Pulmonary rehabilitation (PR) may not suit all individuals with chronic obstructive pulmonary disease (COPD) and may not result in increased physical activity. Higher levels of physical activity are associated with reduced mortality and morbidity. The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention (PAI) versus PR in improving physical activity in patients with COPD referred to PR. In this randomised controlled mixed methods feasibility study, all patients referred to PR who were eligible and willing were assessed at baseline and then randomised to the PAI or to PR. The assessments were repeated post-intervention and at 3-month follow-up. The main outcome was step count measured by Actigraph. Semi-structured interviews were conducted post-intervention. The N = 50 patients; mean (SD) age, 64.1(8.6) years, 24M were recruited and randomised; N = 23 (PAI) and n = 26 (PR): one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria. Key feasibility criteria were met; recruitment was 11%, dropouts in PAI were 26% (n = 6) and 50% (n = 13/26) PR. Participants in both groups experienced a range of health benefits from their respective programmes. The PAI appears to be effective in increasing step counts in people with COPD: mean change (standard deviation) [confidence interval] for the PAI group was 972.0(3230.3)[-1080.3 to 3024.4], n = 12 and 4.3(662.7)[-440.9 to 449.5], n = 11 for the PR group. The PAI met all domains of fidelity. This study provides key information to inform a future-randomised controlled trial in physical activity.

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Nasal intermittent positive pressure ventilation (NIPPV) represents a major advance in the management of respiratory failure. While its role in chronic respiratory failure is well documented, its use in acute respiratory failure is less well defined. We studied four patients with respiratory failure due to kyphoscoliosis, two of whom presented with acute respiratory acidosis. All four patients were on conventional maximum medical therapy prior to treatment with NIPPV. All patients survived to be discharged from hospital on home ventilation and significant improvements were noted in pO2, pCO2 and pulmonary function. We conclude that NIPPV is useful in the management of both acute and chronic ventilatory failure due to kyphoscoliosis.

P Ps se eu ud do om mo on na as s a ae er ru ug gi in no os sa a e ex xo ot to ox xi in n A A i in nd du uc ce es s p pu ul lm mo on na ar ry y e en nd do ot th he el li ia al l c cy yt to ot to ox xi ic ci it ty y: : p pr ro ot te ec ct ti io on n b by y d di ib bu ut ty yr ry yl l--c cA AM MP P can attenuate this injury. The object of this study was to examine the mechanisms of this pulmonary endothelial cell injury and the mechanism of Db-cAMP protection. The effects of differing duration of exposure to exotoxin A and a reduction in temperature on endothelial cell injury were examined. In addition, the effect of post-treatment with Db-cAMP on exotoxin A-induced endothelial cell injury was studied.A brief, 5 min, exposure to exotoxin resulted in maximum injury comparable to that produced by 18 h exposure. This injury did not occur at low temperatures, which would inhibit receptor-mediated endocytosis. Db-cAMP protected endothelial cells, even when added up to one hour after exotoxin exposure.These results suggest that, in this model, exotoxin A-induced injury of endothelial cells is receptor-mediated. Furthermore, this injury may be attenuated even after exotoxin A internalization has taken place.

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The finding of two cases of levofloxacin-induced tendinopathy in our patients suggests that the problem may be more frequent than previously considered. Patients with COPD treated with fluoroquinolones may have other risk factors for tendinopathy such as advanced age, corticosteroid use and renal impairment and merit vigilance for signs of tendonitis.

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Introduction and objectivesThe format of pulmonary rehabilitation (PR) may not meet the needs of all patients with COPD or lead to improved physical activity (PA) levels. Drop outs from PR can be high. A pedometer driven physical activity intervention (PAI) may offer patients an alternative method for increasing their PA. The aim of this study was to assess the feasibility of a 12 week clinician facilitated PAI versus PR in people with COPD.MethodsThe design was a multicenter-randomised, parallel-group, feasibility study. Patients with COPD referred for PR were included. Spirometry and demographics were recorded. The following were assessed at baseline, post-intervention and follow up (12 weeks): PA using an ActiGraph GT3X+ accelerometer, sealed Yamax Digiwalker pedometer and the International Physical Activity Questionnaire (IPAQ) (long form); exercise capacity (Incremental Shuttle Walk Test (ISWT)); COPD Assessment Test (CAT). Recruitment, retention and completion/rates were recorded. Descriptive statistics and mean differences were used to analyse the data.Results50 patients (mean (SD) age 64 (8) years, 24M, FEV1 1.44 (0.63)) were recruited and randomised: PR n = 26, PAI n = 24. Of those screened 50/651, 13% were recruited. One participant randomised to the PAI started PR, a per protocol analysis was conducted; PR n = 27 and PAI n = 23. Completion of the PAI was 74% (17/23) and PR was 48% (13/27). Retention overall was 74% post-intervention (n = 18 PAI; n = 19 PR), and 66% at follow up (n = 15 PAI; n = 18 PR). There was a mean (95% confidence interval (CI)) change of 972 (−1080 to 3024) steps/day and 4 (−441 to 449) in the PAI and PR group respectively; results are found in Table 1. There were 4 minor adverse events (PAI n = 3 PR n = 1).ConclusionsThis study will inform a future large scale randomised control trial (RCT). The LIVELY PAI intervention appears to be feasible and safe within this preliminary study, and enhanced physical activity in people with COPD. While the results require confirmation in a fully powered RCT, the mean increase in step count is in line with a recently published minimally clinically important difference.1 ReferenceDemeyer H, et al. The Minimal Important Difference in Physical Activity in Patients with COPD. PLoS One. 2016;11:0154587.Abstract S33 Table 1Main outcome measures at baseline and post intervention: change from baseline