**10. References**

418 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

Fig. 20. Visual analog graphs of expired tidal volume (ETV) (right above), chest expansion (left above), dyspnea score (right below) with their autocorrelation with trend lines, and CXR showed an improvement of aerotion in the right lower lobe on the 7th day of treatment

baseline. Expirated tidal volume and chest expansion were significant difference, and dyspnea score reduced. Moreover, chest radiography of post-treatment showed increasing

Chest mobilization techqniues are very useful in clinical practice for improving lung ventilation and gas exchange. They also can be applied in various cases, for example, chronic obstructive pulmonary disease (COPD), pneumonia, chronic illness from stroke, spinal injury, prolonged use of a ventilator, etc. These techniques can be applied with others such as breathing exercise, cough training, or exercise in regular pulmonary rehabilitation. Before and after intervention, assessments of observations, palpation or chest expansion measurement,, including X-ray recheck and lung function test, are very important for confirmation of clinical improvement with a single case research design. Improvement of ventilation and gas exchange is very important in gaining health status or quality of life in ICU, or sub-acute or chronic stages. Efficiency of aerobic capacity directs the function and physical performance in daily life. However, this chapter is an example of interesting theory that needs more study to confirm its results. It is hoped that there will be more reports or wider application of chest mobilization in hospitals and communities for improving health

(left below). (Leelaraungrayub et al., 2009)

in the lung volume and less infiltration.

status and pulmonary rehabilitation.

**9. Conclusion** 


Chest Mobilization Techniques for Improving

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**21** 

*Spain* 

**Antipneumococcal** 

**Vaccination in COPD Patients** 

Angel Vila-Corcoles and Olga Ochoa-Gondar

 *Institut Català de la Salut, Tarragona, Catalonia* 

*Research Unit of the Primary Care Service of Tarragona-Valls,* 

*Streptococcus Pneumoniae*, the most common cause of community-acquired pneumonia (CAP), remains a major cause of morbidity and mortality worldwide. Despite appropriate antibiotic therapy and intensive care treatment, mortality rates due to pneumococcal infections remain considerable, especially in elderly and high-risk individuals such as

The main reservoir of pneumococci is the nasopharynx, and the possible outcomes after colonisation are clearance by the organism, asymptomatic persistence of infection (carrier state), or progression to disease. Disease presentation depends on whether the bacteria spreads to adjacent mucosal tissues causing mucosal infections (otitis, sinusitis, bronchitis and nonbacteraemic pneumonias) or whether it invades the bloodstream, or other sterile sites, resulting in invasive pneumococcal disease (IPD), principally bacteraemic pneumonia, meningitis and sepsis. The outcome is a complex process that depends on interactions between factors related to the host, therapy and microorganism (Feikin 2000, Baddour 2004). Figure 1 illustrates the overlap between overall community-acquired pneumonia,

The reported incidences of IPD have widely varied in different studies. These differences probably reflect different rates of obtaining blood cultures from patients with pneumonia. The incidence of bacteremic pneumococcal pneumonia ranged from 9 to 18 cases per 100.000 adults-year in a multicentre study carried out in five countries (Kalin 2000). The true incidence of nonbacteremic pneumococcal pneumonia is unknown, but it is probably 3-4 fold higher considering that it has been estimated that 80% of all pneumococcal pneumonias

Chronic obstructive pulmonary disease (COPD) is a major risk factor for communityacquired pneumonia, and smoking (the most common cause of COPD) has been reported as

Nowadays, COPD is a leading cause of morbidity and mortality worldwide. The prevalence of COPD increases with increasing age (approximately 1-3% in middle aged adults *vs* 6-10% in elderly people) and it is approximately three-fold higher in men than in women (Murtagh 2005). Likely, the prevalence of COPD is underestimated given the absence of systematic

patients with chronic heart or pulmonary disease (Kyaw 2005).

**1. Introduction** 

pneumococcal pneumonia and IPD.

happen without bacteremia (Orqvist 2005).

an important risk factor for IPD (Torres 1996, Nuorti 2000).

*the National Physiotherapy Conference*, Brisbane, Queensland, Australian Physiothrapy Association, Australia.

