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BACKGROUND: Data examining the role of pulmonary rehabilitation (PR) in interstitial lung disease (ILD) are limited. We tested the hypothesis that PR can improve functional status and dyspnea in a large group of patients with ILD, and that certain baseline patient variables can predict this improvement. METHODS: Data from patients who were referred to PR with a diagnosis of ILD were included. Baseline and post-PR variables were recorded, and changes in 6-min walk test (6MWT) distance and dyspnea were evaluated. The impact of baseline variables on change in 6MWT distance and dyspnea were analyzed. RESULTS: A statistically significant difference was seen in both the change in Borg score and 6MWT distance after PR (p < 0.0001). These changes were consistent with previously established clinically significant differences. Baseline 6MWT distance was a significant predictor of change in 6MWT distance (p < 0.0001), with increasing baseline 6MWT distance predicting a smaller improvement after PR. CONCLUSIONS: These results suggest that PR should be considered as a standard of care for patients with ILD.

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Skeletal muscle dysfunction (SMD) is frequent in patients with chronic obstructive pulmonary disease (COPD). Mitochondrial abnormalities appear to play a role in the pathogenesis of SMD. The mitochondrion permeability transition pore (MPTP) facilitates the leakage of mitochondrial matrix constituents, such as cytochrome c (cyto-c), and triggers apoptosis, known to occur in skeletal muscle of patients with COPD. Our objective was to study MPTP kinetics and cyto-c release in skeletal muscle mitochondria of patients with COPD. Mitochondria were isolated from the vastus lateralis (VL), external intercostalis (EI), and latissimus dorsi (LD) in 11 patients with COPD (66 +/- 9 yr; FEV(1) 66 +/- 13%) and 15 smokers with normal lung function (64 +/- 6 yr; FEV(1) 95 +/- 11%) who required thoracic surgery for a localized lung neoplasm. MPTP kinetics were determined spectrophotometrically (time to reach V'max, V'max and mitochondrial swelling) and cyto-c release by enzyme-linked immunosorbent assay. MPTP kinetics and cyto-c release were abnormal in patients with COPD in the three muscles studied. In addition, V'max of VL mitochondria was significantly related (P < 0.01) to BMI (r = -0.75 COPD, -0.67 control) and aerobic capacity (r = -0.70 COPD, -0.60 control) for the COPD group. MPTP kinetics and cyto-c release are abnormal in skeletal and respiratory muscles of patients with moderate COPD, suggesting a systemic mechanism(s) occurring early during the course of the disease.

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Introducción: Con el objetivo de mejorar la calidad de la atención hospitalaria de los niños que ingresan por infección respiratoria aguda baja al Centro Hospitalario Pereira Rossell, se aplicó entre mayo y setiembre de 1999 una estrategia que se denominó Plan de Invierno. Objetivo: Evaluar el impacto que tuvo esta estrategia en el gasto en antibióticos (ATB), broncodilatadores (?2 agonistas) y corticoides en el Hospital Pediátrico. Metodología: Se compararon las unidades consumidas y el gasto (en pesos uruguayos) en ATB, ?2 agonistas y corticoides en el período enero-setiembre 1998 versus enero-setiembre 1999. Los datos fueron obtenidos del programa de uso de medicamentos de la farmacia clínica del hospital. Resultados: El gasto, entre enero y setiembre de 1999, fue menor que en el mismo período de 1998 (28,6% versus 37,6%). El gasto en ATB y corticoides disminuyó en los servicios de pediatría general (PG) y unidad de cuidados intensivos pediátricos (UCIN). El gasto en ?2 disminuyó sólo en UCIN. El gasto por día cama ocupado (DCO) en ATB disminuyó en PG y aumentó en UCIN. Conclusión: Es posible que el cumplimiento de las pautas terapéuticas recomendadas y la mejoría en la calidad de los diagnósticos realizados durante la aplicación de esta estrategia asistencial hayan contribuido a un menor gasto en ATB, ?2 y corticoides en los niños con infección respiratoria aguda baja (IRAB) que ingresaron al hospital.

Summary Introduction: A strategy called Plan de Invierno was developed between May and September of 1999 in order to improve the attention at the Centro Hospitalario Pereira Rossell on children affected by low respiratory tract infections. Objective: To evaluate the impact of this strategy on the spending related to the purchase of antibiotics (ATB), bronchodilators (2agonists) and corticosteroids in the Paediatric Hospital. Methods: Numbers of consumed units and money spent on ATB, (2agonistas) and corticosteroids were compared during the periods of January to September of 1998 and January to September of 1999. Data were obtained from the hospital clinical pharmacy. Results: During the period January - September of 1999, the spending was lower than during the period January - September 1998 (28.6% and 37.6% respectively). Spending on ATB and corticosteroids diminished in the general paediatric service (GP) and in the intensive paediatric care unit (UCIN). Spending related to ?2 agonists diminished only at the UCIN. Bed/day spending (DCO) on ATB decreased at the GP but was increased at the UCIN. Conclusions: Following of the recommended therapeutic guidelines and the improvement of quality of diagnoses performed during the period of this assistance strategy probably contributed to reduce ATB, ?2 agonists, and expenses.

Résumé Introduction: Afin d'améliorer la qualité de l'assistance hospitalière des enfants qui sont admis au Centre Hospitalier Pereira Rossell avec infection respiratoire aigüe, on met en marche une stratégie appelée Plan d'Hiver entre mai et septembre 1999. But: Evaluer l'impact que cette stratégie a eu dans le frais d'antibiotiques(ATB),broncho-dilatateurs(?2 agonistes) et corticoïdes à l'Hôpital Pédiatrique. Méthodologie: On compare les unités consommées et les frais (en monnaie uruguayenne)de ATB, ?2 agonistes et de corticoïdes pendant la période janvier-septembre 1998 versus janvier-septembre 1999. Les données ont été tirées du programme de la pharmacie clinique de l'hôpital. Résultats: Les frais ont été moins grands en 1999 qu'en 1998 (28,6% versus 37,6%). Les frais de ATB et de corti-coïdes ont diminué dans les services de pédiatrie générale (PG) et UCIN. Conclusion: Il est possible que le respect des lignes thérapeutiques recommandées et l'amélioration de la qualité des diagnostics réalisés pendant l'application de cette stratégie d'assistance, aient contribué à diminuer les frais de ATB, ?2 et de corticoïdes chez les enfants avec IRAB admis à l'hôpital.

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OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.

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Objetivo: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno. Métodos: La estrategia se basó en la utilización de protolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. Resultados: Durante la aplicación del Plan (19/V-19/IX/99) ingresaron 3317 niños; 1347 (40.61por cento) presentaban infecciones respiratorias agudas bajas. Se captaron 1096 (81por cento), de los cuales 71 por cento eran menores de un año. Predominaron las infecciones respiratorias virales (68por cento). Los criterios de ingreso fueron saturación de oxígeno <95 por cento, polipnea, tiraje o derrame pleural en el 92.4por cento de los niños. La magnitud de la demanda impidió que las pautas de aislamiento individual o en grupo se cumplieran en todos los casos. El uso de la medicación se ajustó a lo recomendado en un elevado porcentaje: no recibieron antibióticos 73 por cento de las bronquiolitis ni 72 por cento de las neumonías virales, y 96 por cento de las neumonias bacterianas los recibieron según pauta; se redujo el uso de broncodilatadores y de corticoides. El gasto en medicamento disminuyó fundamentalmente en el grupo de los corticoides y tuvo el mayor impacto en el costo por día/cama de antibióticos. Conclusiones: Disminuir la morbimortalidad por infecciones respiratorias agudas bajas requiere continuar mejorando la calidad de la tención hospitalaria y fortalecer los programas de promoción de salud de control de las enfermedades prevalentes, en el primer nivel de atención

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