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Pulmonary Rehabilitation Can Improve the Functional Capacity and Quality of Life for Pneumoconiosis Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6174936. [PMID: 32802860 PMCID: PMC7411485 DOI: 10.1155/2020/6174936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) for pneumoconiosis. We systematically searched PubMed, Embase, The Cochrane Library, Web of Science, SinoMed, CNKI, VIP databases and Wanfang Data from their inception to June 1, 2019. A systematic review and meta-analysis of randomized controlled trials (RCTs) of PR for pneumoconiosis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently screened literature, extracted data, and assessed bias risk. All statistical analyses were performed using the RevMan software. Sixteen RCTs with 1307 subjects were ultimately included for analysis. Compared with routine treatment, PR was able to improve the 6-minute walking distance (mean difference (MD) 69.10, 95% confidence interval (CI) 61.95–76.25); the 36-Item Short Form Health Survey total score (MD 17.60, 95% CI 13.59–21.61); physical function score (MD 15.45, 95% CI 3.20–27.69); role physical score (MD 17.87, 95% CI 12.06–23.69); body pain score (MD 14.34, 95% CI 10.33–18.36); general health score (MD 20.86, 95% CI 16.87–24.84); vitality score (MD 11.66, 95% CI 0.18–23.13); social function score (MD 9.67, 95% CI 1.27–18.08); mental health score (MD 20.60, 95% CI 13.61–27.59); forced vital capacity (FVC) (MD 0.20, 95% CI 0.12–0.29); forced expiratory volume in 1 s (FEV1) (MD 0.23, 95% CI 0.09–0.38); FEV1% (MD 5.19, 95% CI 1.48–8.90); maximal voluntary ventilation (MD 4.47, 95% CI 1.14–7.81); reduction in the St. George's Respiratory Questionnaire score (MD -9.60, 95% CI -16.40 to -2.80); and the modified Medical Research Council Scale score. Furthermore, PR did not increase the FEV1/FVC (MD 3.61, 95% CI -3.43 to 10.65), nor the emotional score (MD 6.18, 95% CI -23.01 to 35.38) compared with the control. We found no reports of adverse events associated with PR. Thus, to some extent, PR can improve functional capacity and quality of life in patients with pneumoconiosis. However, these results should be interpreted with caution because of high heterogeneity. This trial is registered with registration number CRD42018095266.
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152
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153
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Utilization and determinants of use of non-pharmacological interventions in COPD: Results of the COSYCONET cohort. Respir Med 2020; 171:106087. [PMID: 32917358 DOI: 10.1016/j.rmed.2020.106087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Guidelines for chronic obstructive pulmonary disease (COPD) recommend supplementing pharmacotherapy with non-pharmacological interventions. Little is known about the use of such interventions by patients. We analyzed the utilization of a number of non-pharmacological interventions and identified potential determinants of use. METHODS Based on self-reports, use of interventions (smoking cessation, influenza vaccination, physiotherapy, sports program, patient education, pulmonary rehabilitation) and recommendation to use were assessed in 1410 patients with COPD. The utilization was analyzed according to sex and severity of disease. Potential determinants of utilization included demographic variables and disease characteristics and were analyzed using logistic regression models. RESULTS Influenza vaccination in the previous autumn/winter was reported by 73% of patients. About 19% were currently participating in a reimbursed sports program, 10% received physiotherapy, 38% were ever enrolled in an educational program, and 34% had ever participated in an outpatient or inpatient pulmonary rehabilitation program. Out of 553 current or former smokers, 24% had participated in a smoking cessation program. While reports of having received a recommendation to use mainly did not differ according to sex, women showed significantly (p < 0.05) higher utilization rates than men for all interventions except influenza vaccination. Smoking was a predictor for not having received a recommendation for utilization and also significantly associated with a reduced odds of utilization. We found a correlation between recommendation to use and utilization. CONCLUSIONS Utilization of non-pharmacological interventions was lower in men and smokers. A recommendation or offer to use by the physician could help to increase uptake.
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154
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Rajnoveanu RM, Rajnoveanu AG, Fildan AP, Todea DA, Man MA, Motoc NS, Mosoiu D. Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based? Int J Chron Obstruct Pulmon Dis 2020; 15:1591-1600. [PMID: 32694913 PMCID: PMC7340370 DOI: 10.2147/copd.s254104] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
The absence or late initiation of palliative care (PC) in chronic obstructive pulmonary disease (COPD) is multidimensional. To provide palliative care from the moment of COPD diagnosis remains utopic. Even the advanced forms or the end-of-life stages benefit late or never from these services. In this context, the research questions for the present systematic review were focused on the prognosis variables or multicomponent indices in COPD patients alongside the symptoms and unmet needs, which may be useful for the palliative care initiation. The aim was to help clinicians to identify not only the tools reliable to predict poor survival in COPD patients but also to identify the criteria for appropriateness for early palliative care onset. The search included systematic reviews and reviews published in English in the PUBMED database from Jan 1, 2015 to Jan 6, 2020. From a total of 202 findings, after applying filters, using additional sources, and eliminating duplicates, the search strategy screened 16 articles, out of which 10 were selected and included. A Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) flow diagram was constructed. The main domains identified as barriers in providing palliative care in COPD patients were complex: from the prognosis difficulties to the prognostic variables and scores proposed for initiating PC; from the troublesome symptoms or the unidimensional symptom tools to the unmet needs of COPD patients. The review concluded that none of the existing prognostic variables and multicomponent indices are reliable enough to exclusively predict poor survival in COPD patients and the decision to initiate PC should be rather based on the presence of refractory symptoms and patients’ unmet needs and preferences. Despite the current advances, the ideal model to initiate palliative care from the moment COPD is diagnosed is a goal for clinicians trained in, and capable of providing palliative care in any COPD patient.
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Affiliation(s)
| | - Armand-Gabriel Rajnoveanu
- Occupational Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Doina Adina Todea
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Milena Adina Man
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicoleta Stefania Motoc
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Mosoiu
- Hospice Casa Sperantei Brasov, Transilvania University, Brasov, Romania
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Sakamoto H, Takamoto H, Matsui T, Kirimoto T, Sun G. A Non-contact Spirometer with Time-of-Flight Sensor for Assessment of Pulmonary Function. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4114-4117. [PMID: 33018903 DOI: 10.1109/embc44109.2020.9176606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Assessment of pulmonary function is vital for early detection of chronic diseases such as chronic obstructive pulmonary disease (COPD) in home healthcare. However, monitoring of pulmonary function is often omitted owing to the heavy burden that the use of specific medical devices places on the patients. In this study, we developed a non-contact spirometer using a time-of-flight sensor that measures very small displacements caused by chest wall motion during breathing. However, this sensor occasionally failed when estimating the values from breathing waveforms because their shape depends on the subject test experience. As a result, further measurements were required to address motion artifacts. To accomplish high accuracy estimation in the face of these factors, we developed methods to estimate parameters from a part of the waveform and remove outliers from multiple-region measurements. According to laboratory experiments, the proposed system achieved an absolute error of 5.26 % and a correlation coefficient of 0.88. This study also addressed the limitations of depth sensor measurements, thereby contributing to the implementation of high-accuracy COPD screening.
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156
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Tsiligianni I, Sifaki-Pistolla D, Gergianaki I, Kampouraki M, Papadokostakis P, Poulonirakis I, Gialamas I, Bempi V, Ierodiakonou D. Associations of sense of coherence and self-efficacy with health status and disease severity in COPD. NPJ Prim Care Respir Med 2020; 30:27. [PMID: 32555199 PMCID: PMC7303183 DOI: 10.1038/s41533-020-0183-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/04/2020] [Indexed: 11/18/2022] Open
Abstract
Sense of coherence and self-efficacy has been found to affect health-related quality of life in chronic diseases. However, research on respiratory diseases is limited. Here we report findings on quality of life (QoL) of COPD patients and the associations with coherence and self-efficacy. This study consists of the Greek national branch of the UNLOCK study, with a sample of 257 COPD patients. Coherence and self-efficacy are positively inter-correlated (Pearson rho = 0.590, p < 0.001). They are negatively correlated with the quality of life (CAT) [Pearson rho: coherence = −0.29, p < 0.001; self-efficacy = −0.29, p < 0.001) and mMRC (coherence = −0.37, p < 0.001; self-efficacy rho = −0.32, p < 0.001)]. Coherence is inversely associated with (Global Initiative for Chronic Obstructive Lung Disease) GOLD 2018—CAT and GOLD 2018—mMRC classification and “having at least one exacerbation in the past year”. Findings are stressing the need for their incorporation in primary health care and COPD guidance as it maybe that enhancing coherence and self-efficacy will improve QoL.
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Affiliation(s)
- Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Herkalion, Crete, Greece.
| | - Dimitra Sifaki-Pistolla
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Herkalion, Crete, Greece.,Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Irini Gergianaki
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Herkalion, Crete, Greece
| | | | | | | | - Ioannis Gialamas
- Primary Care Practice, Health Center of Sitia, Sitia General Hospital, Lasithi, Crete, Greece
| | | | - Despo Ierodiakonou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Herkalion, Crete, Greece.,Heraklion University Hospital, Heraklion, Crete, Greece
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157
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Ko FWS, Tam W, Siu EHS, Chan KP, Ngai JCL, Ng SS, Chan TO, Hui DSC. Effect of short-course exercise training on the frequency of exacerbations and physical activity in patients with COPD: A randomized controlled trial. Respirology 2020; 26:72-79. [PMID: 32542906 DOI: 10.1111/resp.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies have suggested that early pulmonary rehabilitation (PR) programmes post-AECOPD are an effective and safe intervention for reducing hospital admissions and improving quality of life. This study assessed whether a short course of exercise training post-AECOPD with periodic reinforcement exercise training and phone call reminders reduces readmissions and increases physical activity in COPD patients. METHODS Subjects were randomized into either the (i) intervention group (IG), consisting of 4-8 weeks of training supervised by a physiotherapist and phone contact every 2 weeks by a case manager providing support and reinforcement of continuous exercise at home or (ii) usual care group (UG), which had no input by a physiotherapist or case manager. Readmissions were assessed at 12 months. Activities of all patients were assessed by an activity monitor at baseline, 3 and 12 months. RESULTS Altogether, 136 subjects were included and randomized (68 in IG and 68 in UG). The age, gender and FEV1 % predicted were 75.0 ± 6.7 years, 132 males and 47.0 ± 16.2%, respectively. The mean number of readmissions for AECOPD (1.06 vs 1.72 times, P = 0.014) was less and time to first readmission was increased (146.8 vs 122.4 days, P = 0.005) in the IG versus UG at 12 months. At 12 months, there was no change in activity measured by activity monitor between the two groups. CONCLUSION This programme decreased exacerbation frequency and increased the time of readmissions for AECOPD. It did not improve physical activities and exercise tolerance at 12 months.
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Affiliation(s)
- Fanny Wai-San Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Eddy H S Siu
- Department of Physiotherapy, Prince of Wales Hospital, Hong Kong
| | - Ka-Pang Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Jenny Chun-Li Ngai
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - So-Shan Ng
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tat On Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - David Shu-Cheong Hui
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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158
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Naz I, Sahin H, Varol Y, Kömürcüoğlu B. The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients. Chron Respir Dis 2020; 16:1479972318809472. [PMID: 30428708 PMCID: PMC6301838 DOI: 10.1177/1479972318809472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CLINICAL TRIAL NUMBER NCT03319108.
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Affiliation(s)
- Ilknur Naz
- 1 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Hulya Sahin
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yelda Varol
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Berna Kömürcüoğlu
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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159
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Barlow R, Jones B, Rogerson M, Bannister H, Stuart R, Iqbal J, Andrews L, Easton I. An Evaluation of Service Provision and Novel Strength Assessment on Patient Outcomes in a UK-Based Pulmonary Rehabilitation Setting. COPD 2020; 17:280-288. [PMID: 32419522 DOI: 10.1080/15412555.2020.1764519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study's purpose was to (i) assess the impact of a 7-week pulmonary rehabilitation (PR) programme upon patient outcomes; incremental shuttle walk test (ISWT), COPD assessment tool (CAT), Clinical COPD Questionnaire (CCQ) and the Hospital Anxiety and Depression Scale (HADS); (ii) assess the impact of COPD severity on ISWT, psychological functioning and quality of life measures following PR; (iii) assess the feasibility of incorporating individually prescribed one repetition maximum (1RM) training loads into the existing strength training programme. Patients were people with COPD enrolled onto one of three versions (locations A, B and C) of a 7-week PR programme, which consisted of group exercise sessions and a social plus education element. Two locations incorporated individually prescribed training loads. Minimal clinically important changes (MCICs) are reported for the ISWT across all locations. Statistically significant changes in both CAT and the CCQ were found, with MCIC's evident for CAT score overall and individually at location B. MCIC's were not found for the CCQ. No statistically significant or MCICs were evident for the HADS. MCIC's were present only in patients with mild to moderate severity for the ISWT. For the CAT, moderate, severe and very severe patients with COPD experienced MCIC's. MCIC's and statistically significant increases in 1RM strength were seen at both locations. These findings evidence an effective PR service. Basic strength exercise programming and assessment are feasible and should be implemented in PR services to maximise patient outcomes.
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Affiliation(s)
| | - Ben Jones
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Mike Rogerson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | | | | | - Jawadh Iqbal
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Leanne Andrews
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Izzie Easton
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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160
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Nickel R, Troncoso F, Flores O, Gonzalez-Bartholin R, Mackay K, Diaz O, Jalon M, Peñailillo L. Physiological response to eccentric and concentric cycling in patients with chronic obstructive pulmonary disease. Appl Physiol Nutr Metab 2020; 45:1232-1237. [PMID: 32413271 DOI: 10.1139/apnm-2020-0149] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We aimed to compare the cardiorespiratory, metabolic, and perceptual responses to high- and moderate-intensity eccentric cycling versus moderate-intensity concentric cycling in chronic obstructive pulmonary disease (COPD) patients. Ten patients with moderate COPD (forced expiratory volume in 1 s (FEV1) = 68.6% ± 20.4% of predicted; 68.3 ± 9.1 years) performed 30 min of moderate-intensity concentric (CONC-M: 50% maximum workload; Wmax), moderate-intensity eccentric (ECC-M: 50% Wmax), and high-intensity eccentric (ECC-H: 100% Wmax) cycling. Average power output, oxygen consumption (V̇O2), minute ventilation (VE), respiratory frequency (fR), oxygen saturation (SpO2), heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), rate of perceived exertion (RPE), and dyspnea were measured during cycling. Compared with CONC-M, lower V̇O2 (-52% ± 14%), VE (-47% ± 16%), fR (-21% ± 14%), HR (-14% ± 16%), SBP (-73% ± 54%), RPE (-36% ± 26%), and dyspnea (-41% ± 37%) were found during ECC-M. During ECC-H, a similar metabolic demand to CONC-M was found. However, average power output was 117% ± 79% higher during ECC-H. Eccentric cycling can be safely performed by COPD patients and induced lower cardiorespiratory, metabolic, and perceptual responses than concentric exercise when performed at the same workload. Novelty Moderate- and high-intensity eccentric cycling can be performed by COPD patients. Moderate-intensity eccentric cycling showed lower cardiorespiratory, metabolic, and perceptual demand than concentric cycling at the same workload in COPD patients. Even at double workload, eccentric cycling induces lower cardiorespiratory, metabolic, and perceptual demand than moderate-intensity concentric cycling.
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Affiliation(s)
- Rolf Nickel
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Felipe Troncoso
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Orlando Flores
- Burns, Trauma and Critical Care Research Centre, Faculty of Medicine, The University of Queensland. Brisbane, Australia
| | - Roberto Gonzalez-Bartholin
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Karen Mackay
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Orlando Diaz
- Department of Pulmonary Diseases, Faculty of Medicine, Pontifical Catholic, University of Chile, Santiago, Chile.,Department of Critical Care, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Luis Peñailillo
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
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161
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Jenkins AR, Holden NS, Gibbons LP, Jones AW. Clinical Outcomes and Inflammatory Responses of the Frequent Exacerbator in Pulmonary Rehabilitation: A Prospective Cohort Study. COPD 2020; 17:253-260. [DOI: 10.1080/15412555.2020.1753669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alex R. Jenkins
- Division of Respiratory Medicine, University of Nottingham, UK
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Neil S. Holden
- School of Life Sciences, University of Lincoln, Lincoln, UK
| | - Luke P. Gibbons
- Countywide Community Respiratory Service, Lincolnshire Community Health Services NHS Trust, Lincoln, UK
| | - Arwel W. Jones
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
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162
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Lee SW, Lyu YR, Park SJ, Kwak JY, Yang WK, Kim SH, Kang W, Son JW, Jung IC, Park YC. The effect of lung-conduction exercise in chronic obstructive pulmonary disease: Study protocol for randomized, assessor-blind, multicenter trial. Medicine (Baltimore) 2020; 99:e19826. [PMID: 32358353 PMCID: PMC7440170 DOI: 10.1097/md.0000000000019826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an irreversible disease characterized by cough, sputum production, and dyspnea, and has a high prevalence and mortality. Pulmonary rehabilitation (PR) is a management that improves the quality of life for COPD patients; however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed without any limitations. LCE consists of breathing, stretching, and tapping to relieve dyspnea in COPD patients. METHODS/DESIGN This randomized, assessor-blind, multicenter trial aims to recruit 54 patients with moderate and severe COPD. Subjects will be randomly allocated to a control group (only medication), an LCE group (medication + LCE, 5 times a week), or a PR group (medication + PR, 5 times a week). The 6-minute walk distance, pulmonary function tests (forced expiratory volume at 1 second, forced vital capacity, and forced expiratory volume at 1 second/forced vital capacity), modified Borg scale, modified medical research council dyspnea scale, COPD assessment test, and St. George respiratory questionnaire will be measured before starting the trial and after the 4th and 8th weeks to determine motor performance, lung function, and dyspnea. CONCLUSION We aim to demonstrate that LCE is effective in improving symptoms and psychosomatic stability in COPD patients. Therefore, this trial will play an important role in fortifying the foundation of clinical application.
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Affiliation(s)
- Su Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
| | - Yee Ran Lyu
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
| | - So Jung Park
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
| | - Jin Young Kwak
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
| | - Won Kyung Yang
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
- Institute of Traditional Medicine and Bioscience
| | | | - Weechang Kang
- Department of Statistics, Hyehwa Liberal Arts College, Daejeon University
| | - Ji Woong Son
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital
| | - In Chul Jung
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
- Department of Neuropsychology, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
- Institute of Traditional Medicine and Bioscience
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163
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Wang C, Chen X, Du L, Zhan Q, Yang T, Fang Z. Comparison of machine learning algorithms for the identification of acute exacerbations in chronic obstructive pulmonary disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 188:105267. [PMID: 31841787 DOI: 10.1016/j.cmpb.2019.105267] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/19/2019] [Accepted: 12/08/2019] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Identifying acute exacerbations in chronic obstructive pulmonary disease (AECOPDs) is of utmost importance for reducing the associated mortality and financial burden. In this research, the authors aimed to develop identification models for AECOPDs and to compare the relative performance of different modeling paradigms to find the best model for this task. METHODS Data were extracted from electronic medical records (EMRs) of patients with chronic obstructive pulmonary disease who admitted to the China-Japan Friendship Hospital between February 2011 and March 2017. Five machine learning algorithms (random forest, support vector machine, logistic regression, K-nearest neighbor and naïve Bayes) were used to develop the AECOPDs identification models. Feature selection was performed to find an optimal feature subset. 10-folds cross-validation was used to find the best hyperparameters for each model. The following metrics: area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value were used to evaluate the performance of these models. RESULTS A total of 303 EMRs (AECOPDs patients:135; None AECOPDs patients: 168) were included in the study. The SVM model obtained the best performance (sensitivity: 0.80, specificity: 0.83, positive predictive value:0.81, negative predictive value:0.85 and area under the receiver operating characteristic curve: 0.90) after performing feature selection. CONCLUSIONS Our research confirms that the proposed model based on the support vector machine is a powerful tool to identify AECOPDs patients, and it is promising to provide decision support for clinicians when they are struggling to give a confirmed clinical diagnosis.
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Affiliation(s)
- Chenshuo Wang
- Institute of Electronics, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Xianxiang Chen
- Institute of Electronics, Chinese Academy of Sciences, Beijing, China; Personalized Management of Chronic Respiratory Disease, Chinese Academy of Medical Sciences, China
| | - Lidong Du
- Institute of Electronics, Chinese Academy of Sciences, Beijing, China; Personalized Management of Chronic Respiratory Disease, Chinese Academy of Medical Sciences, China
| | | | - Ting Yang
- China-Japan Friendship Hospital, Beijing, China.
| | - Zhen Fang
- Institute of Electronics, Chinese Academy of Sciences, Beijing, China; Personalized Management of Chronic Respiratory Disease, Chinese Academy of Medical Sciences, China; University of Chinese Academy of Sciences, Beijing, China.
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164
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Bourbeau J, De Sousa Sena R, Taivassalo T, Richard R, Jensen D, Baril J, Rocha Vieira DS, Perrault H. Eccentric versus conventional cycle training to improve muscle strength in advanced COPD: A randomized clinical trial. Respir Physiol Neurobiol 2020; 276:103414. [DOI: 10.1016/j.resp.2020.103414] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 01/21/2023]
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165
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Hart MK, Stewardson E, Jamil AK, Tecson KM, Millard MW. Usefulness of harmonica playing to improve outcomes in patients with chronic obstructive pulmonary disease. Proc (Bayl Univ Med Cent) 2020; 33:178-182. [PMID: 32313456 DOI: 10.1080/08998280.2019.1704135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022] Open
Abstract
Pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) includes a multidisciplinary approach of exercise and pursed-lip diaphragmatic breathing. Pursed-lip diaphragmatic breathing reduces alveolar collapse during exhalation, and diaphragmatic breathing improves inspiratory pressures. Harmonica playing has maneuvers similar to those taught in pursed-lip diaphragmatic breathing, with diaphragmatic breathing to create musical tones. Hence, we designed a trial to determine whether patients with COPD would benefit from harmonica playing. COPD patients who completed pulmonary rehabilitation at least 6 months prior were eligible for this trial. Patients attended 12 weeks of harmonica training sessions for 2 hours a week and were encouraged to practice at home. Participants completed pre- and postspirometry testing, maximum inspired and expired pressure (PImax, PEmax) testing, and 6-minute walk tests. Eleven of the 14 participants completed the 12-week trial. PImax and PEmax increased by an average of 15.4 ± 12.0 cm H2O (P = 0.0017) and 14.4 ± 14.0 cm H2O (P = 0.0061), respectively. Additionally, 6-minute walk distance increased by approximately 60 m (61 ± 78, P = 0.03). This pilot study showed that a 12-week harmonica program significantly improved PImax, PEmax, and 6-minute walk distance in COPD patients after rehabilitation. Larger-scale harmonica studies are warranted to evaluate this program's adjunctive potential benefit to formal pulmonary rehabilitation.
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Affiliation(s)
- Mary K Hart
- Heart and Lung Transplant and Pulmonary Research, Baylor Scott & White Research InstituteDallasTexas.,Center for Advanced Heart and Lung Disease, Martha Foster Lung Center, Baylor Scott & White HealthDallasTexas
| | | | - Aayla K Jamil
- Heart and Lung Transplant and Pulmonary Research, Baylor Scott & White Research InstituteDallasTexas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research InstituteDallasTexas
| | - Mark W Millard
- Center for Advanced Heart and Lung Disease, Martha Foster Lung Center, Baylor Scott & White HealthDallasTexas
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166
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NIV Is not Adequate for High Intensity Endurance Exercise in COPD. J Clin Med 2020; 9:jcm9041054. [PMID: 32276370 PMCID: PMC7230463 DOI: 10.3390/jcm9041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/03/2022] Open
Abstract
Noninvasive ventilation (NIV) during exercise has been suggested to sustain higher training intensity but the type of NIV interface, patient-ventilator asynchronies (PVA) or technological limitation of the ventilator may interfere with exercise. We assessed whether these parameters affect endurance exercise capacity in severe COPD patients. In total, 21 patients with severe COPD not eligible to home NIV performed three constant workload tests. The first test was carried out on spontaneous breathing (SB) and the following ones with NIV and a nasal or oronasal mask in a randomized order. PVA and indicators of ventilator performance were assessed through a comprehensive analysis of the flow pressure tracing raw data from the ventilator. The time limit was significantly reduced with both masks (406 s (197–666), 240 s (131–385) and 189 s (115–545), p < 0.01 for tests in SB, with oronasal and nasal mask, respectively). There were few PVA with an oronasal mask (median: 3.4% (1.7–5.2)) but the ventilator reached its maximal generating capacity (median flowmax: 208.0 L/s (189.5–224.8) while inspiratory pressure dropped throughout exercise (from 10.1 (9.4–11.4) to 8.8 cmH2O (8.6–10.8), p < 0.01). PVA were more frequent with nasal mask (median: 12.8% (3.2–31.6), p < 0.01). Particularly, the proportion of patients with ineffective efforts > 10% was significantly higher with nasal interface (0% versus 33.3%, p < 0.01). NIV did not effectively improve endurance capacity in COPD patients not acclimated to home NIV. This was due to a technological limitation of the ventilator for the oronasal mask and the consequence either of an insufficient pressure support or a technological limitation for the nasal mask.
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167
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Patel A, Chernyak Y. The Need for Psychological Rehabilitation in Lung Transplant Recipients. Prog Transplant 2020; 30:140-143. [PMID: 32238032 DOI: 10.1177/1526924820913510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transplant recipients have significant psychosocial stressors due to unique posttransplant sequela that results in an increased incidence of psychopathology. Posttransplant psychological interventions, especially in lung transplant recipients, are understudied, as the focus of prior research has emphasized pretransplant interventions. However, posttransplant psychological stability affects medical outcomes. The importance of posttransplant psychological intervention is highlighted. Recommendations exist which call for attention to specific psychological domains in the posttransplant recovery period and highlight the impact of psychological rehabilitation on overall wellness and success in recovery. A novel psychological rehabilitation intervention is outlined as a response to posttransplant intervention recommendations to demonstrate implementation.
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Affiliation(s)
- Anahli Patel
- Indiana University School of Medicine, IU Health Neurosciences Center/Goodman Hall, Indianapolis, IN, USA
| | - Yelena Chernyak
- Indiana University School of Medicine, IU Health Neurosciences Center/Goodman Hall, Indianapolis, IN, USA
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168
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Kılıç L, Pehlivan E, Balcı A, Bakan ND. Effect of 8-week Pulmonary Rehabilitation Program on Dyspnea and Functional Capacity of Patients on Waiting List for Lung Transplantation. Turk Thorac J 2020; 21:110-115. [PMID: 32203001 DOI: 10.5152/turkthoracj.2019.18202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung transplantation (LTx) candidates. MATERIALS AND METHODS Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical Research Council (MRC) dyspnea scale were recorded. RESULTS Of 23 patients 57% were males; the mean age was 35±10 (range: 16-48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic pulmonary fibrosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there was a significant improvement (median: 60 m) in 6MWT scores (360 [70-254] m vs. 300 [139-489] m; p=0.018). In addition, a clinical improvement was observed in Borg (p=0.000) and MRC scores (p=0.008). CONCLUSION Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.
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Affiliation(s)
- Lütfiye Kılıç
- Department of Pulmonary Rehabilitation, Health Sciences University, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Esra Pehlivan
- Department of Physiotherapy and Rehabilitation, Health Sciences University Faculty of Health Sciences, İstanbul, Turkey
| | - Arif Balcı
- Department of Pulmonary Rehabilitation, Health Sciences University, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nur Dilek Bakan
- Department of Chest Diseases, Şişli Memorial Private Hospital, İstanbul, Turkey
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169
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Bae E, Choi SE, Lee H, Shin G, Kang D. Validity of EQ-5D utility index and minimal clinically important difference estimation among patients with chronic obstructive pulmonary disease. BMC Pulm Med 2020; 20:73. [PMID: 32293387 PMCID: PMC7092534 DOI: 10.1186/s12890-020-1116-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/16/2020] [Indexed: 01/21/2023] Open
Abstract
Background The discriminatory ability of multi-attribute utility (MAU) measures compared to condition-specific measures (CSM) in assessing health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD) is an unsettled issue. This study investigated the quality of life of patients with COPD with three different HRQoL instruments and examined whether they could differentiate between adjacent severity groups in a statistically and clinically meaningful manner. In the process, the minimal clinically important differences (MCID) of the EQ-5D utility index were estimated. Methods Cross-sectional survey data were collected from patients with mild to very severe COPD in South Korea. In addition to demographic and clinical information, the following HRQoL questionnaires were used: The three-level five-dimensional Euro-Quality of Life tool (EQ-5D-3L), the EQ-Visual Analog Scale (EQ-VAS), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT). Patients’ health-related quality of life was analyzed with reference to severity groups based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. To investigate the discriminatory ability of the HRQoL instruments between COPD severity groups, tests examining variance, covariance, and standardized mean difference were performed. After estimating the MCID of the EQ-5D utility index using the anchor-based method, we investigated whether the differences in the EQ-5D utility scores between groups exceeded the clinically meaningful minimum level. Results A total of 298 patients completed this study. All the quality of life scores showed statistically significant differences between the GOLD severity groups. The pooled MCID estimate for the EQ-5D utility index was 0.028 (range: 0.017–0.033). Even after adjusting for other factors affecting quality of life, the EQ-5D utility index differentiated the GOLD groups well. Conclusions We conclude that the EQ-5D utility index is a valid instrument for measuring the quality of life of patients with COPD, and the pooled MCID estimate for the EQ-5D utility index was 0.028.
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Affiliation(s)
- Eunmi Bae
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
| | - Sang-Eun Choi
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea.
| | - Haeyoung Lee
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Gyeongseon Shin
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
| | - Daewon Kang
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
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170
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Bughin F, Desplan M, Mestejanot C, Picot MC, Roubille F, Jaffuel D, Mercier J, Jaussent I, Dauvilliers Y. Effects of an individualized exercise training program on severity markers of obstructive sleep apnea syndrome: a randomised controlled trial. Sleep Med 2020; 70:33-42. [PMID: 32193052 DOI: 10.1016/j.sleep.2020.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a high prevalent disorder with severe consequences including sleepiness, metabolic, and cardiovascular disorders. The aim of this study was to assess the effect of an individualized exercise-training (IET) program with educational sessions vs educational sessions alone on severity markers of OSA over an eight-week duration. METHODS This was a randomised, controlled, parallel-design study. In sum, 64 patients with moderate-to-severe OSA (apnea-hypopnea index AHI 15-45/hour), low physical activity level (Voorrips<9), body-mass index (BMI) <40 kg/m2 were included in intervention group (IG) or control group (CG), and 54 patients finished the study. All underwent polysomnography (PSG), multiple sleep latency test (MSLT), constant workload exercise test, blood samples and fulfilled questionnaires twice. The primary endpoint was the change in apnea-hypopnea (AHI) at eight weeks from baseline. Main secondary endpoints were daytime sleepiness assessed by questionnaire and objective tests. RESULTS No significant between-group differences were found for changes in AHI. A reduction in AHI was found in IG only (p = 0.005). Compared to CG, exercise training leads to a greater decrease in AHI during REM sleep (p = 0.0004), with a significant increase in mean daytime sleep latency (p = 0.02). Between-group differences were significant for weight reduction, severity of fatigue, insomnia and depressive symptoms with trend for sleepiness symptoms. CONCLUSIONS In adult patients with moderate-to-severe OSA, IET did not decrease AHI compared to the control group but improved markers of severity of OSA, in particular AHI in rapid eye movement (REM) sleep and objective daytime sleepiness. Adding personalized exercise training to the management of patients with OSA should be considered. CLINICALTRIALS. GOV IDENTIFIER NCT01256307.
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Affiliation(s)
- F Bughin
- PhyMedExp INSERM U1046 / CNRS UMR9214, Montpellier University, Montpellier, University Hospital, France
| | - M Desplan
- Specialized Medical Center Medimarien, Marcel Marien Street 21, 1030, Brussels, Belgium; LaboCenter for the Study of Sleep Disorders, Neuroscience Pole, DELTA Hospital, CHIREC, Boulevard of the Triumph 201, 1160, Brussels, Belgium
| | - C Mestejanot
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - M C Picot
- Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France
| | - F Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - D Jaffuel
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier Cedex 5, France
| | - J Mercier
- PhyMedExp INSERM U1046 / CNRS UMR9214, Montpellier University, Montpellier, University Hospital, France
| | - I Jaussent
- INSERM, U1061, Neuropsychiatry, Montpellier, France
| | - Y Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France; INSERM, U1061, Neuropsychiatry, Montpellier, France; University Montpellier, Montpellier, France.
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171
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Li J, Lu Y, Li N, Li P, Su J, Wang Z, Wang T, Yang Z, Yang Y, Chen H, Xiao L, Duan H, Wu W, Liu X. Muscle metabolomics analysis reveals potential biomarkers of exercise‑dependent improvement of the diaphragm function in chronic obstructive pulmonary disease. Int J Mol Med 2020; 45:1644-1660. [PMID: 32186768 PMCID: PMC7169662 DOI: 10.3892/ijmm.2020.4537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/17/2020] [Indexed: 12/25/2022] Open
Abstract
Decreased diaphragm function is a crucial factor leading to reduced ventilatory efficiency and worsening of quality of life in chronic obstructive pulmonary disease (COPD). Exercise training has been demonstrated to effectively improve the function of the diaphragm. However, the mechanism of this process has not been identified. The emergence of metabolomics has allowed the exploration of new ideas. The present study aimed to analyze the potential biomarkers of exercise-dependent enhancement of diaphragm function in COPD using metabolomics. Sprague Dawley rats were divided into three groups: COPD + exercise group (CEG); COPD model group (CMG); and control group (CG). The first two groups were exposed to cigarette smoke for 16 weeks to establish a COPD model. Then, the rats in the CEG underwent aerobic exercise training for 9 weeks. Following confirmation that exercise effectively improved the diaphragm function, a gas chromatography tandem time-of-flight mass spectrometry analysis system was used to detect the differential metabolites and associated pathways in the diaphragm muscles of the different groups. Following exercise intervention, the pulmonary function and diaphragm contractility of the CEG rats were significantly improved compared with those of the CMG rats. A total of 36 different metabolites were identified in the comparison between the CMG and the CG. Pathway enrichment analysis indicated that these different metabolites were involved in 17 pathways. A total of 29 different metabolites were identified in the comparison between the CMG and the CEG, which are involved in 14 pathways. Candidate biomarkers were selected, and the pathways analysis of these metabolites demonstrated that 2 types of metabolic pathways, the nicotinic acid and nicotinamide metabolism and arginine and proline metabolism pathways, were associated with exercise-induced pulmonary rehabilitation.
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Affiliation(s)
- Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Jianqing Su
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Zhengrong Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Ting Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Zhaoyu Yang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Yahui Yang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Haixia Chen
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Lu Xiao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Hongxia Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai 200438, P.R. China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
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172
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Hindelang M, Kirsch F, Leidl R. Effectiveness of non-pharmacological COPD management on health-related quality of life - a systematic review. Expert Rev Pharmacoecon Outcomes Res 2020; 20:79-91. [PMID: 32098530 DOI: 10.1080/14737167.2020.1734455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. The chronic progressive disease is accompanied by a high loss of health-related quality of life (HRQoL). The available drugs usually only have symptomatic effects; therefore, non-pharmacological therapies are essential too.Areas covered: This systematic review examines non-pharmacological interventions consisting of pulmonary rehabilitation, physical activity, and training versus usual care or no intervention in COPD using at least one of the following HRQoL measuring instruments: St. George's Respiratory Questionnaire, Clinical COPD Questionnaire, COPD Assessment Test, and EuroQol-5D. Of 1532 identified records from CENTRAL, MEDLINE, and EMBASE, 15 randomized controlled trials met the inclusion criteria. Pulmonary rehabilitation programs were investigated in nine studies, education and counseling-based training programs in three studies, and breathing exercises in three studies. Ten studies were found that investigated non-pharmacological treatment programs that led to a significant and clinically relevant improvement in HRQoL compared with usual care or no treatment.Expert opinion: Non-pharmacological interventions consisting of pulmonary rehabilitation, education and counseling-based training programs, and breathing exercises can improve the HRQoL of COPD patients.
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Affiliation(s)
- Michael Hindelang
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Ludwig-Maximilians-Universität München, Munich, Germany.,Pettenkofer School of Public Health. Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Florian Kirsch
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany
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173
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Nyenhuis SM, Balbim GM, Ma J, Marquez DX, Wilbur J, Sharp LK, Kitsiou S. A Walking Intervention Supplemented With Mobile Health Technology in Low-Active Urban African American Women With Asthma: Proof-of-Concept Study. JMIR Form Res 2020; 4:e13900. [PMID: 32159520 PMCID: PMC7101169 DOI: 10.2196/13900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 11/24/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023] Open
Abstract
Background Physical inactivity is associated with worse asthma outcomes. African American women experience disparities in both physical inactivity and asthma relative to their white counterparts. We conducted a modified evidence-based walking intervention supplemented with mobile health (mHealth) technologies to increase physical activity (PA). Objective This study aimed to assess the preliminary feasibility of a 7-week walking intervention modified for African American women with asthma. Methods African American women with suboptimally controlled asthma were identified from a health system serving low-income minorities. At a baseline data collection visit, participants performed spirometry and incremental shuttle walk test, completed questionnaires, and were given an accelerometer to wear for 1 week. The intervention comprised an informational study manual and 3 in-person group sessions over 7 weeks, led by a nurse interventionist, in a community setting. The supplemental mHealth tools included a wearable activity tracker device (Fitbit Charge HR) and one-way text messages related to PA and asthma 3 times per week. A secure Web-based research platform, iCardia, was used to obtain Fitbit data in real time (wear time, moderate-to-vigorous physical activity [MVPA] and sedentary time) and send text messages. The feasibility of the intervention was assessed in the domains of recruitment capability, acceptability (adherence, retention, engagement, text messaging, acceptability, complaints, and concerns), and preliminary outcome effects on PA behavior (change in steps, duration, and intensity). Results We approached 22 women, of whom 10 were eligible; 7 consented, enrolled and completed the study. Group session attendance was 71% (5/7), 86% (6/7), and 86% (6/7), respectively, across the 3 sessions. All participants completed evaluations at each group session. The women reported being satisfied or very satisfied with the program (eg, location, time, and materials). None of them had concerns about using, charging, or syncing the Fitbit device and app. Participants wore their Fitbit device for at least 10 hours per day in 44 out of the 49 intervention days. There was an increase in Fitbit-measured MVPA from week 1 (19 min/week, SD 14 min/week) to the last week of intervention (22 min/week, SD 12 min/week; Cohen d=0.24, 95% CI 0.1 to 6.4). A slight decrease in step count was observed from week 1 (8926 steps/day, SD 2156 steps/day) to the last week of intervention (8517 steps/day, SD 1612 steps/day; Cohen d=−0.21, 95% CI −876.9 to 58.9). Conclusions The initial feasibility results of a 7-week community-based walking intervention tailored for African American women with asthma and supplemented with mHealth tools are promising. Modifications to recruitment, retention, and the intervention itself are needed. These findings support the need to conduct a further modified pilot trial to collect additional data on feasibility and estimate the efficacy of the intervention on asthma and PA outcomes.
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Affiliation(s)
- Sharmilee M Nyenhuis
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Guilherme Moraes Balbim
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - JoEllen Wilbur
- Department of Women, Children and Family Nursing, Rush University, Chicago, IL, United States
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
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174
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Lee AL, Butler SJ, Varadi RG, Goldstein RS, Brooks D. The Impact of Pulmonary Rehabilitation on Chronic Pain in People with COPD. COPD 2020; 17:165-174. [PMID: 32131643 DOI: 10.1080/15412555.2020.1733952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic pain affects up to 88% of people with chronic obstructive pulmonary disease (COPD) and has been associated with comorbidities. However, with pain not evaluated during pulmonary rehabilitation (PR) assessments, it is unclear whether PR impacts pain intensity and coping ability. This study aimed to 1) determine the effect of PR on pain qualities, coping behavior and psychological symptoms in those with COPD and chronic pain; and 2) assess the impact of PR on exercise capacity and quality of life in individuals with COPD and chronic pain compared to those without pain. Patients with COPD and comorbidities enrolling in outpatient PR were assessed for chronic pain. Those with chronic pain completed the Brief Pain Inventory, Coping Strategies Questionnaire-24, Fear Avoidance Behavior Questionnaire and measures of anxiety and depression. Changes in HRQOL and 6-minute walk distance (6MWD) following PR were compared between participants with and without chronic pain. Thirty-four participants with chronic pain and 34 participants without pain were included (mean ± SD, FEV1 47 ± 19% predicted). In those with chronic pain, PR did not affect pain intensity (median[IQR] pre/post PR 3[2-5] vs. 4[2-6] points, p = 0.21), anxiety (7[2-9] vs. 5[3-8] points, p = 0.82) or depression (4[2-8] vs. 3[1-6] points, p = 0.38) and did not change pain coping strategies. Both groups improved in 6MWD (mean difference [95% CI] 17[-39 to 72] m), and those without pain had greater improvement in mastery (p = 0.013). PR was effective in patients with moderate to severe COPD whether or not they reported chronic pain at the time of their initial assessment.
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Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia.,Cabrini Health, Malvern, Victoria, Australia
| | - Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Robert G Varadi
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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175
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Hernandez A, Bronas UG, Steffen AD, Marquez DX, Fritschi C, Quinn LT, Collins EG. Rhythmic auditory stimulation increases 6-Minute walk distance in individuals with COPD: A repeated measures study. Heart Lung 2020; 49:324-328. [PMID: 32067724 DOI: 10.1016/j.hrtlng.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate if there is an increase in 6-minute walk distance in individuals with chronic obstructive pulmonary disease (COPD) while walking to rhythmically enhanced music. BACKGROUND Individuals with COPD are less active. Walking with rhythmically enhanced music may help Participant's walk farther while simultaneously distracting from symptoms of dyspnea. METHODS Twenty-five men (age = 70.7 ± 4.5 yr), with moderate-to-severe COPD (FEV1 = 47.4 ± 9.7% predicted) completed three, 6 min walk tests (6MWT) in random order. Walks were completed with music, with music that was rhythmically enhanced, or without music. Walking distance and perceived dyspnea were measured. RESULTS Participant's walked 12 m, 95% CI [20.5-, 2.6], p = 0.015 further during the 6MWT when listening to rhythmically enhanced music when compared to no music. Onset of dyspnea was not different between the three walking conditions. CONCLUSIONS Rhythmically-enhanced music may be a useful tool to increase walking distance in Participant's with COPD.
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Affiliation(s)
- Alison Hernandez
- Northwestern University, Feinberg School of Medicine, Center for Education in Health Science and Outcomes Research, 633 N St. Clair, 20th Floor (2024-J), Chicago, IL 60611; University of Illinois at Chicago, College of Nursing, 845 South Damen Ave, Chicago IL 60612.
| | - Ulf G Bronas
- University of Illinois at Chicago, College of Nursing, 845 South Damen Ave, Chicago IL 60612.
| | - Alana D Steffen
- University of Illinois at Chicago, College of Nursing, 845 South Damen Ave, Chicago IL 60612.
| | - David X Marquez
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor, Chicago IL 60612.
| | - Cynthia Fritschi
- University of Illinois at Chicago, College of Nursing, 845 South Damen Ave, Chicago IL 60612.
| | - Lauretta T Quinn
- University of Illinois at Chicago, College of Nursing, 845 South Damen Ave, Chicago IL 60612.
| | - Eileen G Collins
- University of Illinois at Chicago, College of Nursing, 845 South Damen Ave, Chicago IL 60612; Edward Hines Jr., VA Hospital.
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176
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Roh JA, Kim KI, Park J, Lee BJ, Jung HJ. The efficacy of manual therapy (Chuna) for chronic obstructive pulmonary disease: Protocol for a systematic review. Medicine (Baltimore) 2020; 99:e18832. [PMID: 32118706 PMCID: PMC7478514 DOI: 10.1097/md.0000000000018832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a challenging disease whose prevalence has increased over the last decades. Non-pharmacological therapies such as pulmonary rehabilitation occupy a core position in patient management. Among these therapies, manual therapy reduces symptoms and increases exercise capacity targeting musculoskeletal problems. Chuna, a traditional Korean manual therapy, has improved pulmonary disorders in clinical practice but unfortunately has not had its effects reported. This systematic review aims to evaluate the effectiveness and safety of manual therapy, focused on the use of Chuna in the management of COPD patients. METHODS The following databases will be used in this study: MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Database (CNKI), KoreaMed, Korean Medical Database (KMbase), and Oriental Medicine Advanced Searching Integrated System (OASIS). The primary outcome comprises lung function and exercise capacity. Secondary outcomes included symptoms, quality of life, and adverse events. We will include randomized controlled trials (RCTs) and crossover studies. Two independent reviewers will screen the searched studies, determine if they are suitable for inclusion, and perform data extraction. The risk of bias will be assessed using the Cochrane risk of bias tool. When appropriate, data will be pooled across studies for meta-analysis using a fixed or random effects model. When quantitative synthesis is not appropriate, the evidence will be summarized qualitatively. RESULTS This study will provide a comprehensive review of the available evidence to assess the efficacy of Chuna for COPD patients. Results will be published in a peer-reviewed journal and disseminated electronically and in print. CONCLUSIONS This study will provide high-quality current evidence for evaluation the efficacy of Chuna for patients with COPD. Clinicians, patients and policy makers may find this review useful in making decisions regarding the use of Chuna for patients with COPD. PROSPERO REGISTRATION NUMBER CRD42019141150.
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Affiliation(s)
- Ji-Ae Roh
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
| | - Kwan-Il Kim
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
| | - Jihye Park
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Beom-Joon Lee
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
| | - Hee-Jae Jung
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
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177
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do Nascimento IB, Fleig R. Mobility impact and methods of diaphragm monitoring in patients with chronic obstructive pulmonary disease: a systematic review. Clinics (Sao Paulo) 2020; 75:e1428. [PMID: 31939562 PMCID: PMC6943239 DOI: 10.6061/clinics/2020/e1428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
The objectives of the study were to identify the factors that limit diaphragmatic mobility and evaluate the therapeutic results of the monitoring methods previously used in patients with chronic obstructive pulmonary disease. The PubMed, Web of Science, Scopus, and LILACS databases were used. A gray literature search was conducted with Google scholar. PRISMA was used, and the bias risk analysis adapted from the Cochrane Handbook for clinical trials and, for other studies, the Downs and Black checklist were used. Twenty-five articles were included in the qualitative synthesis analysis on physiotherapeutic techniques and diaphragmatic mobility. Eight clinical trials indicated satisfactory domains, and on the Downs and Black scale, 17 cohort studies were evaluated to have an acceptable score. Different conditions must be observed; for example, for postoperative assessments the supine position is suggested to be the most appropriate position to verify diaphragm excursion, although it has been shown to be associated with difficulty of restriction and matching in samples. Therefore, we identified the need for contemporary adjustments and strategies that used imaging instruments, preferably in the dorsal position. Therapeutic evidence on the association between the instrumental method and diaphragmatic mobility can be controversial. The ultrasound measurements indicated some relevance for different analyses, for pulmonary hyperinflation as well as diaphragm thickness and mobilization, in COPD patients. In particular, the study suggests that the ultrasound technique with B-mode for analysis and M-mode for diaphragmatic excursion be used with a 2 - 5 MHz with the patient in the supine position. However, the methods used to monitor diaphragm excursion should be adapted to the conditions of the patients, and additional investigations of their characteristics should be performed. More selective inclusion criteria and better matching in the samples are very important. In addition, more narrow age, sex and weight categories are important, especially in patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Iramar Baptistella do Nascimento
- Departamento de Tecnologia Industrial, Universidade do Estado de Santa Catarina, São Bento do Sul, SC, BR
- *Corresponding author. E-mail:
| | - Raquel Fleig
- Departamento de Tecnologia Industrial, Universidade do Estado de Santa Catarina, São Bento do Sul, SC, BR
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178
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Aldhahir AM, Rajeh AMA, Aldabayan YS, Drammeh S, Subbu V, Alqahtani JS, Hurst JR, Mandal S. Nutritional supplementation during pulmonary rehabilitation in COPD: A systematic review. Chron Respir Dis 2020; 17:1479973120904953. [PMID: 32054293 PMCID: PMC7019390 DOI: 10.1177/1479973120904953] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Uptake of nutritional supplementation during pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD) has been limited by an absence of rigorous evidence-based studies supporting use. The objective was to report and summarise the current evidence supporting the use of nutritional supplementation to improve outcomes during PR in stable COPD patients. A systematic search was conducted up to 7 August 2019 (registration number CRD42018089142). The preferred reporting items for systematic reviews and meta-analyses guidelines were used. Six databases were included: Medical Literature Analysis and Retrieval System Online or MEDLARS Online, Allied and Complementary Medicine Database, the Cochrane Database of Systematic Reviews, Excerpta Medica dataBASE, Cumulative Index of Nursing and Allied Health Literature and Web of Science. This systematic search generated 580 initial matches, of which 22 studies (917 COPD participants) met the pre-specified criteria and were included. Sixteen of 19 studies that used nutritional supplements in addition to PR did not show additional benefit compared to PR alone when measuring exercise capacity. Nutritional supplements significantly increased body weight in 7 of 11 studies. Body mass index increased significantly in two of six studies. Handgrip strength did not improve, while quadriceps muscle strength significantly improved in 3 of 11 studies. Four of eight studies showed a significant improvement in inspiratory muscle function. Only 2 of 14 studies demonstrated a significant improvement in quality of life with supplementation in addition to PR. There remains insufficient evidence on the effect of nutritional supplementation on improving outcomes during PR in patients with COPD due to heterogeneity in supplements, outcome measures and PR programmes. Therefore, controversy remains and further research is needed.
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Affiliation(s)
- Abdulelah M Aldhahir
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
- Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan
University, Jazan, Saudi Arabia
| | - Ahmed M Al Rajeh
- Respiratory Care Department, College of Applied Medical Sciences, King
Faisal University, Al-Ahsa, Saudi Arabia
| | - Yousef S Aldabayan
- Respiratory Care Department, College of Applied Medical Sciences, King
Faisal University, Al-Ahsa, Saudi Arabia
| | - Salifu Drammeh
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
| | | | - Jaber S Alqahtani
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
- Department of Respiratory Care, Prince Sultan Military College of Health
Sciences, Dhahran, Saudi Arabia
| | - John R Hurst
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
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179
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Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap? Lung 2019; 198:135-141. [PMID: 31873783 DOI: 10.1007/s00408-019-00311-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/16/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.
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180
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Silva TSD, Rodrigues A, Micheleti JF, Hernandes NA, Pitta F, Furlanetto KC. Mortality in COPD: Comparison of Different Predictors in Patients Seeking a Pulmonary Rehabilitation Program. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n4p390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Resumo É clinicamente relevante identificar fatores preditores de mortalidade isolados ou multidimensionais em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). O objetivo desse esuto foi comparar diferentes fatores na identificação de pacientes classificados em alto risco de morte e identificar o valor prognóstico de fatores isolados frente ao índice BODE. Foram avaliados pacientes quanto a fatores associado a mortalidade: função pulmonar com a medida do volume expiratório forçado (VEF1); índice de massa corpórea (IMC); índice de massa magra corporal (IMMC); Incremental Shuttle Walk Test (ISWT) com a estimativa do consumo máximo de oxigênio (VO2máx); teste de caminhada de seis minutos (TC6min); escala Medical Research Council; índice BODE e tempo sedentário. Pontos de corte previamente associados com mortalidade foram utilizados para calcular a proporção de pacientes em alto risco. Análise de curva ROC foi utilizada para testar o valor prognóstico das variáveis isoladas frente ao BODE. Foram incluídos 162 pacientes (86 homens, idade 67±8 anos). As proporções de pacientes classificados em alto risco variaram de 12,6% até 76,5% de acordo com os oito fatores analisados (P<0,05 vs todos). A área sob a curva (AUC) desses fatores testados isoladamente frente ao índice BODE indicou insatisfatória capacidade discriminativa (0,26 < AUC < 0,44). Existe uma variabilidade expressiva na proporção dos pacientes classificados como “alto risco” de acordo com cada fator preditor de mortalidade. Além disso, a avaliação prognóstica do paciente obtida com o índice BODE não pode ser substituída pela avaliação de um único fator preditor. Palavras-chave: Doença Pulmonar Obstrutiva Crônica. Mortalidade. Exercício. AbstractIt is clinically relevant to identify isolated factors or multidimensional predictors of mortality in patients with Chronic Obstructive Pulmonary Disease (COPD). To compare different factors in the identification of patients classified as high risk of death and to identify the prognostic value of isolated factors against the BODE index. Patients were evaluated considering the factors associated with mortality: pulmonary function with forced expiratory volume (FEV1); body mass index (BMI); body mass index (LMWI); Incremental Shuttle Walk Test (ISWT) with estimation of maximal oxygen consumption (VO2max); six-minute walk test (6MWT); Medical Research Council scale; BODE index and sedentary time. Cut-off points previously associated with risk of death were used to calculate the proportion of patients at high risk of death. ROC curve analysis was used to test the prognostic value of each variable against the BODE index. A total of 162 patients (86 men, age 67 ± 8 years) were included. The proportions of patients classified as high risk ranged from 12.6 to 76.5% according to all eight factors analyzed (P <0.05 vs all). The area under the curve (AUC) of each factor analyzed against the BODE index indicated insufficient discriminative capacity (0.26 < AUC < 0.44). Conclusion: There is an expressive variability of patients classified as "high risk" according to each predictor factor. Moreover, the prognostic evaluation of the patient using the BODE index cannot be replaced by the assessment of a single predictive factor. Keywords: Chronic Obstructive Pulmonary Disease, Mortality, Exercise.
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181
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Walsh JR, Pegg J, Yerkovich ST, Morris N, McKeough ZJ, Comans T, Paratz JD, Chambers DC. Longevity of pulmonary rehabilitation benefit for chronic obstructive pulmonary disease-health care utilisation in the subsequent 2 years. BMJ Open Respir Res 2019; 6:e000500. [PMID: 31803476 PMCID: PMC6890390 DOI: 10.1136/bmjresp-2019-000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/14/2022] Open
Abstract
Background The primary aim was to determine the healthcare utilisation benefits including respiratory-related hospital admissions, hospital admission days and emergency department presentations in the 0–12 and 12–24 months postpulmonary rehabilitation compared with the 12 months preprogramme. Methods An observational, data-linkage design of 11 standardised pulmonary rehabilitation programmes were used. All programmes were 8 weeks in duration with two supervised exercise sessions per week and were required to use the national pulmonary rehabilitation recommendations with regard to programme organisation, exercise training guidelines and multidisciplinary education. For each participant with chronic obstructive pulmonary disease (COPD), healthcare utilisation data were collected for the 12 months preprogramme and 24 months postprogramme. Results 426 participants (231 males, FEV149.3 (19.6) % predicted) were studied. The number of respiratory admissions/participant/year decreased from 0.7 (1.1) in the 12 months preprogramme to 0.5 (1.9) in the 12 months postprogramme, p=0.083; but increased in the 12–24 months postprogramme to 1.0 (2.3), p<0.001. The hospital days/participant/year improved from 4.0 (7.8) days in the 12 months preprogramme to 2.5 (8.5) days in the 12 months postprogramme, p<0.001; but increased in the 12–24 months postprogramme to 6.1 (16.6) days, p=0.004. The emergency department presentations/participant/year improved from 1.15 (1.75) in the 12 months preprogramme to 0.9 (1.8) in the 12 months postprogramme, p=0.003; but increased in the 12–24 months postprogramme to 2.0 (3.3), p<0.001. Conclusion Pulmonary rehabilitation significantly improves hospital days and emergency department presentations in the first 12 months postprogramme. Healthcare utilisation benefits in the second 12 months are less clear.
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Affiliation(s)
- James R Walsh
- Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Pegg
- Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Norman Morris
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Zoe J McKeough
- Discipline of Physiotherapy, The University of Sydney, Sydney, New South Wales, Australia
| | - Tracy Comans
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Jenny D Paratz
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Daniel C Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Faculty of Health Sciences, Brisbane, Queensland, Australia
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182
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Chua JR, Albay AB, Tee ML. Body Composition of Filipino Chronic Obstructive Pulmonary Disease (COPD) Patients in Relation to Their Lung Function, Exercise Capacity and Quality of Life. Int J Chron Obstruct Pulmon Dis 2019; 14:2759-2765. [PMID: 31819408 PMCID: PMC6897050 DOI: 10.2147/copd.s222809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background and objectives The loss of muscle or fat free mass (FFM) as a result of systemic inflammation and poor nutrition in Chronic Obstructive Pulmonary Disease (COPD), is recognized as an important factor that influences symptoms and disease-related outcomes. To date, there are no data on body composition among Filipino COPD patients and how it impacts COPD disease severity. This paper examined the relationship of Fat Free Mass Index (FFMI = FFM/height) and sarcopenia with COPD disease severity variables. Methods This was a cross-sectional analytic study comparing low and normal FFMI, sarcopenic and nonsarcopenic COPD patients, in terms of lung function, exercise capacity, and quality of life score. Filipino COPD patients older than 40 years were included. Patients performed six minute walking distance (6MWD), handgrip strength (HGS), and quality of life status evaluation using Filipino version of COPD Assessment Test (CAT). Body composition was measured using bioelectrical impedance analysis (BIA). Results A total of 41 patients were included. The mean age was 69.22 years. The prevalence of being underweight and having sarcopenia was 32% and 46%, respectively. Point biserial correlation showed that COPD patients with low FFMI had a statistically significant reduction in peak inspiratory flow (r= -0.5791, P value 0.0002), peak expiratory flow (r= -0.4475, P value 0.0055), and handgrip strength (r= -0.4560, P value 0.0027); and lower CAT score (r= -0.3422, P value 0.0285). Similar findings were observed among sarcopenic COPD patients. Conclusion The prevalence of being underweight and having sarcopenia was high. Low FFMI results in reduction of lung function and upper limb muscle strength among Filipino COPD patients.
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Affiliation(s)
- Jamie R Chua
- Division of Pulmonary Medicine, Department of Medicine, Philippine General Hospital, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Albert B Albay
- Division of Pulmonary Medicine, Department of Medicine, Philippine General Hospital, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Michael L Tee
- Associate Professor, Department of Physiology and Division of Rheumatology, Department of Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
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183
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Alsharaway LA. Pulmonary rehabilitation outcome in chronic obstructive pulmonary disease patients with a different body composition. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_33_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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184
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Nolan CM, Rochester CL. Exercise Training Modalities for People with Chronic Obstructive Pulmonary Disease. COPD 2019; 16:378-389. [PMID: 31684769 DOI: 10.1080/15412555.2019.1637834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice.
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Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Unit, Royal Brompton and Harefield NHS Foundation Trust, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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185
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Effect of Virtual Reality-Based Rehabilitation on Physical Fitness in Patients with Chronic Obstructive Pulmonary Disease. J Hum Kinet 2019; 69:149-157. [PMID: 31666897 PMCID: PMC6815072 DOI: 10.2478/hukin-2019-0022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the effects of rehabilitation in patients with chronic obstructive pulmonary disease (COPD) using the Kinect system during stationary rehabilitation. The study included 68 patients with COPD (35 men, 33 women, mean age 61.3 ± 3.7). The subjects were randomly assigned to one of the two experimental groups described below. Group I included 34 patients – non‐participants in Kinect training. Group II included 34 patients – participants in Kinect training. In all patients before and after rehabilitation physical fitness was assessed using the Senior Fitness Test (SFT). The Xbox 360 and Kinect motion sensor were used to carry out virtual reality training. In group I, statistically significant improvements in SFT performance were observed. Patients in group II also showed statistically significant improvement in physical fitness in all attempts of the SFT. Virtual rehabilitation training in patients with COPD seems to be a practical and beneficial intervention capable of enhancing mobility and physical fitness.
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186
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Varol Y, Şahin H, Aktürk Ü, Kömürcüoğlu B. Effect of Pulmonary Rehabilitation on the Value of the Inspiratory Capacity-to-Total Lung Capacity (IC/TLC) Ratio to Determine Response to Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease. Turk Thorac J 2019; 20:224-229. [PMID: 31390329 PMCID: PMC6777657 DOI: 10.5152/turkthoracj.2018.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In patients with chronic obstructive pulmonary disease (COPD), the inspiratory capacity-to-total lung capacity (IC/TLC) ratio has been found to be correlated with mortality and a reduced exercise capacity. Pulmonary rehabilitation (PR) is known to improve the exercise capacity and respiratory functions of patients with COPD. Our study aims to examine the impact of PR on the IC/TLC ratio in patients with COPD. MATERIALS AND METHODS We included a total of 122 patients with COPD who received PR therapy twice a week over a period of 8 weeks in an outpatient clinic. RESULTS Patients' mean age was 62.5 (±8.2), and 15 patients (12.3%) were female. Post-PR FEV1, TLCO, and pO2 values, and the 6mWD, dyspnea, and quality-of-life (QoL) scores indicated a statistically significant improvement (p<0.05 for all). Patients were grouped as follows: patients with IC/TLC >0.25 as Group 1 and IC/TLC ≤0.25 as Group 2. Both groups exhibited a significantly increased post-PR 6 mWT distance (375-420, 336-400 meters) with no difference between the groups. We observed a significantly increased FEV1% in both groups after the PR (p=0.007, 0.004). Again, QoL questionnaires and Modified Medical Research Council scores significantly improved for both groups (p<0.001). Although no post-PR IC/TLC improvement was detected in patients with good prognosis, we identified an IC/TLC improvement in the poor prognosis group (Group 2) (p=0.002). CONCLUSION COPD patients with IC/TLC ≤0.25 benefit from the PR just as those COPD patients with IC/TLC >0.25.
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Affiliation(s)
- Yelda Varol
- Department of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Hülya Şahin
- Pulmonary Rehabilitation Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Ülkü Aktürk
- Department of Chest Diseases, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Berna Kömürcüoğlu
- Department of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
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187
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Ko FWS, Chan KP, Hui DSC. Comprehensive care for chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:S2181-S2191. [PMID: 31737345 PMCID: PMC6831924 DOI: 10.21037/jtd.2019.09.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common chronic disease worldwide and incurs heavy utilization of healthcare resources. Many COPD patients have comorbidities and experience exacerbations in the course of the disease. Correct diagnosis and appropriate disease assessment are essential for clinical management. Comprehensive care for patients with different severity of disease aims to offer personalized treatment to suit individual needs. Patients with recent exacerbations also need extra care for the post-acute and rehabilitation phases. Comprehensive care consists of self-management and pulmonary rehabilitation and involves multiple healthcare providers working together closely to provide formal structured programmes for patients. The setting, professionals involved, content and the duration of programme vary a lot among different comprehensive care models. Some randomized controlled trials suggested there was improvement in quality of life, exercise capacity and reduced hospital admissions for participants in comprehensive care programmes compared with controls. However, other studies showed that such programmes might not confer benefits and might even bring harm. The reason for the differences in clinical effect of programmes might be due to differences in study design, components and subjects involved in the studies. Careful evaluation of each programme is thus mandatory. Further research is needed to evaluate the safety and effectiveness of comprehensive care management for COPD patients, both at the stable and post-acute exacerbation state.
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Affiliation(s)
- Fanny Wai San Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Pang Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu Cheong Hui
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Simonÿ C, Riber C, Bodtger U, Birkelund R. Striving for Confidence and Satisfaction in Everyday Life with Chronic Obstructive Pulmonary Disease: Rationale and Content of the Tele-Rehabilitation Programme >C☺PD-Life>>. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183320. [PMID: 31505861 PMCID: PMC6766220 DOI: 10.3390/ijerph16183320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022]
Abstract
Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to these patients. To expand useful knowledge in the field, more sophisticated telerehabilitation interventions must be developed and appraised, but first and foremost, thoroughly described. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the >C☺PD-Life>> programme, within the bounds of the checklist of Template for Intervention Description and Replication (TIDieR). Approach:>C☺PD-Life>> is a telerehabilitation programme for COPD patients delivered as a study intervention by an interprofessional team of clinicians collaborating from both the hospital and the municipal healthcare system. Making use of two-way audio and visual communication software, 15 patients participated in the intervention via a tablet computer from their private setting. The programme was a six-month-long empowerment-based rehabilitation that aimed to support COPD patients in leading a satisfactory and confident life with appropriate physical activity and high disease management. Conclusions: A long-term interprofessional cross-sectoral telerehabilitation programme has been justified and described. The intervention was tested in 2017–2018 and the qualitative appraisal, along with an analysis of case-based measurements of development in physical capacity, COPD Assesment Test, and health management, is currently under production.
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Affiliation(s)
- Charlotte Simonÿ
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Faelledvej 7, 4200 Slagelse, Denmark.
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
| | - Claus Riber
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Faelledvej 7, 4200 Slagelse, Denmark.
| | - Uffe Bodtger
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
- Department of Respiratory Medicine, Naestved Hospital, Ringstedgade 61, 4700 Naestved, Denmark.
- Department of Respiratory Medicine, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
| | - Regner Birkelund
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
- Department of Health Research, Lillebaelt Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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Incorvaia C, Panella L, Caserta A, Pellicelli I, Ridolo E. What still prevents to acknowledge a major role for pulmonary rehabilitation in COPD treatment? ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:218-224. [PMID: 31580317 PMCID: PMC7233744 DOI: 10.23750/abm.v90i3.8369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/24/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health issue, particularly in aging people. Despite an increasing availability of drugs to treat COPD, recent data indicate that an actual control of the disease is achieved in a minority of patients. This makes apparent that additional treatments of COPD should be taken into account, such as pulmonary rehabilitation (PR), which was introduced in the 1960s and has large evidence of clinical effectiveness. PR is a non-pharmacologic therapy based on a comprehensive, multidisciplinary, patient-centered intervention comprising exercise training, self-management education and psychosocial support. PR treated patients develop an increased exercise tolerance and quality of life, reduced dyspnea and anxiety, and are concerned by less hospital admissions for disease exacerbations. Notwithstanding, the use of PR in COPD patients is negligible, being globally estimated in 2-5%. Here we update the evidence in favor of PR and the actual need to consider it as a treatment to be considered for COPD patients with significant impairment in daily living activities.
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Silva IS, Pedrosa R, Azevedo IG, Forbes A, Fregonezi GAF, Dourado Junior MET, Lima SRH, Ferreira GMH. Respiratory muscle training in children and adults with neuromuscular disease. Cochrane Database Syst Rev 2019; 9:CD011711. [PMID: 31487757 PMCID: PMC6953358 DOI: 10.1002/14651858.cd011711.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular diseases (NMDs) are a heterogeneous group of diseases affecting the anterior horn cell of spinal cord, neuromuscular junction, peripheral nerves and muscles. NMDs cause physical disability usually due to progressive loss of strength in limb muscles, and some NMDs also cause respiratory muscle weakness. Respiratory muscle training (RMT) might be expected to improve respiratory muscle weakness; however, the effects of RMT are still uncertain. This systematic review will synthesize the available trial evidence on the effectiveness and safety of RMT in people with NMD, to inform clinical practice. OBJECTIVES To assess the effects of respiratory muscle training (RMT) for neuromuscular disease (NMD) in adults and children, in comparison to sham training, no training, standard treatment, breathing exercises, or other intensities or types of RMT. SEARCH METHODS On 19 November 2018, we searched the Cochrane Neuromuscular Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. On 23 December 2018, we searched the US National Institutes for Health Clinical Trials Registry (ClinicalTrials.gov), the World Health Organization International Clinical Trials Registry Platform, and reference lists of the included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs, including cross-over trials, of RMT in adults and children with a diagnosis of NMD of any degree of severity, who were living in the community, and who did not need mechanical ventilation. We compared trials of RMT (inspiratory muscle training (IMT) or expiratory muscle training (EMT), or both), with sham training, no training, standard treatment, different intensities of RMT, different types of RMT, or breathing exercises. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures. MAIN RESULTS We included 11 studies involving 250 randomized participants with NMDs: three trials (N = 88) in people with amyotrophic lateral sclerosis (ALS; motor neuron disease), six trials (N = 112) in Duchenne muscular dystrophy (DMD), one trial (N = 23) in people with Becker muscular dystrophy (BMD) or limb-girdle muscular dystrophy, and one trial (N = 27) in people with myasthenia gravis.Nine of the trials were at high risk of bias in at least one domain and many reported insufficient information for accurate assessment of the risk of bias. Populations, interventions, control interventions, and outcome measures were often different, which largely ruled out meta-analysis. All included studies assessed lung capacity, our primary outcome, but four did not provide data for analysis (1 in people with ALS and three cross-over studies in DMD). None provided long-term data (over a year) and only one trial, in ALS, provided information on adverse events. Unscheduled hospitalisations for chest infection or acute exacerbation of chronic respiratory failure were not reported and physical function and quality of life were reported in one (ALS) trial.Amyotrophic lateral sclerosis (ALS)Three trials compared RMT versus sham training in ALS. Short-term (8 weeks) effects of RMT on lung capacity in ALS showed no clear difference in the change of the per cent predicted forced vital capacity (FVC%) between EMT and sham EMT groups (mean difference (MD) 0.70, 95% confidence interval (CI) -8.48 to 9.88; N = 46; low-certainty evidence). The mean difference (MD) in FVC% after four months' treatment was 10.86% in favour of IMT (95% CI -4.25 to 25.97; 1 trial, N = 24; low-certainty evidence), which is larger than the minimal clinically important difference (MCID, as estimated in people with idiopathic pulmonary fibrosis). There was no clear difference between IMT and sham IMT groups, measured on the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALFRS; range of possible scores 0 = best to 40 = worst) (MD 0.85, 95% CI -2.16 to 3.85; 1 trial, N = 24; low-certainty evidence) or quality of life, measured on the EuroQol-5D (0 = worst to 100 = best) (MD 0.77, 95% CI -17.09 to 18.62; 1 trial, N = 24; low-certainty evidence) over the medium term (4 months). One trial report stated that the IMT protocol had no adverse effect (very low-certainty evidence).Duchenne muscular dystrophy (DMD)Two DMD trials compared RMT versus sham training in young males with DMD. In one study, the mean post-intervention (6-week) total lung capacity (TLC) favoured RMT (MD 0.45 L, 95% CI -0.24 to 1.14; 1 trial, N = 16; low-certainty evidence). In the other trial there was no clear difference in post-intervention (18 days) FVC between RMT and sham RMT (MD 0.16 L, 95% CI -0.31 to 0.63; 1 trial, N = 20; low-certainty evidence). One RCT and three cross-over trials compared a form of RMT with no training in males with DMD; the cross-over trials did not provide suitable data. Post-intervention (6-month) values showed no clear difference between the RMT and no training groups in per cent predicted vital capacity (VC%) (MD 3.50, 95% CI -14.35 to 21.35; 1 trial, N = 30; low-certainty evidence).Becker or limb-girdle muscular dystrophyOne RCT (N = 21) compared 12 weeks of IMT with breathing exercises in people with Becker or limb-girdle muscular dystrophy. The evidence was of very low certainty and conclusions could not be drawn.Myasthenia gravisIn myasthenia gravis, there may be no clear difference between RMT and breathing exercises on measures of lung capacity, in the short term (TLC MD -0.20 L, 95% CI -1.07 to 0.67; 1 trial, N = 27; low-certainty evidence). Effects of RMT on quality of life are uncertain (1 trial; N = 27).Some trials reported effects of RMT on inspiratory and/or expiratory muscle strength; this evidence was also of low or very low certainty. AUTHORS' CONCLUSIONS RMT may improve lung capacity and respiratory muscle strength in some NMDs. In ALS there may not be any clinically meaningful effect of RMT on physical functioning or quality of life and it is uncertain whether it causes adverse effects. Due to clinical heterogeneity between the trials and the small number of participants included in the analysis, together with the risk of bias, these results must be interpreted very cautiously.
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Affiliation(s)
- Ivanizia S Silva
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaBairro Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
| | - Rafaela Pedrosa
- Federal University of ParaibaDepartment of Physical TherapyJoão PessoaParaibaBrazil
| | - Ingrid G Azevedo
- Ana Bezerra University HospitalPhysical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Anne‐Marie Forbes
- University of TasmaniaCreative Arts & Health ‐ School of Creative Arts & MediaPrivate Bag 63HobartTASAustralia7001
| | - Guilherme AF Fregonezi
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaBairro Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
- Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH)PneumoCardioVascular LabNatalRio Grande do NorteBrazil59078‐970
| | - Mário ET Dourado Junior
- Federal University of Rio Grande do NorteIntegrated MedicineAv. Nilo Peçanha, 620PetrópolisNatalRio Grande do NorteBrazil59012‐300
| | - Suzianne RH Lima
- Federal University of Rio Grande do NorteIntegrated MedicineAv. Nilo Peçanha, 620PetrópolisNatalRio Grande do NorteBrazil59012‐300
| | - Gardenia MH Ferreira
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
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Zhao H, Xie Y, Wang J, Li X, Li J. Pulmonary rehabilitation for pneumoconiosis: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e025891. [PMID: 31444176 PMCID: PMC6707706 DOI: 10.1136/bmjopen-2018-025891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Pneumoconiosis is characterised by diffuse fibrosis in lung tissue, and its incidence is on the rise. At present, there are limited therapeutic options for pneumoconiosis. Pulmonary rehabilitation (PR) has been widely used to treat pneumoconiosis,however, there is limited evidence concerning its efficacy. Therefore, we plan to conduct a systematic review to investigate the efficacy and safety of PR for pneumoconiosis. METHODS AND ANALYSIS The following databases will be searched from their inception to 1 April 2019: PubMed, Embase, The Cochrane Library, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chongqing VIP and Wanfang Data. Randomised controlled trials of PR for pneumoconiosis will be included. Primary outcomes will include 6 min walk distance and St. George's Respiratory Questionnaire. Study selection, extraction of data and assessment of study quality each will be independently undertaken. Statistical analysis will be conducted using Review Manager software. ETHICS AND DISSEMINATION This systematic review will provide up-to-date information on PR for pneumoconiosis. The review does not require ethical approval and will be disseminated electronically through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER CRD42018095266.
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Affiliation(s)
- Hulei Zhao
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xie
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiajia Wang
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuanlin Li
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, China
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Bhatt SP, Patel SB, Anderson EM, Baugh D, Givens T, Schumann C, Sanders JG, Windham ST, Cutter GR, Dransfield MT. Video Telehealth Pulmonary Rehabilitation Intervention in Chronic Obstructive Pulmonary Disease Reduces 30-Day Readmissions. Am J Respir Crit Care Med 2019; 200:511-513. [PMID: 30978302 PMCID: PMC6701038 DOI: 10.1164/rccm.201902-0314le] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | - Daniel Baugh
- University of Alabama at BirminghamBirmingham, Alabama
| | - Tina Givens
- University of Alabama at BirminghamBirmingham, Alabama
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Xu L, Ye T, Li J, Hu Y, Xu W, Wang K, Ou C, Chen X. Identification of relevant variables and construction of a multidimensional index for predicting mortality in COPD patients. Int J Chron Obstruct Pulmon Dis 2019; 14:1703-1711. [PMID: 31534324 PMCID: PMC6682173 DOI: 10.2147/copd.s215219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background and objective The Body mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index is a well-known metric for chronic obstructive pulmonary disease (COPD), but it is inadequate for predicting mortality. This study proposed a new index that combines inspiratory muscle training with the BODE index and verified its ability to predict mortality in patients with COPD. Methods Cox regression identified predictors of mortality, which were then included in the new index. The receiver operating characteristic (ROC) curve verified the ability of the new index to predict mortality. The Kaplan-Meier curves compared the survival rates of patients with different scores on the new index. Results Among the 326 patients, 48 died during follow-up (1–59 months). Cox regression showed that the fat-free mass index (FFMI), forced expiratory volume in one second/the predicted value (FEV1%), modified Medical Research Council (mMRC) score, six-minute–walk test (6MWT) distance, and maximal inspiratory pressure were predictors of mortality (P<0.05); these variables were included in the FODEP index. The AUC of the FODEP index (0.860, 95% CI: 95% CI: 0.817–0.896) was greater than that of the BODE index (0.778, 95% CI: 0.729–0.822). The Kaplan-Meier curves suggested that as the FODEP score increased, so did the risk of morality in patients with COPD. The cumulative survival in the group with the highest FODEP-value was significantly lower than that in the other groups (P<0.01). Conclusion The FODEP index was more effective than the BODE index at predicting the risk of mortality in patients with COPD.
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Affiliation(s)
- Limei Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Tiaofei Ye
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiahui Li
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yuhe Hu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Wenhui Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Kai Wang
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Chunquan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People's Republic of China
| | - Xin Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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194
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Saxer S, Schneider SR, Appenzeller P, Bader PR, Lichtblau M, Furian M, Sheraliev U, Estebesova B, Emilov B, Sooronbaev T, Bloch KE, Ulrich S. Asthma rehabilitation at high vs. low altitude: randomized parallel-group trial. BMC Pulm Med 2019; 19:134. [PMID: 31340793 PMCID: PMC6657156 DOI: 10.1186/s12890-019-0890-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the effect of asthma rehabilitation at high altitude (3100 m, HA) compared to low altitude (760 m, LA). Methods For this randomized parallel-group trial insufficiently controlled asthmatics (Asthma Control Questionnaire (ACQ) > 0.75) were randomly assigned to 3-week in-hospital rehabilitation comprising education, physical-&breathing-exercises at LA or HA. Co-primary outcomes assessed at 760 m were between group changes in peak expiratory flow (PEF)-variability, and ACQ) from baseline to end-rehabilitation and 3 months thereafter. Results 50 asthmatics were randomized [median (quartiles) LA: ACQ 2.7(1.7;3.2), PEF-variability 19%(14;33); HA: ACQ 2.0(1.6;3.0), PEF-variability 17%(12;32)]. The LA-group improved PEF-variability by median(95%CI) -7%(− 14 to 0, p = 0.033), ACQ − 1.4(− 2.2 to − 0.9, p < 0.001), and after 3 months by − 3%(− 18 to 2, p = 0.103) and − 0.9(− 1.3 to − 0.3, p = 0.002). The HA-group improved PEF-variability by − 10%(− 21 to − 3, p = 0.004), ACQ − 1.1(− 1.3 to − 0.7, p < 0.001), and after 3 months by − 9%(− 10 to − 3, p = 0.003) and − 0.2(− 0.9 to 0.4, p = 0.177). The additive effect of HA vs. LA directly after the rehabilitation on PEF-variability was − 6%(− 14 to 2), on ACQ 0.3(− 0.4 to 1.1) and after 3 months − 5%(− 14 to 5) respectively 0.4(− 0.4 to 1.1), all p = NS. Conclusion Asthma rehabilitation is highly effective in improving asthma control in terms of PEF-variability and symptoms, both at LA and HA similarly. Trial registration Clinicaltrials.gov: NCT02741583, Registered April 18, 2016. Electronic supplementary material The online version of this article (10.1186/s12890-019-0890-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Saxer
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Simon R Schneider
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Paula Appenzeller
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Patrick R Bader
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Ulan Sheraliev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Bermet Estebesova
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Berik Emilov
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Talant Sooronbaev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland.
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Rochester CL. Patient assessment and selection for pulmonary rehabilitation. Respirology 2019; 24:844-853. [PMID: 31251443 DOI: 10.1111/resp.13616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/10/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co-morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of 'responsiveness to PR', to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health-related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self-efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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Ji W, Kwon H, Lee S, Kim S, Hong JS, Park YR, Kim HR, Lee JC, Jung EJ, Kim D, Choi CM. Mobile Health Management Platform-Based Pulmonary Rehabilitation for Patients With Non-Small Cell Lung Cancer: Prospective Clinical Trial. JMIR Mhealth Uhealth 2019; 7:e12645. [PMID: 31228180 PMCID: PMC6611149 DOI: 10.2196/12645] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/30/2019] [Accepted: 05/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. Objective This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non–small cell lung cancer. Methods We conducted a prospective clinical trial in 64 patients with non–small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. Results Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P=.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P=.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P=.002). Conclusions A personalized mobile health–based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non–small cell lung cancer can supplement traditional health care center–based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life.
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Affiliation(s)
- Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Kwon
- LifeSemantics, Seoul, Republic of Korea
| | | | - Seulgi Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Sook Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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197
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Avdeev SN, Truschenko NV, Gaynitdinova VV, Soe AK, Nuralieva GS. Treatment of exacerbations of chronic obstructive pulmonary disease. TERAPEVT ARKH 2019; 90:68-75. [PMID: 30701836 DOI: 10.26442/00403660.2018.12.000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the quality of medical care provided in large Russian hospitals to patients with COPD exacerbation. MATERIALS AND METHODS The study included patients with acute exacerbations of COPD hospitalized into three large clinical hospitals in Moscow. The diagnosis of "COPD exacerbation" was established in accordance with current clinical recommendations. We collected the data about patients' demography, clinical signs and symptoms, blood gas analysis, chest radiography, drug therapy, oxygen therapy and respiratory support. The follow-up period was 90 days. The obtained data were compared with the data of patients from the multicenter study "European COPD Audit". RESULTS The leading clinical symptoms in COPD exacerbation were dyspnea (95.4%) and sputum production (60.7%). The majority of patients with COPD received short-acting β2-agonists (77.4%), systemic steroids (85.1%), antibiotics (79.0%) and theophyllines (48.1%). Noninvasive ventilation was performed in 8.6% of patients, oxygen therapy - in 23,8% of patients, pulmonary rehabilitation - in only 6,2% of patients. Chest radiography was performed in 97.9% of patients, pulmonary function tests - in 79.8%, blood gases analysis - in 19.3% of patients. The mean duration of hospitalization was 18.2±3.9 days, repeated hospitalization within 90 days occurs in 36.2% of patients. In-hospital mortality was 3.3%. CONCLUSION Based on the results of the study practical recommendations for improving the quality of medical care in acute exacerbations of COPD are proposed.
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Affiliation(s)
- S N Avdeev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Pulmonology Research Institute of Federal Medico-Biological Agency of Russia, Moscow, Russia
| | - N V Truschenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Pulmonology Research Institute of Federal Medico-Biological Agency of Russia, Moscow, Russia
| | - V V Gaynitdinova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A K Soe
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - G S Nuralieva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Pulmonology Research Institute of Federal Medico-Biological Agency of Russia, Moscow, Russia
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198
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El-Komy HM, Awad M, Mansour W, Elsayed EI. Impact of pulmonary rehabilitation on patients with interstitial lung diseases: an Egyptian experience. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_64_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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199
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Marques A, Jácome C, Rebelo P, Paixão C, Oliveira A, Cruz J, Freitas C, Rua M, Loureiro H, Peguinho C, Marques F, Simões A, Santos M, Martins P, André A, De Francesco S, Martins V, Brooks D, Simão P. Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis. BMC Public Health 2019; 19:676. [PMID: 31151409 PMCID: PMC6544941 DOI: 10.1186/s12889-019-7045-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. Discussion This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666). Electronic supplementary material The online version of this article (10.1186/s12889-019-7045-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal. .,Institute of Biomedicine (iBiMED), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.
| | - Cristina Jácome
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrícia Rebelo
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal
| | - Cátia Paixão
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal
| | - Joana Cruz
- School of Health Sciences (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal
| | - Célia Freitas
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marília Rua
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,Research Centre on Didactics and Technology in the Education of Trainers (CIDTFF), University of Aveiro, Aveiro, Portugal
| | - Helena Loureiro
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal
| | - Cristina Peguinho
- Higher Institute for Accountancy and Administration (ISCA-UA), University of Aveiro, Aveiro, Portugal
| | - Fábio Marques
- ESTGA - Águeda School of Technology and Management, Águeda, Portugal.,IEETA - Institute of Electronics and Informatics Engineering of Aveiro, Aveiro, Portugal
| | | | | | - Paula Martins
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,Institute of Biomedicine (iBiMED), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal
| | - Alexandra André
- College of Health Technology of Coimbra (ESTeSC), Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Sílvia De Francesco
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.,IEETA - Institute of Electronics and Informatics Engineering of Aveiro, Aveiro, Portugal
| | - Vitória Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Dina Brooks
- Respiratory Medicine, West Park Healthcare Centre, and University of Toronto, Toronto, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Paula Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
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Kerminen H, Jämsen E, Jäntti P, Mattila AK, Leivo-Korpela S, Valvanne J. Implementation of a depression screening protocol among respiratory insufficiency patients. CLINICAL RESPIRATORY JOURNAL 2019; 13:34-42. [PMID: 30480876 DOI: 10.1111/crj.12977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/13/2018] [Accepted: 11/17/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unnoticed and untreated depression is prevalent among patients with chronic respiratory insufficiency. Comorbid depression causes suffering and worsens patients' outcomes. OBJECTIVES The objective of this evaluation was to assess preliminary outcomes of a depression screening protocol among chronic respiratory insufficiency patients at a tertiary care pulmonary outpatient clinic. METHODS In the depression screening protocol, the patients filled the Depression Scale (DEPS) questionnaire. Patients whose scores suggested depression were offered the opportunity of a further evaluation of mood at a psychiatric outpatient clinic. The outcomes of the protocol were evaluated retrospectively from the patient records. RESULTS During the period of evaluation, 238 patients visited the outpatient clinic. DEPS was administered to 176 patients (74%), of whom 60 (34%) scored ≥9 (out of 30), thus exceeding the cut-off for referral. However, only 13 patients were referred, as the remainder declined the referral. Finally, seven patients were evaluated at the psychiatric clinic, and they all were deemed depressive. Symptoms of depression were most prevalent among patients with a long smoking history, refractory dyspnoea and a history of depression. CONCLUSION Depression screening was positive in a third of the patients. The depression screening protocol improved the detection of depression symptoms, but the effects on the patients' treatment and clinical course were small. Rather than referring patients to a psychiatric unit, the evaluation and management of depression should be undertaken at the pulmonary unit.
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Affiliation(s)
- Hanna Kerminen
- Faculty of Medicine and Life Sciences, The Gerontology Research Centre (GEREC), University of Tampere, Tampere, Finland.,Centre of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Life Sciences, The Gerontology Research Centre (GEREC), University of Tampere, Tampere, Finland.,Centre of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Pirkko Jäntti
- Faculty of Medicine and Life Sciences, The Gerontology Research Centre (GEREC), University of Tampere, Tampere, Finland
| | - Aino K Mattila
- Department of Adult Psychiatry, General Hospital Psychiatry Unit, Tampere University Hospital, Tampere, Finland
| | - Sirpa Leivo-Korpela
- Department of Respiratory Diseases, Tampere University Hospital, Tampere, Finland
| | - Jaakko Valvanne
- Faculty of Medicine and Life Sciences, The Gerontology Research Centre (GEREC), University of Tampere, Tampere, Finland
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