Chronic obstructive pulmonary disease (COPD) induces an imbalance in T helper (Th) 17/regulatory T (Treg) cells that contributes to of the dysregulation of inflammation. Exercise training can modulate the immune response in healthy subjects.

We aimed to evaluate the effects of exercise training on Th17/Treg responses and the differentiation of Treg phenotypes in individuals with COPD.

This randomized controlled trial included 50 individuals with severe or very severe COPD who were allocated to the Exercise or Control groups. The Exercise group underwent eight weeks of aerobic and muscle strength training, whereas the Control group received usual care. The primary outcome was the change in the phenotypic characteristics of Tregs and Th17 profile differentiation in systemic inflammation.

Exercise training increased the frequency of total and activated Tregs and decreased the frequency of Th17 cells in between-group comparisons. Additionally, Th17/Treg responses were moderately correlated with improvements in the six-minute walking test, muscle strength of the upper and lower limbs, and daily life physical activity levels.

Exercise training improved functional exercise capacity, muscle strength, and physical fitness, which was associated with a decrease in the Th17 inflammatory response and an increase in Treg cell phenotypes immunosuppressive activity.

Persistent respiratory symptoms and impaired gas exchange are common in patients recovering from COVID-19 pneumonia. The Lung Diffusing Capacity for Carbon Monoxide (DLCO) and Carbon Monoxide Transfer Coefficient (KCO) do not adequately distinguish alveolar membrane dysfunction from vascular abnormalities. This study aimed to characterize persistent diffusion impairment in post-ICU patients with prior SARS-CoV-2 pneumonia and reduced DLCO.

After hospital discharge, patients underwent spirometry, DLCO measurement, and a 6-minute walking test every six months. If DLCO remained impaired at 18-24 months, a combined Lung Diffusing Capacity for Nitric Oxide (DLNO) and DLCO assessment was performed to differentiate alveolar-capillary membrane (DmCO) and pulmonary capillary blood volume (Vc) alterations.

Among 20 patients with persistent DLCO reduction, 3 had an obstructive ventilatory pattern, 6 had restriction, and 12 had low KCO. In restrictive cases, KCO was reduced but remained within normal limits without compensation. The DLNO/DLCO ratio exceeded 113.5% predicted in all patients. DmCO was impaired in 7 patients, while Vc was reduced in 16.

Both DLCO determinants were affected, with vascular impairment predominating. Vc reduction was present in most patients, with mean values below the lower limit of normality, whereas DmCO was less affected and often normal. The elevated DLNO/DLCO ratio suggests that persistent DLCO reduction is primarily driven by prolonged pulmonary capillary circulation dysfunction rather than alveolar membrane alterations, highlighting the vascular component as the primary site of long-term impairment.

Although demand oxygen delivery system (DODS) prolongs ambulatory oxygen supply, the efficacy of preventing hypoxemia is likely to be lower than continuous oxygen flow (CF). We developed a new oxygen delivery method combining CF and DODS (CF + DODS). This study aimed in comparing the efficacy between conventional oxygen delivery methods and a new method during walking in patients with COPD.

We conducted three-treatment crossover study. Stable COPD patients performed three 6-min walk tests (6MWT) with different oxygen delivery methods in random order with CF, DODS, and CF + DODS.

Twenty-six COPD patients were included in the study. The linear mixed model on SpO2 revealed significant main effects of oxygen conditions (P < 0.001) and exercise time (P < 0.001), however no significant interaction (P = 0.537). In the post-hoc analysis, SpO2 in DODS was significantly lower than in CF and CF + DODS throughout the 6MWT. CF and CF + DODS showed no significant differences in SpO2 at any exercise timepoint. There were no significant differences among each oxygen delivery method in walking distance and dyspnea before and after 6MWT. DODS utilized significantly less oxygen than CF and CF + DODS, and CF + DODS consumed significantly less oxygen than CF during 6MWT.

CF + DODS enables a longer duration of oxygen supply, while preventing hypoxemia to the same degree as CF. These findings suggest that CF + DODS promotes outdoor activities in daily living while preventing hypoxemia in patients with COPD.

This study was registered in the UMIN Clinical Trials Registry (UMIN00005299).

While effects of COVID-19 on lung function are commonly described in those with severe illness, less is known about those with less severe illness, and most studies do not extend beyond 6 months following initial presentation.

What are the effects of COVID-19 on lung function in a cohort of participants that included those with more severe and less severe disease over a 1 year period from time of enrollment?

We enrolled 52 participants who included those with more severe (had been hospitalized) and less severe (not hospitalized) illness and measured spirometry, lung volumes, diffusing capacity, oscillometry, maximal muscle pressures, inspiratory drive, exercise capacity, and symptom and quality of life surveys at presentation, and repeated the measurements 6 and 12 months later.

While participants who had been hospitalized had consistently lower lung function in all measures, all values were within normal reference ranges. The pattern of lung function change suggested a predominant restrictive physiologic defect with reduced exercise capacity. Over 1 year, there was no significant improvement in lung function. Similar findings were seen when participants were stratified by whether they had shortness of breath at presentation.

In our cohort of participants with both more severe and less severe disease, there were only minor differences in lung function associated with severe illness or whether participants had shortness of breath. COVID-19 resulted in subtle changes related to physiologic restriction, but overall lung function remained in the normal range with little change over time, suggesting that other factors besides lung function contribute to shortness of breath in participants following COVID-19.

Chronic obstructive pulmonary disease (COPD) is a critical disease, with lung function closely linked to disease severity. This study aimed to evaluate the clinical efficacy of treatments for stable COPD in patients with pulmonary function Grades I and II.

We conducted a multicenter, randomized, double-blind, placebo-controlled trial (registration number: NCT01486186). A total of 502 patients were randomly assigned to an experimental group (n = 251, treated with Bufei, Bufei Jianpi, and Bufei Yishen granules based on traditional Chinese medicine [TCM] syndromes) and a control group (n = 251, treated with a Chinese medicine-based placebo). Acute exacerbations (AEs), lung function, clinical symptoms, 6-min walking distance (6MWD), and dyspnea were assessed over 12 months of treatment and 12 months of follow-up.

A total of 432 patients, including 214 and 218 patients in the experimental and control groups, respectively, completed the trial. The early treatment group had fewer AEs (p < 0.05), better clinical symptom scores (p < 0.05), longer 6MWD (p < 0.05), and better Modified Medical Research Council (mMRC) scores than the control group (p < 0.05). No significant differences were found in forced vital capacity (FVC) and forced expiratory volume in first second (FEV1%) between the two groups, but there was a significant difference in FEV1 and the annual rate of FEV1 decline between the groups over 2 years (p < 0.05).

Treatment with TCM for stable COPD significantly reduced AEs, increased the 6MWD, and alleviated dyspnea in patients with pulmonary function Grades I and II. FEV1 was improved, and the slower FEV1 decline indicates a potential benefit in mitigating disease progression.

BackgroundDisproportionately increased workload is one of the main reasons affecting work performance. Healthcare workers who got infected by COVID-19 were further affected mentally and physically which had an impact on their work performance.ObjectiveIn this study, we aimed to show whether work performance is affected even in people with mild Covid 19 disease or whether it is a part of Post-Acute COVID-19 Syndrome (PACS).MethodsThirty healthcare workers in a tertiary hospital had COVID-19 one month ago and gender and age matched 30 healthy workers without a history of COVID-19 (control group) was enrolled between January 2021 and March 2021. Work performance was assessed on a 7-point Likert scale. Participants performed 1-min sit-to-stand test (1MSTS), 5 times sit-to-stand test (5TSTS), and 6-min walk test (6MWT).ResultsAll participants in the COVID-19 group had a mild (non-hospitalized) form of the disease. 23 patients had ongoing symptoms 4-7 weeks after the initial symptoms of COVID-19 (fatigue/malaise (n = 9), myalgia/arthralgia (n = 7), cough (n = 7), loss of smell/taste (n = 5), headache (n = 5), dyspnea (n = 4), and diarrhea (n = 1). The increase in systolic blood pressure after 6MWT was higher in the COVID group (p = 0.018).ConclusionThe functional status and work performance in healthcare workers with COVID-19 infection were negatively affected in the first month even if the disease severity was mild. It is important to prevent both acute and long-term physical and mental complications of the disease and to ensure that these strategies improve the functional status and work performance of healthcare professionals.

We examined cardiorespiratory fitness and physical performance in long-term survivors of paediatric haematopoietic stem cell transplantation (HSCT) and explored how these are associated with the presence of metabolic syndrome (MetS).

We included 90 survivors of paediatric HSCT (median age, 30.3 years; range, 19.6-53.0; median follow-up time, 20.2 years) and 32 healthy controls. Cardiorespiratory fitness was evaluated by cardiopulmonary exercise tests, and physical performance was assessed through sit-to-stand, handgrip strength, timed-up-and-go, walking pace and six-minute walk tests. We assessed for components of MetS (blood pressure, waist circumference, plasma lipids, and glucose). For comparison of physical capacity between survivors and controls and survivors with or without the presence of MetS, a multiple linear regression analysis corrected for age and sex was applied.

Survivors demonstrated lower cardiorespiratory fitness compared with controls (mean ± SD VO2 peak 29.3 ± 7.0 mL/kg/min vs. 44.3 ± 6.8 mL/kg/min, p < 0.0001) and impairment in all physical performance outcomes, where the most prominent differences compared with controls were seen in the sit-to-stand test (33% reduction). Twenty-eight percent of survivors fulfilled the criteria for MetS. The presence of MetS associated with lower VO2 peak (p = 0.03), poorer outcomes in the six-minute walk test (p = 0.02), walking pace (p = 0.03) and the timed-up-and-go test (p = 0.003).

Young adult survivors of paediatric HSCT are at risk of markedly reduced physical capacity compared with age- and sex-matched controls, and the high incidence of MetS observed among survivors was associated with this impairment. Overall, these data underline the importance of monitoring physical capacity in survivors of paediatric HSCT.

We explored the underlying mechanisms that may drive post-tuberculosis (TB) lung disease, a multifactorial, heterogenous, and prevalent disease. Extensive clinical phenotyping through fluorine-18 Fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) scans, pulmonary function testing, and symptom and quality of life questionnaires, was performed on a cohort of 48 adults who completed TB treatment within 6 months prior. Immunological characteristics of paired blood- and bronchoalveolar lavage fluid (BALF)-derived immune cells were assessed by multiplex bead-based immunoassay, ELISA and flow cytometry. There was agreement between measures of inflammation on PET, the severity of anatomical abnormalities on CT, and pulmonary function testing. However, of these, only PET was associated with exercise tolerance and symptom scores. Measures of radiologic extent (total glycolytic activity and SUVmax on PET, and segments involved on CT) also correlated with proteins detected in blood that implicate type 1 (IFN-γ, TNFα, IL-12) and type 2 (IL-4, IL-33) responses, ongoing remodelling of lung tissue (MMPs), airways and vasculature (VEGF), as well as subsets of activated CD8+ and CD4+ T-cells. The radiologic extent of structural post-TB lung involvement is associated with a range of impaired lung function measures and immunological dysregulation. Our findings suggest that obstructive and restrictive lung pathology due to pulmonary TB do not occur in opposition but rather point towards a mixed pathology in most TB survivors.

ObjectiveTo document the occurrence of post-intensive care syndrome (PICS) in intensive care unit (ICU) survivors with coronavirus disease-2019 (COVID-19) up to one year.MethodsRetrospective observational study at a university hospital post-ICU outpatient clinic. Patients were followed up in-person at 1 month, 3 months, 6 months and one-year after hospital discharge. Cognitive, physical and psychological domains of PICS were evaluated. PICS was defined as at least one dysfunction in the assessment tools in each domain.ResultsSixty-four patients were evaluated during the study period. Median age was 62.5 (55.0-71.0). Fifty-eight percent of them were male. Median APACHE II and admission SOFA scores were 13 (10-16) and 3 (3-4), respectively. Sixty-four, 54, 44, 20 patients were evaluated during the 1 -month, 3-month, 6-month and one-year visits. 94% of patients had PICS at the 1st visit and this declined to 75% in one-year. The ratio of patients who fulfilled all PICS domains were 15%, 10%, 13% and 13%, respectively at 4 follow-up visits. Physical impairment was the most commonly observed dysfunction during all visits.DiscussionThis study showed that at least one domain of PICS persisted in 75% of patients at one-year in COVID-19 ICU survivors.

Pulmonary function testing dates back to the 19th century, and the most commonly performed tests pre-date the use of computers. Despite its long and rich history, much is still unknown about how to best perform, interpret, and apply pulmonary function tests. This year-in-review article will discuss recently published papers covering important topics including the performance of lung volume testing, the definition and severity grading of air flow obstruction, the clinical utility of bronchodilator responsiveness, and the use of race-neutral reference equations.

The 6-Minute Walk Test (6MWT) is recommended for assessing the functional exercise capacity of the elderly. It was hypothesized that faster functional tests could identify low exercise capacity in this population.

To investigate which simple functional test are associated with the performance in the 6MWT of fully functional adults above 60 years of age and to determine the cutoff points that discriminate the worst functional capacity.

The Sit-to-stand test, usual and maximum gait speed, usual and maximum Timed-up-and-go test and the 6MWT were performed.

A total of 113 elderly people aged 67(64-73) years were analyzed. The ROC curve identified the cutoff point of each functional test, which discriminated the worst exercise capacity. The area under the curve were satisfatory (0.549

CONCLUSION

Cutoff points of simple functional tests can be used to identify elderly people with low exercise capacity.

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Central nervous system dysfunction is an extrapulmonary complication of chronic obstructive pulmonary disease (COPD), and brain function, particularly frontal lobe function, has been shown to deteriorate. It has also been reported that the time taken to complete a functional test involving a cognitive task is prolonged in patients with COPD. The aim of this study is to evaluate the effect of dual-task performance on motor and cognitive function in COPD and to determine the effect of dual-task exercises delivered in a pulmonary rehabilitation program on cardiopulmonary and musculoskeletal parameters.

COPD patients who are admitted to pulmonary rehabilitation, meet the inclusion criteria, and volunteer to participate will be randomly divided into the pulmonary rehabilitation group (control group) and dual-task exercise group. The Dual Task Exercise Group will continue the established rehabilitation programs. During the walking and balance exercises in the program, they will also do cognitive exercises, which are different from those in the pulmonary rehabilitation control group. The COPD Assessment Questionnaire will be applied, and dyspnea assessment will be done with the Modified Medical Research Council Dyspnea Scale. Mini-Mental State Examination and Frontal Assessment Battery will be used to assess cognitive status. Mini-BESTest: Balance Evaluation Systems Test will be used to assess balance. Functional balance and mobility assessment will be performed with the Timed Up and Go Test and the 10-m Walk Test. The tests will be applied twice, as a single task (normal walking) and a dual task (walking and cognitive task). The 6-min walk test will be used to assess functional capacity. Quality of life will be assessed using the St. George Respiratory Questionnaire. Results of pulmonary function tests performed at routine check-ups will be obtained. Assessments will be repeated at the end of the 8-week exercise program.

Extrapulmonary clinical problems may affect the treatment process in COPD. Studies examining the effect of cognitive dysfunction evaluated dual-task performance in COPD and compared it with healthy controls. Despite the differences in the results, it emphasized that the effects of adding dual-task training to pulmonary rehabilitation should be investigated. Our study may contribute to the literature at this point.

ClinicalTrials.gov ID: NCT05930158 (Date: 14.06.2023).

Pulmonary rehabilitation (PR) plays a vital role in managing chronic obstructive pulmonary disease and other chronic respiratory diseases (CRDs). However, implementation of this multidisciplinary approach in resource-poor settings may not be sufficient because of referrers' uncertainty regarding the effectiveness of PR, inconvenient timing, travel issues, patients' lack of motivation, and poor family support. The aim was to test the feasibility of a peer-led, professionally assisted community-based PR programme for CRD patients in a rural, low literacy setting.

We conducted a single-centre, pre-post feasibility study. Participants with a confirmed diagnosis of CRD were recruited and treatment was optimised. After completing baseline assessments, the participants underwent eight weeks of PR training (16 sessions) in six groups at five local facilities led by peers selected by the participants and assisted by professionals. Exercise capacity was assessed with 6-Minute Walk Test. Other outcomes were: International Physical Activity Questionnaire; Hospital Anxiety and Depression Scale; London Chest Activity of Daily Living scale. Upper and lower limb strength were assessed using a handheld dynamometer and cycle ergometer, respectively. Descriptive analysis was performed, and pre-and post-outcomes were compared using parametric tests.

Thirty participants (20 chronic obstructive pulmonary disease and 10 asthma; 15 female; median age 57.5 years) completed baseline and endline assessments. Seventy percent completed at least 12/16 sessions. After eight weeks of training, the 6-Minute Walk Test had improved from 263.3 (standard deviation (SD) = 72.3) to 319.6 (SD = 84.7) metres (P < 0.001) with significant improvement in modified Medical Research Council (P = 0.022), London Chest Activity of Daily Living scale (P < 0.001) and dominant handgrip strength (P < 0.001) but no significant change in physical activity (P = 0.791).

The community-based PR led by peer volunteers and supported by professionals proved to be feasible in our low-resource setting and was associated with improved exercise tolerance and other outcomes.

The study was registered at the Clinical Trials Registry - India (CTRI/2020/09/027818).

The main diffuse cystic lung diseases (DCLD) include lymphangioleiomyomatosis (LAM), pulmonary Langerhans cell histiocytosis (PLCH), Birt-Hogg-Dubé syndrome, and lymphocytic interstitial pneumonia. Exercise limitation is frequent and secondary to multiple mechanisms in DCLD. Some studies addressed mechanisms for exercise limitation, field tests, and pulmonary rehabilitation (PR) in DCLD.

This review aims to present the main mechanisms that determine exercise limitation, the responses of patients in field tests, and the details regarding the safety and efficacy of PR in DCLD, with emphasis on LAM and PLCH. A search on the issue was performed in the MEDLINE and SciELO databases between 27 November 2024 and 20 February 2025. Manuscripts were reviewed and important topics were included in this review.

Reduced exercise capacity is common and multifactorial, including ventilatory, cardiocirculatory, and peripheral limitations, pulmonary hypertension (PH), and impaired gas exchange in LAM and PLCH. Variables from field tests are correlated with pulmonary function tests, and PR is safe and beneficial in LAM. Further studies are necessary to evaluate exercise in other DCLDs, the impact of other therapeutic modalities on DH, hypoxemia, and exercise-induced PH in LAM and PLCH, and the safety and benefits of PR mostly in PLCH.

Treatment options for those living with chronic respiratory disease include non-pharmacological therapies to maximize outcomes. However, some individuals are limited by their symptoms, which inhibit their ability to benefit to an equivalent or expected level. Both music therapy and music medicine are therapeutic approaches which could address these limitations.

This perspective reviews the clinical effects of music therapy and music medicine in chronic respiratory diseases. This considers active music therapy methods of re-creating (group singing), improvisation (instrument playing), receptive music listening and music medicine, with a specific focus at rest and during exercise.

The precise role of music therapy or music medicine as an adjunct to exercise testing or structured exercise programs for people with chronic respiratory disease is unclear. Choice of music (for background or individual use for this purpose) requires input from participants and would benefit from music therapists to guide selection. While preliminary findings of group singing and instrument playing highlight some efficacy, their role in comparison to pulmonary rehabilitation requires further clarification. At present, these music therapy and music medicine approaches can be considered as adjunct therapies which may assist in managing symptoms and improving wellbeing alongside existing management strategies.

The 6-min walk test (6MWT), used to monitor disease progression or exacerbation in interstitial lung disease, faces challenges such as requiring a 30-m walking path and difficulty assessing patients with gait disturbance. The 1-min sit-to-stand test (1STST) offers a convenient alternative, potentially addressing these issues. Despite its advantages, the effectiveness of the 1STST in patients with idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) still needs to be explored. We assessed 1STST's ability to detect exercise-induced desaturation in a randomized, crossover trial involving patients with IPF or PPF.

Participants were divided into group A (6MWT to 1STST) and B (1STST to 6MWT), with a 30-min rest period between the tests. The primary endpoint was the difference in nadir oxygen saturation (SpO2) between the groups throughout the study. Secondary endpoints included the percentage of participants with a nadir SpO₂ <88% during the tests, a decline of ≥4% in SpO2, and the variation in Borg scores post-tests.

Twenty-three participants (91.3% male; mean age ± standard deviation: 77.2 ± 7.4 years) diagnosed with IPF and PPF were enrolled in this study. The difference in nadir SpO2 between the 1STST and 6MWT was 1.14% (95% confidence interval: -0.18, 2.48), with the 95% confidence intervals falling within the predefined equivalence range. No significant differences were observed in the secondary endpoints.

The results suggest that the 1STST is as effective as the 6MWT in detecting desaturation in patients with IPF and PPF.

This study was registered on the website of the Japan Registry of Clinical Trials (jRCT1032230037; URL: https://jrct.niph.go.jp/).

Background: Pulse oximetry is a common technique used to measure SpO2, with increasing numbers of portable devices of different designs and technical specifications. This study examined accuracy of commercial and medical-grade portable oximetry devices (BioBeat wristwatch, Nonin WristOx2 3150, and Heart Sure A320) in measuring SpO2 compared with the reference standard (Masimo Rad-5) during 6-min walk tests (6MWTs). Methods: This prospective study included 50 subjects, with 10 recruited for each of the five target groups, including COPD, interstitial lung disease, pulmonary hypertension, oxygen therapy users, and other cardiac/respiratory diseases. All subjects underwent 6MWT using the reference standard and the three test oximetry devices. Accuracy was measured by comparing mean nadir SpO2. Subjects were asked to rate their preference for different oximetry devices at test completion. Results: In contrast to the Masimo, the Nonin had lower nadir and mean SpO2 (P ≤ .001 for both), with higher measurements for the BioBeat (P < .001 for both) and no differences for the Heart Sure (P = .18 for nadir SpO2, P = .96 for mean SpO2). Time spent at SpO2 ≤ 88 was higher for the Nonin (70%, P < .001) but lower for the Heart Sure (58%, P < .001), compared with the Masimo (64%). There were no significant differences observed in peak heart rate measurements between the Masimo with the Nonin and BioBeat (P < .05 for both), with lower measurements using the Heart Sure (P < .001). The BioBeat was most preferable amongst subjects (n = 31), with all test oximeters having high patient satisfaction (mean \7-point Likert scale scores of 6-7). Conclusion: The Heart Sure A320 and Nonin Wrist-Ox2 3150 had comparable performance in detecting nadir SpO2 within a mean difference of 3% in comparison with the Masimo Rad-5, with potential use for remote monitoring.

Exposure to charcoal biomass (CB) pollutants affects the cardiorespiratory system. We assessed cardiopulmonary responses (CPR) to exercise in charcoal producers (CPs) compared to farmers and evaluated the prevalence of exercise-induced bronchoconstriction (EIB). Forty-five CPs and 36 farmers, healthy males aged 23-39, completed a 15-m Incremental Shuttle Walk and Run Test (15-m ISWRT). Air quality index (AQI) and CO intoxication were measured, CPR was assessed through heart rate (HR), blood pressures (SBP, DBP), and spirometry at rest, peak exercise, and during recovery at 5 and 15 min. Aerobic capacity (VO2 max) was estimated from the distance covered during the 15-m ISWRT, and EIB was defined as a >10% decrease in FEV1 from baseline values. AQI was worse in charcoal workplaces, and CPs had higher CO intoxication than farmers (p < 0.0001). Both groups reached maximal exercise %HRmax: 84 (82-89) versus 84 (80-89), p = 0.37 and showed similar predicted VO2 max 36.2 (31.1-43.1) versus 38.9 (32.2-43.7) mL/kg/min, p = 0.60. However, after ISWRT, CPs had lower FEV1 than farmers (2.9 ± 0.6 vs. 3.3 ± 0.6 L, p < 0.003) and slower recovery. EIB prevalence was higher in CPs (60.0% vs. 27.8%, p = 0.006). Chronic exposure to CB increases EIB in healthy CPs, suggesting heightened airway hyperreactivity.

Patients with acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) typically have a poor prognosis; however, no effective treatment is available. In recent years, several retrospective studies have suggested the clinical benefits of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) in patients with AE-IPF. Herein, we aimed to investigate the efficacy and safety of PMX-DHP treatment in patients with AE-IPF.

Patients diagnosed with AE-IPF (n = 10) with a partial pressure of oxygen to fraction of inspiratory oxygen ratio (P/F ratio) > 100 were prospectively enrolled at a single center. PMX-DHP was performed twice for 6 hours (at 24-h intervals) at a flow rate of 80-100 mL/min, and steroid pulse therapy was concurrently administered (500 mg of methylprednisolone for 3 d).

The mean patient age was 67 years, and 80.0% were male. During the follow-up (median, 42.5 d; interquartile range, 16.0-174.0 d), seven (70.0%) patients died (including two who underwent transplantation); the in-hospital mortality rate was 70%, while the 30- and 90-day mortality rates were 50.0% and 70.0%, respectively. After 48 hours of PMX-DHP treatment, the P/F ratio improved (mean, 160.0 vs. 229.0; p = 0.054) and C-reactive protein level decreased (mean, 8.3 mg/dL vs. 3.5 mg/dL; p = 0.012). During hospitalization, no PMX-DHP-associated adverse events were observed.

Our results suggest that PMX-DHP treatment may be useful at improving oxygenation and reducing inflammation in patients with AE-IPF with acceptable safety profiles, however without affecting their prognosis.

Chronic Obstructive Pulmonary Disease (COPD) patients experience limitations in activities of daily living (ADL) despite optimal inhaled treatment. L-arginine depletion is associated with poor exercise performance. Our aim was to assess whether oral L-arginine supplementation improves dyspnea and ADL in COPD patients.

Randomized, multicenter, single blind, placebo-controlled study (NCT05412160). Stable COPD patients received L-arginine (1.66 g) plus liposomal vitamin C (500 mg) twice daily or placebo for 4 weeks. At baseline (T0) and after treatment (T1) lung function, six minutes walking test (6MWT), dyspnea and ADL perfomance, evaluated through: COPD assessment test (CAT), self-administered chronic respiratory questionnaire (CRQ-SA), Clinical COPD Questionnaire 24 h and 7 days (CCQ) and London Chest Activity of Daily Living Scale (LCADL) -were assessed. The primary endpoint was CRQ score change compared with placebo.

150 patients were enrolled (67 % males, median FEV1 57 %predicted), with 76 receiving L-arginine. Baseline characteristics and questionnaire scores were balanced between arms. At T1, L-arginine patients demonstrated significant improvements compared to placebo in CRQ total score (median (IQR) 3.5 (0.0;6.75); P = 0.006), CRQ dyspnea domain (3.0 (0.0;6.0); P < 0.001); LCADL total score (-1.0 (-3.0;0.0); P = 0.005); LCADL housework (-1.0 (-3.0;0.0); P < 0.001) and LCADL free time (0.0 (-1.0;0.0); P = 0.003). More L-arginine patients reached the minimal clinically important difference (MCID) in CRQ dyspnea and total LCADL. Baseline CRQ dyspnea<20 (OR (95 %CI): 4.296 (2.051-8.999); P < 0.001) and a LCADL score<27 (7.126 (2.729-18.609); P < 0.001) predicted MCID response.

Oral supplementation with L-arginine added to inhaled therapy appears to improve dyspnea and ADL in COPD.

Chronic obstructive pulmonary disease (COPD) is closely related to skeletal muscle dysfunction, and the evaluation of respiratory muscle function has recently been recommended. We aimed to investigate the effects of respiratory muscle dysfunction on clinical outcomes.

We retrospectively reviewed the medical records of patients with COPD whose respiratory muscle strength was measured between June 2015 and December 2021. We then analysed the effects of respiratory muscle strength on moderate-to-severe exacerbations after adjusting for confounding factors, including sex, age, forced expiratory volume in 1-s percent predicted, hand grip strength, and skeletal muscle mass index. We also compared the temporal relationship between respiratory and systemic skeletal muscle dysfunctions.

Respiratory muscle weakness (RMW) was observed in 48.1% (100) of the 208 patients. Low percent predicted maximal inspiratory pressure was an independent risk factor for moderate-to-severe exacerbations within 1 year in the Cox regression analysis (adjusted hazard ratio per 1 standard deviation increase, 0.521; 95% confidence interval, 0.317-0.856). Approximately half of the patients already exhibited RMW at the mild systemic skeletal muscle dysfunction, while those with sarcopenia had higher RMW rates. More patients with RMW experienced progressive systemic skeletal muscle dysfunction within 1 year compared to those without RMW.

Lower respiratory muscle strength is associated with an increased risk of exacerbation. Respiratory muscle function could serve as a marker of disease status and early prognosis in COPD.

This study aimed to analyse the criterion-related validity and reliability of the 6-minute walk test (6MWT) to assess cardiorespiratory fitness in the adult population, according to sex, age and physical activity level. Sociodemographic and anthropometric measurements, a treadmill maximal test, and the 6MWT were performed on 410 adults aged 18-64 years. Measured VO2max was associated with the total distance in the 6MWT and estimated VO2max by Burr's and Manttari's equations (R2 = 0.35, 0.61 and 0.61, respectively, all p < 0.01; SEE = 6.564-5.089 ml* kg-1 * min-1, %SEE = 11.80-15.30). The stepwise linear regression analysis showed that the total distance in the 6MWT, sex, age, physical activity level and body fat mass (%) explained 75% variance of measured VO2max (SEE = 4.203 ml* kg-1 * min-1, %SEE = 9.78, p < 0.001). The systematic error in the total distance in the 6MWT was 0.87-m (p < 0.001). The ICC showed excellent agreement (0.99, p < 0.001), with low error values and most of the MCD95 close to 0.

This study aimed to evaluate the applicability of existing 6MWT reference equations to healthy children and adolescents living in a high-altitude city.

Healthy children aged 5 to 15 years attending two non-randomly selected schools in Bogotá were invited to participate in the study. All participants performed the 6MWT according to the European Respiratory Society/American Thoracic Society technical standards. To identify the model or set of 6MWT equations that best predicted individually measured 6MWT values in our population, we identified the narrowest limits of agreement (LOA) (mean difference between measured and predicted values ± 1.96 SD) after constructing Bland-Altman plots. We performed separate analyzes based on sex and onset of puberty, which was assumed to occur at 12 years of age for girls and 13 years of age for boys.

105 children and adolescents (61 girls, 58.1%) with a mean age of 10.04 years (±2.21), ranging from 6 to 15 years, were evaluated. We determined that equations derived from two different studies conducted in Brazil, de Assis, and Oliveira 6MWT equations provided the narrowest LOA in the Bland-Altman plots for the individually-measured 6MWT values for all study participants, except for the older female participants who obtained narrower LOA with the Ulrich equations.

For the mean walked distance of the 6MWT, we have provided information on the 6MWT predictive equations that may be most appropriate for use in healthy children living in Bogota, Colombia, a city at 2640 m altitude.

To explore the feasibility of integrating palliative care education in pulmonary rehabilitation (PR).

A mixed-methods feasibility study was conducted in people with chronic respiratory diseases enrolled in 12-weeks outpatient hospital-based PR. A session about palliative care was integrated in the education content. Feasibility was assessed by attendance to the palliative care session, feasibility and acceptability of outcome assessment, acceptability of the intervention and undesirable effects. After PR, two focus groups were carried out. Descriptive and inductive thematic analyses were performed.

Out of 44 individuals referred to PR, 14 were excluded, six declined to participate and two were referred to another rehabilitation programme. Twenty-two people with chronic respiratory diseases started PR, however, six had discontinued the programme at the time of the palliative care session. Attendance to this session was 81 % (n = 13/16; 11 chronic obstructive pulmonary disease, 1 severe asthma and 1 interstitial lung disease; 77 % men, 65 ± 9 years-old, FEV1 41 ± 21 % of predicted). Outcome assessment was completed in 77 % (n = 10/13) of participants and lasted approximately 90 minutes. Three themes were identified from the focus groups: daily living with a chronic respiratory disease, meaningful care and demystifying misconceptions. Participants found the intervention and outcome assessment acceptable. An improvement in knowledge and change of attitude towards palliative care was considered a major effect of the palliative care session. No undesirable effects were reported.

Integrating an education session about palliative care in PR is feasible, meaningful for people with chronic respiratory diseases, and has no undesirable effects. A randomised controlled study is being prepared to strengthen these results.

Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≥12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19.

This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping.

181 participants (55% male, mean±sd age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19-85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1-66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8+ T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31).

Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.

Nocturnal hypoxemia (NH) negatively impacts the prognosis of several chronic cardiopulmonary diseases.

To assess the risk factors associated with sustained NH in adults with precapillary pulmonary hypertension (pPH).

This cross-sectional study was performed between June 2021 and June 2024. Outpatients with a hemodynamic diagnosis of pPH (Groups 1 and 4) were consecutively recruited. Sustained NH was defined as ≥ 30 % of the percentage of time spent with oxygen saturation (SpO2) <90 % during a home sleep apnea test (HSAT). Clinical, laboratory, hemodynamic, echocardiographic, functional, and exercise-related variables were collected blindly regarding the HSAT data. We considered a difference in SpO2 [resting - final] (Δ SpO2) ≥ 3 % as indicative of exercise-induced oxyhemoglobin desaturation (EID) by the six-minute walk test. Multiple logistic regression analysis was used to identify possible predictive factors for the occurrence of NH.

Fifty-two pPH adults were included (71.2 % were females). Thirty-one patients (59.6 %) were classified as having NH. In the univariate logistic regression analysis, four parameters were identified as risk factors for the presence of NH: mean pulmonary artery pressure (p = 0.023), right atrial mean pressure (p = 0.037), systolic pulmonary arterial pressure (p = 0.042) and EID (p = 0.003). However, only EID was an independent predictor for detecting NH with an adjusted odds ratio of 10.590 (95 % confidence interval: 1.095-102.420); p = 0.042.

EID is an easily implementable risk factor for prolonged NH, suggesting that adults with pPH who experience EID have a high probability of also experiencing NH.

Reduced functional capacity and muscle weakness are two major contributors to functional impairment in chronic obstructive pulmonary disease (COPD). The underlying causes of functional impairment are poorly understood and, therefore, we sought to investigate the contribution of genetic factors.

We conducted a cross-sectional analysis of sociodemographic, clinical and genetic information of people with COPD. Hierarchical clustering based on functional capacity (6-minute walk test and 1-minute sit-to-stand test) and muscle strength (quadriceps isometric muscle strength and handgrip muscle strength) was performed. A genome-wide association study (GWAS) was performed using cluster assignment as phenotype. Polygenic risk scores (PRSs) were calculated for each variable. Genomic-derived data was used to construct a model to predict functional impairment.

Two clusters were identified among 245 individuals. Cluster 1 (n=104) was composed of younger, less symptomatic patients, with preserved functional capacity and muscle strength, whereas cluster 2 (n=141) included those older, more symptomatic, with reduced functional capacity and muscle weakness. GWAS identified two polymorphisms suggestively associated with functional impairment, mapped to xanthine dehydrogenase. Cluster 2 was enriched in individuals with risk alleles for rs1991541 and rs10524730, and lower PRSs for functional capacity and muscle strength. A prediction model using genomic-derived data was constructed (n=159) and tested (n=37), yielding an area under the curve of 0.87 (0.76-0.99).

Genetic factors are significantly associated with functional impairment in COPD. The incorporation of genetic information, particularly PRSs, into a predictive model offers a promising avenue for timely identifying individuals at greater risk of functional decline, potentially facilitating personalised and preventive interventions. Further studies on independent external cohorts are needed to validate our model.

Studies assessing sub-maximal aerobic capacity in non-cirrhotic chronic hepatitis B (CHB) patients are scarce. This study aimed to evaluate sub-maximal aerobic capacity in CHB patients compared to apparently healthy participants (control-group (CG)).

A 6-min walk test (6MWT) was performed. The 6-min walk distance (6MWD) was recorded, along with heart-rate (HR), oxy-hemoglobin saturation (SpO 2), blood-pressure, and dyspnea ( ie ; visual analogue scale) at rest (Rest) and at the end (End) of the 6MWT. Additionally, the 6-min walk work (6MWW), and estimated cardiorespiratory and muscular chain age were calculated. Signs of physical intolerance were determined including abnormal 6MWD ( ie ; 6MWD < lower limit of normal), chronotropic insufficiency (ie ; HREnd < 60% of maximal predicted HR (MPHR)), high dyspnea ( ie ; dyspneaEnd > 5), and desaturation ( ie ; drop in SpO 2 > 5 points).

Compared to the CG (n=28), the CHB-group (n=26) exhibited significantly lower 6MWD by 61 meters (8%), lower 6MWW by 10%, and lower HR End by 21% (when expressed in bpm) and 17% (when expressed in %MPHR). The CHB-group, compared to the CG, included higher percentages of participants with chronotropic insufficiency and abnormal 6MWD (23.08% vs. 3.57%, and 34.61% vs. 3.57%, respectively). The CHB-group was 8.1 and 14.3 times more likely to have chronotropic insufficiency and abnormal 6MWD than the CG, respectively. CHB accelerated the aging of the cardiorespiratory and muscular chain by 11 years.

Non-cirrhotic CHB may contribute to reduced submaximal aerobic capacity and acceleration of cardiorespiratory and muscular chain aging.

The manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection range from flu-like symptoms to severe lung disease. The consequences of this inflammatory process impact overall function, which can be detected through both short- to long-term assessments. This study aimed to assess the pulmonary functional and structural characteristics of post-SARS-CoV-2 infection in patients with mild/moderate, severe, and critical clinical presentations.

An observational, analytical, and cross-sectional study was conducted between 2020 and 2022, including participants with a confirmed diagnosis of coronavirus disease (COVID)-19, with mild/moderate (G1), severe (G2), and critical (G3) clinical presentations, all evaluated at least 3 months after acute infection. Spirometry, impulse oscillometry, fractional exhaled nitric oxide (FeNO), chest computed tomography, the 6-min walk test (6MWT), hand grip strength, maximum inspiratory pressure, and maximum expiratory pressure were assessed.

We enrolled 210 participants aged 18-70 years, 32.6% of whom were male, with older age observed in G3. The participants were grouped as follows: G1 (42.3%), G2 (25.7%), and G3 (31.9%). Percentage of predicted X5 differed between G1 and G2, being higher in G1. The percentage of predicted forced vital capacity (FVC) according to the Global Lung Function Initiative and its z-score were higher in G1. The FVC by Pereira was lower in G3 compared to G1. The percentage of predicted forced expiratory volume in 1 s (FEV1) by Pereira was also lower in G3. The Tiffeneau (FEV1/FVC) index was different among groups, increasing with disease severity. The percentage of predicted forced expiratory flow rate at 25-75% (FEF25-75%) of the FVC and FeNO were both higher in G2 than G1. Chest computed tomography revealed the presence of interstitial abnormalities, associated with disease severity. The respiratory muscle strength evaluation showed an association between higher maximum expiratory pressure values in G3 compared to G1, but no association with maximum inspiratory pressure was observed. The 6MWT distance covered decreased with increasing severity, with a lower percentage of predicted values in G3 compared to G1. The right-hand grip strength was also lower in G3 compared to G1.

Alterations in pulmonary and functional markers were observed in post-COVID-19 evaluations, increasing with disease severity, as seen in G2 and G3. These findings highlight the complexity of post-COVID-19 functional assessments, given the long-term pulmonary sequelae and the consequent impairment of functional capacity.

Survivors of critical illness may present physical, psychological, or cognitive symptoms after hospital discharge, encompassed within what is known as post-intensive care syndrome. These alterations result from both the critical illness itself and the medical interventions surrounding it. For its prevention, the implementation of the ABCDEF bundle (Assess/treat pain, Breathing/awakening trials, Choice of sedatives, Delirium reduction, Early mobility and exercise, Family) has been proposed, along with additional strategies grouped under the acronym GHIRN (Good communication, Handout materials, Redefined ICU architectural design, Respirator, Nutrition). In addition to these preventive measures during the ICU stay, high-risk patients should be identified for subsequent follow-up through multidisciplinary teams coordinated by Intensive Care Medicine Departments.

Preoperative rehabilitation lowers the surgical morbidity-mortality risk of patients with non-small cell lung cancer (NSCLC). This study evaluated the feasibility of a preoperative-rehabilitation program consisting of high-intensity exercises, at home, teleguided by physical trained sports coach.

This monocenter study included patients diagnosed with resectable NSCLC, scheduled segmentectomy or lobectomy, and FEV1 < 80 % and/or DLCO < 80 %. The main exclusion criteria were neoadjuvant chemotherapy, contraindication for high-intensity physical activity, poor understanding of connected-watch use, without a smartphone and cognitive or psychiatric disorder(s).The program combines 1-hour daily high-intensity training at home, teleguided, associated with non-supervised activity advice, with tracing via an internet-connected watch. T. Program-efficacy evaluation was based on the number of patients completing the entire program, mean increase of the maximum oxygen uptake (VO2 max) and postoperative complications assessed with the Clavien-Dindo classification.

Among the 76 patients eligible for surgery during the inclusion period, 29 (38 %) satisfied inclusion criteria and 24 (83 %) accomplished at least 7 days of training for a mean ± standard deviation of 17.8 ± 9 sessions; 44 % also executed non-scheduled supplementary sessions; 96 % used the internet-connected watch. VO2 max increased significantly from 19.3 ± 3.1 to 20.4 ± 3.5 ml/kg/min (p = 0.04). Postoperatively, 9/25 (36 %) experienced a grade 1-3 adverse event, without grade 4/5.

Preoperative rehabilitation with teleguided, high-intensity exercises at home is feasible and significantly increased VO2 max. Prospective, randomized studies are needed to evaluate the benefit compared to current care practices.

This case study reports the novel use of inpatient pulmonary rehabilitation (PR) with near-maximal high-flow oxygen therapy in a patient recovering from very severe hepatopulmonary syndrome (HPS) following liver transplantation. HPS is a rare condition where advanced liver disease alters lung microvasculature through intrapulmonary vascular dilatation (IPVD) and angiogenesis. Platypnoea-orthodeoxia (postural dyspnoea with concurrent blood oxygen desaturation) is characteristic of HPS due to redirection of blood flow to the basal lung where IPVDs are more prominent, secondary to gravity. Currently, the only definitive treatment is liver transplantation, which allows normalization of oxygenation over an extended period, typically within 1 year. Pulmonary rehabilitation is an effective intervention for improving dyspnoea, health-related quality of life (HRQoL), and exercise capacity in people with chronic respiratory disease. Despite this, little is known of the effect PR has on individuals recovering from HPS post liver transplant. The aim is to describe an inpatient PR program for a patient recovering from HPS. This case study describes a 27-year-old male with "very severe" HPS who undertook inpatient PR 5 months posttransplant. The patient completed an 8-week program of twice-weekly PR supported by high-flow oxygen therapy (fraction of inspired oxygen of 90%). He performed aerobic and resistance exercises for the upper and lower limbs in recumbent, seated, and standing positions. The patient improved in exercise capacity on the 1-min sit-to-stand test (+4 repetitions), lower limb strength on the 5-repetition sit-to-stand test (-3.4 s) and in HRQoL outcomes assessed. Following rehabilitation, the patient still had a high burden of respiratory symptoms and required continuous high-flow oxygen therapy. This case study demonstrates that inpatient PR, modified for HPS-associated platypnoea-orthodeoxia and supported by high-flow oxygen therapy, is safe and effective and therefore feasible for other HPS patients.