Long-term effect of respiratory training for chronic obstructive pulmonary disease patients at an outpatient clinic: a randomised controlled trial.

OBJECTIVE: To assess the effect of respiratory training (RT) on lung function, activity tolerance and acute exacerbation frequency with chronic obstructive pulmonary disease (COPD). DESIGN: A randomised controlled trial. SETTING: Outpatient clinic and home of the COPD patients, Zhengzhou City, China. SUBJECTS: Sixty participants with COPD were randomised into two groups: an intervention group (n = 30) which received the RT in self-management and a control group (n = 30) that received an education program during the study. INTERVENTION: Pulmonary function, activity tolerance and frequency of acute exacerbation of these COPD patients were evaluated before and after the program. The intervention and control programs were delivered at monthly outpatient clinic visits over a period of 12 months. The pulmonary rehabilitation (PR) program was conducted by a physiotherapist (who delivered RT to the participant over a minimum of 1 h per visit) for the intervention group, whereas the control group received routine health education provided by physiotherapists. The intervention group patients were then instructed to perform exercises at home as taught in the RT at least 5 days per week at home. RESULTS: After 12 months of RT, the lung function and the activity tolerance of the COPD patients in the intervention group were significantly improved and the exacerbation frequency was also decreased. CONCLUSION: Long-term RT can improve lung function and activity tolerance while decreasing the frequency of acute exacerbation for COPD patients.

Hope and despair: making sense of politics in the twenty-first century.

As his life degenerates into accelerating cycles of chaos in the film 'Clockwork', the headmaster, played by John Cleese, expresses his existential response to the latest crisis in his life: 'It's not the despair, I can cope with the despair. It's the hope I can't stand.' Politics as hope has fallen out of favour. Whether from cynicism, pessimism or realism--or a combination of all three--the standing of politics, let alone politicians, is at a very low ebb. This reality provides the opportunity to assess both causes and consequences by asking: how do we make sense of politics? The following discussion considers this vital question under four headings: context, participation, issues and goals.