Gesundheitsbezogene Lebensqualität bei Patienten mit Heimbeatmung

Chronic illness permanently changes a patient;s lifestyle and requires continuous adaptation. Chronic diseases like COPD and its treatment place extensive behavioral demands on patients. The need for precisely scheduled daily medication, regular physical exercise, visits to health care providers and monitoring are some of the demands. Exacerbations, inspiratory dyspnea, immobility, and the management of unpredictable situations aggravate the situation. These demands invade nearly every aspect of patients} lives. The quality of patients}self-management of disease depends largely on their assessment of health related quality of life, functioning, ability to comply and coping. COPD patients often have perceived barriers and factors, which will hinder or facilitate an optimal self-management. For instance their individual treatment goals can differ from those of the physician, or patients feel distressed about having a chronic disease. The comprehension of psychological factors in medical treatment is essential not only to be more effective in improving patients' confidence in their ability to follow a self-care regimen but also have beneficial effects in achieving treatment goals.

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“…Insbesondere bei schwer erkrankten COPD-Patienten mit Heimbeatmung kann von einer niedrigen Lebensqualität ausgegangen werden [18,19,20]. …”

Section: Wie Gehen Copd-patienten Mit Ihrer Erkrankung Um? Psychologiunclassified

Wie gehen COPD-Patienten mit ihrer Erkrankung um?

Vries

Petermann²

2007

Dtsch med Wochenschr

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“…In der Regel erfolgt dies über krankheitsübergreifende oder krankheitsspezifische Fragebogen [104]. Verwendet wurden der krankheitsübergreifende Fragebogen MOS 36-Item Short-Form Heath Survey (SF36) [107 -109] Tab.…”

Section: Veränderung Der Mortalitätunclassified

Beatmung bei chronisch ventilatorischer Insuffizienz

Schucher¹,

Magnussen²

2007

Pneumologie

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Mechanical ventilation has become an important treatment option in chronic ventilatory failure. There are different diseases which lead to ventilatory failure and to home mechanical ventilation (HMV). A primary loss of in- and expiratory muscle strength is the reason for respiratory deterioration in neuromuscular disease. In most of these diseases ventilatory failure develops because of the progressive character of muscular damage. Initially, ventilatory failure can be found during night-time. In the case of hypercapnia at daytime, life expectancy is strongly reduced, especially in amyotrophic lateral sclerosis and Duchenne muscular dystrophy. HMV leads to a prolongation of life and to an increase in quality of life, if bulbar involvement is not severe. Impressive clinical improvements under HMV have been found in restrictive disorders of the rib cage like kyphoscoliosis or posttuberculosis sequelae, with an increase of quality of life, walking distance and a decrease in pulmonary hypertension. Only few data are published about long-term results of HMV in Obesity Hypoventilation. In terms of retrospective analyses of clinical data HMV seems to improve survival in this population. Some patients only need CPAP treatment, but most patients have to be treated with ventilatory support. The application of HMV in patients with chronic ventilatory failure due to chronic obstructive pulmonary disease (COPD) is growing, but there are controversial results in randomised clinical trials. Analysis of these data suggest better results of HMV in patients with severe hypercapnia, with the application of higher effective ventilatory pressure and a ventilator mode with a significant reduction in the work of breathing. Under such conditions HMV leads to a reduction of hypercapnia, an improvement in sleep quality, walking distance and quality of life, but until now there is no evidence in reduction of mortality in COPD.

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“…Die Messung der gesundheitsbezogenen Lebensqualität ist jedoch methodisch nicht ohne Schwierigkeiten. In der Regel erfolgt dies über krankheitsübergreifende oder krankheitsspezifische Fragebogen[44]. Verwendet wurden der krankheitsübergreifende Fragebogen MOS 36-Item Short-Form Heath Survey (SF36)[45 ± 47] und die krankheitsspezifischen Fragebogen St. George's Respiratory Questionnaire (SGRQ) [33, 38, 48] und der Chronic Respiratory Disease Questionnaire (CRQ) [29].…”

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Die nichtinvasive Beatmung bei Patienten mit stabiler, schwergradiger chronisch-obstruktiver Bronchitis und Lungenemphysem (COPD)

Schucher¹,

Zerbst²,

Baumann³

2004

Pneumologie

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Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use.

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Gesundheitsbezogene Lebensqualität bei Patienten mit Heimbeatmung

Cited by 13 publications

References 11 publications

Wie gehen COPD-Patienten mit ihrer Erkrankung um?

Wie gehen COPD-Patienten mit ihrer Erkrankung um?

Beatmung bei chronisch ventilatorischer Insuffizienz

Die nichtinvasive Beatmung bei Patienten mit stabiler, schwergradiger chronisch-obstruktiver Bronchitis und Lungenemphysem (COPD)

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