Experiences of hatha yogic exercises among patients with obstructive pulmonary diseases: A qualitative study

Associations between mindfulness and symptom severity among adults living with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Mindfulness-based interventions (MBI) benefit adults with chronic obstructive pulmonary disease (COPD) by helping them manage their symptoms and improve their quality of life. Little is known about their baseline mindfulness knowledge and practice and how these may relate to symptom management.

OBJECTIVES

To 1) compare symptom severity scores of depression, anxiety, dyspnea, fatigue, and insomnia between those who know and practice mindfulness and those who do not, and 2) construct phenotype profile characteristics of COPD patients based on their levels of mindfulness.

METHODS

339 community-dwelling adults (mean age 53.43±13.48 years, 61.28 % male, and 48.21 % White) completed an online cross-sectional survey study indicating their mindfulness knowledge, practice, level, and COPD symptom severity. After adjusting for multiple comparisons among the three groups, we used Kruskal-Wallis, Fisher's exact, and Chi-squared tests to compare variables' differences among these three mindfulness levels.

RESULTS

Participants who self-identified as knowledgeable about mindfulness (n = 315) reported significantly lower severity of dyspnea and fatigue. Participants who self-identified as current practitioners of mindfulness (n = 282) reported substantially lower symptom severity. Among the different mindfulness groups, levels of phenotype profile analysis showed statistically significant differences in demographic and clinical characteristics, including depressive symptoms, age, ethnicity, education level, and years living with COPD. We found no differences in gender or disease severity levels.

CONCLUSIONS

Community-dwelling adults with COPD who practiced mindfulness reported lower symptom severity than those who did not. This suggests the potential benefits of MBI integration as a complementary health approach to symptom management. The mindfulness level phenotype profile is critical to tailoring MBIs. It can guide the design and delivery of MBIs with optimal feasibility, acceptability, effectiveness, and sustained adherence for adults with COPD according to their mindfulness level profiles.

Breathing techniques to reduce symptoms in people with serious respiratory illness: a systematic review

BACKGROUND

In adults with serious respiratory illness, breathlessness is prevalent and associated with reduced health-related quality of life. The aim of this review was to assess the impact of breathing techniques on breathlessness in adults with serious respiratory illness.

METHODS

Electronic databases were searched to identify randomised controlled trials testing breathing techniques (techniques that aim to alter the respiratory pattern, excluding respiratory muscle training) in people with serious respiratory illness. The primary outcome was breathlessness and secondary outcomes were health-related quality of life and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.

RESULTS

73 randomised controlled trials were included with 5479 participants, most with COPD or asthma. Breathing exercises (pursed lip and/or diaphragmatic breathing) reduced breathlessness measured by the modified Medical Research Council scale compared to usual care (mean difference (MD) -0.40 points, 95% CI -0.70- -0.11, eight studies, n=323), although the effect did not exceed the minimal important difference. Yoga breathing also improved modified Medical Research Council score compared to usual care (MD -1.05 points, 95% CI -2.45-0.35, three studies, n=175). Breathing techniques consistently improved health-related quality of life in people with COPD and asthma on multiple health-related quality of life measures in comparison to usual care, with effects that generally exceeded the minimal important difference. No adverse events related to breathing techniques were reported.

CONCLUSION

Breathing techniques may improve breathlessness, and consistently improve health-related quality of life, in people with serious respiratory illness. These findings support the use of breathing exercises in the care of people with serious respiratory illness.

Mind-body exercise for patients with stable COPD on lung function and exercise capacity: a systematic review and meta-analysis of RCTs

Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. Mind-body exercises like Tai Chi and Yoga are suggested as non-pharmacological interventions for COPD management. This meta-analysis evaluates mind-body exercises' impact on lung function and exercise capacity in stable COPD patients, aiming to assess their effectiveness in rehabilitation. A systematic search across various databases identified relevant randomized controlled trials until April 2024. Primary outcomes included lung function tests (FEV1, FVC, FEV1/FVC, FEV1%) and Six-Minute Walk Test (6MWT) results. The Standardized Mean Difference (SMD) measured intervention effects. Fifteen studies with 1047 participants were analyzed. Mind-body exercises significantly improved FEV1 (SMD = 0.87), FEV1/FVC (SMD = 0.19), FEV1% (SMD = 0.43), and 6MWT (SMD = 1.21) compared to standard care. Sensitivity and subgroup analyses confirmed result stability despite some heterogeneity.In conclusion, Mind-body exercises enhance lung function and exercise capacity in stable COPD patients. Integrating them into comprehensive rehabilitation programs is advisable. Further research should explore the specific impacts of different exercise types and intensities.

European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness

Respiratory symptoms are ubiquitous and impair health-related quality of life in people with respiratory disease. This European Respiratory Society (ERS) task force aimed to provide recommendations for symptomatic treatment in people with serious respiratory illness. The ERS task force comprised 16 members, including representatives of people with serious respiratory illness and informal caregivers. Seven questions were formulated, six in the PICO (Population, Intervention, Comparison, Outcome) format, which were addressed with full systematic reviews and evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). One question was addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. To treat symptoms in people with serious respiratory illness, the task force suggests the use of graded exercise therapy (conditional recommendation, low certainty of evidence); and suggests the use of a multicomponent services, handheld fan and breathing techniques (conditional recommendations, very low certainty of evidence). The task force suggests not to use opioids (conditional recommendation, very low certainty of evidence); and suggests either administering or not administering supplemental oxygen therapy (conditional recommendation, low certainty of evidence). The task force suggests that needs assessment tools may be used as part of a comprehensive needs assessment, but do not replace patient-centred care and shared decision making (conditional recommendation, low certainty of evidence). The low certainty of evidence, modest impact of interventions on patient-centred outcomes, and absence of effective strategies to ameliorate cough highlight the need for new approaches to reduce symptoms and enhance wellbeing for individuals who live with serious respiratory illness.

Effectiveness of mind-body exercises in chronic respiratory diseases: an overview of systematic reviews with meta-analyses

PURPOSE

To gather evidence on the effectiveness and safety of qigong, tai chi, and yoga to modulate symptoms associated with chronic respiratory diseases.

METHODS

A search of systematic reviews was conducted in CINHAL, Embase, PubMed, PsycINFO, SPORTDiscus, and the Cochrane Library from inception to November 2022. Systematic reviews with meta-analyses investigating physical and psychological measures were eligible. The methodological quality of systematic reviews (AMSTAR-2), the spin of information in abstracts, and the overlap of primary studies were explored.

RESULTS

Twenty-seven systematic reviews involving 37 000 participants, 146 studies, and 150 meta-analyses were included. Reviews investigated asthma (n = 4) and chronic obstructive pulmonary disease (COPD) (n = 23). Most reviews discussed their findings without considering the risk of bias of primary studies. The overlap ranged between slight (5%) and very high (35%). Yoga was better than control interventions to improve symptoms related with asthma. In adults with COPD, qigong improved dyspnoea, exercise endurance, lung function, and quality of life, while tai chi and yoga increased exercise endurance.

CONCLUSIONS

The impact of yoga on symptoms associated with asthma varied depending on the lung function parameter and the control group. Qigong, tai chi, and yoga could be effective to improve COPD-related symptoms, especially exercise endurance.

Yoga and Tai Chi: a mind-body approach in managing respiratory symptoms in obstructive lung diseases

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation because of airway and/or alveolar abnormalities. Symptoms include dyspnea, cough, chronic sputum production. As the third-ranked cause of death as well as disability-adjusted life years (DALYs), it poses a significant burden on patients, families, healthcare system and society. Regular physical activity is linked to decrease in morbidity and mortality associated with COPD, but implementation remains challenging. There is a need for community-based interventions that promote physical activity. Yoga and Tai Chi are widely available in the community and have been shown to be beneficial in patients with COPD as well as many of the co-morbid conditions associated with COPD.

RECENT FINDINGS

Yoga and Tai Chi have been found to be more effective than usual care in COPD with clinically meaningful improvements in 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1), and health-related quality of life (HRQoL). They have also been found to be comparable to pulmonary rehabilitation interventions.

SUMMARY

Yoga and Tai Chi provide community-based options for patients with COPD to improve their physical activity, quality of life, and pulmonary function.