Pulmonary Rehabilitation (PR) Improves Exercise Tolerance and Quality of Life Among Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients With Late-Onset Noninfectious Pulmonary Complications (LONIPCs).

Published May 24, 2013

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 791A
Shannon V

SESSION TYPE: Physiology/PFTs/ Rehabilitation IIPRESENTED ON: Monday, October 22, 2012 at 11:15 AM – 12:30 PMPURPOSE: The study aim is to examine the impact of a 12-week, outpatient, multidisciplinary PR program on cardiopulmonary and quality of life (QOL) endponts among symptomatic patients with LONIPCs following allogeneic HSCT.METHODS: Patients with LONIPCs following allogeneic HSCT who were referred to the outpatient PR clinic for management of chronic shortness of breath and fatigue were retrospectively identified from an institutional database. Those patients who completed the PR program between September 2006 and December 2010 were included in the study. Assessments of exercise performance, pulmonary function, dyspnea and fatigue were performed at baseline and used to develop the individualized, 12-week PR program. PR program strategies included thrice weekly high intensity (60 to 80% of maximal work rate) muscle strength training and aerobic exercises along with weekly educational sessions. Repeat assessments were performed immediately following PR completion, and at 3 and 12 months post PR.RESULTS: Among the 251 HSCT recipients with LONIPCs following HSCT that were referred to PR, 173 (69%) completed the 12 week program and were included in the study. LONIPCs were diagnosed based on strict pathologic, radiologic and clinical criteria, and included bronchiolitis obliterans syncrome (91%), bronchiolitis obliterans with organizing pneumonia (5%), and idiopathic pneumonia (3%). The mean age was 38 years. Two patients reported pretransplant tobacco use, however no history of chronic lung disease prior to transplantation was recorded. All patients showed significant improvements in maximal exercise tolerance, as evidenced by a mean 97-meter improvement in 6MWD (P <0.005) and a mean 0.34 L/min increase in maximal oxygen uptake (P < 0.001) immediately following PR. Symptoms scores for perceived breathlessness and fatigue fell on average by a 4.9 and 3.7, respectively, following program completion (P < 0.001). Improvements tended to diminish at 3 and 12 months follow-up, but remained significantly better than pre-PR values.CONCLUSIONS: Pulmonary rehabilitation improves exercise tolerance and subjective symtoms of dyspnea and fatigue among HSCT recipients with LONIPCs.CLINICAL IMPLICATIONS: Exercise intolerance, dyspnea and fatigue are debilitating symptoms that profoundly impact quality of life among patients with LONIPCs following HSCT. Therapeutic options are limited. PR may represent an important adjunctive treatment strategy among this group of patients.DISCLOSURE: The following authors have nothing to disclose: Vickie ShannonNo Product/Research Disclosure InformationUniversity of Texas at MD Anderson Cancer Center, Houston, TX. HubMed – rehab

Rehospitalization Rates and Clinical Characteristics of Patients Enrolled in a Transition of Care Plan Following Hospitalization for Pneumonia.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 139A
Carlin B, Easley D, Wiles K

SESSION TYPE: Pneumonia Morbidity and MortalityPRESENTED ON: Sunday, October 21, 2012 at 01:15 PM – 02:45 PMPURPOSE: To evaluate the outcomes of a home-care based, respiratory therapist centered transition of care program on rehospitalization rates for patients hospitalized with pneumonia who require supplemental oxygen on hospital discharge. To evaluate the clinical characteristics of these patients.METHODS: Patients with pneumonia who required supplemental oxygen therapy on hospital discharge were entered into a post hospitalization transition of care program {Discharge, Assessment and Summary @ Home (D.A.S.H., Klingensmith HealthCare, Ford City , PA)]. The program consists of face to face visits by a respiratory therapist with the patient on days 2, 7, and 30 following hospital discharge. The visits are supplemented by a series of care coordinator phone interviews. Education, behavior modification, skills training, oxygen titration during performance of activities of daily living, clinical assessment, and adherence data collection are components of the program. The 30 day readmission rates following discharge for all patients entered into the program over a two year period (March 2010 through March 2012) were evaluated.RESULTS: 22 consecutive patients with pneumonia (mean age 72 + 13 years, range 56-98 years) from 23 different hospitals were enrolled into the program. All required supplemental oxygen use on hospital discharge. Nine (41%) patients completed the 30 day program, 3 (13.6%) discontinued at the end of week 1, 5 (22.7%) discontinued after the initial visit, and 5(22.7%) refused entry into the program. The 30 day readmission rate for the group of 22 was 0 (0%). The mean Borg score for dyspnea was 1.34 (range 0-8). No patients were entered into a rehabilitation program during the month. Seven were entered into a home health program (4 who entered the program and 3 who refused program entry).CONCLUSIONS: The use of this patient centered management program resulted in a decrease in the 30 day readmission rates (compared to historical controls) for those patients with pneumonia who required supplemental oxygen therapy.CLINICAL IMPLICATIONS: Transition of care programs can help to reduce the rehospitalization rates for patients who have pneumonia. Further research into the clinical characteristics of such patients is necessary.DISCLOSURE: Dan Easley: Employee: Klingensmith HealthCare Kim Wiles: Employee: Klingensmith HealthCareThe following authors have nothing to disclose: Brian CarlinNo Product/Research Disclosure InformationDrexel University School of Medicine, Pittsburgh, PA. HubMed – rehab

Predictors of Poor Outcomes Among Ischemic Stroke Patients Who Received Revascularization Therapy in an Inner City Minority Population.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 373A
Casanova P, Garg N, Victor T, Mangla S, Balaventakesh B, Schori M, Loganathan R

SESSION TYPE: Neuro Critical CarePRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM – 05:45 PMPURPOSE: Ethnicity and gender have been shown previously to be associated with poor outcomes among ischemic stroke patients who undergo revascularization interventions(RIs). Our study evaluated the predictors of poor outcomes at a certified stroke center that serves inner-city minority New-Yorkers.METHODS: All ischemic-stroke patients between 2006-2011 who received RIs were prospectively analyzed. IV-tPa was provided to all eligible patents during the 5-year-period while IA-tPA/mechanical-thrombectomy was available after August-2009. Door to needle time, BMI, age, sex, NIHSS(pre/discharge), eligibility/contraindications for RIs, discharge-disposition and overall mortality were recorded. Using logistic regression, odds ratios was calculated and 95%CI’s reported. P-value < 0.05 was considered significant.RESULTS: 628/1411(44.5%) patients who presented within the therapeutic window were screened for eligibility, of these 112/628(17.8%) patients received RIs. This represented 97.8% of all patients who were eligible for RIs. 78 patients received IV-tPA alone, 17 IA-tPA and/or mechanical-thrombectomy and 17 a combination of all. 67(59.8%) were females, 40(35.7%) were African-American and 72(64.2%) Hispanics. The average age was 62.4years, and average BMI was 29.5. Average door to needle time was 51minutes, Pre-RI NIHSS was 13.2 and at discharge was 6.16. Of the 112 patients, 9(8%) expired, 19(17%) were discharged to nursing home and 84(75%) to an acute rehabilitation or to home. None of the demographic/ clinical variables including gender, ethnicity , BMI, door to needle time or pre-RI NIHSS predicted mortality in patients with acute-stroke(p=NS). When a composite endpoint of death/discharge to nursing home was analyzed, older age (OR1.06, 95%CI 1.01-1.1,p=0.010) was associated with significantly poorer outcomes. Comparing patients with NIHSS on admission of > 10 versus < 10, older-age(OR1.04,95%CI:1.01-1.07,p=0.016), and greater composite of poor outcomes(OR4.87,95%CI:1.36-17.5,p=0.015) were noted among those with NIHSS>10 on admission.CONCLUSIONS: Compared to previous reports, our study did not find gender, ethnicity or BMI as predictors of mortality among ischemic-stroke patients who received RIs.CLINICAL IMPLICATIONS: However, patients who died or were discharged to a nursing home had greater odds of advanced age and presented with severe strokes with NIHSS>10 on admission.DISCLOSURE: The following authors have nothing to disclose: Paola Casanova, Neha Garg, Teresita Victor, Sundeep Mangla, Balaventakesh Balaventakesh, Melissa Schori, Raghu LoganathanNo Product/Research Disclosure InformationLincoln Medical & Mental Health Center, Pomona, NY. HubMed – rehab

Correlation of FVC and FEV1 to TLC in Restrictive Lung Disease.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 798A
Roark S, Holley A, Quast T

SESSION TYPE: Physiology/PFTs/ Rehabilitation PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM – 02:30 PMPURPOSE: Background: Spirometry is used to identify restrictive processes and estimate their severity. Total lung capacity (TLC) measured via plethysmography or nitrogen wash out. It is considered the gold standard for characterizing restrictive thoracic disease. In 2005, the ATS guidelines recommended that the forced expiratory volume in one second (FEV1) be used to grade restrictive deficits on spirometry, rather than the previously used forced vial capacity (FVC). It is unclear which of the two parameters more accurately reflects the TLC.METHODS: Methods: The Vmax spirometry database at our institution was searched for all studies where TLC was determined by plethysmography over the past 10 years. Any patient with coexisting obstruction was excluded. The severity of restriction was graded using the reduction of the percent predicted volume of TLC, FEV1, and FVC according to ATS guidelines. Grades were then compared across all three measures using the kappa statistic to measure agreement.RESULTS: Results: A total of 456 studies matching the inclusion criteria were identified. The mean age for the group was ±, 236 (51.6%) were male, and the majority was Caucasian (49.7%) or African American (29.1%). The severity of restriction was mild-to-moderate in 77.5%, 72.6%, and 65.1% when graded using TLC, FEV1, and FVC respectively. Agreement in severity was poor for TLC and both FVC (kappa=0.24; p<0.001) and FEV1 (kappa=0.25, p<0.001).CONCLUSIONS: Conclusions: Both FVC and FEV1 tend to over-estimate the severity of restriction graded using TLC measured via plethysmography. Neither measure is particularly accurate in characterizing severity, and neither measure is superior to the other.CLINICAL IMPLICATIONS: Spirometry must be used with caution when grading the severity of restrictive pulmonary disease.DISCLOSURE: The following authors have nothing to disclose: Sean Roark, Aaron Holley, Timothy QuastNo Product/Research Disclosure InformationWalter Reed National Military Medical Center, North Bethesda, MD. HubMed – rehab