In patients with stable severe COPD, it was possible to increase activity by regular phone calls without performing previous rehabilitation. Increased activity resulted in increased exercise capacity and quality of life within 2 weeks, underlining the effectiveness of continued motivational support in patients with severe COPD.

This study was designed to assess the effect of differential leukocyte depletion during chemotherapy by monitoring the levels of exhaled hydrogen peroxide H 2 O 2 and nitric oxide (FeNO) present.In 39 patients with lung cancer (chronic obstructive pulmonary disorder up to stage II, median forced expiratory volume in one second 78% predicted), measurements were performed before a cycle of therapy (day 1), at least once during the cycle (day 8: n534; day 15: n519), and afterwards (days 21-29).There were significant changes in the level of H 2 O 2 , FeNO and peripheral blood cell differentials over the visits. The level of H 2 O 2 was decreased only on day 15, with a median (difference between the upper and lower quartiles) fall of 31 (57)%, while FeNO was reduced only on day 8, by 22 (40)%. Neutrophil numbers were unchanged on day 8 and decreased by 59 (48)% on day 15, while monocyte numbers were decreased on day 8 by 87 (39)%. On days 21-29, values had returned to baseline.Taken together with previous findings, the parallel course of levels of exhaled hydrogen peroxide and neutrophil counts suggests that a major part of exhaled hydrogen peroxide is due to neutrophils via the conducting airways. In contrast, the production of exhaled nitric oxide seems to be primarily associated with monocytes.

The 6-min walking (6MWD) and 6-min treadmill distance (6MTD) are often used as measures of exercise performance in patients with COPD. The aim of our study was to assess their relationship to daily activity in the course of an exercise training program. Eighty-eight patients with stable COPD (71m/17f; mean +/- SD age, 60 +/-8 year; FEV1, 43+/-14% pred) were recruited, 66 of whom performed a hospital-based 10-day walking training, whereas 22 were treated as control. On day 16MTD, and on days 8 and 10, 6MTD and 6MWD were determined. In addition, patients used an accelerometer (TriTrac-R3D) to record 24 h-activity, whereby training sessions were excluded. In both groups there was a linear relationship (r > or = 0.84 and P < 0.0001) between 6MTD and 24 h-activity, the slope of which was 2.5-fold greater in the training group (P < 0.01). Similar relationships emerged for 6MWD. There was no association between baseline 6MTD, FEV1 or BMI and any of the other measures. These data suggest that daily activity did not markedly vary with exercise capacity under baseline conditions. Participation in a training program increased activity significantly stronger than predicted from the gain in exercise capacity. This underlines the importance of non-physiological, patient-centered factors associated with training in COPD.

EinleitungChronische Atemwegserkrankungen stellen lang verlaufende Krankheitsprozesse dar, die in der Regel eine lebenslange Thera− pie erfordern. Die fachgerechte Versorgung der Patienten wird ± neben einer qualifizierten medikamentösen Therapie ± durch eine darüber hinausgehende langfristige Unterstützung und Be− treuung verbessert, die speziell auf die Charakteristika der jewei− ligen Atemwegserkrankung abgestimmt ist. In den letzten Jahren wurden neben den klassischen Verfahren der stationären Reha− AbstractIn Germany there is a long tradition of rehabilitation and exercise training programs to improve the clinical state and physical function of patients with chronic obstructive pulmonary dis− eases. This is particularly true regarding inpatient rehabilitation. Based on experiences gained in other countries, outpatient and home−based programs are currently getting more attention. One of the key components of pulmonary rehabilitation is exercise training which can be expected to exert direct and indirect bene− ficial effects on physical performance, health−related quality of life and even the progress of the disease. Most of the available ex− perience refers to patients with COPD ± besides those with bron− chial asthma. The data available so far suggest that exercise training programs can reduce exacerbation rates and that this ef− fect is achievable by minimal personal assistance. Thus the most important aim of future studies seems to be the development and evaluation of training programs which are efficient but also easy to implement and minimally expensive. Furthermore it needs to be studied whether such programs can be transferred to pulmonary disorders other than obstructive airway diseases. Übersicht 328Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.