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Long-term Efficacy of Pulmonary Rehabilitation: A STATE-OF-THE-ART REVIEW.

PURPOSE:: While the short-term efficacy of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) is well documented, less is known about its sustainability and long-term effects in non-COPD patients, as well as secondary effects on exacerbation rates and the use of health care resources.

METHODS:: We conducted a MEDLINE literature search on studies of pulmonary rehabilitation from the years 2000 to 2010. For each study, design, modalities, and outcomes were tabulated.

RESULTS:: Design, group size, and duration of followup varied considerably between studies. Fifteen studies assessed physical performance, quality of life, or dyspnea in patients with COPD up to 24 months after rehabilitation. Six studies conducted followup evaluations in patients with interstitial lung disease, and 1 study considered asthma. Exacerbation rates and the use of health care resources were assessed in 20 studies in COPD and in 1 study in asthma. Results indicated the maintenance of the primary effects up to 1 year after pulmonary rehabilitation in COPD, while such effects were less pronounced in patients with interstitial lung disease. Secondary improvements regarding exacerbation rates and the use of health care resources were not consistent throughout studies and diseases.

CONCLUSIONS:: Pulmonary rehabilitation has positive short- and longterm functional effects in COPD and more recent research supports improvements of exacerbation rates and the use of health care resources as secondary outcomes of pulmonary rehabilitation. Additional research on long-term efficacy regarding secondary effects and non-COPD patients is essential.

Reduction of severe exacerbations and hospitalization-derived costs in alpha-1-antitrypsin-deficient patients treated with alpha-1-antitrypsin augmentation therapy.

OBJECTIVE: Severe exacerbations in alpha-1-antitrypsin (AAT)-deficient patients with chronic obstructive pulmonary disease (COPD) and/or emphysema are a major cause of hospitalization. A multicentre, observational, retrospective study was undertaken to evaluate the effect of continuous AAT augmentation therapy in reducing the incidence of exacerbations in these patients.

METHODS: Patients treated with Trypsone(®) or Prolastin(®) for at least 18 months were recruited if their medical records for 18 months before starting augmentation therapy were available. The number of mild and severe exacerbations in the two periods was compared and hospitalization-related costs were analysed.

RESULTS: A total of 127 patients were recruited; 75 of them experienced at least one exacerbation in the period prior to augmentation. In the treatment period, the mean number of exacerbations per patient was reduced in both the total population and the population with exacerbations (mean ± SD: 1.2 ± 1.6 versus 1.0 ± 2.2 and 2.0 ± 1.6 versus 1.4 ± 2.7, respectively; p < 0.01). The percentage of patients experiencing exacerbations was reduced in the total population (59.1% versus 44.1%; p < 0.05). In the patient subgroup of the total population who experienced a change in their number of exacerbations between the two periods, 43.7% had a reduction and 21.4% had an increase (p < 0.01). The number of severe exacerbations diminished in 42.9% of this subgroup and increased in 12.0% (p < 0.001). Most adverse events were nonserious or not related to treatment. Hospitalization costs savings per patient associated with treatment ranged from ~€400 to €900 (p < 0.05).

CONCLUSIONS: Augmentation therapy with AAT concentrates was associated with a reduction in the incidence and severity of exacerbations in AAT-deficient patients, which resulted in lower hospitalization expenditures.

Silent PE raises risk for early symptomatic PE in DVT patients

Patients with silent pulmonary embolism at the time of deep vein thrombosis diagnosis have an increased risk for symptomatic PE during the first 2 weeks of therapy, study findings indicate.

Postop radiotherapy no benefit to elderly lung cancer patients

US research has cast doubts on the benefits of postoperative radiotherapy for elderly patients with locally advanced nonsmall cell lung cancer.

COPD patients at increased risk for peptic ulcer bleeding

Patients with chronic obstructive pulmonary disease are nearly twice as likely to develop peptic ulcer bleeding as the general population, suggest study findings that also identified a number of important risk factors in these patients.

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