Background. AECOPD is a life threatening condition for patients with chronic obstructive pulmonary disease (COPD) and lack of specific biomarker hinders effective management. Sputum, blood, breath and urinary biomarkers have all been investigated. We measured maximum respiratory pressure post exacerbation once the patient was compliant with the test and after 6 weeks, to assess any correlations. Methods and Results. The maximum pressures were measured using a closed circuit spirometer with a clean rubber mouthpiece properly placed with the patients lips sealed around it. Patients were properly instructed to exhale slowly and completely, then inspire with maximum possible effort and advised to keep it for nearly 1.5 s for maximum inspiratory pressure (MIP). For maximum expiratory pressures (MEP) patients were instructed to inspire slowly and completely, then expire forcefully with maximum effort. With the recorded values TTI (time tension index) was calculated. This was repeated again after 6 weeks. Using Pearsons correlation coefficient we found that MIP had a negative correlation with TTI and a positive correlation with FEV1. FEV1 had a positive correlation with FVC. MEP showed no significant correlation with TTI, but a positive correlation with FEV1. Conclusion. Acute exacerbations of COPD has a profound effect on the respiratory musculature especially the expiratory muscles but the maximum pressures are not specific enough to be prognostic markers. It might be worthwhile studying transformations of the respiratory musculature at the molecular level. More studies must be conducted to find a specific marker to aid in the management of the condition.
BACKGROUND: Pulmonary rehabilitation is a common type of complex treatment especially in patients with chronic obstructive pulmonary disease (COPD). By contrast, only few rehabilitation centres in the Czech Republic provide pulmonary rehabilitation programme to non-COPD patients. OBJECTIVE: To find out if the rehabilitation programme has a similar effect in patient with obstructive and restrictive ventilatory disorder. METHODS: Twenty-eight patients with either COPD or pulmonary sarcoidosis (PS) have been enrolled for the 6-week rehabilitation programme. Lung functions, maximal inspiratory (MIP) and expiratory (MEP) mouth pressures, chest expansion at the level of the 4th intercostal space (IC) and at the level of the xiphoid process (XP), sixminute walk test, health-related quality of life using the St. George's Questionnaire (SGRQ) and fatigue occurrence using the Multidimensional Assessment of Fatigue scale (MAF) were tested at the baseline and after 6 weeks. The rehabilitation programme consisted of exercise training, ventilatory muscle training, respiratory physiotherapy and soft-tissue techniques. RESULTS: Patients with COPD improved significantly (p < .05) in MIP by 17% (10.5 cm H 2 O), MEP by 18% (16.8 cm H 2 O), IC by 65% (1.7 cm), XP by 90% (1.9 cm), six-minute walk distance (6MWD) by 15% (64.1 m) and SGRQ by -28% (-12.3 points). Patients with PS improved significantly (p < .05) in MIP by 25% (20.1 cm H 2 O), IC by 29% (1.3 cm), XP by 29% (1.3 cm) and 6MWD by 6% (31.6 m). The change in lung functions and MAF in both groups; MEP and SGRQ in PS group were insignificant after the 6-week rehabilitation programme. CONCLUSIONS: The 6-week rehabilitation programme produces similar responses in functional health status of patients with either obstructive or restrictive ventilatory disorder. However, patients with restrictive ventilatory disorder in particular should be encouraged to continue in the programme to enhance the health-related quality of life, which might not be sufficiently affected after 6 weeks.
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