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Introduction: Non-small cell lung cancer (NSCLC) survivors suffer from impaired physical and psychological functioning and reduced health-related quality of life (HRQoL) that persist after active treatment ends. Sustaining rehabilitation benefits, promoting a healthy lifestyle and facilitating self-management at home require a multifaceted aftercare programme. We aim to investigate the effect of a 12-week digital lifestyle intervention on HRQoL and lifestyle-related outcomes in NSCLC survivors after completion of inpatient rehabilitation., Methods and Analysis: QUAlity of life in LUng CAncer Survivors (QUALUCA) is a multicentre randomised controlled trial that follows a hybrid type 1 design. We randomly allocate participants in a 1:1 ratio to the intervention group (digital lifestyle intervention) or the control group (standard care) using block randomisation stratified by tumour stage and study site. Four accredited Swiss inpatient rehabilitation centres recruit participants. Key inclusion criteria are a diagnosis of NSCLC, an estimated life expectancy of ≥6 months and access to a smartphone or tablet. The 12-week intervention comprises physical activity, nutrition and breathing/relaxation, delivered through a mobile application (app). The primary outcome is the change in HRQoL from baseline (1 week after rehabilitation) to follow-up (3 months after baseline), assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Secondary outcomes include body mass index, self-reported physical activity, exercise capacity, risk of low protein intake, appetite, psychological distress, cancer-related fatigue, enablement and self-rated health. Explanatory outcomes in the intervention group include app usability, acceptability, appropriateness, and feasibility of the intervention, experiences and satisfaction with the intervention, and app usage data. We aim to enrol 88 participants. For the main statistical analysis, we will use analysis of covariance, adjusted for baseline measures, stratification variables, age and sex., Ethics and Dissemination: The Ethics Committees of the Canton of Zurich (lead), the Canton of Bern and Northwest and Central Switzerland approved the study (2023-00245). We will disseminate study results to researchers, health professionals, study participants and relevant organisations, and through publications in international peer-reviewed journals., Trial Registration Number: NCT05819346., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Clinical COPD Questionnaire (CCQ) is a simple patient-reported tool to measure clinical control of chronic obstructive pulmonary disease (COPD)., Objective: This open-label, single-arm, non-interventional study (NCT03663569) investigated changes in CCQ score during treatment with tiotropium/olodaterol in clinical practice., Methods: Data were included from consenting COPD patients, enrolled in Bulgaria, Czech Republic, Hungary, Israel, Lithuania, Poland, Romania, Russia, Slovenia, Switzerland and Ukraine, who were receiving a new prescription for tiotropium/olodaterol according to the treating physician in a real-world environment. The primary endpoint was the occurrence of therapeutic success, defined as a 0.4-point decrease in CCQ score after treatment with tiotropium/olodaterol for approximately 6 weeks., Results: Overall, 4819 patients were treated; baseline and Week 6 CCQ scores were available for 4700 patients, mostly classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B (51.6%) or D (42.7%). After 6 weeks' treatment, 81.4% (95% confidence interval [95% CI] 80.24-82.49) of patients achieved therapeutic success; mean improvement in overall CCQ score was 1.02 points (95% CI 1.00-1.05). Improved CCQ score was seen in 92.2% of patients (95% CI 91.43-92.98), 2.5% had no change and 5.3% showed a worsening. When stratified by prior treatment, the greatest benefit was seen in treatment-naïve patients, with 85.7% achieving therapeutic success, compared with 79.5% of those pretreated with long-acting β 2 -agonist (LABA)/inhaled corticosteroid (ICS) and 74.2% of those pretreated with LABA or long-acting muscarinic antagonist (LAMA) monotherapy. Overall, rescue medication decreased by 1.25 puffs/day (95% CI 1.19-1.31) versus baseline. In total, 29 patients (0.6%) reported drug-related adverse events and 7 patients reported serious adverse events (0.15%)., Conclusion: In 4700 COPD patients, 6 weeks' treatment with tiotropium/olodaterol, as initial treatment or follow-up to LAMA or LABA monotherapy or LABA/ICS, improved CCQ and decreased rescue medication use. The adverse event profile was consistent with the known safety profile of tiotropium/olodaterol., Competing Interests: Arschang Valipour has received speaker/consultancy fees from Boehringer Ingelheim during the conduct of the study; and speaker/consultancy fees from Boehringer Ingelheim, Chiesi, Novartis, Menarini and AstraZeneca outside the submitted work. Sergey Avdeev has nothing to disclose. Adam Barczyk has received personal fees from Boehringer Ingelheim. Valentina Bayer was an employee of Boehringer Ingelheim during the conduct of the study. Zvi Fridlender received institutional support for conducting the study from Boehringer Ingelheim. Dr Fridlender received personal fees for lectures/conference travel/advice from GlaxoSmithKline, Novartis, AstraZeneca, Boehringer Ingelheim, Teva and Rafa outside the submitted work. In addition, Dr. Fridlender has a patent for a neutrophil-specific drug delivery pending. Mariela Georgieva received trial sponsorship fees from Chiesi and AstraZeneca, grants for travel and lectures from Boehringer Ingelheim, grants for lectures from Mundipharma, and participated in lectures for Novartis outside the submitted work. Ondřej Kudela reports personal fees from the Charles University in Prague and Boehringer Ingelheim outside the submitted work. Alexey Medvedchikov was an employee of Boehringer Ingelheim during the conduct of the study. Ramona Miron has nothing to disclose. Maria Sanzharovskaya was an employee of Boehringer Ingelheim during the conduct of the study. Virginija Šileikienė has received advisory fees from AstraZeneca and GlaxoSmithKline, speaker fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, GlaxoSmithKline and Novartis, and has been involved with clinical trials for Boehringer Ingelheim, MSD and Novartis outside the submitted work. Jurij Šorli has nothing to disclose. Marc Spielmanns reports personal fees from Boehringer Ingelheim during the conduct of the study. Zsuzsanna Szalai has nothing to disclose. The authors report no other conflicts of interest in this work., (© 2021 Valipour et al.)

Background: Obstructive Sleep Apnea (OSA) is common in patients with cardiovascular diseases (CVD) and can negatively impact the course of CVD. However, scarce data are available for patients before or after cardiac surgery (CS) in the context of OSA., Aim: This study investigated the impact of an undetected OSA on the results of cardiac rehabilitation (CR) in patients after CS., Design: Observational study over a period of 3 months following CS., Setting: The setting of this study was inpatient CR after CS or cardiac interventions., Population: CS cohort referred to a CR program to an inpatient rehabilitation clinic in Switzerland., Methods: In this prospective observational study 256 patients were screened for OSA at the entry of CR via a level III screening device (ApneaLink Air TM , Resmed, San Diego, CA, USA). They were stratified into two groups: apnea hypopnea index (AHI) >15 or <15/h. A comprehensive assessment was performed at entry and end of CR including six-minute walk test (6-MWT), Functional Independence Measure (FIM), Hospital Anxiety and Depression Scale, MacNewHeart (MNH), STOP-Bang Questionnaire (SBQ) and Epworth Sleepiness Scale (ESS).All patients participated in a comprehensive CR program with a mean duration of approximately 3 weeks. Another OSA screening was performed at the end of the PR program and after 3 months in order to observe the clinical course of OSA., Results: An AHI>15/h was found in 133 patients (59%) at baseline, 54% after 3 weeks and 43% after 3 months. The AHI>15/h-group was older, had a higher BMI, more frequent hypertension and coronary artery disease, and higher ESS and SBQ scores compared to the AHI<15/h-group. The results of the STOP-Bang and ESS questionnaires showed a statistically significant but weak positive correlation with AHI. However, in both groups ESS did not improve from baseline to the end of CR. A multivariable logistic regression model confirmed age and ESS as independent positive predictors of OSA. No differences were found between both groups according to the results of the 6-MWT, HADS and MNH., Conclusions: OSA had a high prevalence in a large CS cohort referred to CR. However, moderate-severe OSA, though symptomatic, had no significant influence on the outcome during CR and on the parameters representing success., Clinical Rehabilitation Impact: In our study the improvements during CR after CS were not influenced by the presence of significant OSA which is remarkable since the presence of OSA is thought to be associated with increased rates of cardiovascular adverse events after cardiovascular intervention or CS. This is true at least for the success of CR after CS. The long-term consequences of untreated OSA in CVD remain unclear and are still the subject of current research.

Background: Increasing physical activity (PA) is considered to be an important factor for the efficient management of chronic obstructive pulmonary disease (COPD). Successful methods required to achieve improvements in PA following pulmonary rehabilitation (PR), however, are rarely reported. Therefore, we will conduct this trial to evaluate the effectiveness of using a COPD management program delivered to the patient via the KAIA COPD app, a mobile medical application, after the completion of PR., Methods: This is the protocol for a randomized, controlled, open-label, multicentered trial that will be carried out at inpatient PR hospital centers in Germany and Switzerland. The interventions will involve the use of the KAIA COPD app program (Arm 1) or an active comparator, i.e., usual care (Arm 2). Patients completing an in-hospital PR program and consenting to participate in the study will be screened with the inclusion and exclusion criteria and enrolled in the study. After fulfilling the screening requirements, the patients will be randomized into one of the two arms with parallel group assignment in a 1:1 ratio. The training program will be delivered to the participants grouped in Arm 1 via the KAIA COPD app and to participants grouped in Arm 2 via the regular recommendations or standard of care by the PI. In total, 104 participants will be included in the trial. The treatment period will last for 24 weeks. Electronic versions of questionnaires will be used to collect patient-reported assessments remotely. The primary outcome measure is the change in physical activity of the intervention group in comparison to the control group, measured over 1 week as the mean steps per day with a Polar A 370 activity tracker, from baseline (end of PR) to the 6-month follow-up. The secondary outcome measures are functional exercise capacity, health status, sleep quality, exacerbation rate, and depression and anxiety symptoms assessed at several intervals., Discussion: This study seeks to prove the effects of the KAIA COPD mobile application in COPD patients after PR. The app offers educational, exercise training plus activity monitoring and motivational programs that can be easily implemented in the patient's home setting, enabling patients to maintain the effects that are typically elicited in the short term after pulmonary rehabilitation for the long term., Trial Registration: German Clinical Trials Register ( DRKS00017275 ). Protocol version 2.0 dated 3 June 2019.

Fresh air for weakened lungs - pulmonary rehabilitation in Switzerland 2019 Abstract. Pulmonary rehabilitation traditionally plays an important role in the treatment of chronic pulmonary diseases in Switzerland. There is a good availability of pulmonary rehabilitation with 17 centers offering inpatient pulmonary rehabilitation across the country. There is good evidence that pulmonary rehabilitation is not only effective but also cost-effective, especially for the indication of COPD but also for other chronic pulmonary diseases. According to the GOLD guidelines there is an undersupply of COPD patients with pulmonary rehabilitation in Switzerland. Pulmonary rehabilitation is not only limited to the improvement of physical exercise, but also covers all the important aspects for an individual to function in everyday life. Though the daily costs for pulmonary rehabilitation are only a fourth to a thirth of the costs in a hospital. Offering pulmonary rehabilitation to the patients who also have an indication for it lies in the responsibility of the admitting doctors, the insurances and the patients themselves, who need to bring a basic motivation to participate in pulmonary rehabilitation.