Cardiopulmonary

This on-line course includes the following topics:

1. What is breathlessness and how common is it in terminal illness?

2. How is it measured?

3. How is it evaluated?

4. What is the approach to management?

5. Non-drug interventions.

6. Drug interventions.

7. Oxygen therapy and other drugs

This online course examines the current evidence base and best clinical practice in the area of airway clearance. Mechanical devices such as the flutter valves, positive end expiratory pressure and high frequency chest wall oscillation may be able to provide the benefits of improved airway clearance in the patient’s home potentially with reduced demands on healthcare resources.

Part 1 is from pages 19 - 22 of the reading material.

Careful review of the currently available literature clearly shows the benefit of pulmonary rehabilitation in COPD. More evidence will be presented concerning the magnitude and mechanisms of the obtained benefits. In addition, it has become clearer that patients at both ends of the disease spectrum can be good candidates for properly designed rehabilitation programs. This article will summarize the available evidence and added some clinical practice advice in an attempt to define the present state of the art.

Part 2 is from pages 23 - 31 of the reading material.

Careful review of the currently available literature clearly shows the benefit of pulmonary rehabilitation in COPD. More evidence will be presented concerning the magnitude and mechanisms of the obtained benefits. In addition, it has become clearer that patients at both ends of the disease spectrum can be good candidates for properly designed rehabilitation programs. This article will summarize the available evidence and added some clinical practice advice in an attempt to define the present state of the art.

Background and objective: In chronic obstructive pulmonary disease (COPD), accessory respiratory muscles are recruited as a compensatory adaptation to changes in respiratory mechanics. This results in shortening and overactivation of these and other muscles. Manual therapy is increasingly being investigated as a way to alleviate these changes. The aim of this study was to measure the immediate effect on lung function of a soft tissue manual therapy protocol (STMTP) designed to address changes in the accessory respiratory muscles and their associated structures in patients with severe COPD.

Methods: Twelve medically stable patients (n=12) with an existing diagnosis of severe COPD (ten: GOLD Stage III and two: GOLD Stage IV) were included. Residual volume, inspiratory capacity and oxygen saturation (SpO2) were recorded immediately before and after administra­tion of the STMTP.

Results: The mean age of the patients was 62.4 years (range 46–77). Nine were male. Residual volume decreased from 4.5 to 3.9 L (P=0.002), inspiratory capacity increased from 2.0 to 2.1 L (P=0.039) and SpO2 increased from 93% to 96% (P=0.001).

Conclusion: A single application of an STMTP appears to have the potential to produce immediate clinically meaningful improvements in lung function in patients with severe and very severe COPD.

Described by Jean Chevaillier in 1967, autogenic drainage is widely used throughout Europe. This paper describes the technique which is based Chevaillier’s work; and offers a physiological explanation for how it works. This course also reviews the evidence supporting the use of autogenic drainage.

This on-line course discusses the successes and failures of a respiratory rehabilitation programme designed for an overweight, sedentary 61-year-old woman who has been diagnosed with chronic obstructive pulmonary disease.

Part 2 is from pages 1171 - 1179 of the reading material.

Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction.

These courses examine the systemic consequences of airflow obstruction and the serious potential side effects of conventional drug treatment including potentially aggravating a range of comorbid diseases.

The courses also discuss the pros and cons of other therapies.

Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction.

These courses examine the systemic consequences of airflow obstruction and the serious potential side effects of conventional drug treatment including potentially aggravating a range of comorbid diseases.

The courses also discuss the pros and cons of other therapies.