Browsing by Author "Saldías, F."

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    Cost-effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
    (2011) Reyes, C.; Silva, R.; Saldías, F.
    Patients with chronic respiratory disease are heavy users of health care and social services resources worldwide. Although the major goals of pulmonary rehabilitation programs are to reduce levels of morbidity and to improve activity as well as participation in patients with chronic respiratory disease, their role in the management of these patients must also be validated by cost-effectiveness. Pulmonary rehabilitation's role in decreasing utilization of health care resources is an important potential benefi t. Pulmonary rehabilitation is an effective intervention in patients disabled by chronic respiratory disease; however, there are relatively few studies that evaluate its effect on health care utilization. An 18-session, 6-week outpatient pulmonary rehabilitation program decreased inpatient hospital days and decreased the number of home visits when compared with standard medical management. A comprehensive costeffectivenes analysis of the addition of this multidisciplinary pulmonary rehabilitation program to standard care for patients with chronic disabling respiratory disease concluded that the program was cost-effective and produced cost per quality-adjusted-life-years (QALY) ratios within the bounds considered to be cost-effective and therefore likely to result in financial benefits to the health care system. Patients with COPD who receive an education intervention with supervision and support based on disease-specific self management principles have decreased hospital admissions, decreased emergency department visits, and reduced number of unscheduled physician visits. This approach of care through self-management strategies is of interest because it does not require specialized resources and could be implemented within normal health care practice. In a before-after designed study, a community-based, 18-session, comprehensive pulmonary rehabilitation program was associated with an average reduction of total costs of US$344 per person per year. This was associated with decreased health service utilization, reduced direct costs, and improved health status of patients with COPD, regardless of disease severity. In summary, pulmonary rehabilitation programs in COPD patients reduces hospital stay and hospital readmissions especially after exacerbations. Pulmonary rehabilitation programs significantly reduce the use of healthcare resources and are cost-effective.
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    Inspiratory muscle training in patients with chronic obstructive pulmonary disease
    (2011) Pinheiro, G.; Saldías, F.
    Respiratory muscle weakness is observed in chronic obstructive pulmonary disease (COPD) patients and contributes to hypoxemia, hypercapnia, dyspnoea, nocturnal oxygen desaturation and reduced exercise performance. During exercise it has been shown that diaphragm work is increased in COPD and COPD patients use a larger proportion of the maximal inspiratory pressure (PImax) than healthy subjects. This pattern of breathing is closely related to the dyspnoea sensation during exercise and might potentially induce respiratory muscle fatigue. However, diaphragmatic fatigue was not demonstrated after exhaustive exercise. Studies in patients with COPD have shown natural adaptations of the diaphragm to greater oxidative capacity and resistance to fatigue. The above mentioned considerations gave conflicting arguments to the rationale of inspiratory muscle training (IMT) in COPD. Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improvedfunctional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMTplus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness. From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness. The effect on exercise performance is still to be determined. In summary, IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspiratory muscle endurance training was shown to be less effective than respiratory muscle strength training.
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    Pathophysiological bases of muscular training in patients with chronic obstructive pulmonary disease
    (2011) Saldías, F.; Díaz, O.
    La disnea y la disminución de la capacidad de realizar ejercicio son los principales factores que limitan las actividades de la vida diaria en pacientes con enfermedades respiratorias crónicas. Los síntomas cardinales que limitan la capacidad de ejercicio en la mayoría de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) son la disnea y/o fatigabilidad, los cuales pueden ser ocasionados por trastornos de la ventilación alveolar e intercambio gaseoso, disfunción de los músculos esqueléticos y/o falla cardiovascular. La ansiedad, falta de motivación y depresión también han sido asociadas a una menor capacidad de realizar ejercicio, probablemente afectando la percepción de los síntomas. La relación entre el estado psicológico y los trastornos del ánimo en pacientes con EPOC y la tolerancia al ejercicio es compleja y aún no ha sido completamente dilucidada. El origen de la limitación de la capacidad de ejercicio en pacientes con EPOC es multifactorial, por lo cual la separación de las variables involucradas con fines académicos no siempre es factible realizarlo en los pacientes. Los mecanismos patogénicos pueden relacionarse en forma compleja, a modo de ejemplo, el desacondicionamiento físico y la hipoxemia pueden contribuir a aumentar la ventilación alveolar ocasionando limitación del ejercicio de causa ventilatoria. Por lo tanto, el entrenamiento físico y el suplemento de oxígeno pueden reducir la limitación ventilatoria durante el ejercicio sin modificar la función pulmonar o la capacidad ventilatoria máxima. El análisis de los factores limitantes de la capacidad de ejercicio permite identificar trastornos potencialmente reversibles que pueden mejorar la calidad de vida de los enfermos, tales como la hipoxemia, broncoespasmo, insuficiencia cardiaca, arritmias, disfunción musculoesquelética y/o isquemia miocárdica. En esta revisión se examinan los principales mecanismos que contribuyen a la limitación de la actividad física en pacientes con EPOC: anomalías de la ventilación alveolar e intercambio gaseoso, disfunción cardiovascular y del sistema músculo-esquelético y disfunción de los músculos respiratorios.
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    Six-minute-walk test and maximum exercise test in cycloergometer in chronic obstructive pulmonary disease. Are the physiological demands equivalent?
    (2010) Díaz, O.; Morales, A.; Osses, R.; Klaassen Lobos, Julieta Isabel; Lisboa Basualto, Carmen; Saldías, F.
    BACKGROUND AND OBJECTIVES: The physiological load imposed by the six minute walk test (SMWT) in chronic obstructive pulmonary disease (COPD) patients come from small studies where the influence of disease severity has not been assessed. The aim of the preBACKGROUND AND OBJECTIVES: The physiological load imposed by the six minute walk test (SMWT) in chronic obstructive pulmonary disease (COPD) patients come from small studies where the influence of disease severity has not been assessed. The aim of the preBACKGROUND AND OBJECTIVES: The physiological load imposed by the six minute walk test (SMWT) in chronic obstructive pulmonary disease (COPD) patients come from small studies where the influence of disease severity has not been assessed. The aim of the pre