https://www.monaldi-archives.org/index.php/macd/issue/feed Monaldi Archives for Chest Disease 2020-02-17T17:43:05+00:00 Nadia Moscato nadia.moscato@pagepress.org Open Journal Systems <p><strong>Monaldi Archives for Chest Disease</strong> is an international scientific journal of the <em>Istituti Clinici Scientifici Maugeri</em>, Pavia, Italy, dedicated to the advancement of knowledge in all fields of cardiopulmonary medicine and rehabilitation. <!--It is published in two series: the “Cardiac Rehabilitation and Prevention Series” (volume, even numbers) which, since 2002, is the official journal of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR); and the “Pulmonary Medicine and Rehabilitation Series” (volume, odd numbers).--></p> <p><strong>Monaldi Archives for Chest Disease</strong> publishes original articles, new methodological approaches, reviews, opinions, editorials, position papers on all aspects of cardiac and pulmonary medicine and rehabilitation, and, in addition, provides a forum for the inter-exchange of information, experiences and views on all issues of the cardiology profession, including education. Accordingly, original contributions on nursing, exercise treatment, health psychology, occupational medicine, care of the elderly, health economics and other fields related to the treatment, management, rehabilitation and prevention of cardiac and respiratory disease are welcome.</p> <p><strong>Monaldi Archives for Chest Disease</strong> promotes excellence in the profession of cardiology and pneumology through its commitment to the publication of research, support to continuous education, and encouragement and dissemination of ‘best practice’.</p> <p>This journal does not apply charge for publication to Authors as it is supported by institutional funds.</p> https://www.monaldi-archives.org/index.php/macd/article/view/1186 Gait-speed and oxygen flow during six-minute walk test predicts mortality in patients with advanced lung disease 2020-02-17T17:43:03+00:00 Irina Timofte Irtimofte@SOM.umaryland.edu Adriano Tonelli mdiaz@som.umaryland.edu Montserrat Diaz-Abad mdiaz@som.umaryland.edu Avelino Verceles avercele@som.umaryland.edu Nicholas Ladikos nladiko1@jhmi.edu Aldo Iacono aiacono@som.umaryland.edu Martin L. Terrin mterrin@som.umaryland.edu Marniker Wijesinha mwijesinha@umaryland.edu Olufemi Akindipe AKINDIO@ccf.org Maher Baz maher.baz@uky.edu <p>The six-minute walk test (6MWT) is a useful tool to predict outcomes in patients with advanced lung diseases. Greater distance walked has been shown to have more favorable prognostic value compared to other recorded variables.&nbsp; We reviewed the medical records of 164 patients with advanced lung disease who underwent lung transplant evaluation. Results of the 6MWT (distance walked, oxygen required, and mean gait speed) were recorded and analyzed with respect to mortality. 6MWT mean oxygen (O2) flow via nasal cannula was 3.5 ± 3.7 L/min. The distance walked in meters (m) and % predicted were inversely associated with mortality, OR: 0.995 (0.992-0.998) and 0.970 (0.950-0.990), respectively. Patients who walked &lt; 200 meters (OR: 2.1 (1.1-4.0)) or &lt; 45% of predicted, OR: 2.7 (1.2-5.7) had higher mortality. O2 flow during the test had a direct association with mortality (OR: 1.1 (1.0-1.2). In multivariate analysis, O2 flow &gt; 3.5 L/min remained predictive of mortality, OR: 1.1 (1.0-1.2). Mean gait speed was higher in patient who lived compared with patients who died (mean 0.83 ± 0.35 m/mim vs mean 0.69 ± 0.33 m/min, respectively, p= 0.03). Gait speed was a predictor of survival, OR 3.4 (1.1, 10.6). O<sub>2</sub> flow during the 6MWT was an independent predictor of mortality in patients with advanced lung disease. The patients that required more than 3.5 L/m of O2 had a higher mortality. Faster gait speed during the 6MWT was also associated with better survival.</p> 2020-02-12T15:06:05+00:00 ##submission.copyrightStatement## https://www.monaldi-archives.org/index.php/macd/article/view/1176 Use of inhaled devices during a hospital exacerbation of COPD: a summary of an interdisciplinary audit held at ICS Maugeri Pavia, Italy (March-June 2019) 2020-02-17T17:43:04+00:00 Michele Vitacca michele.vitacca@icsmaugeri.it Cinzia Lastoria cinzia.lastoria@icsmaugeri.it Monica Delmastro monica.delmastro@icsmaugeri.it Domenico Fiorenza domenico.fiorenza@icsmaugeri.it Pasquale De Cata pasquale.decata@icsmaugeri.it Barbara Fusar Poli barbara.fusarpoli@icsmaugeri.it Sonia Gilè sonia.gile@icsmaugeri.it Paola Prometti paola.prometti@icsmaugeri.it Mara Paneroni mara.paneroni@icsmaugeri.it Cristina Bianchi cristina.bianchi@icsmaugeri.it Elena Mandora elena.mandora@icsmaugeri.it Roberta Porri roberta.porri@icsmaugeri.it Claudio Fracchia claudio.fracchia@icsmaugeri.it <p>To date treatment protocols in Respiratory and or Internal departments across Italy for treatment of chronic obstructive pulmonary disease (COPD) patients at hospital admission with relapse due to exacerbation do not find adequate support in current guidelines. Here we describe the results of a recent clinical audit, including a systematic review of practices reported in literature and an open discussion comparing these to current real-life procedures. The process was dived into two 8-hour-audits 3 months apart in order to allow work on the field in between meeting and involved 13 participants (3 nurses, 1 physiotherapist, 2 internists and 7 pulmonologists). This document reports the opinions of the experts and their consensus, leading to a bundle of multidisciplinary statements on the use of inhaled drugs for hospitalized COPD patients. Recommendations and topics addressed include: i) monitoring and diagnosis during the first 24 h after admission; ii) treatment algorithm and options (i.e., short and long acting bronchodilators); iii) bronchodilator dosages when switching device or using spacer; iv) flow measurement systems for shifting to LABA+LAMA within 48 h; v) when nebulizers are recommended; vi) use of SMI to deliver LABA+LAMA when patient needs SABA &lt;3 times/day independently from flow limitation; vii) use of DPI and pre-dosed MDI to deliver LABA+LAMA or TRIPLE when patient needs SABA &lt;3 times/day, with inspiratory flow &gt; 30 litres/min; viii) contraindication to use DPI; ix) continuation of LABA-LAMA when patient is already on therapy; x) possible LABA-LAMA dosage increase; xi) use of SABA and/or SAMA in addition to LABA+LABA; xii) use of SABA+SAMA restricted to real need; xiii) reconciliation of drugs in presence of comorbidities; xiv) check of knowledge and skills on inhalation therapy; xv) discharge bundle; xvi) use of MDI and SMI in tracheostomized patients in spontaneous and ventilated breathing.</p> 2020-02-12T14:50:06+00:00 ##submission.copyrightStatement## https://www.monaldi-archives.org/index.php/macd/article/view/1107 Effectiveness of chest physiotherapy and pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: a narrative review 2020-02-17T17:43:04+00:00 Sara Annoni sara.annoni@asst-monza.it Angela Bellofiore angelabellofiore@gmail.com Elena Repossini elenarep@libero.it Marta Lazzeri marta.lazzeri@ospedaleniguarda.it Antonello Nicolini antonellonicolini@gmail.com Paolo Tarsia paolo.tarsia@policlinico.mi.it <p>Respiratory physiotherapy and rehabilitation are important therapeutic options in non-cystic fibrosis bronchiectasis (NCFB). The aims of this review of clinical trials were to evaluate the safety and the effects on physiologic and clinical outcomes of airway clearance techniques (ACTs) and rehabilitation in NCFB patients, in comparison to usual care. The search was performed on March 2018 by using PubMed and PeDro databases. 33 studies were selected. The use of ACTs for NCFB were effective in increasing sputum volume although no benefit in quality of life (QoL) or pulmonary exacerbations were observed. There were no differences in effectiveness between the several techniques used. Humidification and saline inhalation were able to aid airway clearance. Hypertonic solution (HS) was more effective than isotonic solutions (IS) in improving expectoration and sputum viscosity. Pulmonary rehabilitation (PR) was found to be associated with short term benefits in exercise capacity, dyspnea and fatigue. Exercise training seems to improve quality of life and lower exacerbation rate, but long-term data are not available. Further studies are necessary to identify the most feasible long-term outcomes such as QoL and exacerbation rate.</p> 2020-02-12T14:40:26+00:00 ##submission.copyrightStatement## https://www.monaldi-archives.org/index.php/macd/article/view/1126 Iron deficiency in non-anemic chronic obstructive pulmonary disease in a predominantly male population: an ignored entity 2020-02-17T17:43:05+00:00 Vidushi Rathi vidushirathi@gmail.com Pranav Ish pranavish2512@gmail.com Gulvir Singh gulvir786@gmail.com Mani Tiwari manitiwari123@gmail.com Nitin Goel drnitingoel@gmail.com Shailendra Nath Gaur sngaur@yahoo.com <p>Non-anemic iron deficiency has been studied in heart failure, but studies are lacking in chronic obstructive pulmonary disease (COPD). The potential clinical implications of association of iron deficiency with the severity of COPD warrant research in this direction. This was an observational, cross-sectional study on patients with COPD to compare disease severity, functional status and quality of life in non-anemic patients with COPD between two groups - iron deficient and non-iron deficient. Stable non-anemic COPD with no cause of bleeding were evaluated for serum iron levels, ferritin levels, TIBC, 6MWD, SGRQ, spirometry, and CAT questionnaire. The study patients were divided into iron replete (IR) and iron deficient (ID) groups. A total of 79 patients were studied, out of which 72 were men and seven were women. The mean age was 61.5±8.42 years. Of these, 36 (45.5%; 95% CI, 34.3-56.8%) had iron deficiency. Mean 6-minute-walk distance was significantly shorter in ID (354.28±82.4 meters <em>vs</em> 432.5±47.21 meters; p=0.001). A number of exacerbations in a year were more in ID group (p=0.003), and more patients in ID had at least two exacerbations of COPD within a year (p=0.001). However, the resting pO<sub>2</sub>, SaO<sub>2</sub>, and SpO<sub>2 </sub>levels did not differ significantly between the two groups (p=0.15 and p=0.52, respectively). Also, there was no significant difference in the distribution of patients of a different class of airflow limitations between the two groups. Non-anemic iron deficiency (NAID) is an ignored, yet easily correctable comorbidity in COPD. Patients with iron deficiency have a more severe grade of COPD, had lesser exercise capacity and more exacerbations in a year as compared to non-iron deficient patients. So, foraying into the avenue of iron supplementation, which has shown promising results in improving functional capacity in heart failure and pulmonary hypertension, may well lead to revolutionary changes in the treatment of COPD.</p> 2020-02-06T10:33:08+00:00 ##submission.copyrightStatement##