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Xiong T, Bai X, Wei X, Wang L, Li F, Shi H, Shi Y. Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits. Int J Chron Obstruct Pulmon Dis 2023; 18:1251-1266. [PMID: 37362621 PMCID: PMC10289097 DOI: 10.2147/copd.s408325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.
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Affiliation(s)
- Ting Xiong
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Xinyue Bai
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Xingyi Wei
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Lezheng Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Fei Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yue Shi
- School of Athletic Performance, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
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2
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Tsang A, Lynes D, McKenzie H, Spencer S, Kelly C. Self-management programmes for adult patients with bronchiectasis: a systematic review and realist synthesis. Disabil Rehabil 2022; 44:6939-6948. [PMID: 34658309 DOI: 10.1080/09638288.2021.1978563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Self-management for patients with bronchiectasis has been identified as an important component that could potentially empower patients to manage their condition and improve their quality of life. Evidence was reviewed to investigate what self-management programmes work, why and in what circumstances. METHODS A systematic review and realist synthesis were conducted. A comprehensive database search was performed on seven databases for evidence published up to July 2021. Leading candidate self-management programmes identified from the systematic review became the focus of the realist synthesis. A realist logic of analysis was applied to produce explanatory context-mechanism-outcome configurations. These explanations were consolidated into programme theories drawing on health behaviour change theory. RESULTS By synthesising the data from eight eligible articles, programme theories articulated how three different self-management programmes work that included: (i) education and action planning, (ii) education and airway clearance techniques (ACT) and, (iii) education, exercise and ACT. Patient characteristics and collaborative partnership between healthcare professionals and patients were identified as important contexts that influenced the improvement in self-efficacy, health-related quality of life, and exercise capacity. CONCLUSIONS This review contributes to a better understanding of how the complex interaction between contexts and mechanisms can improve outcomes of clinical interest.IMPLICATIONS FOR REHABILITATIONThis evidence synthesis has identified potentially important combinations of interventions to be considered in self-management programmes for adults with bronchiectasis.Collaborative partnership between patient and healthcare professionals should be considered to improve short-term self-efficacy.Targeting self-management programmes to increase short-term health-related quality of life and exercise capacity should consider the context of patient characteristics.
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Affiliation(s)
- Anthony Tsang
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK.,Department of Nursing, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Dave Lynes
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Hayley McKenzie
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Sally Spencer
- Faculty of Health & Social Care, Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Carol Kelly
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK.,Faculty of Health & Social Care, Health Research Institute, Edge Hill University, Ormskirk, UK
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3
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Yang F, Gao L, Wang Q, Deng W, Gao W. Effect of exercise-based pulmonary rehabilitation in patients with bronchiectasis: A meta-analysis. Respir Med Res 2022; 81:100910. [PMID: 35461014 DOI: 10.1016/j.resmer.2022.100910] [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: 10/23/2021] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aimed to assess the effectiveness of exercise training in patients with bronchiectasis in terms of exercise capacity, pulmonary function, and quality of life. METHODS PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) examining pulmonary rehabilitation to treat bronchiectasis, and the search timeline was from inception through November 2020. Two researchers independently screened the literature, extracted data, evaluated the risk of bias in the included studies, and used Review Manager 5.3 software to perform the meta-analysis. The primary outcomes were incremental shuttle walk distance (ISWD) and 6-minute walk distance (6-MWD) at 8 weeks. The secondary outcomes were forced expiratory volume in 1 second (FEV1), St. George's Respiratory Questionnaire (SGRQ) score, and Leicester Cough Questionnaire (LCQ) score at 8 weeks. RESULTS A total of five RCTs with a total of 198 patients were included. A pooled analysis showed that improvements in ISWD (mean difference [MD] = 92.47 m, 95% confidence interval [CI] 49.87, 135.08; P < 0.0001), 6-MWD (MD = 31.01 m, 95% CI 1.60, 60.42; P = 0.04), and FEV1 (MD = 0.08 L, 95% CI 0.04, 0.12; P = 0.0002) in the pulmonary rehabilitation group were more marked than in the control group. There was no significant difference between the two groups in terms of the improvement in SGRQ and LCQ scores. CONCLUSIONS Pulmonary rehabilitation improves exercise capacity and pulmonary function (specifically FEV1) in patients with bronchiectasis. However, due to limitations in the number and quality of current studies, the above conclusions need to be verified in future research.
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Affiliation(s)
- Feng Yang
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, 100068, China
| | - Lianjun Gao
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, 100068, China
| | - Qimin Wang
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, 100068, China
| | - Weiping Deng
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, 100068, China
| | - Wei Gao
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, 100068, China.
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4
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O’Donnell AE. Airway Clearance and Mucoactive Therapies in Bronchiectasis. Clin Chest Med 2022; 43:157-163. [DOI: 10.1016/j.ccm.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Ora J, Prendi E, Ritondo BL, Pata X, Spada F, Rogliani P. Pulmonary Rehabilitation in Noncystic Fibrosis Bronchiectasis. Respiration 2021; 101:97-105. [PMID: 34352795 DOI: 10.1159/000517527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Current guidelines for the treatment of noncystic fibrosis bronchiectasis (NCFB) recommend pulmonary rehabilitation (PR), but to date, there are few studies that have proven its effectiveness. OBJECTIVE The main objective of this study was to examine the effect of PR on pulmonary function tests and exercise capacity. METHOD The aim of this study was to systematically review the effects of PR in NCFB on (1) forced expiratory volume in the first second (FEV1) and (2) exercise capacity evaluated by the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT). This meta-analysis was undertaken according to PRISMA recommendations. RESULTS This pair-wise meta-analysis included data obtained from studies that enrolled 529 NCFB patients. The FEV1 assessment after PR between the active and control group did not show any significant increase (FEV1 difference 0.084 mL; CI: -0.064, +0.233; p = 0.264), and there was an increasing trend (188 mL; CI: -0 to 0.009, +0.384) at the limits of statistical significance (p = 0.061). Walked distance showed a significant increase in the PR group compared to the control group (ISWT distance difference 070.0 m; CI: 55.2, 84.8; p < 0.001), and this finding was confirmed before and after PR both by the ISWT (68.85 m greater than baseline; CI: 40.52, 97.18; p < 0.001) and by the 6MWT (37.7 m greater than baseline; CI: 20.22, 55.25; p < 0.001). CONCLUSIONS PR improves exercise tolerance in NCFB patients, but it has a modest impact on respiratory function.
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Affiliation(s)
- Josuel Ora
- Division of Respiratory Medicine, Department of Emergency Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Emanuela Prendi
- Department of Biomedical Sciences, Catholic University "Nostra Signora del Buon Consiglio,", Tirana, Albania
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
| | - Xhesika Pata
- Department of Biomedical Sciences, Catholic University "Nostra Signora del Buon Consiglio,", Tirana, Albania
| | - Florian Spada
- Department of Biomedical Sciences, Catholic University "Nostra Signora del Buon Consiglio,", Tirana, Albania
| | - Paola Rogliani
- Division of Respiratory Medicine, Department of Emergency Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata,", Rome, Italy
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6
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Moroli RG, Santos DOD, Souza HCDD, Perossi L, Ribeiro MA, Perossi J, Baddini-Martinez JA, Gastaldi AC. Effects of Controlled Voluntary Increase in the Ventilatory Demand on Respiratory System Resistance in Healthy and Non-Cystic Fibrosis Bronchiectasis Subjects: A Cross-Sectional Study. Arch Bronconeumol 2021; 57:528-532. [PMID: 35699030 DOI: 10.1016/j.arbr.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/08/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Bronchiectasis patients may present a reduced functional capacity due to an increase in the ventilatory demand during exercise. OBJECTIVE To evaluate the effects of controlled voluntary hyperinflation and increased respiratory rate on the mechanics of the respiratory system, simulating what happens during exercise, in bronchiectasis and healthy subjects. METHODS Bronchiectasis (n=30) and healthy (n=16) subjects were evaluated by impulse oscillometry (IOS) during a baseline condition, and in controlled conditions with baseline (b) tidal volume (V) and hyperinflation (H), with respiratory rates at 30(R30) and 40(R40) bpm, in a random order. The mixed effects and a significance level at 0.05 were used for comparisons. RESULTS Resistance at 5Hz (R5), and at minus 20Hz (R5-R20), in kPa/L/s, were higher in subjects with bronchiectasis in all experimental conditions (p<0.05). For the bronchiectasis group, R5 and R5-20 increased with R increase at V (VRb versus VR30 and VR40; VR30 versus VR40; R5, R20 and R5-20 increased with R increase at H (HRb versus HR40; HR30 versus HR40). For the same R, there was a decrease with H compared to V (HRb versus VR30 and VR40; and HR30 versus VR30 and VR40). For the healthy group, only R20 showed differences (HR30 versus HR40; HR40 versus VR40). CONCLUSION The tachypnea increases the resistance and reactance of the respiratory system in bronchiectasis patients, and the voluntary hyperinflation caused attenuates this increase. These results can guide the development of strategies to reduce the limitation of physical activity in patients with bronchiectasis.
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Affiliation(s)
- Ricardo Grassi Moroli
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Daniele Oliveira Dos Santos
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Larissa Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Maytê Assunção Ribeiro
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Jéssica Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | | | - Ada Clarice Gastaldi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
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Detailleur S, Vos R, Goeminne P. The Deteriorating Patient: Therapies Including Lung Transplantation. Semin Respir Crit Care Med 2021; 42:623-638. [PMID: 34261186 DOI: 10.1055/s-0041-1730946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this review paper, we discuss the characteristics that define severe bronchiectasis and which may lead to deterioration of noncystic fibrosis bronchiectasis. These characteristics were used to establish the current severity scores: bronchiectasis severity index (BSI), FACED, and E-FACED (exacerbation frequency, forced expiratory volume in 1 second, age, colonization, extension and dyspnea score). They can be used to predict mortality, exacerbation rate, hospital admission, and quality of life. Furthermore, there are different treatable traits that contribute to severe bronchiectasis and clinical deterioration. When present, they can be a target of the treatment to stabilize bronchiectasis.One of the first steps in treatment management of bronchiectasis is evaluation of compliance to already prescribed therapy. Several factors can contribute to treatment adherence, but to date no real interventions have been published to ameliorate this phenomenon. In the second step, treatment in deteriorating patients with bronchiectasis should be guided by the predominant symptoms, for example, cough, sputum, difficulty expectoration, exacerbation rate, or physical impairment. In the third step, we evaluate treatable traits that could influence disease severity in the deteriorating patient. Finally, in patients who are difficult to treat despite maximum medical treatment, eligibility for surgery (when disease is localized), should be considered. In case of end-stage disease, the evaluation for lung transplantation should be performed. Noninvasive ventilation can serve as a bridge to lung transplantation in patients with respiratory failure.
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Affiliation(s)
- Stephanie Detailleur
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Pieter Goeminne
- Department of Respiratory Diseases, AZ Nikolaas, Sint-Niklaas, Belgium
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8
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Moroli RG, Santos DOD, Souza HCDD, Perossi L, Ribeiro MA, Perossi J, Baddini-Martinez JA, Gastaldi AC. Effects of Controlled Voluntary Increase in the Ventilatory Demand on Respiratory System Resistance in Healthy and Non-Cystic Fibrosis Bronchiectasis Subjects: A Cross-Sectional Study. Arch Bronconeumol 2020; 57:S0300-2896(20)30125-3. [PMID: 32593534 DOI: 10.1016/j.arbres.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/11/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Bronchiectasis patients may present a reduced functional capacity due to an increase in the ventilatory demand during exercise. OBJECTIVE To evaluate the effects of controlled voluntary hyperinflation and increased respiratory rate on the mechanics of the respiratory system, simulating what happens during exercise, in bronchiectasis and healthy subjects. METHODS Bronchiectasis (n=30) and healthy (n=16) subjects were evaluated by impulse oscillometry (IOS) during a baseline condition, and in controlled conditions with baseline (b) tidal volume (V) and hyperinflation (H), with respiratory rates at 30(R30) and 40(R40) bpm, in a random order. The mixed effects and a significance level at 0.05 were used for comparisons. RESULTS Resistance at 5Hz (R5), and at minus 20Hz (R5-R20), in kPa/L/s, were higher in subjects with bronchiectasis in all experimental conditions (p<0.05). For the bronchiectasis group, R5 and R5-20 increased with R increase at V (VRb versus VR30 and VR40; VR30 versus VR40; R5, R20 and R5-20 increased with R increase at H (HRb versus HR40; HR30 versus HR40). For the same R, there was a decrease with H compared to V (HRb versus VR30 and VR40; and HR30 versus VR30 and VR40). For the healthy group, only R20 showed differences (HR30 versus HR40; HR40 versus VR40). CONCLUSION The tachypnea increases the resistance and reactance of the respiratory system in bronchiectasis patients, and the voluntary hyperinflation caused attenuates this increase. These results can guide the development of strategies to reduce the limitation of physical activity in patients with bronchiectasis.
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Affiliation(s)
- Ricardo Grassi Moroli
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Daniele Oliveira Dos Santos
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Larissa Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Maytê Assunção Ribeiro
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Jéssica Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | | | - Ada Clarice Gastaldi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
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9
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Oxidative and inflammatory effects of pulmonary rehabilitation in patients with bronchiectasis. A prospective, randomized study. NUTR HOSP 2020; 37:6-13. [PMID: 31960695 DOI: 10.20960/nh.02763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: systemic inflammation and oxidative stress are important factors in the pathogenesis of bronchiectasis. Pulmonary rehabilitation (PR) is recommended for bronchiectasis, but there is no data about its effect on the inflammatory and REDOX status of these patients. Aims: to investigate the effect of PR in non-cystic-fibrosis bronchiectasis (NCFB) patients, and to compare it with the effect of PR plus a hyperproteic oral nutritional supplement (PRS) enriched with beta-hydroxy-beta-methylbutyrate (HMB) on serum inflammatory and oxidative biomarkers. Materials and methods: this was an open randomized, controlled trial. Thirty individuals (65 years old or younger with a body mass index over 18.5, older than 65 years with a body mass index over 20) were recruited from September 2013 to September 2014, and randomly assigned to receive PR or PRS. Total neutrophils, and inflammatory and oxidative biomarker levels were measured at baseline, and then at 3 and 6 months. Results: in the PRS group neutrophil levels were decreased from baseline at 6 months. A significantly different fold change was found between the PR and PRS groups. In the PR group, IL-6 and adiponectin were increased by the end of the study while TNFα levels were decreased from baseline at 6 months. REDOX biomarkers remained stable throughout the study except for 8-isoprostane levels, which were increased from baseline at 6 months in both groups of patients. Conclusions: a PR program induced a pro-oxidative effect accompanied by changes in circulating inflammatory cytokine levels in NCFB patients. Our results would also suggest a possible beneficial effect of the HMB enriched supplement on neutrophil level regulation in these patients. The information provided in this study could be useful for choosing the right therapeutic approach in the management of bronchiectasis.
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Maierean A, Alexescu TG, Ciumarnean L, Motoc N, Chis A, Ruta MV, Dogaru G, Aluas M. Non Cystic Fibrosis Bronchiectasis-new clinical approach, management of treatment and pulmonary rehabilitation. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract Non-Cystic Fibrosis Bronchiectasis (NCFB) are characterised by abnormal, permanently damaged and dilated bronchi due to the innapropiate clearence of various microorganisms and recurrent chronic infections.The diagnosis is suggested by the clinical presentation and is confirmed by multiple investigations. There are some comorbidities associated with bronhciectasis, such as chronic obstructive pulmonary disease (COPD), cardiovascular disorders, gastro-esophageal reflux disease (GERD), psychological illnesses, pulmonary hypertension, obstructive apnea syndrome(OSA). The condition has a substantial socioeconomic impact because it requests a multidisciplinary management and periods of exacerbations are common. The aims of the management of bronchiectasis are to reduce symptoms (such as sputum volume and purulence, cough and dyspnea), reduce the frequency and severity of exacerbations, preserve lung function and improve health-related quality of life. The multidisciplinary approach of bronchiectasis patients require along with the medical treatment, a specific plan of nonphamarcological strategies, including balneological intervention. There are a lot of techniques improving the airway clearence, such as: active cycle of breathing techniques (which include breathing control, thoracic expansion exercises, forced expiratory technique), oscilatting possitive expiratory pressure, autogenic drainage, gravity-assisted-positioning, modified postural drainage. Together with specific medication, these techniques can diminuate symptoms and improve the quality of life. Key words: NCFB, airway clearence, physiotherapy,
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Affiliation(s)
- Anca Maierean
- 1. ”Iuliu Hatieganu”University of Medicine and Pharmacy, Department of Pneumology, Cluj - Napoca, Romania
| | - Teodora Gabriela Alexescu
- 2. „Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Internal Medicine, Cluj - Napoca, Romania
| | - Lorena Ciumarnean
- 2. „Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Internal Medicine, Cluj - Napoca, Romania
| | - Nicoleta Motoc
- 1. ”Iuliu Hatieganu”University of Medicine and Pharmacy, Department of Pneumology, Cluj - Napoca, Romania
| | - Ana Chis
- 1. ”Iuliu Hatieganu”University of Medicine and Pharmacy, Department of Pneumology, Cluj - Napoca, Romania
| | - Maria Victoria Ruta
- 3. „Iuliu Hatieganu”‚ University of Medicine and Pharmacy, Department of Physiology, Cluj - Napoca, Romania
| | - Gabriela Dogaru
- 4. „Iuliu Hatieganu”‚ University of Medicine and Pharmacy, Department of Medical Rehabilitation, Clinical Rehabilitation
| | - Maria Aluas
- 5. „Iuliu Hatieganu”‚ University of Medicine and Pharmacy, Department of Medical Education, Cluj - Napoca, Romania
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11
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Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR, Grillo L, Gruffydd-Jones K, Harvey A, Haworth CS, Hiscocks E, Hurst JR, Johnson C, Kelleher PW, Bedi P, Payne K, Saleh H, Screaton NJ, Smith M, Tunney M, Whitters D, Wilson R, Loebinger MR. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019; 74:1-69. [PMID: 30545985 DOI: 10.1136/thoraxjnl-2018-212463] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Adam T Hill
- Respiratory Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Anita L Sullivan
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust (Queen Elizabeth Hospital), Birmingham, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Anthony De Soyza
- Institute of Cellular Medicine, NIHR Biomedical Research Centre for Aging and Freeman Hospital Adult Bronchiectasis service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Stuart J Elborn
- Royal Brompton Hospital and Imperial College London, and Queens University Belfast
| | - Andres R Floto
- Department of Medicine, University of Cambridge, Cambridge UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
| | | | | | - Alex Harvey
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
| | | | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Peter W Kelleher
- Centre for Immunology and Vaccinology, Chelsea &Westminster Hospital Campus, Department of Medicine, Imperial College London.,Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London.,Chest & Allergy Clinic St Mary's Hospital, Imperial College Healthcare NHS Trust
| | - Pallavi Bedi
- University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | | | | | | | - Maeve Smith
- University of Alberta, Edmonton, Alberta, Canada
| | - Michael Tunney
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | | | - Robert Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
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12
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O'Neill K, O'Donnell AE, Bradley JM. Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis. Respirology 2019; 24:227-237. [DOI: 10.1111/resp.13459] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Katherine O'Neill
- The Wellcome‐Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical ScienceQueen's University Belfast Belfast UK
| | - Anne E. O'Donnell
- Division of Pulmonary, Critical Care and Sleep MedicineGeorgetown University Hospital Washington DC USA
| | - Judy M. Bradley
- The Wellcome‐Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical ScienceQueen's University Belfast Belfast UK
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13
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Pehlivan E, Niksarlıoğlu EY, Balcı A, Kılıç L. The Effect of Pulmonary Rehabilitation on the Physical Activity Level and General Clinical Status of Patients with Bronchiectasis. Turk Thorac J 2019; 20:30-35. [PMID: 30664424 DOI: 10.5152/turkthoracj.2018.18093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We aimed to investigate the effects of pulmonary rehabilitation (PR) on the level of physical activity (PA) and the general clinical status in adult patients with non-cystic fibrosis bronchiectasis. MATERIALS AND METHODS The patients were included prospectively in the study and followed a home-based PR program for 2 months comprising breathing exercises, training in chest hygiene techniques, peripheral muscle strengthening training, and self-walking. The outcomes measurements were the following: 6-minute walking distance, pulmonary function test, peripheral and respiratory muscle strength measurements, International Physical Activity Questionnaire (IPAQ), Saint George Respiratory Questionnaire, and modified Medical Research Council dyspnea scores. RESULTS Of the total 25 patients included in the study, six were excluded due to follow-up and adherence problems. A comparison of the outcome measures recorded before and after PR showed statistically significant improvements in the IPAQ total (p=0.015) and walking scores (p=0.011). While the proportion of patients in the low PA category was 73% (n=14) prior to PR, this rate decreased to 42% (n=8) post-PR. The proportion of patients in the moderate PA category was 26% (n=5) prior to PR and increased to 52% (n=10) post-PR. While positive improvements were seen in all clinically monitored parameters, aside from spirometric values, these changes did not reach a statistically significant level. CONCLUSION The majority of patients with bronchiectasis have a low level of PA. PR ensures positive improvements in the level of PA and general physical clinical status of such patients.
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Affiliation(s)
- Esra Pehlivan
- Clinic of Pulmonary Rehabilitation, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Elif Yelda Niksarlıoğlu
- Clinic of Pulmonary Rehabilitation, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Arif Balcı
- Clinic of Pulmonary Rehabilitation, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Lütfiye Kılıç
- Clinic of Pulmonary Rehabilitation, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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Pulmonary Rehabilitation Only Versus With Nutritional Supplementation in Patients With Bronchiectasis. J Cardiopulm Rehabil Prev 2018; 38:411-418. [DOI: 10.1097/hcr.0000000000000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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15
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dos Santos DO, de Souza HCD, Baddini-Martinez JA, Ramos EMC, Gastaldi AC. Effects of exercise on secretion transport, inflammation, and quality of life in patients with noncystic fibrosis bronchiectasis: Protocol for a randomized controlled trial. Medicine (Baltimore) 2018; 97:e9768. [PMID: 29443739 PMCID: PMC5839837 DOI: 10.1097/md.0000000000009768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bronchiectasis is characterized by pathological and irreversible bronchial dilatation caused by the inefficient mucus and microorganism clearance and progression of inflammatory processes. The most frequent characteristic is the increase in bronchial mucus production resulting in slower transport and damage to the mucociliary transport. AIMS To evaluate the effects of exercise on mucus transport, inflammation, and resistance of the respiratory and autonomic nervous systems and subsequent effects on quality of life in patients with bronchiectasis who are enrolled in a pulmonary rehabilitation program. METHODS Sixty subjects of both sexes between 18 and 60 years (30 volunteers with clinically stable bronchiectasis and 30 healthy volunteers) will be included. Participants with chronic obstructive pulmonary disease, decompensated cardiovascular or metabolic diseases, neuromuscular and musculoskeletal diseases, and active smokers will be excluded. Volunteers will be randomly allocated to the pulmonary rehabilitation or control groups. The primary outcomes will be nasal transport time as evaluated by nasal saccharin transport time, analysis of nasal lavage, enzyme immunoassay of exhaled expiration, and analysis of the mucus properties. The secondary outcomes will include pulmonary function tests, impulse oscillometry, heart rate variability analysis, and quality of life questionnaires. DISCUSSION In addition to the benefits for patients already described in the literature, the additional benefit of mucus removal may contribute to optimizing treatments and better control of the disease. CONCLUSION This protocol could provide new information about the unclear mechanisms regarding exercise to aid in the removal of secretions.
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Affiliation(s)
| | | | | | - Ercy Mara Cipulo Ramos
- Department of Physiotherapy, São Paulo State University, Presidente Prudente, São Paulo, Brazil
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16
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Yoon SY, Kim YW, Choi JY. Pulmonary Rehabilitation in a Patient With Bronchiectasis and Underlying Cerebral Palsy: A Case Presentation. PM R 2017; 10:548-551. [PMID: 28988977 DOI: 10.1016/j.pmrj.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022]
Abstract
Bronchiectasis is a chronic pulmonary disease characterized by the permanent dilatation of the airways, with recurrent infections. As the disease progresses, extrapulmonary symptoms manifest. If the patient with bronchiectasis has an underlying central nervous system disease such as cerebral palsy (CP), extrapulmonary functions decline faster. The co-occurrence of these 2 diseases may make care more complex, and there have been no reports about pulmonary rehabilitation (PR) in this class of patients. Here, we present a patient with bronchiectasis and underlying CP who showed marked improvement of pulmonary function and clinical symptoms after 6 weeks of a patient-specific intensive PR program. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea; Department of Medicine, Graduate Program, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Physical Medicine and Rehabilitation, Eulji University Hospital, Eulji University College of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea; Department of Medicine, Graduate Program, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Physical Medicine and Rehabilitation, Eulji University Hospital, Eulji University College of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
| | - Ja Young Choi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea; Department of Medicine, Graduate Program, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Physical Medicine and Rehabilitation, Eulji University Hospital, Eulji University College of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
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José A, Holland AE, Oliveira CSD, Selman JPR, Castro RASD, Athanazio RA, Rached SZ, Cukier A, Stelmach R, Corso SD. Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care? Braz J Phys Ther 2017; 21:473-480. [PMID: 28869119 PMCID: PMC5693395 DOI: 10.1016/j.bjpt.2017.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/26/2017] [Accepted: 06/22/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis. OBJECTIVES To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis. METHODS An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. INTERVENTIONS The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20min (intensity: 60-80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). CONTROL The patients will receive an educational manual and a recommendation to walk three times a week for 30min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. MAIN OUTCOME MEASURES incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization. DISCUSSION The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis. TRIAL REGISTRATION www.ClinicalTrials.gov (NCT02731482). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00060X6&selectaction=Edit&uid=U00028HR&ts=2&cx=1jbszg.
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Affiliation(s)
- Anderson José
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil.
| | - Anne E Holland
- La Trobe University, Institute for Breathing and Sleep, Melbourne, Australia
| | - Cristiane S de Oliveira
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
| | - Jessyca P R Selman
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
| | - Rejane A S de Castro
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
| | - Rodrigo A Athanazio
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Samia Z Rached
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Alberto Cukier
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Rafael Stelmach
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Simone Dal Corso
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
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18
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Lee AL, Hill CJ, McDonald CF, Holland AE. Pulmonary Rehabilitation in Individuals With Non–Cystic Fibrosis Bronchiectasis: A Systematic Review. Arch Phys Med Rehabil 2017; 98:774-782.e1. [DOI: 10.1016/j.apmr.2016.05.017] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/27/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
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19
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Field Walking Tests Are Reliable and Responsive to Exercise Training in People With Non–Cystic Fibrosis Bronchiectasis. J Cardiopulm Rehabil Prev 2015; 35:439-45. [DOI: 10.1097/hcr.0000000000000130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Olveira G, Olveira C, Doña E, Palenque FJ, Porras N, Dorado A, Godoy AM, Rubio-Martínez E, Rojo-Martínez G, Martín-Valero R. Oral supplement enriched in HMB combined with pulmonary rehabilitation improves body composition and health related quality of life in patients with bronchiectasis (Prospective, Randomised Study). Clin Nutr 2015; 35:1015-22. [PMID: 26522923 DOI: 10.1016/j.clnu.2015.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/02/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND & AIMS Pulmonary Rehabilitation (PR) is recommended for bronchiectasis but there is no data about its effect on body composition. The aim of this study is to assess the effect of Pulmonary Rehabilitation (PR) for 12 weeks in normally-nourished non-cystic-fibrosis bronchiectasis patients compared with the effect of PR plus a hyperproteic oral nutritional supplement enriched with beta-hydroxy-beta-methylbutyrate (HMB) on body composition, muscle strength, quality of life and serum biomarkers. METHODS single center randomized controlled trial, parallel treatment design: Participants were randomly assigned to receive PR for 12 weeks or PR plus ONS (PRONS) (one can per day). Outcome assessments were performed at baseline, 12 weeks and 24 weeks: body composition (Dual-energy X-Ray Absorptiometry (DEXA), mid-arm muscle circumference (MAMC), phase angle by Bio-impedance), health related quality of life (Spanish QOL-B-V3.0, Physical Functioning Scale), handgrip strength, diet questionnaire, and plasma levels of prealbumin, myostatin and somatomedin-c. RESULTS Thirty patients were randomized (15 per group) without differences in clinical and respiratory variables. In the PRONS group bone mineral density (BMD), mean and maximum handgrip dynamometry, MAMC, QOLB and prealbumin were significantly increased from baseline at 12 and 24 weeks and Fat free Mass (FFM) and FFM index, at 12 weeks. In the PR group only mean handgrip dynamometry and prealbumin were significantly increased at 12 and 24 weeks. In both groups plasma myostatin was reduced at 12 weeks (without significant differences). CONCLUSION The addition of a hyperproteic ONS enriched with HMB to Pulmonary Rehabilitation could improve body composition, BMD, muscle strength and health related quality of life in bronchiectasis patients. Clinical Trials Number NCT02048397.
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Affiliation(s)
- Gabriel Olveira
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain; CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain.
| | - Casilda Olveira
- UGC de Neumología, IBIMA (instituto de Biomedicina de Málaga), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain, Avenida Carlos Haya, Málaga 29010, Spain.
| | - Esperanza Doña
- Neumología, Hospital de Alta resolución de Benalmádena, Spain.
| | | | - Nuria Porras
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain.
| | - Antonio Dorado
- UGC de Neumología, IBIMA (instituto de Biomedicina de Málaga), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain, Avenida Carlos Haya, Málaga 29010, Spain.
| | - Ana M Godoy
- UGC Rehabilitación, Hospital Regional Universitario de Málaga, Spain.
| | - Elehazara Rubio-Martínez
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain; CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain.
| | - Gemma Rojo-Martínez
- UGC Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain; CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain.
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21
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Chiavegato LD. Assessing quadriceps muscle strength as a tool to determine the approach to and prognosis in COPD patients. J Bras Pneumol 2015; 41:297-8. [PMID: 26398748 PMCID: PMC4635948 DOI: 10.1590/s1806-37132015000400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Vodanovich DA, Bicknell TJ, Holland AE, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Thompson P, Stirling RG, Lee AL. Validity and Reliability of the Chronic Respiratory Disease Questionnaire in Elderly Individuals with Mild to Moderate Non-Cystic Fibrosis Bronchiectasis. Respiration 2015; 90:89-96. [PMID: 26088151 DOI: 10.1159/000430992] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The chronic respiratory disease questionnaire (CRDQ) is designed to assess health-related quality of life (HRQOL) in chronic respiratory conditions, but its reliability, validity and responsiveness in individuals with mild to moderate non-cystic fibrosis (CF) bronchiectasis are unclear. OBJECTIVES This study aimed to determine measurement properties of the CRDQ in non-CF bronchiectasis. METHODS Participants with non-CF bronchiectasis involved in a randomised controlled trial of exercise training were recruited. Internal consistency was assessed using Cronbach's α. Over 8 weeks, reliability was evaluated using intra-class correlation coefficients and Bland-Altman analysis for measures of agreement. Convergent and divergent validity was assessed by correlations with the other HRQOL questionnaires and the Hospital Anxiety and Depression Scale (HADS). The responsiveness to exercise training was assessed using effect sizes and standardised response means. RESULTS Eighty-five participants were included (mean age ± SD, 64 ± 13 years). Internal consistency was adequate (>0.7) for all CRDQ domains and the total score. Test-retest reliability ranged from 0.69 to 0.85 for each CRDQ domain and was 0.82 for the total score. Dyspnoea (CRDQ) was related to St George's respiratory questionnaire (SGRQ) symptoms only (r = 0.38), with no relationship to the Leicester cough questionnaire (LCQ) or HADS. Moderate correlations were found between the total score of the CRDQ, the SGRQ (rs = -0.49) and the LCQ score (rs = 0.51). Lower CRDQ scores were associated with higher anxiety and depression (rs = -0.46 to -0.56). The responsiveness of the CRDQ was small (effect size 0.1-0.24). CONCLUSIONS The CRDQ is a valid and reliable measure of HRQOL in mild to moderate non-CF bronchiectasis, but responsiveness was limited.
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Snijders D, Fernandez Dominguez B, Calgaro S, Bertozzi I, Escribano Montaner A, Perilongo G, Barbato A. Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis: Is there evidence? Int J Immunopathol Pharmacol 2015; 28:150-9. [PMID: 26078380 DOI: 10.1177/0394632015584724] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/18/2015] [Indexed: 11/17/2022] Open
Abstract
Non-cystic fibrosis bronchiectasis (nCFb) is an acquired condition of variable etiology. An impaired mucociliary clearance seems to be one of the mechanisms behind nCFb, and treatment involves antibiotics, mucoactive agents, and airway clearance techniques (ACTs). Traditional ACTs have four components: postural drainage, percussion, vibration of the chest wall, and coughing. Reviewing the international medical literature on the use of ACTs for patients with nCFb from 1989 to the present day, we retrieved 93 articles, of which 35 met our selection criteria for this analysis. We reviewed active cycle of breathing techniques (ACBT), forced expiration techniques (FET), autogenic drainage, postural drainage, oscillating positive expiratory pressure (OPep), high frequency chest wall oscillation (HFCWO), and exercise or pulmonary rehabilitation. Overall, ACTs appear to be safe for individuals (adults and children) with stable bronchiectasis; where there may be improvements in sputum expectoration, selected measures of lung function, and health-related quality of life. Unfortunately, there is a lack of RCTs in nCFb patients, especially in children. Moreover, none of the studies describes long-term effects of ACTs. It should be noted that a single intervention might not reflect the longer-term outcome and there is no evidence to recommend or contest any type of ACTs in nCFb management. Multicenter RCTs are necessary to evaluate the different techniques of ACTs especially in children with nCFb.
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Affiliation(s)
- D Snijders
- Department of Women's and Children's Health, University of Padova, Italy
| | | | - S Calgaro
- Department of Women's and Children's Health, University of Padova, Italy
| | - I Bertozzi
- Department of Women's and Children's Health, University of Padova, Italy
| | | | - G Perilongo
- Department of Women's and Children's Health, University of Padova, Italy
| | - A Barbato
- Department of Women's and Children's Health, University of Padova, Italy
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Bradley JM, Wilson JJ, Hayes K, Kent L, McDonough S, Tully MA, Bradbury I, Kirk A, Cosgrove D, Convery R, Kelly M, Elborn JS, O'Neill B. Sedentary behaviour and physical activity in bronchiectasis: a cross-sectional study. BMC Pulm Med 2015; 15:61. [PMID: 25967368 PMCID: PMC4456779 DOI: 10.1186/s12890-015-0046-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/22/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis. METHODS Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables. RESULTS Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV1% predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms). CONCLUSIONS Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV1% predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population. TRIAL REGISTRATION NCT01569009 ("Physical Activity in Bronchiectasis").
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Affiliation(s)
- Judy M Bradley
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Jason J Wilson
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Kate Hayes
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Lisa Kent
- Northern Ireland Clinical Research Network: Respiratory Health, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
| | - Suzanne McDonough
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, Northern Ireland, UK.
| | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, Northern Ireland, UK.
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, UK.
| | - Ian Bradbury
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
| | - Alison Kirk
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK.
| | - Denise Cosgrove
- Northern Ireland Clinical Research Network: Respiratory Health, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
| | - Rory Convery
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, UK.
| | - Martin Kelly
- Western Health and Social Care Trust, Altnagelvin Area Hospital, Derry, Northern Ireland, UK.
| | - Joseph Stuart Elborn
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, UK.
| | - Brenda O'Neill
- Centre for Health and Rehabilitation Technologies, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK.
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Zanini A, Aiello M, Adamo D, Cherubino F, Zampogna E, Sotgiu G, Chetta A, Spanevello A. Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis Bronchiectasis: A Retrospective Analysis of Clinical and Functional Predictors of Efficacy. Respiration 2015; 89:525-33. [DOI: 10.1159/000380771] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/31/2015] [Indexed: 11/19/2022] Open
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Burtin C, Hebestreit H. Rehabilitation in Patients with Chronic Respiratory Disease Other than Chronic Obstructive Pulmonary Disease: Exercise and Physical Activity Interventions in Cystic Fibrosis and Non-Cystic Fibrosis Bronchiectasis. Respiration 2015; 89:181-9. [DOI: 10.1159/000375170] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med 2014; 35:369-89. [PMID: 24874132 DOI: 10.1016/j.ccm.2014.02.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary rehabilitation (PR) is an important therapeutic intervention that should no longer be considered suitable only for patients with chronic obstructive pulmonary disease (COPD). A strong rationale exists for providing PR to persons with a broad range of respiratory disorders other than COPD. Evidence shows that PR for these patients is feasible, safe and effective. A disease-relevant approach should be undertaken, based on individual patients' needs. Further research is needed to better understand the optimal program content, duration and outcomes measures, to enable diverse patients to achieve maximal benefits of PR.
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep, Yale University School of Medicine, 333 Cedar Street, Building LCI-105, New Haven, CT 06520, USA.
| | - Carl Fairburn
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
| | - Rebecca H Crouch
- Duke Cardiopulmonary Rehabilitation, Duke University School of Medicine, 1821 Hillandale Road, Suite 25B, Durham, NC 27705, USA
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Lee AL, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Rautela L, Stirling RG, Thompson PJ, Holland AE. The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis--a randomised controlled trial. Respir Res 2014; 15:44. [PMID: 24731015 PMCID: PMC3996132 DOI: 10.1186/1465-9921-15-44] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/01/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exercise training is recommended for non-cystic fibrosis (CF) bronchiectasis, but the long-term effects are unclear. This randomised controlled trial aimed to determine the effects of exercise training and review of airway clearance therapy (ACT) on exercise capacity, health related quality of life (HRQOL) and the incidence of acute exacerbations in people with non-CF bronchiectasis. METHODS Participants were randomly allocated to 8 weeks of supervised exercise training and review of ACT, or control. Primary outcomes of exercise capacity and HRQOL (Chronic respiratory disease questionnaire) and secondary outcomes of cough-related QOL (Leicester cough questionnaire) and psychological symptoms (Hospital anxiety and depression scale) were measured at baseline, following completion of the intervention period and at 6 and 12 months follow up. Secondary outcomes of the exacerbation rate and time to first exacerbation were analysed over 12 months. RESULTS Eighty-five participants (mean FEV1 74% predicted; median Modified Medical Research Council Dyspnoea grade of 1 (IQR [1-3]) were included. Exercise training increased the incremental shuttle walk distance (mean difference to control 62 m, 95% CI 24 to 101 m) and the 6-minute walking distance (mean difference to control 41 m, 95% CI 19 to 63 m), but these improvements were not sustained at 6 or 12 months. Exercise training reduced dyspnoea (p = 0.009) and fatigue (p = 0.01) but did not impact on cough-related QOL or mood. Exercise training reduced the frequency of acute exacerbations (median 1[IQR 1-3]) compared to the control group (2[1-3]) over 12 months follow up (p = 0.012), with a longer time to first exacerbation with exercise training of 8 months (95% CI 7 to 9 months) compared to the control group (6 months [95% CI 5 to 7 months], p = 0.047). CONCLUSIONS Exercise training in bronchiectasis is associated with short term improvement in exercise capacity, dyspnoea and fatigue and fewer exacerbations over 12 months. TRIAL REGISTRY ClinicalTrials.gov (NCT00885521).
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Affiliation(s)
- Annemarie L Lee
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg 3084, Australia
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton 3010, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg 3084, Australia
- Austin Health, 145 Studley Road, Heidelberg 3084, Australia
| | - Nola Cecins
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth 6009, Australia
- Lung Institute of Western Australia and Centre for Asthma, Hospital Avenue, Nedlands, Perth 6009, Australia
| | - Sue Jenkins
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth 6009, Australia
- Lung Institute of Western Australia and Centre for Asthma, Hospital Avenue, Nedlands, Perth 6009, Australia
- Curtin University, Kent Street, Bentley, Perth 6102, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg 3084, Australia
- Austin Health, 145 Studley Road, Heidelberg 3084, Australia
| | - Angela T Burge
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia
| | - Linda Rautela
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg 3084, Australia
- Austin Health, 145 Studley Road, Heidelberg 3084, Australia
| | - Robert G Stirling
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia
- Department of Medicine, Monash University, Melbourne 3800, Australia
| | - Philip J Thompson
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth 6009, Australia
- Lung Institute of Western Australia and Centre for Asthma, Hospital Avenue, Nedlands, Perth 6009, Australia
- Curtin University, Kent Street, Bentley, Perth 6102, Australia
| | - Anne E Holland
- Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg 3084, Australia
- Physiotherapy, La Trobe University, Melbourne 3086, Australia
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