Elena Venturelli - Academia.edu (original) (raw)

Papers by Elena Venturelli

Advances in Respiratory Medicine

Zaostrzenia mają poważny i niekorzystny wpływ na jakość życia i czynność płuc u chorych na POChP.... more Zaostrzenia mają poważny i niekorzystny wpływ na jakość życia i czynność płuc u chorych na POChP. Powrót do stanu wyjściowego po zaostrzeniu, jest opóźniony do 2 miesięcy, nawet przy zastosowaniu optymalnego leczenia. Potrzebny jest czas, aby chory powrócił do wykonywania zwykłych aktywności fizycznych, w takim zakresie, jak przed zaostrzeniem. Dotychczas, rehabilitacja oddechowa (PR, pulmonary rehabilitation) była postrzegana jako forma leczenia niefarmakologicznego, w stabilnej postaci POChP, ale w kilku opublikowanych pracach oceniano wpływ zastosowania rehabilitacji oddechowej w trakcie i / lub wkrótce po zaostrzeniu. W przedstawianej pracy dokonano przeglądu i aktualizacji wiedzy na temat korzyści, wynikających ze stosowania rehabilitacji oddechowej i ćwiczeń fizycznych, w zaostrzeniu POChP i to zarówno w trakcie hospitalizacji, jaki i po powrocie chorych do domu. Ostatnio, opublikowano wyniki badań, w których wykazano przydatność i efektywność zastosowania rehabilitacji oddech...

In this retrospective analysis on a cohort of 823 COPD patients (age 71±8 yrs, FEV 1 56±18% pr.) ... more In this retrospective analysis on a cohort of 823 COPD patients (age 71±8 yrs, FEV 1 56±18% pr.) admitted in 3 centres, we aimed at describing the effect of standard rehabilitation on exercise tolerance and symptoms in the subgroup of emphysema-like individuals, as defined by lung function parameters. Pre-to-post changes (D) in exercise tolerance (6MWT), Borg dyspnea (D), fatigue (F) and SatO 2 nadir (N) on effort, perceived breathlessness (MRC), and quality-of-life (SGRQ) were reported. Proportion of patients reaching the minimally clinical important difference (MCID) in 6MWT, D, F, MRC and SGRQ were also recorded. Outcomes were then compared between the Emphysema ( E , n=283) and the COPD ( C , n=540) subgroups. Lung functions were different by definition when comparing the two groups, with similar age, body mass, exercise tolerance, and breathlessness at baseline. D-6MWD (+72±47 and +62±42 m, p=0.002), D-D (-2.3±1.7 and -1.9±1.3 point, p=0.002), D-F (-2.2±1.9 and -1.9±1.6 point, p=0.070), and D-N (+1.4±3.0 and +0.5±3.3 point, p=0.002) were higher, whereas a larger proportion of patients improved at the MCID in 6MWT (62% and 54%, p=0.040) in group E when compared with group C. Using a multivariate logistic regression model, we found that higher normalised PaO 2 , and lower 6MWT, and FRC at baseline significantly correlated with D-6MWT within the E group (p This study generates the hypothesis that COPD patients with emphysema phenotype are more likely to gain exercise tolerance and perceived symptoms after standard rehabilitation.

Respiration, 2015

Background: Recently, it has been proposed that different clinical phenotypes can be recognized i... more Background: Recently, it has been proposed that different clinical phenotypes can be recognized in patients with chronic obstructive disease (COPD), namely predominant airway disease or parenchymal destructive changes. Objectives: The aim of this prospective multicenter study was to evaluate whether these two phenotypes may influence outcomes following a pulmonary rehabilitation program (PRP). Methods: We have prospectively evaluated 364 consecutive COPD patients (70 ± 8 years, 76.3% males) admitted to a standard hospital-based PRP in 6 Italian centers. According to their phenotype, the study cohort was divided into two groups: patients with airway obstructive (group 1, n = 208) or parenchymal destructive COPD (group 2, n = 156). Before and after PRP, values of 6-min walking distance, perceived breathlessness (Medical Research Council), health-related quality of life (St. George's Respiratory Questionnaire) and respiratory muscle function (maximal inspiratory and expiratory pres...

European Respiratory Journal, 2011

In critically ill patients, a prolonged hospital stay, due to the initial acute insult and advers... more In critically ill patients, a prolonged hospital stay, due to the initial acute insult and adverse side-effects of drug therapy, may cause severe late complications, such as muscle weakness, prolonged symptoms, mood alterations and poor health-related quality of life. The clinical aims of physical rehabilitation in both medical and surgical intensive care units (ICUs) are focussed on the patient to improve their short-and even long-term care. The purpose of this article is to review the currently available evidence on comprehensive rehabilitation programmes in critically ill patients, and describe the key components and techniques used, particularly in specialised ICUs. Despite the literature suggesting that several techniques have led to beneficial effects and that muscle training is associated with weaning success, scientific evidence is limited. Due to limitations in undertaking comparative studies in ICUs, further studies with solid clinical shortand long-term outcome measures are now welcomed.

European Respiratory Journal, 2012

Platelets count (PTL) and activity in complex COPD is still a matter of debate in recent years. W... more Platelets count (PTL) and activity in complex COPD is still a matter of debate in recent years. We have therefore undertaken a preliminary retrospective analysis in 196 stable patients (age 73±7 yrs, FEV 1 47±16% pred.), to investigate PTL across the patient9s characteristics and functions (including lung volumes and exercise tolerance by the six-minute walk test-6MWT). Patients with chronic liver disease were excluded. PTL (n*10 -3 /µL) increased according to the GOLD classes of airway obstruction (see figure). When adjusted for potential confounders (age, inflammation index, comorbidities, and use of anti-thrombotic agents) PTL correlated with FEV 1 %pred. (r= -0.19, p=0.008) and meters performed at the 6MWT (r= -0.22, p=0.002). Circulating platelets increase in COPD patients with progressive lung severity and physical disability, possibly related to the parallel increase of systemic inflammation. The study warrants future prospective investigations to test this hypothesis.

Karger Kompass Pneumologie

ABSTRACT

European Respiratory Journal, Sep 1, 2012

European Respiratory Journal, Sep 1, 2013

BioMed research international, 2013

To evaluate the clinical efficacy and feasibility of an expiratory muscle training (EMT) device (... more To evaluate the clinical efficacy and feasibility of an expiratory muscle training (EMT) device (Respilift) applied to patients recovering from recent open cardiothoracic surgery (CTS). Prospective, double-blind, 14-day randomised-controlled trial. A total of 60 inpatients recovering from recent CTS and early admitted to a pulmonary rehabilitation program. Interventions. Chest physiotherapy plus EMT with a resistive load of 30 cm H2O for active group and chest physiotherapy plus EMT with a sham load for control group. Changes in maximal expiratory pressure (MEP) were considered as primary outcome, while maximal inspiratory pressures (MIP), dynamic and static lung volumes, oxygenation, perceived symptoms of dyspnoea, thoracic pain, and well being (evaluated by visual analogic scale-VAS) and general health status were considered secondary outcomes. All outcomes recorded showed significant improvements in both groups; however, the change of MEP (+34.2 mmHg, P < 0.001 and +26.1%, P &...

Internal and Emergency Medicine, 2011

The role of pulmonary rehabilitation (PR) in COPD patients with lung hyperinflation has not yet b... more The role of pulmonary rehabilitation (PR) in COPD patients with lung hyperinflation has not yet been fully investigated. We retrospectively evaluated the effect of a standard PR course on exercise tolerance and symptoms according to the presence or absence of associated lung hyperinflation, as defined by lung function parameters in three Italian rehabilitation centres. In a cohort of 823 COPD patients (age 71 ± 8 years, FEV1 56 ± 18% pred.) we have systematically recorded: changes (∆) in 6-minute walking test (6MWD) as the primary outcome; dyspnoea (D); muscle fatigue (F); SO2nadir during effort; perceived breathlessness score (MRC); and specific health-related quality of life (SGRQ). Outcomes were compared between patients with lung hyperinflation (n = 283, LH) or without (n = 540 No-LH). Groups were comparable for age, body mass index, baseline exercise tolerance, and breathlessness. ∆-6MWD (+72 ± 47 vs. +62 ± 42 m, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05); ∆-D (-2.3 ± 1.7 vs. -1.9 ± 1.3 point, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and ∆-SO2nadir (+1.4 ± 3.0 and +0.5 ± 3.3 point, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) were greater in LH than in No-LH. Using a multivariate linear regression model, ∆-6MWD in the LH group significantly correlated with lower functional residual capacity (p = 0.021) and baseline 6MWD (p = 0.004). Tolerance, gas exchange and perceived symptoms during effort are the parameters that gain a significant benefit from standard rehabilitation in COPD patients with a lung hyperinflation condition.

Respiratory Care, 2013

BACKGROUND: Oxygen desaturation during walking can have important consequence on prognosis of COP... more BACKGROUND: Oxygen desaturation during walking can have important consequence on prognosis of COPD patients. However, a standard 6-min walk test (6MWT), useful in detecting desaturation in COPD patients, can be difficult to execute in some settings of COPD management, as in the community healthcare service. We evaluated a new scoring system for the risk of oxygen desaturation during walking in COPD patients: the walking desaturation score. METHODS: We collected data from symptomatic COPD in-patients admitted for rehabilitation (derivation cohort) and out-patients referred to the local community health service (validation cohort). S pO 2 was monitored during 6MWT, and the subjects were classified as walking desaturators or non-desaturators. By a regression analysis model we assigned a weighted score proportional to the measured percentage of explained variance for each variable. Risk estimates were computed as odds ratios. A receiver operating characteristic curve analysis and a Hosmer-Lemeshow goodness-of-fit test were then performed to measure discrimination and calibration of walking desaturation score. RESULTS: Baseline characteristics in the derivation cohort (n ‫؍‬ 435, 74% of whom were walking desaturators) and the validation cohort (n ‫؍‬ 238, 37% of whom were walking desaturators) were different. Resting arterial oxygen saturation measured from an arterial blood sample, P aO 2 , and percent-of-predicted FEV 1 were the variables that predicted walking desaturation. The proportion of walking desaturators (and odds ratio estimate) gradually increased according to walking desaturation score (range 0 -6) and associated categories of desaturation risk (total walking desaturation score: low 0 or 1, high 2-3, very high 4 -6) (chi-square P < .001). There was considerable predictive discrimination (area under the curve 0.90, 95% CI 0.86 -0.93, P < .001), and calibration (Hosmer-Lemeshow chi-square 1.31, P ‫؍‬ .86) values have been shown. CONCLUSIONS: Walking desaturation score accurately predicts and classifies the risk of walking desaturation in COPD patients. ClinicalTrials.gov Number NCT01303913.

Journal of Medicine and the Person, 2011

... Rehabilitation, Villa Pineta Hospital, Via Gaiato 127, 41026 Pavullo, MO, Italy e-mail: crisa... more ... Rehabilitation, Villa Pineta Hospital, Via Gaiato 127, 41026 Pavullo, MO, Italy e-mail: crisafulli.ernesto@villapineta.it EM Clini e-mail: enrico.clini@unimore ... Crisafulli E, Costi S, Luppi F, Cirelli G, Cilione C, Coletti O, Fabbri LM, Clini EM (2008) Role of comorbidities in a cohort ...

Clinical Rehabilitation, 2013

Objective: To evaluate whether temporary positive expiratory pressure provides benefit in patient... more Objective: To evaluate whether temporary positive expiratory pressure provides benefit in patients with lung diseases and chronic hypersecretion. Design: Single blind multicentre randomized trial. Setting: Five Italian rehabilitation centres. Participants: Ninety-eight patients with chronic obstructive pulmonary disease and/or chronic bronchitis (n=78), or bronchiectasis (n=20), with a peak cough expiratory flow >150 l/min and sputum production >30 ml/day, randomly included into two treatment groups. Interventions: For 10 consecutive days, the active group performed twice a day 20-minute cycles of manually assisted breathing techniques in sequence with the addition of 15 minutes of temporary positive expiratory pressure, while the control group was treated by manually assisted breathing techniques alone. Measures: Within and between group changes of arterial oxygenation index, lung volumes and respiratory muscles strength were recorded at enrolment and after 3 and 10 treatment sessions.