**10. References**


For COPD exacerbations NPPV should now be considered as a standard of care in properly selected patients, used in preference to invasive mechanical ventilation. Available evidence and experience have indicated that NPPV has an important role in managing COPD exacerbations, markedly by reducing the need for intubation and improving outcomes, including lowering complication and mortality rates, as well as shortening the hospital stay. NPPV can also be used in certain other situations in COPD patients: in respiratory failure precipitated by a superimposed pneumonia, in postoperative respiratory failure, in intubated patients to facilitate extubation with the aim of reducing the complications of prolonged intubation, in patients with postextubation failure to avoid reintubation, and in do-not-intubate patients; although the evidence to support these applications is not as strong as for NPPV in typical COPD exacerbations. For patients with severe stable COPD, currently available evidence suggests that NPPV can improve daytime and nocturnal gas exchange, prolong sleep duration, improve quality-of-life scores, and possibly reduce the need for hospitalization. However, the findings among studies have not been consistent on these benefits, partly related to numerous methodological shortcomings in most studies performed to date. Despite the weakness of the evidence base, however, some of the consensus and guidelines agree that COPD patients with substantial daytime carbon dioxide retention and evidence of superimposed nocturnal hypoventilation are the ones most likely to benefit (ACCP consensus conference 1999). Achieving desired NPPV adherence by COPD patients will remain still a challenge. Identification of eligible patients, establishment of the appropriate settings and close monitoring of the patients with trained staff are the key points of success of NPPV therapy. Technological improvement of NPPV devices and masks besides new guidelines on the selection of patient, ventilation mode and

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**18** 

**Types of Physical Exercise Training for COPD Patients** 

*Psyquiatry and Physiotherapy Department* 

*Málaga University* 

*Spain* 

R. Martín-Valero, A. I. Cuesta-Vargas and M. T. Labajos-Manzanares

Pulmonary diseases are increasingly important causes of morbidity and mortality in the modern world (Ries et al., 2007). Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease, and a major cause of lung-related death and disability (Fishman, 2008). COPD is characterized by chronic airflow limitation, progressive and largely irreversible, associated with an abnormal inflammatory reaction (Ancochea Bermúdez et al., 2009). COPD is very disabling and features extra-pulmonary

The disease is diagnosed by a clinical history based on the combination of history, physical examination and confirmation of the presence of airflow obstruction with the use of spirometry (Figure 1 Spirometry). Spirometric assessment is performed according to the guidelines of the American Thoracic Society (ATS) (Laszlo, 2006). The technician asks the subjects three exhaling exercises and the best is used for the analysis (Miller et al., 2005). If the Tiffenau rate (value of FEV1/FVC) is less than seventy percent, COPD exists (Global initiative for chronic obstructive lung disease *[GOLD],* 2010). Smoking is the major risk

**1. Introduction** 

Fig. 1. Spirometry

manifestations, but it can be prevented and treated.

factor for the disease (Hilberink et al. 2011).

*School of Nursing, Physiotherapy, Podiatry and Occupational Therapy* 

