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ABSTRACT Background and objective The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation ( PR) specific to Australian and New Zealand healthcare contexts. Methods The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation ( AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts. Results The Guideline panel recommended that patients with mild-to-severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme; that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary. Conclusion The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pulmonary rehabilitation (PR) programs proven to be one of the most effective treatment options for respiratory diseases; yet, they are not well-established in hospitals in Saudi Arabia. AIM: To determine the main barriers for setting up PR programs in Saudi Arabia. METHODS: A cross-sectional study was conducted in the Eastern Province of Saudi Arabia. Health care providers involved in treatment of chronic obstructive pulmonary disease (COPD) patients were recruited from 22 general government hospitals. Data were collected using questionnaires: Full version if they had heard about PR before the study, and a short version if they had not heard about PR before. RESULTS: A total of 123 health care providers were recruited (physicians [n = 44], nurses [n = 49], and respiratory therapists/technicians [n = 30]). Only 3.2% of the recruited health care providers had heard about PR programs before. According to the health care providers, the main barriers for setting up PR programs were a lack of (1) hospital capacity (75.6%), (2) trained health care providers (72.4%), and (3) funds (48.0%). There were significant differences in barriers reported by the health care providers. Compared to physicians, nurses were more likely to nominate the PR costs as a barrier (18.0% vs. 38.8%; P < 0.05). CONCLUSION: There is a worrisome lack of knowledge regarding content and benefits of PR programs among Saudi health care providers treating COPD patients. These findings imply that improving awareness and increasing education of the health care providers regarding PR will be required before PR can be more widely implemented as an integral treatment modality for patients with COPD in Saudi Arabia. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study investigated whether descriptors of breathlessness differed after participation in an 8 week pulmonary rehabilitation program and whether changes in sensory quality would be reflected in responsiveness to pulmonary rehabilitation. METHODS: People with COPD provided descriptors for their sensation of breathlessness before and after an 8 week pulmonary rehabilitation program. Primary outcomes for responsiveness to pulmonary rehabilitation were the 6 minute walk distance (6MWD) and the St George Respiratory questionnaire. Significant proportional shifts for sensory categories after rehabilitation were identified using the McNemar test. Random effects mixed modeling was used to determine significance of differences for primary outcomes between subjects modifying or not modifying descriptors of breathlessness. RESULTS: Of the 107 people referred to the pulmonary rehabilitation program, 94 met the spirometric criteria for COPD, with 58 having data for pre and post assessments (36 males, 71 ± 9 years old, percent of predicted FEV1 58 ± 24%). A significant proportion of subjects reduced descriptors of air hunger (P = .03, odds ratio 0.31, 95% CI 0.09-0.89) and depressed, regret, helpless (P = .04, odds ratio 0.36, 95% CI 0.10 -1.05) following rehabilitation. Subjects reducing their use of descriptors of air hunger had greater improvements in the 6MWD after rehabilitation (P = .006, mean increase 46 m). CONCLUSIONS: The sensory quality of breathlessness was modified for approximately one third of subjects after pulmonary rehabilitation, with significant improvements in the 6MWD for subjects who reduced their use of descriptors of air hunger. [ABSTRACT FROM AUTHOR]

Aim: To determine, in Australian chronic obstructive pulmonary disease (COPD) outpatients, the prevalence of nutritional depletion, adequacy of dietary intake and relationship between nutritional depletion and clinical indicators. Methods: Cross-sectional study of 66 stable COPD outpatients (mean forced expiratory volume in one second (FEV1) of 60% predicted (95% confidence interval 54, 67) ). Nutritional status was assessed using body mass index (BMI) and fat-free mass index (FFMI). Four-day estimated food records were compared with the new Australian Nutrient Reference Values. Clinical indicators included respiratory function and quality of life (QoL) using the St George Respiratory Questionnaire. Results: Thirty per cent of subjects (n = 20) were nutritionally depleted (BMI < 20 kg/m2 and/or FFMI < 16.7 kg/m2 (male) or <14.6 kg/m2 (female) ). Low FFMI despite normal/high BMI was present in 20% of subjects (n = 13). Many subjects were not meeting estimated requirements for energy (n = 43 of 57), calcium (n = 47), fibre (n = 47), folate (n = 37), magnesium (n = 28) and zinc (n = 14). Nutritionally depleted subjects had significantly lower respiratory function (FEV1 (% predicted) ( P = 0.003) and FEV1/forced vital capacity (%) ( P = 0.038) ), while QoL scores were not significantly different. Conclusion: While nutritional depletion is a recognised complication of COPD that is predictive of early mortality, this is the first nutritional analysis of stable ambulatory COPD patients in Australia. One-third of this sample was nutritionally depleted, characterised particularly by low fat-free mass. Intake of energy and several nutrients was also inadequate. Prompt diagnosis and treatment of nutritional depletion are required, as it is highly prevalent in this population and associated with poorer outcomes. [ABSTRACT FROM AUTHOR]

Background and objectives: The fifteen-count breathlessness score (15CBS) has been reported to quantify breathlessness; however, a ceiling effect limits its ability to discriminate between subjects with varying degrees of breathlessness. The aim of this study was to determine the reliability, sensitivity, specificity and validity of the thirty-count breathlessness score (30CBS) in adults with COPD. Methods: Using an observational correlation design, subjects with clinical signs and symptoms of COPD were videotaped performing the 30CBS on two occasions. Respiratory related quality of life questionnaires, self-report shortness breathlessness measures and pulmonary function tests were completed by all subjects. Asymptomatic subjects of a similar age completed the 30CBS for comparison. Results: Thirty-eight COPD subjects and 24 control subjects completed the protocol. The 30CBS was reliable within and between assessors (intraclass correlation coefficients >0.7). The 30CBS demonstrated a higher sensitivity (55.8% sensitivity, 82.3% specificity) than the 15CBS (33.2% sensitivity, 93.2% specificity); however, the sensitivity of the 30CBS was still not great enough to discriminate between those with and without COPD. Regression analysis calculated significant relationships between the 30CBS and a majority of measures of pulmonary impairment (flows and volumes), age, height, Visual Analogue Scale for breathlessness and physical aspects of the Short Form-36. Conclusions: While reliable, the 30CBS did not display sufficient discriminative ability to predict subjects with COPD though subjects requiring greater than two breaths may warrant further investigation. The 30CBS may be a useful indicator of physiological impairment, but was not significantly correlated with measures of breathlessness. [ABSTRACT FROM AUTHOR]

A response by Marie Therese Williams, Timothy Olds, and John Petkov to a letter to the editor about their article "The language of breathlessness differentiates between patients with chronic obstructive pulmonary disease and age-matched adults" in the September 2008 issue is presented.