. RESULTS: The survey response rate was 152/171 (89%). We identified 4,334 ventilator-assisted individuals: an estimated prevalence of 12.9/100,000 population, with 73% receiving noninvasive ventilation (NIV) and 18% receiving intermittent mandatory ventilation (9% not reported). Services were delivered by 39 institutional providers and 113 community providers. We identified variation in initiation criteria for NIV, with polysomnography demonstrating nocturnal hypoventilation (57%), daytime hypercapnia (38%), and nocturnal hypercapnia (32%) as the most common criteria. Various models of ventilator servicing were reported. Most providers (64%) stated that caregiver competency was a prerequisite for home discharge; however, repeated competency assessment and retraining were offered by only 45%. Important barriers to home transition were: insufficient funding for paid caregivers, equipment, and supplies; a shortage of paid caregivers; and negotiating public funding arrangements. CONCLUSIONS: Ventilatory support in the community appears well-established, with most individuals managed with NIV. Although caregiver competency is a prerequisite to discharge, ongoing assessment and retraining were infrequent. Funding and caregiver availability were important barriers to home transition.

Background Decreased exercise capacity and impairments in health-related quality of life (HRQoL) are common in people following lung resection for non-small cell lung cancer (NSCLC). Exercise training has been demonstrated to confer gains in exercise capacity and HRQoL for people with a range of chronic conditions, including chronic obstructive pulmonary disease and heart failure, as well as in people with cancers such as prostate and breast cancer. A programme of exercise training for people following lung resection for NSCLC may confer important gains in these outcomes. To date, evidence of its efficacy in this population is unclear. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer (Review)

BackgroundIn patients with chronic obstructive pulmonary disease (COPD), interval exercise has gained recent attention as a possible means of achieving greater physiological training effects compared with continuous exercise. The primary aim of this systematic review was to compare the effects of interval versus continuous training on peak oxygen uptake, peak power, 6 minute walk test (6MWT) distance and health-related quality of life in individuals with COPD. Methods Randomised controlled trials comparing the effects of interval versus continuous training in patients with COPD were identified after searches of six databases and reference lists of appropriate studies in May 2009. Two reviewers independently assessed study quality. Weighted mean differences (WMD) with 95% CIs were calculated using a random effects model for measures of exercise capacity and health-related quality of life. Results: Eight randomised controlled trials, with a total of 388 patients with COPD, met the inclusion criteria. No significant differences were found for peak power (WMD 1 W, 95% CI À1 to 3) or peak oxygen uptake (WMD À0.04 l/min, 95% CI À0.13 to 0.05) between interval and continuous training. The WMD for the Chronic Respiratory Questionnaire dyspnoea score was À0.2 units (95% CI À0.5 to 0.0). There was no difference in 6MWT distance between groups (WMD 4 m, 95% CI À15 to 23). Conclusions Interval and continuous training modalities did not differ in their effect on measures of exercise capacity or health-related quality of life. Interval training may be considered as an alternative to continuous training in patients with varying degrees of COPD severity.

Objective: To evaluate the health-related quality of life of patients with chronic obstructive pulmonary disease receiving long-term oxygen therapy (LTOT) at home through oxygen cylinders and compare these results with those obtained six months after the transition from oxygen cylinders to oxygen concentrators. Methods: A total of 45 patients were evaluated. Of those, 24 had chronic hypoxemia and 21 presented no evidence of hypoxemia. The patients with chronic hypoxemia had been regularly receiving LTOT for at least the last six months and were evaluated at baseline, while using cylinders, and six months after the transition from cylinders to concentrators. The non-hypoxemic patients were evaluated at the same time points as were the hypoxemic patients. In order to evaluate quality of life, a version of the Saint George's Respiratory Questionnaire (SGRQ), translated and validated for use in Brazil, was administered. Results: At baseline, quality of life, as evaluated using the total score and the symptom and impact domain scores of the SGRQ, was more impaired in the hypoxemic patients than in the non-hypoxemic patients. After six months of using the concentrators, the hypoxemic patients presented a significant improvement in the quality of life, and, at that time, no difference was found between the patients with and without hypoxemia. Conclusion: Our findings show that quality of life is impaired in patients with chronic obstructive pulmonary disease and chronic hypoxemia, that their quality of life can be improved through regular use of LTOT, and that the oxygen delivery system has an influence on this improvement. Resumo Objetivo: Avaliar a qualidade de vida relacionada à saúde de pacientes com doença obstrutiva crônica das vias aéreas recebendo oxigenoretapia domiciliar prolongada (ODP) por meio de cilindros de oxigênio e comparar estes resultados com os obtidos após seis meses de modificação do sistema de fornecimento para concentradores de oxigênio. Métodos: Um total de 45 pacientes, 24 com hipoxemia crônica e 21 sem evidências de hipoxemia, foram avaliados. Os pacientes com hipoxemia crônica estavam recebendo ODP regularmente durante pelo menos os últimos seis meses e foram avaliados no momento basal, em uso de cilindro, e após seis meses de transição para concentradores. Os pacientes não hipoxêmicos foram avaliados no mesmo intervalo de tempo que os pacientes hipoxêmicos. Para avaliar a qualidade de vida foi utilizada a versão validada para língua portuguesa (Brasil) do Questionário Respiratório Saint George (Saint George's Respiratory Questionnaire-SGRQ). Resultados: No momento inicial, os pacientes hipoxêmicos apresentaram maior comprometimento da qualidade de vida, avaliada pelo escore total e pelos escores dos domínios sintomas e impacto do SGRQ, que os pacientes não hipoxêmicos. Após seis meses, houve melhora significativa da qualidade de vida dos pacientes hipoxêmicos e, neste momento, não foi encontrada diferença entre os pacientes com e sem hipoxemia. Conclusão: Nossos achados mostraram que os pa...

Background Decreased exercise capacity and impairments in health-related quality of life (HRQoL) are common in people following lung resection for non-small cell lung cancer (NSCLC). Exercise training has been demonstrated to confer gains in exercise capacity and HRQoL for people with a range of chronic conditions, including chronic obstructive pulmonary disease and heart failure, as well as in people with cancers such as prostate and breast cancer. A programme of exercise training for people following lung resection for NSCLC may confer important gains in these outcomes. To date, evidence of its efficacy in this population is unclear. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer (Review)