Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.

Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.

Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

/pdf/an-official-american-thoracic-society-european-respiratory-5fbz6s326i.pdf

An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

Abbreviations and symbols used in this guideline 

Executive summary 

Summary of recommendations 

Section 1 Introduction 

Section 2 Methodology of guideline production 

Section 3 Normal values and definitions

https://thorax.bmj.com/content/thoraxjnl/72/Suppl_1/ii1.full.pdf

BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings

The subject matter and literary style of this book are excellently characterized by its pithy title Lung Function. It is probably the most complete and concise account so far published devoted to this subject and the techniques available for its assessment. There are outstanding sections on the historical aspects of lung diseases; the subdivisions of the lung volumes; the distribution of ventilation and perfusion, particularly the differences in respiratory exchange rates and alveolar-toarterial nitrogen gradients; and an excellent discussion of factors that limit exercise. There are also reasonably good accounts of such subjects of recent investigative interest as the use of hyperbaric oxygenation, application of gas chromatographic and electrode techniques for respiratory gas analysis, the surface active properties of lung tissue, the effect of respiratory gas and hydrogen-ion concentration on the pulmonary circulation, and the use of radioactive gases to evaluate pulmonary function.In general, however, this book lacks the

Lung Function: Assessment and Application in Medicine

The delivery of oxygen by arterial blood to the tissues of the body has a number of critical determinants including blood oxygen concentration (content), saturation (S O2 ) and partial pressure, haemoglobin concentration and cardiac output, including its distribution. The haemoglobin-oxygen dissociation curve, a graphical representation of the relationship between oxygen satur-ation and oxygen partial pressure helps us to understand some of the principles underpinning this process. Historically this curve was derived from very limited data based on blood samples from small numbers of healthy subjects which were manipulated in vitro and ultimately determined by equations such as those described by Severinghaus in 1979. In a study of 3524 clinical specimens, we found that this equation estimated the S O2 in blood from patients with normal pH and S O2 >70% with remarkable accuracy and, to our knowledge, this is the first large-scale validation of this equation using clinical samples. Oxygen saturation by pulse oximetry (S pO2 ) is nowadays the standard clinical method for assessing arterial oxygen saturation, providing a convenient, pain-free means of continuously assessing oxygenation, provided the interpreting clinician is aware of important limitations. The use of pulse oximetry reduces the need for arterial blood gas analysis (S aO2 ) as many patients who are not at risk of hypercapnic respiratory failure or metabolic acidosis and have acceptable S pO2 do not necessarily require blood gas analysis. While arterial sampling remains the gold-standard method of assessing ventilation and oxygenation, in those patients in whom blood gas analysis is indicated, arterialised capillary samples also have a valuable role in patient care. The clinical role of venous blood gases however remains less well defined.

https://breathe.ersjournals.com/content/breathe/11/3/194.full.pdf

Relating oxygen partial pressure, saturation and content: the haemoglobin–oxygen dissociation curve

Lung function: Assessment and application in medicine

Pain During Arterial Puncture

Diagnostic utility of inflammatory biomarkers in asthma: exhaled nitric oxide and induced sputum eosinophil count.

Airway and alveolar nitric oxide measurements in obstructive sleep apnea syndrome

Duration of pulmonary rehabilitation to achieve a plateau in quality of life and walk test in COPD.

Background Inherited kidney diseases are one of the leading causes of chronic kidney disease (CKD) that manifests before the age of 30 years Precise clinical diagnosis of early-onset CKD is complicated due to the high phenotypic overlap, but genetic testing is a powerful diagnostic tool We aimed to develop a genetic testing strategy to maximize the diagnostic yield for patients presenting with early-onset CKD and to determine the prevalence of the main causative genes Methods We performed genetic testing of 460 patients with early-onset CKD of suspected monogenic cause using next-generation sequencing of a custom-designed kidney disease gene panel in addition to targeted screening for c428dupC MUC1 Results We achieved a global diagnostic yield of 65% (300/460), which varied depending on the clinical diagnostic group: 77% in cystic kidney diseases, 76% in tubulopathies, 67% in autosomal dominant tubulointerstitial kidney disease, 61% in glomerulopathies, and 38% in congenital anomalies of the kidney and urinary tract Among the 300 genetically diagnosed patients, the clinical diagnosis was confirmed in 77%, a specific diagnosis within a clinical diagnostic group was identified in 15%, and 7% of cases were reclassified Of the 64 causative genes identified in our cohort, seven (COL4A3, COL4A4, COL4A5, HNF1B, PKD1, PKD2, and PKHD1) accounted for 66% (198/300) of the genetically diagnosed patients Conclusions Two-thirds of patients with early-onset CKD in this cohort had a genetic cause Just seven genes were responsible for the majority of diagnoses Establishing a genetic diagnosis is crucial to define the precise etiology of CKD, which allows accurate genetic counseling and improved patient management

Mercedes González

Papers

Pain During Arterial Puncture

Diagnostic utility of inflammatory biomarkers in asthma: exhaled nitric oxide and induced sputum eosinophil count.

Airway and alveolar nitric oxide measurements in obstructive sleep apnea syndrome

Duration of pulmonary rehabilitation to achieve a plateau in quality of life and walk test in COPD.

Clinical utility of genetic testing in early-onset kidney disease: seven genes are the main players.