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PubMed2005

[Respiratory rehabilitation in patients with pulmonary sarcoidosis].

INTRODUCTION: In clinical practice, physical therapy is more often applied in patients with obstructive pulmonary disease than in other pulmonary diseases. One of them is pulmonary sarcoidosis. Depending on the stage, there are a few different types of pulmonary dysfunctions. With early disease progression pulmonary obstruction is expected and later interstitial fibrosis may lead to restrictive syndrome and development of bronchiectasias. RESPIRATORY REHABILITATION: Respiratory rehabilitation may improve pulmonary ventilation and the choice depends on lesion features. The objectives of respiratory rehabilitation are. to establish the optimal respiratory rate, sustain opened airways, achieve automatic diaphragm breathing and improve ventilation. For these purposes different techniques are used: aerosol therapy, breathing exercises, forced expiration, postural drainage, kinesitherapy. Using more than one of these techniques in the same patient we can prevent or delay consequences of respiratory failure and early disability. Early respiratory rehabilitation in these patients is an opportunity to reduce disability and improve quality of life.

Humans↗
PubMed2006

Reliability of respiratory tidal volume estimation by means of ambulatory inductive plethysmography.

Ambulatory monitoring of ventilatory parameters in everyday life, field research and clinical situations may offer new insights into respiratory functioning in health and disease. Recent technological advances that employ ambulatory inductive plethysmography could make monitoring of respiration outside the clinic and laboratory feasible. Inductive plethysmography provides a method for nonintrusive assessment of both timing (e.g. respiration rate) and volumetric parameters (e.g. tidal volume and minute ventilation), by which tidal volume is initially calibrated to direct measures of volume. Estimates of tidal volume assessed by this technique have been validated in laboratory investigations, usually examining within-individual relations to direct measures over a large range of tidal volume variation. However, the reliability of individual differences in tidal volume or other breathing parameters has not been tested under naturalistic measurement conditions using inductive plethysmography. We examined the test-retest reliability of respiration rate, tidal volume and other volumetric parameters of breathing over a period of six weeks of repeated measurements during baseline conditions and breathing exercises with 16 healthy freely moving volunteers in a Yoga course. Reliability of measurement was evaluated by calculating the average week-to-week between-subject correlation coefficients for each physiological measure. Additionally because body-mass index has been previously positively correlated to tidal volume, we also assessed this relationship as an external criterion of validity of tidal volume estimation. Regarding the latter, similar correlations to those previous studies were found (r = 0.6). Furthermore, reliability estimates were high and consistent across respiratory measures (typically r's = 0.7-0.8). These results suggest the validity of ambulatory inductive plethysmographic measurement of respiration, at least under relatively sedentary conditions. Findings also point to the stability of individual differences in respiratory parameters over consecutive weeks.

Activities of Daily Living↗
PubMed1999

Cognitive predictors of self-management behavior of asthmatic children and their families in Alexandria.

The aim of this work was to study self-management behavior (SMB) of asthmatic children and their parents, its cognitive predictors as well as its effect on the child stress and health care utilization. Data was collected by interviewing 500 asthmatic children aged 9-18 years and 500 of their parents. The study revealed that very low percentage of the respondents had good asthma management behavior. The most frequent behaviors were taking medication, going to doctor and avoiding asthma triggers. The least practiced behaviors were breathing exercises and bronchial hygiene practices. The main predictor for children's SMB which constituted 36.3% of its variance was parental management behavior. Most of the studied cognitive factors were proved as predictors for children's SMB including knowledge, self-efficacy, health locus of control, perceived seriousness and barriers. Socioeconomic status was the main predictor of parental SMB, together with knowledge, powerful others health locus of control, health value, perceived barriers and father's education shared by 46.4% in explanation of its variance. Child knowledge, parental SMB, and socioeconomic status were significantly predicting health care utilization and level of child stress. A need was highlighted for initiation an asthma management educational program to families of asthmatic children.

Adaptation, Psychological↗
PubMed1991

[Physiotherapy and mask treatment of chronic bronchitis and chronic obstructive lung disease].

The literature concerning traditional chest physiotherapy (postural drainage, percussion, vibration, breathing exercises), treatments with masks (CPAP, IPPB, RMT, PEP, PEEP) and general physical training in the treatment of chronic bronchitis is reviewed. The mucociliary clearance is increased after postural drainage, cough, forced expiratory manoeuvres and general physical training, but the influence of this upon the course of the disease is unknown. Chest physiotherapy in the treatment of patients admitted due to acute exacerbation of chronic bronchitis seems of no help. The use of face masks in this population has only been subject to limited investigation, but results from controlled trials do not indicate any favourable effect. In contrast general physical training seems to increase physical endurance and decrease dyspnoea. Specific rehabilitation programmes comprising psychological assistance, cessation of smoking and general physical training seem promising.

Bronchitis↗
PubMedDate not supplied

A randomized controlled evaluation of a psychosocial intervention in adults with chronic lung disease.

The effect of a stress management program on morbidity and psychosocial and physical function in patients with chronic lung disease was assessed. Adults attending either a VA pulmonary clinic or university hospital pulmonary rehabilitation clinic who met criteria for obstructive or restrictive pulmonary disease were randomly assigned to receive the intervention or to a control group. The intervention was provided by a nurse and included one to three teaching sessions, reading material, audiotapes, and telephone follow-up. The program focused on stress management techniques such as cognitive restructuring, progressive relaxation, breathing exercises, and visual imagery. The 45 experimental subjects were similar to the 49 controls with respect to baseline characteristics. Experimental and control subjects had similar rates of mortality, hospital days, bed-disability days, restricted-activity days, and physician visits during the 12-month follow-up. There were no differences between the two groups in physical or psychosocial function at six months or in levels of stressful life changes, social supports, and self-esteem at six and 12 months. Intervention recipients had better function at 12 months, suggesting a possible benefit of the intervention.

Chronic Disease↗
PubMed1990

[Physical therapy and mask treatment of chronic bronchitis and chronic obstructive lung disease (COPD)].

The literature concerning traditional chest physiotherapy (postural drainage, percussion, vibration, breathing exercises), treatments with masks (CPAP, IPPB, RMT, PEP, PEEP) and general physical training in the treatment of chronic bronchitis is reviewed. The mucociliary clearance is increased after postural drainage, cough, forced expiratory manoeuvres and general physical training, but the influence of this upon the course of the disease is unknown. Chest physiotherapy in the treatment of patients admitted on account of acute exacerbation of chronic bronchitis does not appear to help. The use of face masks in this population has only been subject to limited investigation, but results from controlled trials do not indicate any favourable effect. In contrast, general physical training seems to increase physical endurance and decrease dyspnoea. Specific rehabilitation programmes comprising psychological assistance, cessation of smoking and general physical training seem promising.

Bronchitis↗
PubMed1990

Efficacy of continuous epidural analgesia and the implications for patient care in the early postoperative phase.

Management of postoperative pain has been shown to be inadequately controlled, and, in fact, can have significant deleterious effects on a patient's early postoperative recovery. Continuous epidural analgesia has recently been used to control postoperative pain. This mode of analgesia controls postoperative pain without the delays inherent in the PRN administration of systemic narcotics. This was a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 53 thoracic and 81 abdominal surgery patients. The focus of the study was to identify the benefits and problems of continuous epidural analgesia for postoperative pain management and the implications for the nursing care of the patients. Evaluation of the effectiveness of the analgesia was based on the following measures: (1) pain measured at regular intervals in the 72-hour period with a visual analog; (2) pain as measured after 72 hours with the word descriptor section of the McGill Pain Questionnaire; (3) amount of supplemental systemic narcotic analgesic needed; (4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; (5) occurrence of adverse effects; and (6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used (PRN) systemic administration of narcotics. With the exception of the report of back pain by patients receiving the normal saline epidural solution, complications did not occur in a significantly greater proportion when using the epidural route. Although some nursing care problems were identified, patients who received epidural analgesia were able to be cared for on general care units with no adverse effects reported.

Analgesia, Epidural↗
PubMedDate not supplied

[Psychotherapy with expressive technics in psychotic patients].

In February 1984, it was decided to resort to non-verbal expressive techniques as a suitable way for doing group psychotherapy with psychotic patients. A corporal language technique was selected which comprised (a) sense-perception elements, (b) corporal expression, and (c) yoga, arranged in five-step sessions: space acknowledgment, deep-breathing exercise, palpation of an osteoarticular structure, motility test of the previously palpated zone, and expressive exercise. Such an experiment was carried out with a group of psychotic patients, another group with psychosomatic symptoms, and a third, changeable, heterogenous group, with, obviously, a control group. Observations were made of patients' behavior during sessions, and their clinical progress throughout. All patients showed good response to the movement proposals, and no emotional excesses were detected. It was clinically observed that, in all cases, sociability improved, and anxiety decreased--in this connection, medication could be cut down accordingly. As regards 2 schizophrenic female patients, biological therapy could be ruled out.

Adolescent↗
PubMed1989

[Rehabilitation of patients with chronic bronchitis who are engaged in agricultural work].

The efficiency was studied of rehabilitation of 115 patients with chronic bronchitis engaged in agricultural work under the effect of a complex of traditional health-resort climatic factors as well as this complex supplemented by breathing exercises with additional dead space or intensified graded physical exercises (cycling, running). Only the therapeutic complex including physical exercises proved efficient.

Agricultural Workers' Diseases↗
PubMed1988

Use of respiratory care procedures in the management of hospitalized asthmatics.

The current management of the hospitalized asthmatic includes a number of respiratory therapy techniques, both diagnostic and therapeutic. These include measures to increase arterial oxygen content, monitoring of gas exchange, administration of bronchodilator aerosols, chest physiotherapy techniques, breathing exercises, and mechanical ventilation. While many of these are potentially helpful, some are misused or are not of proven benefit. This review is designed to acquaint the clinician with the procedures commonly used, their potential benefits, or lack thereof, and their possible hazards. Recommendations are given for the rational use of these techniques, based upon the experience of the authors.

Aerosols↗
PubMed1988

Conventional physiotherapy and forced expiration manoeuvres have similar effects on tracheobronchial clearance.

This study compared the effect of two forms of chest physiotherapy. In the "conventional" form of physiotherapy, postural drainage was combined with percussion and directed coughing. The other, relatively new form of physiotherapy, was the forced expiration technique, i.e. huffing combined with postural drainage, breathing exercises and, if necessary, coughing. Eight patients (six with cystic fibrosis, two with agammaglobulinaemia) took part in the study. No difference was found in tracheobronchial clearance, regional lung clearance, sputum production or lung function between the two forms of treatment. The forced expiration technique can be performed without an assistant. Therefore, it is concluded that in general the forced expiration technique is preferable.

Adolescent↗
PubMed1979

[New aspects of long-term asthma therapy].

Asthma is a chronic disease requiring long-term treatment, principally on an ambulant basis. A regimen is described involving all the measures which are practicable in ambulant use--elimination of allergens, hyposensitization and multiple drug treatment with corticosteroids, ACTH, beta-adrenergic agents, anticholinergics, theophylline, sodium cromoglicate and the new compound, ketotifen--taking into account both the aetiology and pathogenesis of the disease and synergistic effects of the available medicines. The immediate aim is to give the patient sustained freedom from symptoms. Once this has been achieved, multiple drug treatment can gradually give way to a protective/prophylactic regimen. Two-and-a-half years of experience with the oral antianaphylactic histamine-release inhibitor, ketotifen, have convinced us that this new drug is very suitable both as part of a multiple-drug regimen designed to bring the condition under control, and as a prophylactic for subsequent protection against further attacks. An additional advantage of ketotifen is the very low incidence of adverse reactions. Brief reference is also made to the treatment of infections and to the role of psychotherapy, breathing exercises and sport in asthma therapy.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Past, present and future of the therapy of emphysema.

Senile atrophic emphysema was for a long time a term used to describe the pulmonary structure of elderly people. Since emphysema occurs mostly in elderly people, it was understood as the premature occurrence of a more or less normal ageing process. Therefore, almost no therapy seemed to be possible. Later emphysema was thought to be the consequence of airway obstruction, where the narrowed bronchi behave as check valves, so that the trapped air leads to overinflation and rupture of the alveoli. Thus bronchodilators were tried in the prevention of emphysema. This concept was partially successful, but also without bronchial obstruction emphysema can develop and progress. Experiments by Gross suggested that emphysema is a self-digesting process in the course of inflammatory defence of the body. Thus the inflammatory process itself became the target of the therapy. Additional therapy was tried by teaching special types of breathing and by breathing exercises, but had rather small success. Today our interest is focused on the imbalance of oxidants and antioxidants as the main reason for the self-digesting process. We hope to correct this imbalance, but we must be careful not to block a useful defence mechanism of the body.

Humans↗
PubMed1986

[Program and effectiveness of psychologically-oriented preparation for childbirth. 1. Behavior therapeutic program for childbirth preparation].

A program of preparation for childbirth tested at present by the author is demonstrated, and some results of an investigation about anxieties for labour are pointed out. The program of preparation for childbirth is oriented on behavioural and learning-theoretical principles and contains the following elements: information on pregnancy and labour, functions and effects of pains in labour and the influence of anxiety to muscle tension, vasoconstriction and pain as well as a good knowledge of hospital; relaxation training, breathing exercises and anxiety management techniques as well as self-control strategies.

Adaptation, Psychological↗
PubMed1979

[The role of respiratory physiotherapy in an intensive care unit].

In an intensive care unit an important role is assigned to respiratory physiotherapy. Its principal task is efficacious toilet of the bronchi by fluidifying the secretions, promoting their ungluing from the respiratory tree and facilitating their evacuation by cough or by aspiration with a catheter or bronchoscope. The technique comprises the inhalation of a secretolytic (e.g. Bisolvon, NaCl 9%) and, in the case of asthma, bronchospasmolytic (e.g. Ventoline) aerosol followed by breathing exercises. The other objectives of physiotherapy are to ensure a better distribution of inspired air, increase failing ventilation, ameliorate disturbed gas exchange, relax the contracted respiratory muscles and prevent bronchiolar collapse in emphysema during expiration. The field of application of respiratory physiotherapy is large; its purpose is prophylactic and therapeutic. The method is prophylactic in all patients confined to bed, where there is a risk of bronchial obstruction or ventilatory failure, especially in those with severe operation, traumatism or consciousness disorder. Physiotherapy has a therapeutic role in several, principally broncho-pulmonary diseases, such as asthma, obstructive emphysema, pneumonia, bronchiectasis, pulmonary abscess, atelectasis, and pulmonary and pleural fibrosis. Myocardial infarction and pulmonary embolism in the acute state, acute pulmonary edema, pneumothorax and pulmonary hemorrhage are contraindications for physiotherapy. If the method is to be effective the intensive care unit should have a specialized physiotherapist attached to it working there on a daily basis.

Bronchodilator Agents↗
PubMed1984

Two-dimensional echocardiography and radionuclide angiocardiography in pulmonary hypertension.

In precapillary pulmonary hypertension two-dimensional echocardiography documents anatomo-functional alterations of valvular and cavitary structures of the heart in real time. It supplies useful information on ventricular interdependence and on the motion of the interventricular septum. In the same kind of pathology first pass or equilibrium radionuclide angiocardiography has been used for the calculation of the ejection fraction of the right ventricle, both at rest and during exercise, breathing either air or pure oxygen. The Authors think that these two methods are complementary. For this reason they decided to associate them and they report here their preliminary experience. Their first observations seem to show that the association of the two techniques is useful in the study of the dimensions and shape of the two ventricles and for the visualisation of even regional abnormalities in motion of the interventricular septum.

Cardiomegaly↗
PubMedDate not supplied

Transcutaneous electrical nerve stimulation (TENS) after open heart surgery.

Open heart surgery is associated with postoperative sternal pain, which is exacerbated by cough, deep breathing and movement, thus limiting the physical activity of the patient. Transcutaneous electrical nerve stimulation (TENS) was administered to 40 patients suffering from persistent chest pain immediately following open heart surgery, and to ten other patients complaining of pain between three and eight weeks after operation. The efficacy of TENS was assessed by the subjective recordings, analgesic drug requirement, capability to carry out deep inspirations with an "Incentive Deep Breathing Exerciser" apparatus, and repeated chest X-ray examinations. We conclude that TENS is a useful method of pain control and should be used more frequently in patients after open heart surgery, especially in the older patient and in patients with chronic lung disease.

Cardiac Surgical Procedures↗