Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease, with pulmonary and extrapulmonary manifestations, which leads to the need to personalize the assessment and treatment of these patients. The latest updates of national and international guidelines for the management of COPD reveal the importance of respiratory rehabilitation (RR) and its role in improving symptoms, quality of life, and psychosocial sphere of patients. Within RR, the inspiratory muscle training (IMT) has received special interest, showing benefits in maximum inspiratory pressure, perception of well-being, and health status in patients with chronic heart disease, respiratory diseases, and dyspnea during exercise. The aim of this review is to assess the efficacy of IMT in COPD patients through the use of inspiratory muscle training devices, compared with respiratory rehabilitation programs without inspiratory muscle training. In the last years, many mechanical devices focused on inspiratory muscle training have been developed, some of them, such as the AirOFit PRO™, PowerBreath^®, or FeelBreathe^®, have shown clear benefits. The active search for candidate patients to undergo the RR program with inspiratory muscle training using this type of device in COPD patients represents an advance in the treatment of this disease, with direct benefits on the quality of life of the patients. In this article, we review the available evidence on IMT in these patients and describe the different devices used for it.

The appropriate titration for the personalized oxygen needs of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia is a determining factor in the success of long-term oxygen therapy. There are no standardized procedures to assist in determining the patient’s needs during the physical activities of daily life. Despite that effort tests are a wide broad approach, further research concerning the development of protocols to titrate O₂ therapy is needed. The main objective of this study was to assess whether the level of oxygen titrated through the 6-minute walking test (6MWT) for patients with COPD and exertional hypoxemia is adequate to meet the patients’ demand during their activities of daily living. Physiological and subjective variables were estimated for a study population during two walking tests: a 6MWT and a 20-minute walking circuit (20MWC), designed ad-hoc to reproduce daily physical activities more truthfully. The results indicate that in a significant proportion of patients, the 6MWT might not accurately predict their oxygen needs at a domiciliary environment. Therefore, the titration of the portable O₂ therapy could not be optimal in these cases, with the detrimental impact on the patient’s health (hyperoxia episodes), the autonomy of the oxygen device, and the decrease of time out of the home.

Introduction: It remains unclear whether surgical staging by mediastinoscopy, VATS or open surgery is always necessary after a negative result of EBUS-TBNA. The objective of this study is to determine the negative predictive value (NPV) of EBUS-TBNA for mediastinal staging of lung cancer. Methods: Retrospective analysis of patients undergoing EBUS-TBNA, for pre-operative mediastinal staging of lung cancer, in the period from February 2016 to September 2019. Results: Of a total of 453 examinations in the referred study period, 56 patients met the study criteria. The average age was 66 years (48-80), and 51 cases (91.1%) were men. A total of 118 punctures of mediastinal adenopathies were perdormed, with a mean of 3.46 passes for adenopathy. Puncture adenopathies were 7 (n =40), 4R (n = 33); 4L (n = 16), 10R (n = 9), 2R (n = 7), 11R (n = 5), 11L (n = 4), 10L (n = 3) and 8 (n= 1). Clot was obtained in 66.9% of punctures (n = 79). The needle size was 19G (n = 1), 21G (n = 18), 22G (n = 9) and not recorded in 28 cases. The definitive surgical technique for staging was mediastinoscopy (n = 8), VATS (n = 12) or open surgical resection (n = 41). The overall negative predictive value of EBUS-TBNA was 92.9% with false negatives in 4 patients. Conclusions: EBUS-TBNA has a high NPV in mediastinal staging of lung cancer, confirming that this endoscopic technique is safe and effective in the preoperative staging of non-small cell lung cancer. Depending on the results presented, it is posible that EBUS-TBNA negative mediastinal lymph nodes do not need surgical confirmation.

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