Evaluation for airway obstruction in adult patients with stable ischemic heart disease

Effects of Respiratory Muscle Training on Exercise Capacity, Quality of Life, and Respiratory and Pulmonary Function in People With Ischemic Heart Disease: Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on functional exercise capacity, health-related quality of life (HRQoL), respiratory muscle function, and pulmonary function in individuals with ischemic heart disease (IHD).

METHODS

The MEDLINE, Web of Science, Scopus, PEDro, CINAHL, Science Direct, and CENTRAL electronic databases were searched in January 2023. Randomized controlled trials published in English, Spanish, or Portuguese that were conducted to determine the effect of RMT versus passive control and/or sham RMT on the target variables in individuals with IHD, irrespective of age or sex were included. Two reviewers performed the searches and extraction of the most relevant data. The quality and risk of bias for each included study were examined with the PEDro scale and Cochrane risk-of-bias tool.

RESULTS

Thirteen studies (849 participants) were included. The meta-analysis showed a significant increase in peak oxygen consumption (mean difference [MD] = 2.18 mL·kg-1·min-1 [95% CI = 0.54 to 3.83]), inspiratory muscle strength (MD = 16.62 cm H2O [95% CI = 12.48 to 20.77]), inspiratory muscle endurance (standardized mean difference = 0.39 [95% CI = 0.19 to 0.60]), and expiratory muscle strength (MD = 14.52 cm H2O [95% CI = 5.51 to 23.53]). There were no benefits in 6-minute walking distance (MD = 37.57 m [95% CI = -36.34 to 111.48]), HRQoL (standardized mean difference = 0.22 [95% CI = -0.16 to 0.60]), pulmonary function (forced vital capacity; MD = 2.07% of predicted value [95% CI = -0.90 to 5.03], or forced expiratory volume at the first second (MD = -0.75% of predicted value [95% CI = -5.45 to 3.95]).

CONCLUSION

This meta-analysis provided high- and moderate-quality evidence that inspiratory muscle training (IMT) improves inspiratory muscle strength and endurance, respectively; and very low-quality evidence for effects on peak oxygen consumption and expiratory muscle strength in individuals with IHD. No superior effects were found in the 6-minute walking test, HRQoL, or pulmonary function compared with the control group.

IMPACT

The results shown in this systematic review with meta-analysis will provide clinicians a better understanding of the effects of IMT in people with IHD. IMT could be integrated into the cardiac rehabilitation management, although more research is needed.

Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort

OBJECTIVES

The impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking.

METHODS

Data from 1283 men and 759 women (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 or former grade 0, without alpha-1-antitrypsin deficiency) of the COPD and Systemic Consequences Comorbidities Network cohort were analysed. Cumulative exposure to gases/fumes, biological dust, mineral dust or the combination vapours/gases/dusts/fumes was assessed using the ALOHA job exposure matrix. The effect of both occupational and smoking exposure on lung function and disease-specific QoL (St George's Respiratory Questionnaire) was analysed using linear regression analysis adjusting for age, body mass index, diabetes, hypertension and coronary artery disease, stratified by sex.

RESULTS

In men, exposure to gases/fumes showed the strongest effects among occupational exposures, being significantly associated with all lung function parameters and QoL; the effects were partially stronger than of smoking. Smoking had a larger effect than occupational exposure on lung diffusing capacity (transfer factor for carbon monoxide) but not on air trapping (residual volume/total lung capacity). In women, occupational exposures were not significantly associated with QoL or lung function, while the relationships between lung function parameters and smoking were comparable to men.

CONCLUSIONS

In patients with COPD, cumulative occupational exposure, particularly to gases/fumes, showed effects on airway obstruction, air trapping, gas uptake capacity and disease-related QoL, some of which were larger than those of smoking. These findings suggest that lung air trapping and QoL should be considered as outcomes of occupational exposure to gases and fumes in patients with COPD.

TRIAL REGISTRATION NUMBER

NCT01245933.

Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the noncommunicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981-May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.

Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is highly prevalent around the world and has a large impact on its patients, leading to a poor health-related quality of life (HRQL) and exercise capacity. Even under optimal medications, there are still many patients with poor HRQL. Body acupuncture therapy (BAT) is a non-invasive and a popular therapy. Therefore, we aimed to comprehensively analyze the effects of BAT in COPD.

MATERIALS AND METHODS

Eight electronic databases were searched. We included randomized controlled trials (RCTs) that evaluated the effect of BAT, medication (M), and pulmonary rehabilitation (PR). The primary outcome was HRQL evaluated by St. George's respiratory questionnaire (SGRQ) or COPD assessment test (CAT).

RESULTS

Of the 922 articles, 12 studies were included with attesting a total of 798 participants. The result obtained indicated a significant improvement that favored the BAT + M group over the M group in CAT scores (MD: -4.77; 95% CI: -6.53 to -3.01; p < 0.00001).

CONCLUSIONS

BAT is an effective adjunctive non-pharmacological treatment to improve HRQL in patients under medical treatment for COPD. We suggested that BAT should be considered as one of the methods of management in patients with COPD.