Advancing Sustainable Pulmonary Rehabilitation in Latin America.

Exploring pulmonary rehabilitation programs implemented and conducted in Latin America for people with chronic respiratory conditions: A scoping review.

Pulmonary rehabilitation (PR) is a mandatory component of a comprehensive treatment of patients with chronic respiratory disease. However, there is no officially published data about PR Centers in Latin America. The objetive is to identify Latin American Pulmonary Rehabilitation Centers and evaluate their characteristics and organizational aspects. A cross-sectional study with the Pulmonary Rehabilitation Centers indicated by the Latin American Respiratory and Physiotherapy Societies and by our own personal survey among physicians and physiotherapists. An eletronic transmission questionnaire with 20 questions was sent to the Coordinator of each one of the Centers. 217 Pulmonary Rehabilitation Centers were found throughout Latin America and a total of 160 (73.7%) Centers answered the questionnaire. Of these, 65.8% had private administration; 68.8% had an associated program for patients with heart disease; programs lasted an average of 24 sessions; the rehabilitation team consisted mainly of physiotherapists, physicians and dietitians; 90.6% of the centers evaluated the patients with different questionnaires; 91.9% used treadmill and 90.6% bicycle for exercises of lower limbs and 80.1% proprioceptive neuromuscular facilitation technique with weights to train the upper limbs of their patients; 55.6% had an educational program and 36.9% presented a home-based program. There has been a great increase in the number of Latin American Pulmonary Rehabilitation Centers, presenting diversity in organizational aspects.

Variability in Walk Test Conditions at Pulmonary Rehabilitation Programs in Latin America and on the Iberian Peninsula

<b>Introduction:</b> The impact caused by the Coronavirus disease (COVID-19) has considerably altered the provision of outpatient rehabilitation services, especially pulmonary rehabilitation (PR). <b>Objective:</b> To describe the situation of PR services in Latin America 18 months after the beginning of the COVID-19 pandemic. <b>Methods:</b> Cross-sectional study in which a survey was sent to professionals from PR centers in Latin America. An online questionnaire was applied from May to September 2021. The following data were included: demographic data of the programs, evaluation strategies, program structure, RP intervention in post-COVID-19 patients, and perception of therapeutic strategies for the care of post-COVID patients. COVID-19. The questionnaire was distributed in Spanish and Portuguese languages. This study was approved by the ethics committee. <b>Results:</b> Responses were received from 196 centers from 14 countries; Most of the surveys were answered by physiotherapists/kinesiologists in 65.7%. In the evaluation of exercise tolerance, the 6-minute walk test is the most used. Less than 50% of the institutions evaluate the quality of life, symptoms, and lung function. In the prescription of exercise intensity, there is reduced use of CPET and it is prescribed mainly with subjective scales of symptoms (Borg Scale) (78.1%), and response to exercise with vital signs (71.4%). The programs have, practically, for the most part, physical therapists (90.8%), as well as pulmonologists (60%), psychologists (35%), among other professionals. <b>Conclusion:</b> The application of these programs in Latin America is heterogeneous, both in the evaluations and the interventions carried out.

Background: In December 2019, China reported a severe upper respiratory failure syndrome caused by a new virus identified as coronavirus COVID-19. Aims and Objectives: The aim of this exploratory study is to outline the current state of pulmonary rehabilitation in Latin American (LA) countries during the COVID-19 pandemic. Materials and Methods: A total of 1162 rehabilitation professionals (rehabilitation medicine specialists and residents, physiotherapists, occupational therapists, and speech therapists) from 20 countries in LA answered a 34-question online survey related to the current state of pulmonary rehabilitation in LA during the COVID-19 pandemic. Results: More than half of the professionals reported the absence of pulmonary rehabilitation services in their work centers, limited or non-existent pulmonary rehabilitation materials or equipment, and little or no training by their multidisciplinary team and themselves. Regarding COVID-19, 49.2% of the respondents indicated not receiving the necessary material for the protection against COVID-19, and more than half reported limited equipment to perform interventions in patients hospitalized by this disease, and not to have clear about the recommendations to prescribe pulmonary physiotherapy in these patients. Moreover, almost all the professionals did not feel capable of treating patients with lung disease from COVID-19 and felt anxiety doing it. Conclusion: Pulmonary rehabilitation is vital for providing optimal care for respiratory impairments, and this relationship has been magnified by the COVID-19 pandemic. This manuscript highlights the limited professional training and resource availability in LA and provides recommendations to improve the current situation.

IntroductionThe Coronavirus disease (COVID-19) pandemic has significantly altered the provision of rehabilitation services, especially pulmonary rehabilitation (PR). Our objective was to assess the provision of PR services in Latin America 18 months after the COVID-19 pandemic was declared.MethodsA cross-sectional study that included professionals dedicated to PR in centres in Latin America was applied. Responses to an online questionnaire were collected from May to September 2021. The following data were included for the analysis: demographic data, evaluation strategies, program structure, PR intervention in post-COVID-19 patients, and perception of strategies therapies for the care of post-COVID-19 patients. The questionnaire was distributed in Spanish and Portuguese languages.ResultsResponses were received from 196 PR centres. Exercise tolerance was predominantly measured with the six-minute walk test. Less than 50% of the institutions evaluate quality of life, physical qualities, symptoms, and lung function. Most of the programmes have physiotherapists (90.8%), as well as pulmonologists (60%), and psychologists (35%), among other professionals.ConclusionPR services in Latin America have adapted in their way to the requirements of the pandemic, and most continued to provide face-to-face services. It was identified that the application of the programs is heterogeneous both in evaluations and interventions.

Objectives: To describe the current state of pulmonary rehabilitation of patients with Spinal Cord Injury (SCI) in Latin America (LA) during the COVID-19 pandemic. Methods: 468 rehabilitation professionals working with SCI patients from 20 countries in LA answered an online survey related to their training, qualifications, medical practices, and resources. Results: Less than half of pulmonary rehabilitation professionals reported working with SCI patients. Of these, more than half indicated that they had not received training in pulmonary rehabilitation of these patients and did not feel qualified to provide this kind of care. In fact, only 23.4% of those surveyed indicated treating patients with SCI who require mechanical ventilation. Around 60% of providers reported having a multidisciplinary team trained and qualified to practice pulmonary rehabilitation in patients with SCI. Finally, the majority indicated having less than 5 beds to carry out this practice. Conclusions: This manuscript highlights the limited professional training and resource availability in LA to assist patients with SCI requiring pulmonary rehabilitation and provides recommendations to improve the current situation.

Interstitial Lung Diseases (ILD) is a group of diseases characterized by poor prognosis and high mortality. Patient’s symptoms are dyspnea and cough, which directly affect Health-Related Quality of Life (HRQoL). Information about incidence, prevalence and mortality in ILD is scarce in Latin America, so it is difficult to estimate the magnitude of the problem. In ILD the decrease in HRQoL frequently is originate by emotional distress, anxiety and depression as two of the most common problems associated. Our aim was to assess the frequency of anxiety and depression in ILD patients from two specialized centers in Latin American. Additionally, we analyze the relationship between mood alterations and clinical variables with HRQoL. We developed a cross-sectional study, with 149 patients; we used Hospital Anxiety and Depression Scale (HADS). Of all patients 27% had anxiety and depression, argentine cohort with higher means (anxiety 6 ± 3 vs. 2 ± 2 and depression 5 ± 4 vs. 2 ± 2, p>0.0001). We found difference only in the forced vital capacity, which was lower in Mexican subgroup. Our findings indicate that ILD are associated with anxiety/ depression problems and they have a direct impact in terms of quality of life in this cohort. Interstitial Lung Diseases (ILD) is a group of diseases that affect pulmonary interstitium, characterized by poor prognosis and high mortality. For example, in Idiopathic Pulmonary Fibrosis (IPF), the average expected of survival is 3 to 5 years without treatment, the most frequent symptoms are dyspnea and cough, which directly affect Health-Related Quality of Life (HRQoL) ILD are usually associated with different chronic comorbidities In Mexican population several comorbidities have been reported: 52% diabetes mellitus, 40% systemic arterial hypertension, 35% COPD, 27% pulmonary hypertension, 5% obstructive sleep apnea syndrome and 3% gastroesophageal reflux disease Absence of data about incidence, prevalence and mortality in ILD in Latin America, makes difficult to estimate the magnitude of the problem; however, ILD are considered pulmonary Chronic- Degenerative Disease (CDD) In CDD, progressive decrease in terms of quality of life, loss of motor skills, physical and esthetical deterioration frequently originate emotional distress; we understand anxiety and depression as two of the most common and stressful problems. Depression is characterized by the presence of feelings like sadness, loss of interest or pleasure in daily activities, low energy and loss of concentration. Its prevalence and the relationship with other chronic disease such as cancer, AIDS, diabetes among others have been studied Worldwide prevalence of depression is 4.4%. In Latin America, the country with the highest levels of depression is Brazil with 5.8% of its total population, while Argentina presents 4.7% and Mexico only 4.2% Reported studies that measure the impact on mental health in respiratory diseases have been performed mainly in COPD, asthma and lung cancer. There are few studies in patients with ILD. Some authors such as Youth, Glaspole and Jin Lee have reported between 15% and 30% of this population presents symptoms of anxiety or depression, most of them underdiagnosed ILD´s have a direct impact on HRQoL, oxygen desaturation impacts even at basic activities such as talking or self-care. On the other hand, these diseases imply a high economic burden given that the patient’s work activities are affected or impeded, and the treatments are expensive and necessaries. The aim of our study was to assess the frequency of anxiety and depression in patients with ILD from two specialized centers in Latin American countries. Additionally, we analyze the relationship between scales that evaluate mood alterations and clinical variables, functional tests and HRQoL. Materials and Methods We developed a cross-sectional study in 2 centers specialized in ILD: The National Institute of Respiratory Diseases “Ismael Cosio Villegas” in Mexico City and the Respiratory Rehabilitation Hospital “Maria Ferrer” in the city of Buenos Aires, Argentina between August 2017 to December 2018. Patients were prospectively enrolled in a consecutive manner from the external consultation of the 2 centers specialized in interstitial diseases by the psychologists of the multidisciplinary team, who explained the objective of the study and obtained informed consent. Only one patient was excluded for not signing the informed consent. After signing informed consent (approved by the respective research bioethics committee of both institutions), respiratory function test we performed during regular follow-up visits of patients. For spirometry and diffusion of carbon monoxide we use EASY ONE PRO® and CPFS/D MEDGRAPHICS® equipment, according to the ATS/ERS guidelines. 6-minute walk was conducted according to the ATS guidelines Later, Hospital Anxiety and Depression Scale (HADS) was applied by the psychologists using the criteria described by Galindo HADS instrument was interpreted as normal with score of 0-7, moderate 8-10, and severe >11, either in anxiety or in depression. Keywords: Anxiety; Depression; Interstitial lung disease; Emotional distress; Health related quality of life

Can nurses successfully diagnose and manage patients with COPD?

Tengo el agrado de presentar este número de la Revista Colombiana de Neumología en el cual se encuentran novedades interesantes. Hemos modificado la portada de presentación de la revista en la que se adoptó un esquema más dinámico y moderno, para darle un espacio más relevante a las imágenes y anticipar el contenido de la misma; además, en conjunto con la nueva Junta Directiva Nacional, tomamos la decisión de alinearnos con la tendencia mundial de conservación ambiental y la iniciativa nacional de “cero papel” en las instituciones, de tal manera que pasamos a publicar nuestra revista solo en formato en línea.Con esta medida disminuimos el uso de recursos renovables tan valiosos como el papel, tenemos más libertad en el manejo, diseño, cantidad y calidad de las imágenes, y pretendemos llegar a muchos más usuarios con cada ejemplar. En este número, la revista tiene contribuciones de neumología, radiología, cirugía de tórax, neumología pediátrica, neumología intervencionista y patología, entre otras, tanto de Colombia como de Latinoamérica; se presenta una revisión sistemática de rehabilitación pulmonar en la que se exploran los resultados de esta intervención en el grupo específico de pacientes que tienen síndrome de superposición de la enfermedad pulmonar obstructiva crónica (EPOC) y asma. Incluye un artículo original que explora la contribución del destete temprano como factor de riesgo para la neumonía muy grave en el infante; en este estudio, más del 50% de la población presentó neumonía y destete temprano, lo que sugiere una relación entre este y la presentación de neumonía muy grave en niños, especialmente entre los niños mayores de 2 meses y menores de 5 años, por lo que se concluye que la lactancia materna sigue siendo un factor protector contra varias patologías, entre estas, las respiratorias.Se presenta un artículo de revisión con respecto al tratamiento con inhaladores de acción prolongada, que son una herramienta terapéutica para el tratamiento de pacientes con enfermedades bronco-obstructivas como la EPOC y el asma bronquial. También hay otro artículo que explora las implicaciones y perfil de seguridad infecciosa de la terapia biológica con omalizumab y mepolizumab en asma severa refractaria, con el fin de dar a conocer los riesgos relacionados con infecciones al usar estas moléculas y generar algunas recomendaciones para la prevención y manejo en el contexto latinoamericano. Además, se incluye una extensa revisión de las manifestaciones radiológicas típicas y atípicas de la sarcoidosis pulmonar, que tienen un amplio espectro desde el compromiso ganglionar típico (adenomegalias hiliares bilaterales y paratraqueales derechas), parenquimatoso (nódulos perilinfáticos, opacidades parahiliares bilaterales y cambios por fibrosis), hasta manifestaciones atípicas de compromiso ganglionar (adenomegalias unilaterales, asimétricas), parenquimatoso (sarcoidosis alveolar y masas pulmonares), enfermedad de vía aérea, pleural y otras (micetomas).En este número también se encuentran varios casos clínicos interesantes como el desarrollo de histoplasmosis en un individuo inmunocompetente, la enucleación de un leiomioma esofágico asistida por cirugía robótica, el diagnóstico y manejo de un tumor mucoepidermoide de la tráquea y el caso clínico de una paciente con fibroelastosis pleuroparenquimatosa idiopática; además de las secciones de glosario patológico, imágenes en broncoscopia y la información para pacientes que, en esta oportunidad, se relaciona con fibrosis quística.Esperamos que disfruten este número y reiteramos la invitación para que envíen sus manuscritos originales, revisiones, reflexiones, imágenes, inquietudes y propuestas, pues la revista es una ventana más de comunicación de nuestra Asociación con el mundo.

Perspective of pulmonary rehabilitation centers in Latin America

Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the world, represents an important public health challenge that is both preventable and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer from this disease for years and die prematurely due to it or its complications. Worldwide, the COPD burden is projected to increase in coming decades because of the continued exposure to risk factors and population aging. Menezes et al., in a study including data from five Latin American countries, observed that the prevalence of COPD in the general population older than 40 years varied from 7.8% to 19.7% and that it was more prevalent among men, elderly people, and individuals exposed to tobacco. The characteristic symptoms of COPD are progressive dyspnea, cough, and sputum production, associated with frequent fatigue and impairment in exercise capacity and functional performance. There is a large body of evidence showing that pulmonary rehabilitation (PR) is beneficial to patients with chronic respiratory disease, including COPD. Its benefits include increase in exercise tolerance, reduction in symptoms, and improvement of healthrelated quality of life. A more recent definition describes PR as a ‘‘comprehensive intervention based on a thorough patient assessment followed by patienttailored therapies which include, but are not limited to, exercise training, education and behavior change, designed to improve the physical and emotional condition of people with chronic respiratory disease and to promote the long-term adherence to healthenhancing behaviour.’’ Regardless of the clear benefits provided by PR programs, there is a substantial part of the enrolled patients who do not complete the intervention. There is scant published evidence showing the factors that lead patients with COPD to nonadherence to PR. Young et al. used an interviewer administered questionnaire and suggested that nonadherers were more likely to be depressed, widowed, or divorced, live alone, live in rented accommodation, and be smokers. More recently, another study showed that the referring doctor plays a key role in the uptake of PR programs. The authors discussed that a positive doctors’ approach may increase the level of adherence to PR and would be essential to an effective intervention. In addition, a systematic review performed by Keating and colleagues identified travel and transport difficulties as a predominant barrier to attendance at PR. Lack of perceived rehabilitation benefits and the influence of the doctor were also identified as reasons for nonattendance. In order to achieve better understanding of this issue and to answer simple questions about the opinions of patients enrolled in PR programs, the interest in qualitative studies has been growing in the scientific field. In this issue of Chronic Respiratory Disease, Pinto and colleagues contributed to the scientific literature by writing a systematic review of qualitative researches in patients with COPD about their experiences related to PR. First, the review disclosed the lived-experience from the point of view of patients who completed a PR program. Patient’s reports included a feeling of being supported by health-professionals, peer groups and family, as well as the acquisition of knowledge

Exploring Pulmonary Rehabilitation Programs Implemented and Conducted in Latin America for People With Chronic Respiratory Conditions: A Scoping Review

The interaction between SARS-CoV-2 and ACE2 may have consequences for skeletal muscle viral susceptibility and myopathies.