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Tonga KO, Oliver BG. Effectiveness of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Therapy: Focusing on Traditional Medical Practices. J Clin Med 2023; 12:4815. [PMID: 37510930 PMCID: PMC10381859 DOI: 10.3390/jcm12144815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and serious disease that is characterized by dyspnea, fatigue, decreased exercise tolerance, peripheral muscle dysfunction, and mood disorders. These manifestations are successfully treated with pulmonary rehabilitation, a comprehensive intervention and holistic approach designed to improve the physical and psychological condition of people with COPD. Exercise is a big component of pulmonary rehabilitation programs, but the efficacy of non-traditional forms of exercise as used in alternative medicine is poorly understood. Here, we aim to address this gap in knowledge and summarize the clinical evidence for the use of traditional exercise regimens in the pulmonary rehabilitation of COPD patients.
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Affiliation(s)
- Katrina O Tonga
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- Saint Vincent's Hospital Sydney, Darlinghurst, NSW 2010, Australia
| | - Brian G Oliver
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- School of Life Sciences, University of Technology Sydney, Sydney, NSW 2007, Australia
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2
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de Medeiros Nogueira MG, Silva GAG, Marinho MHT, de Fátima Costa Brito O, de Brito Vieira WH, Ururahy MAG, Nogueira IDB, da Silva IS, de Miranda Silva Nogueira PA. Acute effects of NIV on peripheral muscle function and aerobic performance in patients with chronic obstructive pulmonary disease: a pilot study. BMC Pulm Med 2022; 22:399. [PMID: 36333720 PMCID: PMC9635205 DOI: 10.1186/s12890-022-02201-w] [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: 04/22/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Non-invasive ventilation (NIV) reduces respiratory load and demands on peripheral muscles. Methods This study aims to evaluate the acute effects of bi-level NIV on peripheral muscle function during isokinetic exercise and aerobic performance in chronic obstructive pulmonary disease (COPD) patients. This is a pilot crossover study performed with a non-probabilistic sample of 14 moderate to very severe COPD patients. Procedures carried out in two days. Dyspnea, quality of life, lung function, respiratory muscle strength, functional capacity (6-min walk test—6MWT), and isokinetic assessment of the quadriceps were assessed. Blood samples (lactate, lactate dehydrogenase, and creatine kinase concentration) were also collected. Right after, NIV was performed for 30 min (bi-level or placebo, according to randomization) followed by new blood sample collection, 6MWT, and isokinetic dynamometer tests. Before and after evaluations, the subjective perception of dyspnea and fatigue in the lower limbs was quantified. After a wash-out period of seven days, participants returned, and all assessments were performed again. Results NIV showed improvements in perceived exertion and dyspnea after isokinetic exercise (p < 0.02 and p < 0.05, respectively). Conclusions NIV improves the perception of dyspnea and fatigue during the isokinetic exercise.
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Affiliation(s)
- Mariana Galvão de Medeiros Nogueira
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
| | - Gabriely Azevêdo Gonçalo Silva
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
| | | | - Ozana de Fátima Costa Brito
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
| | - Wouber Hérickson de Brito Vieira
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
| | - Marcela Abbott Galvão Ururahy
- grid.411233.60000 0000 9687 399XDepartment of Clinical and Toxicological Analysis, Federal University of Rio Grande Do Norte, Natal, Rio Grande Do Norte Brazil
| | - Ivan Daniel Bezerra Nogueira
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
| | - Ivanízia Soares da Silva
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
| | - Patrícia Angélica de Miranda Silva Nogueira
- grid.411233.60000 0000 9687 399XPhysiotherapy, Federal University of Rio Grande Do Norte, Av. Senador Salgado Filho, 3000, Candelária, Caixa Postal: 1524, Natal, Rio Grande Do Norte 59072970 Brazil
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3
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Reeve J, Mooney S, Jepsen N, White D. The Utility and Acceptability of a New Noninvasive Ventilatory Assist Device, Rest-Activity Cycler-Positive Airways Pressure, During Exercise in a Population of Healthy Adults: Cohort Study. JMIR Rehabil Assist Technol 2022; 9:e35494. [PMID: 35916705 PMCID: PMC9379794 DOI: 10.2196/35494] [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: 12/06/2021] [Revised: 05/30/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Noninvasive ventilation has been demonstrated to benefit people who have moderate to severe chronic obstructive pulmonary disease during acute exacerbations. Studies have begun to investigate the effectiveness of noninvasive ventilation during pulmonary rehabilitation to improve outcomes for people with chronic obstructive pulmonary disease; however, the lack of portability and humidification of these devices means their use is limited, especially when performing activities of daily living. A new prototype device, RACer-PAP (rest-activity cycler-positive airways pressure), delivers battery-operated positive airway pressure via a nasal interface while regulating nasal airway apportionment bias, removing the need for supplementary humidification. This device may offer people with chronic obstructive pulmonary disease an improved ability to participate in pulmonary rehabilitation and activities of daily living. Objective To assess the feasibility of exercising with the RACer-PAP in situ and the acceptability of the device during exercise in normal, healthy individuals. Methods A total of 15 healthy adults were invited to attend 2 exercise sessions, each 1 week apart. Sessions lasted approximately 1 hour and included 2 baseline 6-minute walk distance assessments, once with and once without the RACer-PAP in situ. Vital signs and spirometry results were monitored throughout, and spirometry was performed pre- and posttesting with RACer-PAP. Subjective questionnaires ascertained participant feedback on exercising with the device in situ. Results Of the 15 initial participants, 14 (93%) completed both sessions. There were no adverse events associated with exercising with the device in situ. There were no differences in vital signs or 6-minute walk distance whether exercising with or without the device in situ. There were small increases in maximum dyspnea score (on the Borg scale) when exercising with the device in situ (median score 2.0, IQR 0.5-3.0, vs 3.0, IQR 2.0-3.25). There were small increases in forced vital capacity following exercise with the RACer-PAP. None of the participants reported symptoms associated with airway drying. Participant feedback provided recommendations for modifications for the next iteration of the device prior to piloting the device with people with chronic obstructive pulmonary disease. Conclusions This study has shown RACer-PAP to be safe and feasible to use during exercise and has provided feedback for modifications to the device to improve its use during exercise. We now propose to consider the application of the device in a small pilot feasibility study to assess the safety, feasibility, and utility of the device in a population of people with moderate to severe chronic obstructive pulmonary disease. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619000478112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375477
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Affiliation(s)
- Julie Reeve
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Mooney
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Jepsen
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - David White
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
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Al Chikhanie Y, Bailly S, Amroussa I, Veale D, Hérengt F, Verges S. Clustering of COPD patients and their response to pulmonary rehabilitation. Respir Med 2022; 198:106861. [DOI: 10.1016/j.rmed.2022.106861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
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5
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Xiang G, Zhu X, Ma L, Huang H, Wu X, Zhang W, Li S. Clinical guidelines on the application of Internet of Things (IOT) medical technology in the rehabilitation of chronic obstructive pulmonary disease. J Thorac Dis 2021; 13:4629-4637. [PMID: 34527304 PMCID: PMC8411163 DOI: 10.21037/jtd-21-670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Guiling Xiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodan Zhu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Ma
- Department of Pulmonary Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huai Huang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Pulmonary Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Rodrigues A, Muñoz Castro G, Jácome C, Langer D, Parry SM, Burtin C. Current developments and future directions in respiratory physiotherapy. Eur Respir Rev 2020; 29:29/158/200264. [PMID: 33328280 DOI: 10.1183/16000617.0264-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/24/2020] [Indexed: 01/06/2023] Open
Abstract
Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the profession's diversity, summarises the current evidence and practice, and addresses future research directions in respiratory physiotherapy. Herein, we describe an overview of the areas that respiratory physiotherapists can act in the integrated care of patients with respiratory diseases based on the Harmonised Education in Respiratory Medicine for European Specialists syllabus. In addition, we highlight areas in which further evidence needs to be gathered to confirm the effectiveness of respiratory therapy techniques. Where appropriate, we made recommendations for clinical practice based on current international guidelines.
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Affiliation(s)
- Antenor Rodrigues
- Laboratory of Research in Respiratory Physiotherapy - LFIP, State University of Londrina, Londrina, Brazil.,Dept of Physical Therapy, University of Toronto, Toronto, Canada
| | - Gerard Muñoz Castro
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Dept of Physical Therapy EUSES, University of Girona, Girona, Spain
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Dept of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, KU Leuven, Dept of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium.,Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Selina M Parry
- Dept of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Chris Burtin
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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7
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Xiang G, Wu Q, Wu X, Hao S, Xie L, Li S. Non-invasive ventilation intervention during exercise training in individuals with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Ann Phys Rehabil Med 2020; 64:101460. [PMID: 33271344 DOI: 10.1016/j.rehab.2020.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/01/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE evidence is inconsistent for the effect of non-invasive ventilation (NIV) for individuals with chronic obstructive pulmonary disease (COPD) during exercise training. This review aimed to determine the effect of NIV in COPD individuals during exercise training on exercise capacity, quality of life, functional performance and symptoms. MATERIAL AND METHODS we searched for studies evaluating the effect of NIV on COPD individuals during exercise training published until May 2020 in 6 electronic databases (PubMed, Embase, Cochrane Library, Web of Science, clinical trial registers and Wanfang). The included studies were appraised with the Cochrane Risk of Bias tool and Downs and Black criteria. The primary outcomes were improvement in 6-min walking distance and quality of life. Mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated. RESULTS among 855 identified articles, reports for 15 studies with heterogeneous populations were eligible, with 520 individuals: 257 in the NIV group and 263 in the control group. Across studies, NIV intervention during exercise training affected exercise performance (6-min walking distance: SMD: 0.33, 95% CI: 0.06; 0.59, P=0.02; quality of life: SMD: -0.77, 95% CI: -1.01; -0.53, P<0.001). In the analysis of dyspnea, pooled estimates demonstrated improvement in the NIV versus control group. NIV intervention was also better than exercise alone in ameliorating oxygen saturation, PaO2, PaCO2, blood lactate level and breath rate. The groups did not differ in duration of exercise, BODE index, minute ventilation, heart rate and systolic blood pressure. CONCLUSIONS our review suggests that NIV is a relevant adjuvant for exercise training in COPD individuals because the intervention could improve exercise performance and quality of life. The current results also demonstrate the importance of further investigations of higher methodological quality to assess the effect on exercise capacity and quality of life.
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Affiliation(s)
- Guiling Xiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, China
| | - Qinhan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, China
| | - Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, China
| | - Shengyu Hao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, China
| | - Liang Xie
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, China
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, China.
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Noninvasive Ventilation Accelerates Oxygen Uptake Recovery Kinetics in Patients With Combined Heart Failure and Chronic Obstructive Pulmonary Disease. J Cardiopulm Rehabil Prev 2020; 40:414-420. [PMID: 33074848 DOI: 10.1097/hcr.0000000000000499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Oxygen uptake (V˙o2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V˙o2, heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD. METHODS Nineteen males (10 HF/9 age- and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (Tlim), receiving either sham ventilation or NIPPV. RESULTS Despite greater V˙o2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4 ± 14.0 sec vs 62.8 ± 15.2 sec, P < .05) and mean response time (MRT) (86.1 ± 19.1 sec vs 68.8 ± 12.0 sec, P < .05) with NIPPV and greater ΔNIPPV-sham (τ: 5.6 ± 19.5 vs -25.2 ± 22.4, P < .05; MRT: 4.1 ± 32.2 vs -26.0 ± 19.2, P < .05) compared with HF. There was no difference regarding Tlim between sham and NIPPV in both groups (P < .05). CONCLUSION Our results suggest that NIPPV accelerated the V˙o2 recovery kinetics following high-intensity CLE to a greater extent in patients with coexisting HF and COPD compared with HF alone. NIPPV should be considered when the objective is to apply high-intensity interval exercise training as an adjunct intervention during a cardiopulmonary rehabilitation program.
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Effect of portable non-invasive ventilation on exercise tolerance in COPD: One size does not fit all. Respir Physiol Neurobiol 2020; 277:103436. [DOI: 10.1016/j.resp.2020.103436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022]
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Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, Sastry M, Spruit MA, Franssen FM. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 14:149-161. [PMID: 31931636 DOI: 10.1080/17476348.2020.1700796] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team.Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed.Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.
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Affiliation(s)
- Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands
| | - Maud Koopman
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Wai-Yan Liu
- CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Maurice J Sillen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Bita Hajian
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Manu Sastry
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Frits M Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
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Milesi I, Porta R, Barbano L, Cacciatore S, Vitacca M, Dellacà RL. Automatic tailoring of the lowest PEEP to abolish tidal expiratory flow limitation in seated and supine COPD patients. Respir Med 2019; 155:13-18. [DOI: 10.1016/j.rmed.2019.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
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12
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Hemodynamic effects of portable non-invasive ventilation in healthy men. Respir Physiol Neurobiol 2019; 268:103248. [PMID: 31271841 DOI: 10.1016/j.resp.2019.06.005] [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: 04/05/2019] [Revised: 06/10/2019] [Accepted: 06/29/2019] [Indexed: 11/23/2022]
Abstract
VitaBreath is a portable, non-invasive ventilation device (pNIV) that relieves shortness of breath in COPD by delivering fixed inspiratory and expiratory positive airway pressures (IPAP/EPAP: 18/8 cmH2O). Fixed pressures may cause circulatory compromise. We investigated the circulatory effects of pNIV during normal breathing (NB) and after Eucapnic Voluntary Hyperpnoea trials (EVH) sustained at 80% MVV. In a balanced order sequence, 10 healthy men performed four trials on one visit: 1-min of pNIV (intervention) or 1-min quiet breathing (QB) during NB; and 1-min pNIV (intervention) or 1-min QB during recovery from 3-min EVH. Compared to QB, pNIV application was associated with greater cardiac output (CO: 1.6 ± 1.9 L.min-1; P = 0.03). One minute into recovery from EVH, pNIV caused greater CO (2.2 ± 1.6 L.min-1; P = 0.01) compared to QB. Mean blood pressure was not different with pNIV compared to control. pNIV increased thoracoabdominal volumes and breathing frequency during NB and recovery from EVH. pNIV application does not induce adverse hemodynamic effects in healthy men.
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13
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Vanfleteren LEGW, Gloeckl R. Add-on interventions during pulmonary rehabilitation. Respirology 2019; 24:899-908. [PMID: 31115114 DOI: 10.1111/resp.13585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Both pulmonary rehabilitation (PR) and chronic obstructive pulmonary disease (COPD) are generic terms and it increasingly becomes clear that rehabilitation programmes need to be tailored to the complexity and circumstances of the individual patient. Indeed, PR is described as a comprehensive, individualized intervention based on thorough assessment of identifiable treatable traits. The current review summarizes ongoing developments regarding additional interventions and tools to facilitate PR and improve outcomes in patients with a chronic respiratory disease.
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Affiliation(s)
- Lowie E G W Vanfleteren
- COPD Center, Sahlgrenska University Hospital, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,CIRO, Horn, The Netherlands
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany
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Ambrosino N, Fracchia C. Strategies to relieve dyspnoea in patients with advanced chronic respiratory diseases. A narrative review. Pulmonology 2019; 25:289-298. [PMID: 31129045 DOI: 10.1016/j.pulmoe.2019.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The management of symptoms in patients with advanced chronic respiratory diseases needs more attention. This review summarizes the latest evidence on interventions to relieve dyspnoea in these patients. METHODS We searched randomised controlled trials, observational studies, systematic reviews, and meta-analyses published between 1990 and 2019 in English in PubMed data base using the keywords. Dyspnoea, Breathlessness AND: pharmacological and non pharmacological therapy, oxygen, non invasive ventilation, pulmonary rehabilitation, alternative medicine, intensive care, palliative care, integrated care, self-management. Studies on drugs (e.g. bronchodilators) or interventions (e.g. lung volume reduction surgery, lung transplantation) to manage underlying conditions and complications, or tools for relief of associated symptoms such as pain, are not addressed. RESULTS Relief of dyspnoea has received relatively little attention in clinical practice and literature. Many pharmacological and non pharmacological therapies are available to relieve dyspnoea, and improve patients' quality of life. There is a need for greater knowledge of the benefits and risks of these tools by doctors, patients and families to avoid unnecessary fears which might reduce or delay the delivery of appropriate care. We need services for multidisciplinary care in early and late phases of diseases. Early integration of palliative care with respiratory, primary care, and rehabilitation services can help patients and caregivers. CONCLUSION Relief of dyspnoea as well as of any distressing symptom is a human right and an ethical duty for doctors and caregivers who have many potential resources to achieve this.
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Affiliation(s)
- N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Pneumologia Riabilitativa, Montescano (PV), Italy.
| | - C Fracchia
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Pneumologia Riabilitativa, Montescano (PV), Italy
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Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial. J Clin Med 2019; 8:jcm8010094. [PMID: 30650617 PMCID: PMC6352193 DOI: 10.3390/jcm8010094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/26/2018] [Accepted: 01/14/2019] [Indexed: 01/20/2023] Open
Abstract
During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients.
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Vitacca M, Ambrosino N. Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review. Respiration 2018; 97:3-11. [PMID: 30380534 DOI: 10.1159/000493691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients' symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. OBJECTIVE This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. METHODS We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords "chronic respiratory failure AND exercise," "non invasive ventilation AND exercise," "pulmonary rehabilitation" and "exercise training." RESULTS Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. CONCLUSION We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Pulmonary Rehabilitation, Institute of Lumezzane (BS), Lumezzane,
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Institute of Montescano (PV), Montescano, Italy
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Gloeckl R, Andrianopoulos V, Stegemann A, Oversohl J, Schneeberger T, Schoenheit‐Kenn U, Hitzl W, Dreher M, Koczulla AR, Kenn K. High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial. Respirology 2018; 24:254-261. [DOI: 10.1111/resp.13399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Rainer Gloeckl
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Prevention, Rehabilitation and Sports MedicineTechnical University of Munich (TUM) Munich Germany
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Antje Stegemann
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Julian Oversohl
- Department of Internal MedicinePhilipps‐University of Marburg Marburg Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
| | - Ursula Schoenheit‐Kenn
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics)Paracelsus Medical University Salzburg Austria
- Department of Ophthalmology and OptometryParacelsus Medical University Salzburg Austria
| | - Michael Dreher
- Department of Pneumology and Intensive Care MedicineUniversity Hospital RWTH Aachen Germany
| | - A. Rembert Koczulla
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
| | - Klaus Kenn
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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Outcome of pulmonary rehabilitation in patients with COPD: Comparison between patients receiving exercise training and those receiving exercise training and CPAP. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Vitacca M, Kaymaz D, Lanini B, Vagheggini G, Ergün P, Gigliotti F, Ambrosino N, Paneroni M. Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support: A randomized controlled trial. Respirology 2017; 23:182-189. [PMID: 28940820 DOI: 10.1111/resp.13181] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. METHODS All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone. Outcome measures were 6MWD (primary outcome), incremental and endurance cycle ergometer exercise time, respiratory muscle function, quality of life by the Maugeri Respiratory Failure questionnaire (MRF-28), dyspnoea (Medical Research Council scale) and leg fatigue at rest. RESULTS Forty-two patients completed the study. Following training, no significant difference in 6MWD changes were found between groups. Improvement in endurance time was significantly greater in the NIV group compared with the non-NIV training group (754 ± 973 vs 51 ± 406 s, P = 0.0271); dyspnoea improved in both groups, while respiratory muscle function and leg fatigue improved only in the NIV ET group. MRF-28 improved only in the group training without NIV. CONCLUSION In CRF patients on long-term NIV and long-term oxygen therapy (LTOT), the addition of NIV to ET sessions resulted in an improvement in endurance time, but not in 6MWD.
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Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
| | - Dicle Kaymaz
- Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Barbara Lanini
- Respiratory Unit, Fondazione Don Gnocchi IRCCS, Florence, Italy
| | | | - Pınar Ergün
- Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Nicolino Ambrosino
- Pulmonary and Respiratory Medicine Department, Medical Faculty Sebelas Maret University, Solo, Indonesia
| | - Mara Paneroni
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
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