Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial.

OBJECTIVE: To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity (PA) compared with standard medical care in patients with moderate chronic obstructive pulmonary disease (COPD). DESIGN: Randomised controlled trial. SETTING: Primary care physiotherapy. PARTICIPANTS: Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale. INTERVENTION: Ten-week combined exercise training and home-based walking programme compared with standard medical care. MAIN OUTCOMES: At baseline and after 10 weeks, daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task. In addition, daily activities (Physical Activity Scale for the Elderly), functional exercise capacity (6-minute Walk Test), health-related quality of life (Chronic Respiratory Questionnaire) and exercise self-efficacy (Exercise Self-Regulatory Efficacy Scale) were measured. RESULTS: Fifty-two patients {34 females; mean age 70.2 [standard deviation (SD) 9.5] years; mean forced expiratory volume in 1second 67% (SD 9.2) of predicted} were randomised. PA, adjusted for baseline differences, increased significantly in the intervention group compared with the control group, by 26.1minutes/day [95% confidence interval (CI) 7.3 to 44.9]. The increase in functional capacity between groups was clinically relevant (34.0m, 95% CI 2.3 to 65.6) in favour of the intervention group. CONCLUSIONS: A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD. Clinical trial registration number NL24766.018.08.

First-line gemcitabine with cisplatin or epirubicin in advanced non-small-cell lung cancer: a phase III trial.

The purpose of our study was to compare progression-free survival and quality of life (QOL) after cisplatin-gemcitabine (CG) or epirubicin-gemcitabine (EG) in chemotherapy-naive patients with unresectable non-small-cell lung cancer. Patients (n=240) were randomised to receive gemcitabine 1125 mg x m(-2) (days 1 and 8) plus either cisplatin 80 mg x m(-2) (day 2) or epirubicin 100 mg x m(-2) (day 1) every 3 weeks for a maximum of five cycles. Eligible patients had normal organ functions and Eastern Cooperative Oncology Group performance status

Pergolide-induced pleuropulmonary fibrosis.

Pleuropulmonary fibrosis is a rare, but well-recognized adverse effect of ergot alkaloids. We report on four patients who developed pleural and/or pulmonary fibrosis during treatment with pergolide and give characteristics of 87 cases with one or more symptoms of serosal fibrosis. Retroperitoneal and pleuropulmonary fibrosis are serious conditions, which are often irreversible after drug withdrawal. Increased awareness may help to diagnose these complications at an earlier stage and to minimize any permanent damage to the patient.

Home-based rehabilitation for patients with COPD: organization, effects and financial implications.

Rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to be an effective treatment and can be carried out in different settings, i.e. inpatient, outpatient or home-based. This review focuses on home-based rehabilitation and four important issues are discussed. 1) Which patients should received home-based rehabilitation? 2) How should home-based rehabilitation be organized? 3) What are the effects of home-based rehabilitation? 4) What are the financial implications. Home-based rehabilitation is an attractive approach for most patients with COPD. However, there is some evidence that patients who are severely disabled due to dyspnoea do not gain benefit from home-based rehabilitation. This might not be the appropriate setting for this group, and these patients are probably better candidates for an inpatient or outpatient multidisciplinary approach. After initial evaluation of the patient by a pulmonary physician, home-based rehabilitation can be set up in two different ways. Firstly, the patients can receive their instructions at the hospital: a detailed exercise programme can be developed that the patients can perform unsupervised at home with regular follow-up at the outpatient clinic. Second, home rehabilitation can be fully addressed at home with instruction and regular supervision by a local team. At this moment, it is not clear which disciplines, i.e. what kinds of intervention, are needed in a home rehabilitation team. Nevertheless, the key element of home-based rehabilitation is exercise training, which is the same for the other settings. Short-term studies with a maximum duration of 12 weeks showed increased exercise tolerance, decreased dyspnoea and improved quality of life. Conversely, the effects of long-term home-based rehabilitation are not clearly established. The need for long-term supervision is still open to debate: contradictory results have been shown regarding dyspnoea and exercise tolerance. Cost/benefit analysis showed positive trends in reduction in hospitalization rate and reduction of total costs; however, these results came from uncontrolled studies.

Relationship between subjective fatigue and physiological variables in patients with chronic obstructive pulmonary disease.

Patients with chronic illnesses, such as chronic obstructive pulmonary disease (COPD), report an increase in the perception of fatigue in the clinical setting. Subjective fatigue associated with physiological factors has not been reported. The purpose of this study was to determine the relationship between subjective fatigue and pulmonary function, respiratory and peripheral muscle force and exercise capacity in patients with COPD. Nineteen patients with COPD participated in the study [mean (SD) FEV1 38% (17%) predicted]. Fatigue was measured with the Multidimensional Fatigue Inventory 20 (MFI-20) that includes the following subscale dimensions: general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue. The following physical variables were measured: forced expiratory volume in 1 s (FEV1), vital capacity (VC), maximal inspiratory peak pressure (PImax), symptom-limited bicycle exercise capacity (maximum workload) and maximal voluntary isometric muscle force of both left and right quadriceps (Qu), hamstrings (Ha), biceps (Bi) and triceps (Tr). The MFI-20 fatigue dimensions, reduced activity and reduced Motivation, are significantly correlated with FEV1 (% predicted) (r = -0.62, r = -0.55 respectively). No significant correlation was found between the dimensions of fatigue and maximum workload. In contrast the fatigue dimension, physical fatigue, shows significant correlations with seven of eight muscle forces measured (Qu left r = -0.49, right r = -0.54; Ha left r = -0.49, right r-0.38; Tr left r = -0.61, right r = -0.45; Bi left r = -0.46, right r = -0.48). Data from this study show that activity and physical dimensions of subjective fatigue are related to pulmonary function and skeletal muscle force in COPD patients. Interventions to improve skeletal muscle force might improve subjective fatigue in patients with COPD.

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.

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.

[Generalized side effects with the use of carbamazepine]. / Gegeneraliseerde bijwerkingen bij gebruik van carbamazepine.

Since 1973, 42 cases of generalized adverse reactions to carbamazepine were reported to the Netherlands Centre for Monitoring of Adverse Reactions to Drugs and the Belgian Centre for Drug Monitoring. The organ involvement can be very diverse in an allergic reaction to carbamazepine. Serious and protracted disturbances in pulmonary diffusion capacity may be present even in the absence of changes on the chest X-ray. Analysis of the type IV mechanism involved suggests that caution is warranted with regard to administration of other drugs during the acute phase of the allergic reaction particularly if these drugs have a propensity to cause type IV allergic reactions themselves.