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Biomedical subjects

R van Altena

Publications and source records attributed to R van Altena.

32 records · Page 2Linked to original sources
PubMed1996

A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months.

AIM: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. METHODS: After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV1 percent predicted, 42.8 [8.4]). RESULTS: After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups. CONCLUSION: Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.

Aged↗
PubMed1995

Relation between beta-lactamase producing bacteria and patient characteristics in chronic obstructive pulmonary disease (COPD).

BACKGROUND: In addition to bronchodilator and anti-inflammatory therapy, exacerbations in patients with chronic obstructive pulmonary disease (COPD) are often treated with antibiotics. Haemophilus influenzae and Moraxella (Branhamella) catarrhalis, two important respiratory pathogens, may produce beta-lactamase which makes them resistant to ampicillin. Surveillance studies conducted in various countries have shown an increasing incidence of these beta-lactamase producing bacteria. Although this may simply be a consequence of the increasing use of antibiotics, it is possible that other factors are important. A study was undertaken to investigate whether clinical factors are related to the presence of beta-lactamase forming bacteria in the sputum of patients with COPD. METHODS: One hundred patients with COPD aged over 40 years were sequentially selected from an outpatient clinic on the basis of sputum culture results. Fifty had beta-lactamase positive (beta L+) and 50 had beta-lactamase negative (beta L-) bacteria in their sputum. Patients were included only if sputum culture results yielded one pathogen. The files of these patients were investigated for possible causative factors present during the two preceding years. RESULTS: Both groups were almost identical in terms of lung function, maintenance medication, and smoking history. The total number of antibiotic courses in the beta L+ group was higher, as were individual courses of cephalosporins, tetracyclines, and macrolides. The number of patients admitted to hospital was higher in the beta L+ group, but admissions were of equal duration in both groups. Patients admitted to hospital had poorer lung function. Risk factors for beta-lactamase producing bacteria were identified by logistic regression analysis which revealed an odds ratio for one course of antibiotics of 1.15 (95% CI 1.04 to 1.28). CONCLUSIONS: An increased number of antibiotic courses is related to a higher incidence of beta-lactamase producing bacteria and more patients had hospital admissions in the beta L+ group. beta-lactamase stable antibiotics were used more frequently in the beta L+ group, probably because prescribing was adapted to the presence of beta-lactamase producing bacteria. No other differences were found between the beta L+ and beta L- groups.

Aged↗
PubMed1995

Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease.

BACKGROUND--Pulmonary rehabilitation has been shown to have short term subjective and objective benefits for patients with chronic obstructive pulmonary disease (COPD). However, appropriately controlled studies have not previously been performed, nor have the benefits of different types of continuation programme for rehabilitation been investigated. Both these problems have been addressed in a single study of the long term effects of once monthly physiotherapy versus once weekly physiotherapy at home after a comprehensive home rehabilitation programme on quality of life and exercise tolerance in patients with COPD. METHODS--Thirty six patients with severe airways obstruction (mean SD) forced expiratory volume in one second (FEV1) 1.3(0.4) 1, FEV1/inspiratory vital capacity (IVC) 37.2(7.9)%) were studied. Twenty three patients followed a rehabilitation programme at home for 18 months consisting of physiotherapy and supervision by a nurse and general practitioner. During the first three months all 23 patients visited the physiotherapist twice a week for a 0.5 hour session. Thereafter, 11 patients (group A) received a session of physiotherapy once weekly while 12 patients (group B) received a session of physiotherapy once a month. The control group C (13 patients) received no rehabilitation at all. Quality of life was assessed by the Chronic Respiratory Questionnaire, exercise tolerance by the six minute walking distance, and lung function by FEV1 and IVC. Outcome measures were assessed at baseline and at three, six, 12, and 18 months. RESULTS--Long term improvements in quality of life were found in patients in groups A and B, but not in those in group C compared with baseline, but these only reached significance in group B at all time points. Patients in group B had a higher quality of life than those in group C only at three and 12 months. There was a decrease in both six minute walking distance (at 12 and 18 months) and IVC (at three, 12, and 18 months) in patients in group C compared with the baseline measurement. Between groups analysis showed no differences for six minute walking distance, FEV1, and IVC. CONCLUSIONS--This study is the first to show that rehabilitation at home for three months followed by once monthly physiotherapy sessions improves quality of life over 18 months. The change in quality of life was not associated with a change in exercise tolerance.

Exercise Tolerance↗
PubMed1995

Peak inspiratory mouth pressure in healthy subjects and in patients with COPD.

The validity of peak inspiratory mouth pressure (P.PI-max) as a measure of inspiratory muscle strength was investigated by comparing it with sniff Pes in patients with COPD with respect to (1) learning effect, (2) reproducibility, and (3) measures of agreement. To assess the discriminating capacity of P.PImax, we compared the values in patients with COPD with those of healthy elderly subjects. Thirty-four patients (mean age, 62.5 years) with severe airways obstruction (FEV1, 44% predicted; FEV1/IVC, 37% predicted) and 149 healthy subjects (age > or = 55 years) were included. P.PImax was assessed during a maximal static inspiratory maneuver, while sniff Pes was assessed during a maximal sniff maneuver. Both maneuvers were performed from residual volume ten times on the same day. P.PImax showed no learning effect, while the sniff maneuver used seven attempts to obtain a maximal value. The intraindividual coefficients of variation of P.PImax and sniff Pes were 11.2% and 6.0%, respectively. Measures of agreement showed no significant discrepancies between the mean P.PImax and mean sniff Pes (0.29 kPa, p = 0.49). There was a significant correlation (r = 0.57, p < 0.001) between both measurements. P.PImax was significantly (p < 0.001) lower in both male (8.2 kPa) and female (6.2 kPa) patients with COPD compared with healthy men (11.0 kPa) and healthy women (8.8 kPa). We conclude that P.PImax is a valid and noninvasive assessment of inspiratory muscle strength.

Age Factors↗
PubMed1994

Clinical and bacteriological efficacy and tolerability of FCE 22891 in patients with exacerbations of chronic obstructive pulmonary disease.

A beta-lactamase-stable antibiotic, the oral penem FCE 22891 (ritipenem acoxil), was investigated for use in exacerbations of chronic obstructive pulmonary disease (COPD). Thirteen of the 15 COPD patients had a proven lower respiratory tract infection. Symptom scores and forced expiratory volumes in 1 s significantly improved during therapy with FCE 22891 in combination with bronchodilators and intravenous corticosteroids. Conversion of representative sputum to nonrepresentative sputum or eradication of the original pathogen in representative sputum was effected in 12 patients. Resistance to FCE 22891 was observed in three cases with Haemophilus influenzae. Gastrointestinal disturbances, of which one was severe, were experienced by eight patients. Although FCE 22891 has some beneficial effect in exacerbations of COPD, there are reservations about its use because of adverse effects and potential inefficacy in the treatment of infection with H. influenzae.

Adult↗
PubMed1994

Respiratory resistance measured by flow-interruption in a normal population.

Data on reference values of total respiratory resistance (Rint) in healthy people are limited. The aim of this study was to examine the relationship between Rint and gender, height, weight, age and smoking habits. The instrument used was the Jaeger Pneumoscope with a flow interruption device. The method is based on transient interruption of airflow at the mouth for a brief period during which alveolar pressure equilibrates with mouth pressure. Measurement of mouth pressure is used to estimate alveolar pressure prior to interruption. The ratio of this to the flow prior to interruption gives airway resistance. The Rint data were correlated with height, weight, age, gender and smoking habits in 172 healthy subjects. They had a normal lung function (VC, FEV1) and no signs of pulmonary disease. The important determining factor for the value of the Rint were height and age. The mean Rint of 172 subjects was 0.38 +/- 0.17 kPa.1-1.s. The average within-subject variability of repeated measurements of Rint expressed as coefficient of variation was 14.4 +/- 6.9%. Reference equation and normal values for Rint in a healthy population are related to height and age. The measurements were obtained with a commercially available interruption technique.

Adolescent↗
PubMed1993

Effect of intramuscular administration of thiazinamium and inhaled histamine on forced inspiratory volume in 1 s.

Twenty-one patients with symptoms suggestive of asthma were evaluated clinically by allergy skin tests, pulmonary function, and histamine inhalation challenge. In addition to the forced expiratory manoeuvres (FEV1), forced inspiratory manoeuvres (FIV1), were performed before and after intramuscular administration of thiazinamium (Multergan), a bronchodilator with markedly anticholinergic properties. The same lung function parameters (FEV1 and FIV1) were obtained before and after histamine inhalation challenge. The response after bronchodilatation in litres of FEV1 2.42 +/- 1.12 to 3.27 +/- 0.98 (mean +/- SD) was much larger than in FIV1 3.44 +/- 1.35 to 4.05 +/- 1.14 (p < 0.05). After histamine inhalation the observed decrease in FEV1 (2.65 +/- 0.99 to 2.06 +/- 0.89) was not so great as in FIV1 (3.76 +/- 1.09 to 2.90 +/- 1.15) (p < 0.02). These results suggest that patients often have more difficulty with inspiration rather than expiration.

Adolescent↗
PubMed1993

Plethysmographic parameters in the assessment of reversibility of airways obstruction in patients with clinical emphysema.

Slow inspiratory vital capacity (IVC) and forced expiratory volume in 1 s (FEV1) before and after an inhaled beta-agonist are widely used to detect reversible airflow limitation in patients with chronic obstructive lung disease. The measurement of airways resistance (Raw) during quiet breathing with the body plethysmograph is less frequently used. It may well be of importance in clinical emphysema where measurement of FEV1 is confounded by the collapse of the bronchi, which does not occur when measuring Raw during quiet breathing. We assessed whether Rrs, in addition to IVC and FEV1, can be used to gain a better insight into the reversibility with 400 micrograms of fenoterol in patients with clinical emphysema. We studied a group of 51 patients (9 women and 42 men; mean [+/- SD] age, 64.7 [7.7] years) who had a clinical diagnosis of emphysema. Significant reversibility was identified by spirometry (IVC, FEV1) and body plethysmography (Raw) in 20 patients (39 percent). Inspiratory vital capacity alone identified reversibility of airflow limitation in 11 patients (22 percent). In 5 patients (10 percent), the postbronchodilator improvement was seen exclusively in the Raw measurement. In the remaining patients, absence of improvement in spirometric and plethysmographic parameters was found. Subjective improvement occurred to the same extent in patients whose Raw and IVC improved. We concluded that Raw gives important information about the reversibility of airways obstruction in patients with clinical emphysema. Therefore, we suggest that tests during quiet breathing should be part of the routine examination of airways obstruction in patients with "irreversible" obstruction by conventional spirometry.

Administration, Inhalation↗
PubMed1993

Variability of forced oscillation (Siemens Siregnost FD 5) measurements of total respiratory resistance in patients and healthy subjects.

The reproducibility of total respiratory resistance (Rrs) measured with a simplified forced oscillatory method (Siemens Siregnost FD 5) was measured and compared with that of slow inspiratory vital capacity (IVC) and forced expiratory volume in one second (FEV1). The former technique has the advantage that assessment of bronchial obstruction can be made without a forced maneuver, which may be difficult in patients with chronic obstructive pulmonary disease (COPD). We used the criteria proposed by the American Thoracic Society for the diagnosis of COPD. Pulmonary function tests (IVC, FEV1 and Rrs) were measured in seven healthy subjects and in two groups of patients with COPD. First one technician performed six measurements of IVC, FEV1 and Rrs in all subjects during a period of 90 minutes on the same day. Second to evaluate intraindividual variability the measurements were performed on ten subsequent days. The median interval (range) between the first and last measurements in days was 38 (20-186). The mean +/- SD coefficient of variation (CV) Rrs in patients was 15.7% +/- 5.0% and in normals, 10.8% +/- 3.2%. There was less variation in the FEV1 value of 11.0% +/- 6.2% and normals, 2.2% +/- 1.0%; and IVC, 6.9% +/- 5.0% and normals, 2.4% +/- 0.7%. There is no correlation between age and CV. It is concluded from the study that oscillatory Rrs has a larger coefficient of variation within one patient than FEV1 or IVC. If Rrs is used for longitudinal follow-up in COPD patients, we suggest that variations less than 26% (mean +/- 2 SD) can be considered the result of "spontaneous" variation in lung function.

Adult↗
PubMed1992

Comparison of histamine and acetylcholine for use in bronchial challenge testing in atopic and nonatopic subjects with chronic airways obstruction: a review of 180 cases.

A retrospective study was performed to evaluate the diagnostic yield for bronchial hyperresponsiveness from histamine and acetylcholine challenge tests. The records of 180 cases from the last 10 years were analysed. They were selected because their hyperresponsiveness to inhaled histamine or acetylcholine was equal or less than 32 mg.ml-1. Increasing doses of histamine and acetylcholine were given up to a maximum of 32 mg.ml-1 according to the method of de Vries et al. [3]. The challenges were accomplished on two separate days. The provocative dose of agonist causing a 20% fall in FEV1 (PC20) was noted. The interrelationships between smoking history, objective markers of allergy, patient's complaints, histamine and acetylcholine responsiveness were examined. Separate statistical analyses are presented for atopic and nonatopic subjects with chronic airways obstruction. More subjects had a measurable PC20 with acetylcholine than with histamine (43 vs. 16 subjects, p < 0.0001). Using the chi 2 test, the relationship between PC20 histamine and PC20 acetylcholine was similar in smokers and nonsmokers, and in atopics and nonatopics. It is concluded that for an equal molar basis, acetylcholine evokes a higher frequency of bronchus obstruction than histamine in patients.

Acetylcholine↗
PubMed1992

Comparison of three normal breathing techniques to assess reversibility of airway obstruction.

Measurement of forced expiratory volume in one second (FEV1) is generally used to assess airway obstruction. Function tests during normal breathing are used as complementary tests as well as alternatives. Studies have been done comparing the esophageal pressure method with body plethysmography, and respiratory acoustical impedance with body plethysmography. We have not found any other studies comparing all three methods in the same subject. It is not clear whether those tests contribute to the assessment of reversibility of airways obstruction. We addressed the following questions: (1) How does the response of FEV1 to an inhaled beta agonist (400 micrograms fenoterol) relate to the response of lung function tests during normal breathing? (2) Are values obtained with three normal breathing techniques comparable in assessing severity of obstruction? We collected these data in 17 patients. A significant correlation was found between airway resistance measured with any of the three methods. The scatter was large, both before and after bronchodilation. The reversibility by the three methods expressed as absolute values (before and after inhalation) were comparable. In order of preference it appears that acoustical impedance is to be preferred to esophageal pressure because of less discomfort to the patient, and to body plethysmography because of the lower cost of the apparatus. Acoustical impedance can be used to assess acute changes in bronchomotor tone.

Adult↗
PubMed1992

Forced oscillation technique. Reference values for total respiratory resistance obtained with the Siemens Siregnost FD5.

Total respiratory resistance (Rrs) was measured by the application of a sine wave of airflow to the mouth at an oscillation frequency of 10 Hz. The instrument used was the Siemens Siregnost FD5. The Rrs data were correlated with height, age, sex, and weight in 73 patients and 29 healthy subjects. The patients took part in a rehabilitation program for restoration of their locomotion function. Both groups had normal lung function (VC, FEV1) and no signs of pulmonary disease. The only important determining factor for the value of the Rrs was height. The mean Rrs of 102 subjects was 0.29 +/- 0.08 kPa.1-1.s. Other studies gave values between 0.23 +/- 0.05 and 0.32 +/- 0.10 kPa.1-1.s.

Adult↗
PubMedDate not supplied

Feasibility and effects of a home-care rehabilitation program in patients with chronic obstructive pulmonary disease.

PURPOSE: Pulmonary rehabilitation programs often show beneficial effects in patients with chronic obstructive pulmonary disease (COPD). These programs are usually hospital-based. This study assesses the feasibility and application of a 12-week Home-Care Rehabilitation Program (HCRP), carried out by general practitioners, physiotherapists, and home-care nurses. METHODS: Effects of the HCRP are assessed in 15 COPD patients with moderate to severe airflow limitation (inspiratory vital capacity [IVC]: mean, 75.4 [SD, 13.7] percent predicted, mean FEV1: 45.5 [6.9] percent predicted) and are compared with a stratified and randomized control group (n = 15). RESULTS: All participating disciplines judged the program to be useful and feasible. Patient compliance with the rehabilitation exercises was high. No major problems concerning the rehabilitation program were reported. After the HCRP, 4-minute walking distance improved significantly from 274 m [61] to 301 m [72] and maximal work load (W max), as measured during an incremental cycle test, increased from 75.3 W [24] to 85.3 W [28]. At equal work levels (W submax) during the cycle test both Borg dyspnea and leg effort scores decreased significantly after the HCRP (6.7 [1.3] versus 4.9 [1.7] and 4.2 [2.0] versus 1.7 [2.5], respectively). Changes in walking distance, dyspnea, and leg effort scores at W submax were significantly different between the two groups. IVC and FEV1 did not change significantly. In the control group, no significant changes in any parameter were observed. CONCLUSION: It was possible to design and perform successfully a home-care rehabilitation program, providing both objective and subjective improvements in a group of patients with COPD. A home-care rehabilitation program appears to be a valuable component in the management of COPD patients with a moderate to severe airflow limitation.

Aged↗