneau index = 54 ±9%) with NSCLC, on 2-4-week PPR, before resection. Pulmonary function, and functional and symptom status were evaluated by spirometry, 6-minute walking distance (6MWD) and Borg scale, on admission, after PPR and after surgery.

RESULTS: Following PPR significant improvement was registered in the majority of spirometry parameters (FEV1 by 374 ml, p < 0.001; VLC by 407 ml, p < 0.001; FEF50 by 3%, p = 0.003), 6MWD (for 56 m, p < 0.001) and dyspnoeal symptoms (by 1.0 Borg unit, p < 0.001). A positive correlation was identified between preoperative increments of FEV1 and 6MWD (r s = 0.503, p = 0.001). Negative correlations were found between basal FEV1 and its percentage increment (r s = -0.479, p = 0.001) and between basal 6MWD and its percentage change (r s = -0.603, p < 0.001) during PPR. Compared to basal values, after resection a significant reduction of most spirometry parameters and 6MWD were recorded, while Tiffeneau index, FEF25 and dyspnoea severity remained stable (p = NS).

CONCLUSIONS: Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection. Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR. The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity.

COPD assessment: I, II, III, IV and/or A, B, C, D.

In 2001 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee published its first consensus report. At that time the authors suggested that the assessment of chronic obstructive pulmonary disease (COPD) should be primarily based on the extent of airflow limitation. In the following years, evidence accumulated that COPD is a complex and heterogeneous disease and that airflow limitation is not closely correlated to a variety of patient-related outcomes. These findings, and the intent to create a more comprehensive system to better reflect the situation of an individual patient, were the basis for a novel concept recently published by GOLD. Now, the assessment is no longer based on the extent of airflow limitation alone; in addition, the patient's exacerbation history and symptoms are taken into account. Based on the severity of symptoms and the exacerbation risk, four categories (A, B, C and D) were defined.

Since then, this novel assessment scheme has been studied in several existing cohorts, ranging from more than 2000 clinically stable COPD patients in the ECLIPSE study (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints), over a more broadly composed cohort of 4000 smokers from the COPDGene study, to population samples from Copenhagen and the Spanish COCOMICS study (Collaborative Cohorts to assess Multicomponent Indices of COPD in Spain). Agusti et al. summarised and compared the results of these four cohorts. The prevalence of the four groups varied between populations; patients classified as A or D seem to be stable over time, mortality is lowest in A, highest in D and similar in B and C, exacerbation rates rise from A to D, but hospitalisations show a similar pattern as mortality. Importantly, comorbidities seem to be more prevalent in the more symptomatic groups (B and D) ...

Real-life use of fluticasone propionate/salmeterol in patients with chronic obstructive pulmonary disease: a French observational study

Conclusions: Prescription of dry powder inhaler SFC by GPs and pulmonologists has very low conformity with the three conditions defining the licensed COPD population. Prescription practices need to be improved and systematic FEV1 evaluation for COPD diagnosis and treatment management should be emphasized.

Evidence suggesting that oral corticosteroids increase mortality in stable chronic obstructive pulmonary disease

The use of oral corticosteroids, historically prescribed to improve lung function in patients with acute chronic obstructive pulmonary disease (COPD),  has been suggested to increase mortality in patients with stable COPD based on data from the National Emphysema Treatment Trial.

Biomolecular markers in assessment and treatment of asthma

Asthma is a chronic and heterogeneous inflammatory disorder with several different phenotypes. Whereas clinical features of asthma are non‐specific and pulmonary function tests are often insensitive, further development is needed for efficient treatment or even early diagnosis.

Recently, several airway inflammatory biomarkers have emerged as valuable tools in diagnosis and management of asthma. The analysis of molecular markers of airways inflammation has provided promising and non‐invasive techniques that facilitate the detection of disease phenotypes as well as measurement of therapeutic efficacy. Although conventional treatments remain the preferred therapy, they do not adequately control some severe cases of asthma. Novel therapeutic agents have been developed to target va...

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