Relevance:Pulmonary rehabilitation is an evidencebased intervention for people with COPD. The benefits include reduced breathlessness and fatigue, increased exercise tolerance, and improved well-being. Also, reduces healthcare utilization. However, most of the published studies on the effects of pulmonary rehabilitation over exacerbations in COPD subjects are set out in terms of hospital admission (hospitalization) reduction more than in emergency consultation reduction.Purpose: To evaluate the effects of a pulmonary rehabilitation program (PRP) on exacerbation's impact, analyzing separately hospital admissions and emergency consultations, during the year post PRP.Methods/analysis: Quasi-experimental study. Eligible participants were subjects with a diagnostic of COPD defined by the GOLD; with functional deterioration due to respiratory disability; emergency consultation or hospitalization due to exacerbation ≥1 in previous year to the PRP and with the antibiotic or corticosteroid cycle completed. The exclusion criteria described subjects with cardiopathy or another limiting condition to participate in the exercise program.In the week previous to starting the program, health education sessions were delivered. Subjects were instructed in breathing exercises and bronchial hygiene exercises to be done daily at home.Subjects performed a 7 week PRP, with supervised sessions three times a week. Sessions consisted on: upper limb exercises (15 minutes) and muscular training (15 minutes of inspiratory muscle training with constant pressure load and 30 minutes of lower limbs training, through an ergometric cycle in an interval modality).Exacerbations during the year post PRP in terms of emergency consultation and hospital admission were estimated by interview and clinical history review.A descriptive analysis and a paired sample t-test was performed. The data was analysed through the statistical package SPSS.19.Results: 31 subjects with COPD degrees III (58%) and IV (42%) were studied, with a mean age of 67 (SD ± 9.2). The total number of exacerbations showed a mean reduction of 1.8 in the year post PRP (IC95% [1.2 to 2.4]). Hospitalization admission and emergency consultation also decreased (Hospitalization a mean of 1, IC95% [0.15, 1.5] and emergency consultation a mean of 0.8, IC95% [0.4, 1.3]).It was observed a 64% reduction of subjects that required medical attention due to exacerbation, a 57% decrease of subjects that needed hospital admission, a 78% reduction on subjects that required emergency consultation, and a 62% decrease of subject that required both, emergency consultation and hospital admission.Discussion and conclusions: Our study confirm that a 7 weeks PRP reduces the use of health services by exacerbations, not only the hospital admission but also the emergency consultations during a year post PRP.Impact and implications: The studied PRP could be applied in a clinical set with a minimum of human and technological resources. On base to our results, it would be of interest in future research to analyze its ...

or cardiopulmonary disease. Diaphragm thickness at FRC (DTFRC) and at TLC (DTTLC) was measured with the use of ultrasound image. The DTR was calculated as (DTTLC/DTFRC). VC was measured utilizing spirometry, and inspiratory muscle strength was assessed by maximum effort inspiratory mouth pressure (MIP).Results: Men were higher than women in DTFRC, DTTLC, VC, and MIP, but no significant difference was observed in DTR. DTFRC was significantly correlated with VC (r = 0.75) and MIP (r = 0.54). DTTLC was also significantly correlated with VC (r = 0.55) and MIP (r = 0.46). But DTR was not correlated with VC (r = −0.31) and MIP (r = −0.15). Conclusion(s):The results suggested that DTR assessment does not reflect respiratory muscle strength in young adults. This may be due to other factors, including auxiliary breathing muscles during maximum inspiratory effort and chest wall compliance.Implications: It is necessary to investigate characteristics of indices obtained with diaphragm thickness measured by ultrasound images.Background: Health-related quality of life (HRQoL) has become an important outcome in respiratory patients. Several specific HRQoL questionnaires have been developed, but they are time-consuming to complete and complex to score.Purpose: To describe the correlations between the Airways Questionnaire 20 (AQ20), the St. Georges Respiratory Questionnaire (SGRQ), Chronic Respiratory Disease Questionnaire (CRDQ), before and after a rehabilitation program.Methods: In a quasi-experimental study, 31 patients with moderate-severe COPD (mean age 67 ± 9 yr.; FEV1 34.82 ± 9.55% predicted) filled the validated Spanish versions of the SGRQ, CRDQ and AQ20 before and after a rehabilitation program (20 sessions, 7 weeks). Subjects were selected by consecutive sampling in the University Hospital of A Coruña (Spain). Assessments were performed at the same time, under the same conditions by the same examiner.Descriptive analysis was performed. The quantitative data is presented as mean and standard deviation (±SD). The Wilcoxon test was used for analyze changes in the HRQoL scores. The relationship between two sets of data was analyzed by Spearman's rank correlation test, and a p value of less than 0.05 was considered to be statically significant.Results: Before the training program, the AQ20 showed significant correlations with the three components and the total score of the SGRQ (r s = 0.4 to 0.69) as well as with the total score of the CRDQ (r s = −0.35). The CRDQ components of dyspnea, fatigue and mastery did not achieve significant correlations. After the training program, all subjects improved significantly (p < 0.001) their HRQoL in the SGRQ, the CRDQ and the AQ20 total scores (13.45 ± 9.9; −19.67 ± 11; 3.16 ± .9 respectively. Wilcoxon sign-rank test; p < 0.001). The correlations between AQ20 and SGRQ and CRDQ were stronger after the training (r s = 0.53 to 0.75 and r s = −0.39 to 0.64 respectively) and were of significance for all the components of the questionnaires. Also, changes in the AQ20 scores correlated quite ...