A distância entre o domicílio e o centro de reabilitação não influencia a adesão ao programa de reabilitação pulmonar: um estudo retrospectivo / Distance from home to rehabilitation center did not influence adherence to pulmonary rehabilitation program: a retrospective study

Background: Adherence to treatment is critical when dealing with chronic diseases. One of the difficulties in maintain long-term adherence is the distance from home to rehabilitation center. Objective: To determine the influence of the distance from subjects' residence to rehabilitation center on adherence of a 12-week pulmonary rehabilitation program in chronic respiratory disease. Methods: This retrospective study analyzed patients' medical records with chronic respiratory diseases from a pulmonary rehabilitation center. Driving distance between patients' home and rehabilitation center was calculated with Google maps. The home-rehabilitation center distances were classified in three levels: up to 10, 10-30 and more than 30 km. Results: 280 medical records from patients with chronic pulmonary diseases with medical indication to follow the pulmonary rehabilitation program were found and 148 medical records were included in our study. Out of them, the majority (n = 93) had chronic obstructive pulmonary disease (COPD). Seventy percent of patients lived up to 10 km, 24% lived between 10 and 30 km and 6% lived more than 30 km. No difference in adherence was found comparing the three groups based on the distance from home to rehabilitation center. Conclusion: In this study, distance between home and rehabilitation center did not influence adherence to pulmonary rehabilitation program. (AU)

Benefit of educational feedback for the use of positive expiratory pressure device

BACKGROUND: Positive expiratory pressure (PEP) is regularly used as a self-administered airway clearance technique. OBJECTIVE: The aim of this study was to evaluate the need to teach the correct use of the PEP device and to measure the progress of the success rate of the maneuver after training. METHOD: A PEP system (PariPEP-S Sytem) was used to generate PEP in 30 healthy volunteers. They were instructed by a qualified physical therapist to breathe correctly through the PEP device. Then they were evaluated during a set of ten expirations. Two other evaluations were performed at day 2 and day 8 (before and after feedback). The mean PEP and the success rate were calculated for each set of expirations. The number of maneuvers needed to obtain a correct use was calculated on the first session. RESULTS: An optimal PEP was reached after 7.5 SD 2.7 attempts by all subjects. Success rates and mean pressures were similar between the different sets of expirations (p=0.720 and p=0.326, respectively). Pressure variability was around 10%. After one week, 30% of subjects generated more than two non-optimal pressures in the set of ten expirations. No difference in success rate was observed depending on the evaluations. CONCLUSION: This study demonstrates that good initial training on the use of the PEP device and regular follow-up are required for the subject to reach optimal expiratory pressure.

Recommendations for hygiene of masks and circuits in mechanically home ventilated patients

Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contaminated. Dirtiness and contamination of equipment potentially expose patients to a higher risk of airway colonization, which, in turn, should cause respiratory infections. For this reason, published hygiene instructions include the use of disinfectant solution. Nevertheless, they generally fail to explain how basic maintenance may be achieved by simple cleaning with soap and water. The instructions for post-cleaning disinfection will depend upon the relative sensitivity of patients to respiratory tract infections and the related risks for bacterial colonization of the airways. Restrictive and obstructive disease patients are not equally sensitive to infections and, as a consequence, should not require similarly elaborate disinfection level. According with the restrictive or obstructive origin of respiratory insufficiency, the current educational review suggests simple and adequate rules for hygiene of tubing and masks in the home setting. Written instructions on how to clean the equipment for home ventilation are useful and sufficient in restrictive patients. In obstructive patients, cleaning always precedes disinfection. After cleaning, rinsing and drying are important. An effective weekly 20-minute disinfection may be achieved by using an hypochlorite solution of soaking in a concentration of 0.5 percent.