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Gephine S, Simonelli C, Vagheggini G, Evans R, Ward TJ. The impact of the meta-analysis of pulmonary rehabilitation by Lacasse and colleagues: transforming pulmonary rehabilitation from “art to science”. Breathe (Sheff) 2022; 18:220021. [PMID: 36337127 PMCID: PMC9584586 DOI: 10.1183/20734735.0021-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
#Pulmonaryrehab was transformed in the 1990s into the standard of care for COPD: this article focuses on the impact of the 1996 meta-analysis by Lacasse and colleagues which provided the evidence to silence the scepticshttps://bit.ly/3MIntBC
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Experiences of exercise in patients with asthma: qualitative analysis of discussions in a UK asthma online community. BJGP Open 2022; 6:BJGPO.2021.0162. [PMID: 35487580 DOI: 10.3399/bjgpo.2021.0162] [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: 09/06/2021] [Revised: 12/28/2021] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Engagement with exercise in adults with asthma is suboptimal. Limited information is available regarding factors affecting engagement with exercise. AIM To explore experiences of exercise and linked unmet needs in adults with asthma. DESIGN & SETTING Qualitative thematic analysis of posts in a UK asthma online community, written between 2015 and 2020. METHOD Posts were identified using keywords searches. Posts in the 'Exercise' topic section were additionally included. Thematic analysis of posts was undertaken. RESULTS 143 relevant posts were analysed. 92 participants were identified through posts (11M, 33F, 48 gender not stated, aged 26-73 years). Emerging themes included: fear of experiencing asthma symptoms during exercise, lack of information about how to deal with symptoms, external barriers, emotional response, and involvement of healthcare providers. Environmental factors, concomitant life stressors, distrust of healthcare professionals and embarrassment of displaying asthma symptoms during exercise were barriers to engagement. Facilitators included experiencing positive health outcomes following exercise and positive discussions regarding exercise with healthcare professionals. Strategies participants developed to enable exercise were warming up, increasing reliever and preventer inhalers when exercising and finding exercises felt as enjoyable. CONCLUSION Future interventions to address fears of exercise-induced physical symptoms, and clear instructions on the use of inhalers when exercising are needed. Exploring patients' attitudes to exercise in clinical consultations, especially in primary care, may be beneficial.
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3
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Bairapareddy KC, Augustine A, Alaparthi GK, Hegazy F, Shousha TM, Ali SA, Nagaraja R, Chandrasekaran B. Maximal Respiratory Pressures and Maximum Voluntary Ventilation in Young Arabs: Association with Anthropometrics and Physical Activity. J Multidiscip Healthc 2021; 14:2923-2930. [PMID: 34703244 PMCID: PMC8524059 DOI: 10.2147/jmdh.s333710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV) measurements assist in determining the respiratory muscle strength and endurance. These determinants of respiratory muscles vary significantly by age, gender, height, and ethnic origin. Normative values for maximum respiratory pressures (MRPs) and MVV would aid in evaluating respiratory muscle function in athletes, estimating performance, and assisting in rehabilitation. In addition, the reference values may aid in determining the efficacy of therapeutic interventions in young people with chronic respiratory diseases. The purpose of this study was to see how respiratory muscle strength indices correlated with anthropometric and physical activity characteristics in young Arabs. Methodology The study included 80 male volunteers and 85 female volunteers ranging in age from 18 to 30 years. MicroRPM was used to measure MIP and MEP, and pulmonary function test data, including MVV values, were recorded. All subjects completed the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements. Unpaired t-tests or Mann–Whitney U-tests were used to determine male-female differences. Using the Pearson correlation coefficient and Spearman Rho correlation coefficient tests, MIP and MEP values were correlated with body composition and physical activity. Using stepwise multiple linear regression analysis, the relationships between respiratory function (MVV, MIP, and MEP) and PFT values (FVC, FEV1, and FEV1/FVC), physical activity, and sedentary behavior were investigated. Results MIP, MEP, and MVV values were significantly lower in females than in males. MIP, MEP, and MVV values had a moderate correlation with forced vital capacity, forced expiratory volume in 1 second, and height, but not with weight, BMI, or GPAQ. Age, gender, and body mass index were found to be significant predictors of maximal respiratory pressures in a young Arab population. Conclusion Maximum respiratory pressures and maximal voluntary ventilation were significantly lower in young Arabs than in other ethnic groups; these values were influenced by gender and height but not by levels of physical activity.
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Affiliation(s)
| | - Anulucia Augustine
- Department of Cardiovascular and Respiratory Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatma Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Tamer Mohamed Shousha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Sara Atef Ali
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ravishankar Nagaraja
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, 110007, India
| | - Baskaran Chandrasekaran
- Department of Exercise Sciences and Sports, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Barjaktarevic I, Campos M. Management of lung disease in alpha-1 antitrypsin deficiency: what we do and what we do not know. Ther Adv Chronic Dis 2021; 12_suppl:20406223211010172. [PMID: 34408831 PMCID: PMC8367208 DOI: 10.1177/20406223211010172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
Management of lung disease in patients with alpha-1 antitrypsin deficiency (AATD) includes both non-pharmacological and pharmacological approaches. Lifestyle changes with avoidance of environmental pollutants, including tobacco smoke, improving exercise levels and nutritional status, all encompassed under a disease management program, are crucial pillars of AATD management. Non-pharmacological therapies follow conventional treatment guidelines for chronic obstructive pulmonary disease. Specific pharmacological treatment consists of administering exogenous alpha-1 antitrypsin (AAT) protein intravenously (augmentation therapy). This intervention raises AAT levels in serum and lung epithelial lining fluid, increases anti-elastase capacity, and decreases several inflammatory mediators in the lung. Radiologically, augmentation therapy reduces lung density loss over time, thus delaying disease progression. The effect of augmentation therapy on other lung-related outcomes, such as exacerbation frequency/length, quality of life, lung function decline, and mortality, are less clear and questions regarding dose optimization or route of administration are still debatable. This review discusses the rationale and available evidence for these interventions in AATD.
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Affiliation(s)
- Igor Barjaktarevic
- Division of Pulmonary and Critical Care
Medicine, David Geffen School of Medicine at University of California Los
Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Michael Campos
- Division of Pulmonary, Allergy, Critical Care
and Sleep Medicine, University of Miami School of Medicine, Miami, FL,
USA
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5
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Liu Q, Duan H, Lian A, Zhuang M, Zhao X, Liu X. Rehabilitation Effects of Acupuncture on the Diaphragm Dysfunction in Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2021; 16:2023-2037. [PMID: 34262271 PMCID: PMC8275099 DOI: 10.2147/copd.s313439] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/01/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Diaphragm dysfunction is a significant extrapulmonary effect in chronic obstructive pulmonary disease (COPD), which is manifested by changes in diaphragm structure and reduced diaphragm strength. Acupuncture is a traditional rehabilitation technique in China, which has been used in rehabilitation for COPD. But whether acupuncture can improve the diaphragm function of COPD patients remains to be verified. Objective The objective of this study was to evaluate the rehabilitation effects of acupuncture on diaphragm dysfunction in patients with COPD. Methods The authors retrieved in CNKI, VIP, SinoMed, PubMed, Ebsco, Web of Science, from inception to November 2020, for relevant randomized control trials. Two researchers independently screened the articles and extracted the data. The quality of the included studies was evaluated by Physiotherapy Evidence Database scale. The primary outcome measures were maximal inspiratory pressure and the scale for accessory respiratory muscle mobilization, the secondary outcome measures were pulmonary function-related indicators and arterial blood gas indicators. Results Nine articles were finally obtained. Seven studies added acupuncture to standard treatment for patients with diaphragm dysfunction in COPD and found statistically significant changes in the maximum inspiratory pressure and the scale for accessory respiratory muscle mobilization. Two studies have proved that use acupuncture combined with other Traditional Chinese Medicine methods in the rehabilitation for COPD can effectively improve the diaphragm strength and diaphragmatic motor performance. Seven studies showed that acupuncture has obvious improvement in pulmonary ventilation function. Seven studies reported significant differences in arterial blood gas pre- to post-intervention. Conclusion This systematic review found that acupuncture can effectively enhance the diaphragm strength, relieve respiratory muscle fatigue, it can also play a promoting role in improving lung function, hypoxia, and carbon dioxide retention, as well as preventing and alleviating respiratory failure. The generalizability of these results is limited by the design of the included studies.
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Affiliation(s)
- Qinxin Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Hongxia Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Anbei Lian
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Min Zhuang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xianli Zhao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Engineering Research Center of Intelligent Rehabilitation of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Ohno T, Tanaka N, Fujimori M, Okamoto K, Hagiwara S, Hojo K, Shigematsu T, Sugi T, Kanazawa H, Kunieda K, Fujishima I. Cough-Inducing Method Using a Tartaric Acid Nebulizer for Patients with Silent Aspiration. Dysphagia 2021; 37:629-635. [PMID: 33977315 PMCID: PMC9072470 DOI: 10.1007/s00455-021-10313-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022]
Abstract
The tartaric acid nebulizer is a well-known cough test to evaluate cough function. This study aimed to evaluate the effectiveness of a cough-inducing method using tartaric acid (CiTA). Patients with dysphagia examined by videofluoroscopic examination of swallowing (VF) at a single institution from May 2017 to August 2017 were included in this retrospective observational study. Although undergoing VF, patients who had aspirated without reflexively coughing or who had coughed insufficiently, were instructed to cough voluntarily. Patients who could not cough voluntarily or had expectorated insufficiently underwent the CiTA method. The rate of cough induction and the effectiveness of expectoration using the CiTA method were evaluated. One hundred fifty-four patients (mean age 69.2 ± 16.8 years) were evaluated. Eighty-seven patients aspirated during VF. Of those patients, 15 were able to expectorate via the cough reflex, 18 were able to expectorate with a voluntary cough, and 12 required suctioning for removal of aspirated material. The remaining 42 patients underwent the CiTA method. Thirty-eight patients (90.4%) could reflexively cough, and 30 (71.4%) could expectorate the aspirated material. This novel method, CiTA, was effective for cough induction in patients with dysphagia, especially for those with silent aspiration.
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Affiliation(s)
- Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Naomi Tanaka
- Department of Nursing, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Mariko Fujimori
- Department of Nursing, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Satoe Hagiwara
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Kyoko Hojo
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan
| | - Takafumi Sugi
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan
| | - Hideaki Kanazawa
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan.,Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan.
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7
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Tung LF, Shen SY, Shih HH, Chen YT, Yen CT, Ho SC. Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study. Respir Res 2020; 21:84. [PMID: 32293463 PMCID: PMC7158083 DOI: 10.1186/s12931-020-1328-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD. Methods We enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software. Result We recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group. Conclusions HFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.
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Affiliation(s)
- Lan-Fang Tung
- Division of Pulmonary Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan
| | - Sheng-Yeh Shen
- Division of Pulmonary Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Hui-Hsuan Shih
- Division of Pulmonary Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Yen-Ting Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Chia-Te Yen
- Division of Pulmonary Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan. .,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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8
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Hindelang M, Kirsch F, Leidl R. Effectiveness of non-pharmacological COPD management on health-related quality of life - a systematic review. Expert Rev Pharmacoecon Outcomes Res 2020; 20:79-91. [PMID: 32098530 DOI: 10.1080/14737167.2020.1734455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. The chronic progressive disease is accompanied by a high loss of health-related quality of life (HRQoL). The available drugs usually only have symptomatic effects; therefore, non-pharmacological therapies are essential too.Areas covered: This systematic review examines non-pharmacological interventions consisting of pulmonary rehabilitation, physical activity, and training versus usual care or no intervention in COPD using at least one of the following HRQoL measuring instruments: St. George's Respiratory Questionnaire, Clinical COPD Questionnaire, COPD Assessment Test, and EuroQol-5D. Of 1532 identified records from CENTRAL, MEDLINE, and EMBASE, 15 randomized controlled trials met the inclusion criteria. Pulmonary rehabilitation programs were investigated in nine studies, education and counseling-based training programs in three studies, and breathing exercises in three studies. Ten studies were found that investigated non-pharmacological treatment programs that led to a significant and clinically relevant improvement in HRQoL compared with usual care or no treatment.Expert opinion: Non-pharmacological interventions consisting of pulmonary rehabilitation, education and counseling-based training programs, and breathing exercises can improve the HRQoL of COPD patients.
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Affiliation(s)
- Michael Hindelang
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Ludwig-Maximilians-Universität München, Munich, Germany.,Pettenkofer School of Public Health. Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Florian Kirsch
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany
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9
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Caruso FR, Trimer R, da Luz Goulart C, Ricci PA, Araújo ASG, Carmargo P, Marinho RS, Baptista P, da Silva ALG, Mendes RG, Borghi-Silva A. Thoracoabdominal mobility evaluation of asthmatic patients in physiotherapy practice: Intra-rater reliability. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1837. [PMID: 32135037 DOI: 10.1002/pri.1837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/03/2019] [Accepted: 02/08/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The evaluation of thoracoabdominal mobility is a tool extensively used in the physiotherapy practice in different populations. Photogrammetry may be a simple tool to analyse thoracoabdominal mobility; however, it is unclear whether this assessment can be a reliable method. AIM To test the reliability intra-examinator by photogrammetry in asthmatic patients and in health controls. METHODS Twenty-six asthmatic patients (29 ± 9 years) and 14 healthy matched controls (27 ± 8 years) were assessed by thoracoabdominal mobility. Photographs during rest, during inspiration and expiration maximum were used to calculate latero-lateral and antero-posterior diameters of the thorax (at axillary and xiphoid levels) and umbilical by markers positioned in osseous structures. An evaluator obtained the same measurements in an 8-day interval. RESULTS We found a moderate reliability for axillary, xiphoid and umbilical mobility (average intraclass correlation coefficient [ICC] respectively [0.68, 0.55 and 0.73]) for asthmatic group. In addition, for control group, we found a moderate reliability for axillary mobility (average ICC respectively [0.68] and a good reliability for xiphoid and umbilical mobility) (average ICC 0.81 and 0.70). Bland-Altman plots showed goods limit of agreement in photos 1 and 2 in both groups. CONCLUSION The photogrammetric analysis of thoracoabdominal mobility presented itself as a reliable method and may be used in clinical practice in asthmatic patients and in controls.
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Affiliation(s)
- Flávia R Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Renata Trimer
- Physical Education and Health Department, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Cassia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Paula A Ricci
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Adriana S G Araújo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Patrícia Carmargo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Polliana Baptista
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Andrea L G da Silva
- Physical Education and Health Department, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
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10
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Stringer W, Marciniuk D. The Role of Cardiopulmonary Exercise Testing (CPET) in Pulmonary Rehabilitation (PR) of Chronic Obstructive Pulmonary Disease (COPD) Patients. COPD 2018; 15:621-631. [PMID: 30595047 DOI: 10.1080/15412555.2018.1550476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common multisystem inflammatory disease with ramifications involving essentially all organ systems. Pulmonary rehabilitation is a comprehensive program designed to prevent and mitigate these disparate systemic effects and improve patient quality of life, functional status, and social functioning. Although initial patient assessment is a prominent component of any pulmonary rehabilitation (PR) program, cardiopulmonary exercise testing (CPET) is not regularly performed as a screening physiologic test prior to PR in COPD patients. Further, CPET is not often used to assess or document the improvement in exercise capacity related to completion of PR. In this review we will describe the classic physiologic abnormalities related to COPD on CPET parameters, the role of CPET in Risk Stratification/Safety prior to PR, the physiologic changes that occur in CPET parameters with PR, and the literature regarding the use of CPET to assess PR results. Finally, we will compare CPET to 6MW in COPD PR, the common minimal clinically important difference (MCID) is associated with CPET, and the potential future roles of CPET in PR and Research.
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Affiliation(s)
- William Stringer
- a Chronic Diseases Clinical Research Center (CDCRC), Los Angeles Biomedical Institute at Harbor-UCLA Medical Center , David Geffen School of Medicine at UCLA , Torrance , CA , USA
| | - Darcy Marciniuk
- b Respiratory Research Center, Royal University Hospital , University of Saskatchewan , Saskatoon , Canada
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11
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Kim BS, Kim JH, Park SH, Seo HS, Lee HS, Lee MM. Effect of a Respiratory Training Program Using Wind Instruments on Cardiopulmonary Function, Endurance, and Quality of Life of Elderly Women. Med Sci Monit 2018. [PMID: 30056459 PMCID: PMC6080582 DOI: 10.12659/msm.909492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Physical changes due to aging lead to weakening of respiratory muscles and decreased lung functions that result in increasing risk of chronic respiratory disease. A complex respiratory rehabilitation program is needed to prevent respiratory diseases and improve lung functions and quality of life. The purpose of the present study was to examine the effects of respiratory training programs on pulmonary functions, cardiovascular endurance, and quality of life in elderly women. Material/Methods The program was structured with respiration exercise and playing wind musical instruments for 10 weeks (n=13) and 5 weeks (n=16), respectively, for elderly women in 2 different community welfare centers. The program consisted of breathing exercises twice a week, 20 min per session, and 40 min of wind instrumentation. Effects were assessed using forced vital capacity (FVC), forced expiratory volume-one second (FEV1), FEV1/FVC ratio (FEV1%), maximum voluntary ventilation (MVV), 6-minute walk test (6MWT), modified Borg scale (MBS), and life satisfaction scale (LSS). Results The 10-week program group (10WPG) showed significant differences in FVC, MVV, 6MWT, MBS, and LSS before and after interventions (p<.05), and the 5-week program group (5WPG) showed significant differences in FVC and 6MWT. MVV, MBS, and LSS were not significantly different between the 2 groups (p<.05). Conclusions This study confirms that the long-term respiration training program has positive effects on pulmonary functions, cardiopulmonary endurance, and quality of life. Various respiratory training programs and long-term implementations are needed to prevent respiratory illness and to improve lung functions and quality of life of respiratory patients.
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Affiliation(s)
- Byeong-Soo Kim
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| | - Ji-Hoe Kim
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| | - So-Hyun Park
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| | - Hyeon-Seon Seo
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| | - Hye-Sun Lee
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
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12
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Berry MJ, Sheilds KL, Adair NE. Comparison of Effects of Endurance and Strength Training Programs in Patients with COPD. COPD 2018; 15:192-199. [PMID: 29658804 DOI: 10.1080/15412555.2018.1446926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Comparisons between endurance and strength training in chronic obstructive pulmonary disease (COPD) patients have produced equivocal findings when examining physical function and health-related quality of life (HRQL). One reason for these differences may be due to individual patient responses to the different training modalities. PURPOSE To compare changes in physical function and HRQL in a group of COPD patients completing both an endurance and a strength training program. METHODS Eleven mildly diseased patients completed a three month endurance training program and, approximately 5 years later, completed a three month strength training program. Changes in 6 minute walk distance (6 MW), time to rise from a chair five times (CRT), and the total score and subscores from the SF-36 and Chronic Respiratory Disease Questionnaire (CRQ) were examined. RESULTS The forced expiratory volume as a percent of predicted remained relatively constant over the 5 years (61.1 ± 5.9 vs. 60.0 ± 10.3). Endurance and strength training increased 6 MW by 48.2 ± 11.2 (p = 0.008) and 39.8 ± 9.8 (p = 0.001) meters, respectively. Endurance and strength training decreased CRT by 4.8 ± 0.7 (p = 0.001) and 1.3 ± 1.2 (p = 0.056) seconds, respectively. Endurance training resulted in greater improvements in HRQL as compared to strength training. CONCLUSION These results show that walk distance improves as a result of participating in either an endurance or a strength training program. However, an endurance training program leads to greater improvements in both general and disease specific measures of HRQL.
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Affiliation(s)
- Michael J Berry
- a Health and Exercise Science Department , Wake Forest University , Winston-Salem , North Carolina , USA
| | - Katherine L Sheilds
- a Health and Exercise Science Department , Wake Forest University , Winston-Salem , North Carolina , USA
| | - Norman E Adair
- b Department of Medicine , Wake Forest University , Winston-Salem , North Carolina , USA
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Aksu NT, Erdogan A, Ozgur N. Effects of progressive muscle relaxation training on sleep and quality of life in patients with pulmonary resection. Sleep Breath 2017; 22:695-702. [PMID: 29290053 DOI: 10.1007/s11325-017-1614-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The inadequate quality and nature of sleep is a commonly reported problem among hospitalized patients. The purpose of this study is to examine the effects of progressive muscle relaxation training program on sleep quality, sleep state, pain, and quality of life in patients who underwent pulmonary resection. METHODS Our study was planned as a single-blind prospective randomized controlled trial. The study was conducted on 26 patients who underwent surgery by using posterolateral thoracotomy method. Progressive muscle relaxation training were given to the training group with a therapist two times a day. Sleep quality, daytime sleeping, pain, and quality of life were respectively evaluated in the morning before the surgery and 1 week after the surgery by using Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, visual analogue scale, and Euro Quality of Life-5D (EQ-5D). RESULTS There is no significant difference between preoperative groups in the total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Euro Quality of Life-5D, and visual analogue scale scores (p > 0.05). The intra-group change in the study group showed a significant deterioration in the Euro Quality of Life-5D and visual analogue scale scores (p < 0.05). There was a significant deterioration in the total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, EQ-5D, and visual analogue scale scores in the control group (p < 0.05). The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Euro Quality of Life-5D scores showed significant improvements in the relaxation training group after treatment at 1 week (p < 0.05). CONCLUSIONS Progressive muscle relaxation prevents a decline in patient-reported sleep quality following pulmonary resection.
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Affiliation(s)
- Neriman Temel Aksu
- Department of Physical Therapy and Rehabilitation, Akdeniz University, Antalya, Turkey.
| | - Abdullah Erdogan
- Department of Thoracic Surgery, Akdeniz University Faculty Of Medicine, Antalya, Turkey
| | - Nazmiye Ozgur
- Department of Thoracic Surgery, Akdeniz University Hospital, Antalya, Turkey
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Fabre C, Chehere B, Bart F, Mucci P, Wallaert B, Grosbois JM. Relationships between heart rate target determined in different exercise testing in COPD patients to prescribed with individualized exercise training. Int J Chron Obstruct Pulmon Dis 2017; 12:1483-1489. [PMID: 28553100 PMCID: PMC5439969 DOI: 10.2147/copd.s129889] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background It has been scientifically proven that pulmonary rehabilitation improves exercise tolerance and facilitates the carrying out of daily physical activities. To optimize the physical and physiological benefits, it is necessary to individualize the training intensity for each patient. The aim of this study is to compare the heart rate (HR) responses to three exercise modalities measuring aerobic fitness in chronic obstructive pulmonary disease patients, in order to easily prescribe individual target HRs for endurance training. Patients and method Fifty COPD patients (mean age: 60.1±8.5 years) were included in the study. Each patient carried out a cardiopulmonary exercise test, a 6-minute walk test (6MWT) and a 6-minute stepper test (6MST). During these tests, HR was recorded continuously. After the cardiopulmonary exercise test, the HR was noted at the ventilatory threshold (VT) and at the end of the two exercise field tests (6MWTpeak and 6MSTpeak). The values of the HR during the last 3 minutes of both field tests were averaged (6MWT456 and 6MST456). Finally, the HR at 60% of the HR reserve was calculated with the values of the HR measured during 6MWT and 6MST (HRr60%walk, HRr60%step). Results The HRs measured during the 6MST were significantly higher than those measured during the 6MWT. The HRr60%step was not significantly different from 6MWT456 and 6MWTpeak HR (P=0.51; P=0.48). A significant correlation was observed between 6MWT456 and 6MWTpeak (r=0.58). The 6MWT456 and 6MWTpeak HR were correlated with HRr60%step (r=0.68 and r=0.62). The VT could be determined in 28 patients. The HRVT was not different from 6MWT456, 6MWTpeak, and HRr60%step (P=0.57, P=0.41 and P=0.88) and was correlated to 6MWT456, 6MWTpeak, and HRr60%step (r=0.45, r=0.40, r=0.48). Conclusion An individualized target HR for endurance training can be prescribed from the HR measured during routine tests, such as 6MWT or 6MST.
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Affiliation(s)
- Claudine Fabre
- University of Lille, EA-7369 - URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Faculté des Sciences du Sport et de I'EP, Ronchin
| | - Baptiste Chehere
- University of Lille, EA-7369 - URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Faculté des Sciences du Sport et de I'EP, Ronchin
| | - Frédéric Bart
- Centre Hospitalier Béthune, Service de Pneumologie et d'Allergologie, Rue Delbecque, Beuvry
| | - Patrick Mucci
- University of Lille, EA-7369 - URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Faculté des Sciences du Sport et de I'EP, Ronchin
| | - Benoit Wallaert
- CHRU Lille - Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille and Hospital Center Regional University De Lille, Lille
| | - Jean Marie Grosbois
- Centre Hospitalier Béthune, Service de Pneumologie et d'Allergologie, Rue Delbecque, Beuvry.,FormAction Santé, ZA du Bois, Pérenchies, France
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Endurance and strength training in pulmonary rehabilitation for COPD patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sewell L, Singh SJ. The Canadian Occupational Performance Measure: Is it a Reliable Measure in Clients with Chronic Obstructive Pulmonary Disease? Br J Occup Ther 2016. [DOI: 10.1177/030802260106400607] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Canadian Occupational Performance Measure (COPM) is now a widely used and accepted outcome measure for clients with chronic conditions. The aim of this study was to examine the reproducibility of the COPM in clients with chronic obstructive pulmonary disease (COPD). Test-retest reliability of the performance and satisfaction scores has yet to be established in this population. The reasons for examining reliability are discussed. Fifteen clinically stable clients (eight men and seven women, mean age 67.1 years) were interviewed by an occupational therapist and their COPM performance and satisfaction scores recorded. A reassessment of the performance and satisfaction scores then took place about 7 days later. The scores were analysed using the mean difference, 95% confidence intervals and correlation coefficients. The results were as follows: performance score 1 and performance score 2: mean difference = 0.14 (95% CI: −0.39 to 0.68); and satisfaction score 1 and satisfaction score 2: mean difference = 0.42 (95% CI: −0.18 to 1.01). The intraclass correlation coefficients between test 1 and test 2 were high (r = 0.92 for performance and r = 0.90 for satisfaction). This study indicates that the COPM is a reliable tool in clients with COPD.
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Affiliation(s)
- K Hill
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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ZuWallack R, Hashim A, McCusker C, Normandin E, Benoit-Connors ML, Lahiri B. The trajectory of change over multiple outcome areas during comprehensive outpatient pulmonary rehabilitation. Chron Respir Dis 2016; 3:11-8. [PMID: 16509173 DOI: 10.1191/1479972306cd096oa] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although pulmonary rehabilitation has proven effectiveness in multiple outcome areas, the optimum duration of this intervention is not clear. We evaluated in an observational study the trajectory of change in upper and lower extremity exercise performance, exertional dyspnea and health status over the course of 12 weeks (24 sessions) of pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease. Demonstrating a plateau in response in these areas might be of practical use for pulmonary rehabilitation programs. We measured outcomes at baseline and at four session (two week) intervals over the course of our comprehensive outpatient pulmonary rehabilitation program. These included treadmill endurance time at approximately 85% of initial maximal workrate, the number of arm lifts per minute, dyspnea at isotime during treadmill walking and the Chronic Respiratory Disease Questionnaire (CRQ) total score. Thirteen patients with chronic obstructure pulmonary disease (COPD) (five male, eight female) were studied; their age was 66 ± 8 years and their FEV1 was 34 ± 1% of predicted. Improvement was noted in all four outcome areas very early in the course of pulmonary rehabilitation. Treadmill endurance time and arm lifts increased significantly over baseline by the fourth and eighth session, respectively, and both increased in a near linear fashion throughout pulmonary rehabilitation. Exertional dyspnea and CRQ also improved very early, with each showing a significant change from baseline by the fourth session. Their improvement, however, appeared to plateau relatively early during the course of pulmonary rehabilitation. Although the numbers studied are small and the applicability of these results to other programs is undetermined, this study does suggest that 20 or more sessions are needed for optimal acute changes in exercise performance, but improvement in dyspnea and quality of life may occur earlier.
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Affiliation(s)
- R ZuWallack
- The Section of Pulmonary and Critical Care Medicine, St Francis Hospital and Medical Center, Hartford, CT 06105, USA.
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Abstract
Among the nonpharmacological therapies, pulmonary rehabilitation (PR) is particularly appropriate for patients with chronic respiratory impairment who, despite any optimal drug management, are still symptomatic and experience restriction in every day activities. Pulmonary rehabilitation performed in inpatient, outpatient, or home settings demonstrates short–and long–term clinical efficacy. Although disease severity does not inherently dictate candidacy for exercise training, the degree of physiological and functional impairment may influence setting in which the training should occur. Therefore, inpatient rehabilitation is generally best–suited for the most sick and most disabled patients. The overall results from the literature confirm that the inpatient setting for a PR program is a feasible option and does not necessarily result in higher direct costs when balanced against duration and effectiveness in terms of improved outcomes.
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Affiliation(s)
- E M Clini
- Fondazione Villa Pineta and University of Modena-Reggio Emilia, Department of Pulmonary Rehabilitation, Pavullo, Italy.
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Datta D, ZuWallack R. High versus low intensity exercise training in pulmonary rehabilitation: is more better? Chron Respir Dis 2016; 1:143-9. [PMID: 16281656 DOI: 10.1191/1479972304cd018oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:Exercise training is considered a necessary component of comprehensive pulmonary rehabilitation. However, to date, there is no consensus on an exercise training strategy for pulmonary rehabilitation, and this has resulted in varied approaches to this intervention in its literature. As in healthy individuals, the effect of exercise training on patients with chronic lung disease is dose dependent, with higher intensities resulting in greater physiological adaptations than lower intensities. Results:It is not clear from our review of the literature that these enhanced physiological effects from higher levels of exercise training translate into a reduced burden of symptoms, hence a better quality of life. Indeed, there is some evidence that pulmonary rehabilitation approaches incorporating lower intensities of exercise training are at least as good in improving questionnaire rated symptoms of health status. This provides food for thought, since the prominent goal of pulmonary rehabilitation should be to reduce bothersome symptoms or enhance health status, not simply increase endurance time on a cycle ergometer.
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Affiliation(s)
- D Datta
- Department of Pulmonary and Critical Care Medicine, Manchester Hospital, Manchester, USA
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Spruit MA, Burtin C, De Boever P, Langer D, Vogiatzis I, Wouters EF, Franssen FM. COPD and exercise: does it make a difference? Breathe (Sheff) 2016; 12:e38-49. [PMID: 27408645 PMCID: PMC4933612 DOI: 10.1183/20734735.003916] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
KEY POINTS Physiological changes are observed following a structured exercise training programme in patients with COPD, without changes in resting lung function.Exercise training is the cornerstone of a comprehensive pulmonary rehabilitation programme in patients with COPD.Most comorbidities in patients referred for pulmonary rehabilitation remain undiagnosed and untreated.After careful screening, it is safe for COPD patients with comorbidities to obtain significant and clinically relevant improvements in functional exercise capacity and health status after an exercise-based pulmonary rehabilitation programme. EDUCATIONAL AIMS To inform readers of the positive effects of exercise-based pulmonary rehabilitation in patients with COPD, even with comorbid conditions.To inform readers of the importance of physical activity in patients with COPD. Exercise training is widely regarded as the cornerstone of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Indeed, exercise training has been identified as the best available means of improving muscle function and exercise tolerance in patients with COPD. So, exercise training truly makes a difference in the life of patients with COPD. In this review, an overview is provided on the history of exercise training (as standalone intervention or as part of a comprehensive pulmonary rehabilitation programme), exercise training in comorbid patients with COPD, and the impact of physical activity counselling in a clean air environment.
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Affiliation(s)
- Martijn A. Spruit
- Dept of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Patrick De Boever
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Daniël Langer
- Faculty of Kinesiology and Rehabilitation Sciences and University Hospitals Leuven, Respiratory Rehabilitation and Respiratory Division, KU Leuven-University of Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- National and Kapodistrian University of Athens, Faculty of Physical Education and Sports Sciences and 1st Dept of Respiratory Medicine, Athens, Greece
| | - Emiel F.M. Wouters
- Dept of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Frits M.E. Franssen
- Dept of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Nici L, ZuWallack R. Pulmonary Rehabilitation for Patients with Chronic Airways Obstruction. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:512-8. [PMID: 26164574 DOI: 10.1016/j.jaip.2015.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
Pulmonary rehabilitation is a patient-centered and interdisciplinary intervention with major components of exercise training and self-management education. Although having no direct effect on lung function, this intervention often results in substantial improvements in respiratory symptoms, functional status, and health status. It probably also reduces subsequent health care utilization, especially when provided after a hospitalization for an exacerbation of airways disease. The beneficial effects of pulmonary rehabilitation reflect its ability to reduce the impact of systemic consequences of chronic respiratory disease and to improve patients' self-efficacy through promoting collaborative self-management. Pulmonary rehabilitation is indicated for patients with respiratory diseases (regardless of specific diagnosis) who have persistent symptoms or functional or health status limitation despite otherwise optimal medical therapy. Those patients with severe asthma (particularly those with airways remodeling) or asthma-chronic obstructive pulmonary disease overlap who have daily symptoms and substantial functional/health status limitation despite controller and bronchodilator therapy would be appropriate candidates for pulmonary rehabilitation.
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Affiliation(s)
- Linda Nici
- Providence VA Medical Center, Providence RI
| | - Richard ZuWallack
- Department of Pulmonary Medicine, Critical Care - Medical, Saint Francis Medical Group, Hartford, Conn.
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Abstract
Knowledge about COPD has increased substantially in recent years. Smoking cessation campaigns have significantly decreased smoking prevalence in the United States, and similar efforts in the rest of the world will likely have the same impact. The consequence should be a drop in incidence of COPD in the years to come. The use of LTOT for hypoxemic patients has resulted in increased survival, and expanded drug therapy options have effectively improved dyspnea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. In addition, noninvasive mechanical ventilation offers new alternatives for patients with acute or chronic failure. Furthermore, the revival of surgery for emphysema may serve as an alternative to lung transplantation for patients with severe COPD who remain symptomatic despite maximal medical therapy. With all of these options, a nihilistic attitude toward management of COPD is not justified.
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Affiliation(s)
- Claudia G Cote
- University of South Florida College of Medicine, Tampa, USA
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25
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Chun EM, Han SJ, Modi HN. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:193-9. [PMID: 25670895 PMCID: PMC4315303 DOI: 10.2147/copd.s74438] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), using a fluoroscopy-guided chest X-ray. Patients and methods Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds. Results There were significant improvements (2,022.8±1,548.3 mm2 to 3,010.7±1,495.6 mm2 and 2,382.4±1,475.9 mm2 to 3,315.9±1,883.5 mm2; right side P=0.001 and left side P=0.019, respectively) in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation. Conclusion The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary rehabilitation in COPD patients in terms of cost and time savings compared with computed tomography or magnetic resonance imaging.
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Affiliation(s)
- Eun Mi Chun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Soo Jeong Han
- Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hitesh N Modi
- Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Republic of Korea
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Rossman MJ, Nader S, Berry D, Orsini F, Klansky A, Haverkamp HC. Effects of altered airway function on exercise ventilation in asthmatic adults. Med Sci Sports Exerc 2014; 46:1104-13. [PMID: 24576858 PMCID: PMC4028423 DOI: 10.1249/mss.0000000000000206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Variable airway function is a central feature of the asthmatic condition. Thus, habitually active asthmatics are certain to exercise under conditions of variable airway (dys)function. The purpose of this study was to determine the effects of variable preexercise airway function on ventilation during whole-body exercise in asthmatic adults. METHODS Eight mild asthmatic (age = 26 yr; V˙O2peak = 49 mL·kg·min) and nine nonasthmatic (age = 30 yr; V˙O2peak = 46 mL·kg·min) adults performed constant workrate cycling exercise to exhaustion after four separate interventions: 1) a control trial (CON); 2) inhalation of fast-acting β2-agonist (BD); 3) eucapnic voluntary hyperpnea challenge (BC); and 4) sham to the hyperpnea (SHAM). Pulmonary function was assessed at baseline and after each intervention. Exercise ventilation and operating lung volumes were compared among the four exercise trials in both control and asthmatic subjects. RESULTS Baseline pulmonary function was significantly lower in asthmatic subjects compared with control subjects. In asthmatic subjects, postintervention (i.e., preexercise) forced expiratory volume 1.0 s was significantly different among the four exercise trials (CON = 3.5 ± 0.4, BD = 4.1 ± 0.4, SHAM = 3.6 ± 0.3, BC = 2.8 ± 0.3 L, P < 0.05), whereas it was not different in control subjects. There were no differences in exercise ventilation or operating lung volumes during exercise among the four trials either within asthmatic subjects or between control and asthmatic subjects. CONCLUSIONS These findings suggest that the state of airway function-whether bronchodilated or bronchoconstricted-before exercise in the mild asthmatic does not affect the exercise ventilatory response. Thus, ventilatory system function in the asthmatic appears to be responsive to the acute requirement for increased airflow during whole-body exercise.
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Affiliation(s)
- Matthew J Rossman
- Department of Environmental and Health Sciences, Johnson State College, Johnson, VT
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da Costa CC, de Azeredo Lermen C, Colombo C, Canterle DB, Machado MLL, Kessler A, Teixeira PJZ. Effect of a Pulmonary Rehabilitation Program on the levels of anxiety and depression and on the quality of life of patients with chronic obstructive pulmonary disease. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:299-304. [PMID: 24874610 DOI: 10.1016/j.rppneu.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/27/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyze the effect of a Pulmonary Rehabilitation Program (PRP) on the levels of anxiety and depression and the quality of life of patients with chronic obstructive pulmonary disease. METHOD Patients with chronic obstructive pulmonary disease (COPD) who completed the PRP of 3 weekly sessions of 60 min duration for 12 weeks, a total of 36 sessions, were assessed using Beck Inventory (BAI and BDI) and Saint George's Respiratory Questionnaire (SGRQ). RESULTS A total of 125 individuals, with an average age of 63.7 ± 8.8 years, FEV1: 1.17 ± 0.57L (43.18 ± 18.79% predicted), 61.6% male and 38.4% female, were analyzed. The BAI and BDI before and after PRP were, respectively, 10.15 ± 6.32 vs. 7.67 ± 7.21; p=0.0041 and 12.60 ± 7.99 vs. 8.96 ± 7.29; p=0.00016. The results of the SGRQ domains were, respectively, Before and After symptoms (48.53 ± 20.41 vs. 32.58 ± 18.95), Activity (69.15 ± 20.79 vs. 52.42 ± 23.70), Impact (32.92 ± 18.29 vs. 20.27 ± 16.70), Total (46.69 ± 16.90 vs. 32.07 ± 16.96). When correlating the BDI to the domains of the SGRQ, weak correlations were observed (Symptoms r=0.22; p=0.01; Activity r=0.28; p=0.001; Impact r=0.52; p=2.72; Total r=0.44; p=0.17). In the same way, weak correlations were observed when correlating the BAI to the SGRQ (Symptoms r=0.28; p=0.0009; Activity r=0.32; p=0.0005; Impact r=0.42; p=7.33; Total r=0.43; p=0.74). CONCLUSION Although the PRP improves levels of depression and anxiety as well as the quality of life in patients with COPD, no significant correlation of these analyzed variables was observed.
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Affiliation(s)
- C C da Costa
- Universidade Federal do Rio Grande do Sul, Center for Health Sciences and Coordinator of the Pulmonary Rehabilitation Project, Universidade Feevale, Flores da Cunha, 111 ap. 504, CEP: 93410-110, Novo Hamburgo, RS, Brazil.
| | - C de Azeredo Lermen
- Universidade Feevale, Maurício Cardoso, 980 ap. 206, Novo Hamburgo, RS, Brazil.
| | - C Colombo
- Universidade Feevale, R. Silveira Martins, 655 ap. 905, Novo Hamburgo, RS, Brazil.
| | - D B Canterle
- Universidade Federal do Rio Grande do Sul, Center for Health Sciences, Universidade Feevale, Rua Caeté, 200 ap. 34, Novo Hamburgo, RS, Brazil.
| | - M L L Machado
- Universidade do Vale do Sinos, Center for Health Sciences, Universidade Feevale, Rua Adolfo Jaeger, 44 ap. 201, Novo Hamburgo, RS, Brazil.
| | - A Kessler
- Universidade Federal do Rio Grande do Sul, Center for Health Sciences, Universidade Feevale, RS, Brazil; Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Av. Itajaí, 368 ap. 301, Porto Alegre, RS, Brazil.
| | - P J Z Teixeira
- Universidade Federal do Rio Grande do Sul, Center for Health Sciences, Universidade Feevale, RS, Brazil; Department of Medical Clinic, Pulmonology, Universidade Federal de Ciências da Saúde de Porto Alegre, ERS 239, 2755, Novo Hamburgo, RS, Brazil.
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Thakrar R, Alaparthi GK, Kumar SKK, Vaishali K, Zulfeequer CP, Aanad R. Awareness in patients with COPD about the disease and pulmonary rehabilitation: A survey. Lung India 2014; 31:134-8. [PMID: 24778475 PMCID: PMC3999672 DOI: 10.4103/0970-2113.129837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Objective: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. It overloads the healthcare system and increase healthcare expenditure. As a patient's awareness enables him/her to acquire better self-management skills, it helps to reduce the severity and frequency of exacerbations, prevents hospitalizations, and improves health-related quality of life. The current study aims to assess the awareness amongst COPD patients about the disease itself and pulmonary rehabilitation. Materials and Methods: A cross-sectional survey was carried out in order to evaluate awareness through “a COPD awareness questionnaire”. This was developed and validated for its content. A total of 21 questions were included in this questionnaire. These questions were divided into two domains that included pulmonary disease (1-12) and pulmonary rehabilitation (13-21). Results: Three hundred patients were recruited of which 282 were included in the study. The subject group consisted of 177 males and 105 females. The mean age of the subjects was 63.54 ± 10.656. Awareness in the “disease domain” was 47.84% and “pulmonary rehabilitation domain” was 25.14%. Awareness about the causes of COPD was 34.8%, of common symptoms was 83.0%, and of activities of daily living that could increase breathlessness was found to be 73.8%. The need to consult a physiotherapist was reported by only 26.2%. 81.2% of the subjects believed that breathing exercise could cause breathlessness; whereas, only 19.5% were aware of secretion removal techniques. Conclusion: The findings of the study suggest an imminent need to educate the public about the disease and the scope of pulmonary rehabilitation and its role in the management of COPD. The education of patients in this regard needs to be incorporated into standard health care practice in order to improve their self-management skills and their quality of life.
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Affiliation(s)
- Raksha Thakrar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Bejai, Mangalore, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Bejai, Mangalore, Karnataka, India
| | | | - K Vaishali
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Bejai, Mangalore, Karnataka, India
| | - C P Zulfeequer
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Bejai, Mangalore, Karnataka, India
| | - R Aanad
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Bejai, Mangalore, Karnataka, India
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Chen X, May B, Di YM, Zhang AL, Lu C, Xue CC, Lin L. Oral Chinese herbal medicine combined with pharmacotherapy for stable COPD: a systematic review of effect on BODE index and six minute walk test. PLoS One 2014; 9:e91830. [PMID: 24622390 PMCID: PMC3951501 DOI: 10.1371/journal.pone.0091830] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/15/2014] [Indexed: 01/25/2023] Open
Abstract
This systematic review evaluated the effects of Chinese herbal medicine (CHM) plus routine pharmacotherapy (RP) on the objective outcome measures BODE index, 6-minute walk test (6MWT), and 6-minute walk distance (6MWD) in individuals with stable chronic obstructive pulmonary disease (COPD). Searches were conducted of six English and Chinese databases (PubMed, EMBASE, CENTRAL, CINAHL, CNKI and CQVIP) from their inceptions until 18th November 2013 for randomized controlled trials involving oral administration of CHM plus RP compared to the same RP, with BODE Index and/or 6MWT/D as outcomes. Twenty-five studies were identified. BODE Index was used in nine studies and 6MWT/D was used in 22 studies. Methodological quality was assessed using the Cochrane Risk of Bias tool. Weaknesses were identified in most studies. Six studies were judged as 'low' risk of bias for randomisation sequence generation. Twenty-two studies involving 1,834 participants were included in the meta-analyses. The main meta-analysis results showed relative benefits for BODE Index in nine studies (mean difference [MD] -0.71, 95% confidence interval [CI] -0.94, -0.47) and 6MWT/D in 17 studies (MD 54.61 meters, 95%CI 33.30, 75.92) in favour of the CHM plus RP groups. The principal plants used were Astragalus membranaceus, Panax ginseng and Cordyceps sinensis. A. membranaceus was used in combination with other herbs in 18 formulae in 16 studies. Detailed sub-group and sensitivity analyses were conducted. Clinically meaningful benefits for BODE Index and 6MWT were found in multiple studies. These therapeutic effects were promising but need to be interpreted with caution due to variations in the CHMs and RPs used and methodological weakness in the studies. These issues should be addressed in future trials.
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Affiliation(s)
- Xiankun Chen
- Evidence-Based Medicine & Clinical Research Service Group, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Brian May
- Traditional & Complementary Medicine Research Program, Health Innovations Research Institute, School of Health Sciences, RMIT University, Melbourne, Australia
| | - Yuan Ming Di
- Traditional & Complementary Medicine Research Program, Health Innovations Research Institute, School of Health Sciences, RMIT University, Melbourne, Australia
| | - Anthony Lin Zhang
- Traditional & Complementary Medicine Research Program, Health Innovations Research Institute, School of Health Sciences, RMIT University, Melbourne, Australia
| | - Chuanjian Lu
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Charlie Changli Xue
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Traditional & Complementary Medicine Research Program, Health Innovations Research Institute, School of Health Sciences, RMIT University, Melbourne, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Lin Lin
- Department of Respiratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China
- * E-mail:
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Marques A, Bruton A, Barney A. Clinically useful outcome measures for physiotherapy airway clearance techniques: a review. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/108331906x163441] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kikuchi H, Shiozawa N, Takata S, Ashida K, Mitsunobu F. Effect of repeated Waon therapy on exercise tolerance and pulmonary function in patients with chronic obstructive pulmonary disease: a pilot controlled clinical trial. Int J Chron Obstruct Pulmon Dis 2013; 9:9-15. [PMID: 24363555 PMCID: PMC3865971 DOI: 10.2147/copd.s50860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Controlled clinical trials evaluating the efficacy of repeated Waon therapy for patients with chronic obstructive pulmonary disease (COPD) have yet to be conducted. The purpose of the present study was to evaluate whether repeated Waon therapy exhibits an adjuvant effect on conventional therapy for COPD patients. PATIENTS AND METHODS This prospective trial comprised 20 consecutive COPD patients who satisfied the criteria of the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines, stages 1-4. They were assigned to either a Waon or control group. The patients in the Waon group received both repeated Waon therapy and conventional therapy, including medications, such as long-acting inhaled β2 agonists, long-acting anticholinergics and xanthine derivatives, and pulmonary rehabilitation. The Waon therapy consisted of sitting in a 60°C sauna room for 15 minutes, followed by 30 minutes of being warmed with blankets once a day, 5 days a week, for a total of 20 times. The patients in the control group received only conventional therapy. Pulmonary function and the 6-minute walk test were assessed before and at 4 weeks after the program. RESULTS The change in vital capacity (0.30 ± 0.4 L) and in peak expiratory flow (0.48 ± 0.79 L/s) in the Waon group was larger than the change in the vital capacity (0.02 ± 0.21 L) (P=0.077) and peak expiratory flow (-0.11 ± 0.72 L/s) (P=0.095) in the control group. The change in forced expiratory flow after 50% of expired forced vital capacity in the Waon group, 0.08 (0.01-0.212 L/s), was larger than that in the control group, -0.01 (-0.075-0.04 L/s) (P=0.019). Significant differences were not observed in the change in any parameters in the 6-minute walk test. Data are presented as means ± standard deviation or median (25th-75th percentile). CONCLUSION The addition of repeated Waon therapy to conventional therapy for COPD patients can possibly improve airway obstruction.
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Affiliation(s)
- Hiroshi Kikuchi
- Division of Medicine, Misasa Medical Center, Okayama University Hospital, Misasa, Tottori, Japan
- Division of Internal Medicine, Takamatsu Hospital KKR, Takamatsu, Japan
| | - Nobuyoshi Shiozawa
- Division of Medicine, Misasa Medical Center, Okayama University Hospital, Misasa, Tottori, Japan
| | - Shingo Takata
- Division of Medicine, Misasa Medical Center, Okayama University Hospital, Misasa, Tottori, Japan
| | - Kozo Ashida
- Division of Medicine, Misasa Medical Center, Okayama University Hospital, Misasa, Tottori, Japan
| | - Fumihiro Mitsunobu
- Division of Medicine, Misasa Medical Center, Okayama University Hospital, Misasa, Tottori, Japan
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Grave de Peralta R, Gonzalez Andino S, Perrig S. Patient machine interface for the control of mechanical ventilation devices. Brain Sci 2013; 3:1554-68. [PMID: 24961620 PMCID: PMC4061889 DOI: 10.3390/brainsci3041554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/12/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022] Open
Abstract
The potential of Brain Computer Interfaces (BCIs) to translate brain activity into commands to control external devices during mechanical ventilation (MV) remains largely unexplored. This is surprising since the amount of patients that might benefit from such assistance is considerably larger than the number of patients requiring BCI for motor control. Given the transient nature of MV (i.e., used mainly over night or during acute clinical conditions), precluding the use of invasive methods, and inspired by current research on BCIs, we argue that scalp recorded EEG (electroencephalography) signals can provide a non-invasive direct communication pathway between the brain and the ventilator. In this paper we propose a Patient Ventilator Interface (PVI) to control a ventilator during variable conscious states (i.e., wake, sleep, etc.). After a brief introduction on the neural control of breathing and the clinical conditions requiring the use of MV we discuss the conventional techniques used during MV. The schema of the PVI is presented followed by a description of the neural signals that can be used for the on-line control. To illustrate the full approach, we present data from a healthy subject, where the inspiration and expiration periods during voluntary breathing were discriminated with a 92% accuracy (10-fold cross-validation) from the scalp EEG data. The paper ends with a discussion on the advantages and obstacles that can be forecasted in this novel application of the concept of BCI.
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Affiliation(s)
| | | | - Stephen Perrig
- Geneva Sleep Lab, Department of Neuropsychiatry, Geneva University Hospital (HUG), Geneva 1225, Switzerland.
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Muller JP, Gonçalves PAG, Fontoura FFD, Mattiello R, Florian J. Applicability of the London Chest Activity of Daily Living scale in patients on the waiting list for lung transplantation. J Bras Pneumol 2013; 39:92-7. [PMID: 23503491 PMCID: PMC4075799 DOI: 10.1590/s1806-37132013000100013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/16/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate the applicability of the London Chest Activity of Daily Living
(LCADL) scale in patients on the waiting list for lung transplantation. METHODS: This was a cross-sectional study, conducted between May and September of 2010,
involving 26 male and female patients on the waiting list for lung transplantation
and treated at the Pulmonary Rehabilitation Program in the Complexo
Hospitalar Santa Casa de Misericórdia de Porto Alegre, located in the
city of Porto Alegre, Brazil. We evaluated the patients using the six-minute walk
test (6MWT) and pulmonary function tests. We also obtained the LCADL scores, as
well as the modified Borg scale scores for sensation of dyspnea and leg fatigue.
Cronbach's alpha coefficient was used to determine the internal consistency of the
LCADL scale. Linear regression analysis was used in order to identify associations
between the total LCADL score (expressed as a percentage) and the variables
studied. RESULTS: According to the LCADL scale results, 69% of the patients reported that the
performance of their activities of daily living was significantly impaired by
their dyspnea. The internal consistency of the LCADL scale was 0.89. After
adjusting for age and FEV1, we found that the total LCADL scale score
showed statistically significant negative associations with the six-minute walk
distance (β = −0.087; p < 0.001) and the six-minute walk work (β = −0.285; p
< 0.001). CONCLUSIONS: Our findings suggest that the LCADL scale is a useful tool for assessing patients
on the waiting list for lung transplantation.
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Affiliation(s)
- Jocimar Prates Muller
- Department of Physical Therapy, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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Garrod R, Mathieson T. Pursed lips breathing: are we closer to understanding who might benefit? Chron Respir Dis 2013; 10:3-4. [PMID: 23355402 DOI: 10.1177/1479972312472689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bacon SL, Lavoie KL, Bourbeau J, Ernst P, Maghni K, Gautrin D, Labrecque M, Pepin V, Pedersen BK. The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol. BMJ Open 2013; 3:e003177. [PMID: 23794569 PMCID: PMC3693416 DOI: 10.1136/bmjopen-2013-003177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/16/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles. DESIGN A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50-75% of heart rate reserve for weeks 1-4, then 70-85% for weeks 5-12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques. ETHICS AND DISSEMINATION The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time. RESULTS The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research participants and (3) the general public. REGISTRATION DETAILS CLINICALTRIALSGOV IDENTIFIER NCT00953342.
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Affiliation(s)
- Simon L Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
- Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, Quebec, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Pierre Ernst
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Airway Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Karim Maghni
- Research Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
| | - Denyse Gautrin
- Research Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Manon Labrecque
- Research Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Veronique Pepin
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal—a University of Montreal Affiliated Hospital, Montreal, Quebec, Canada
| | - Bente Klarlund Pedersen
- Centre of Inflammation and Metabolism (CIM), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Kristan SS. Blood specimen biomarkers of inflammation, matrix degradation, angiogenesis, and cardiac involvement: a future useful tool in assessing clinical outcomes of COPD patients in clinical practice? Arch Immunol Ther Exp (Warsz) 2013; 61:469-81. [PMID: 23703244 DOI: 10.1007/s00005-013-0237-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 05/13/2013] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible; this airflow limitation is both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gasses. COPD is undoubtedly an umbrella term, and it seems unlikely that all patients with COPD have the same underlying disease processes; thus, there is a need for differential treatment of different subgroups. A potential solution is to find modifiable biomarkers that can assist in drug development and distinguish subgroups of COPD. With the exception of lung function tests, there are currently no well-validated biomarkers or surrogate endpoints that can be used to establish the efficacy of a drug for COPD. This article discusses biomarkers of inflammation (fibrinogen, C-reactive protein, pulmonary and activation-regulated chemokine/CC-chemokine ligand-18, serum surfactant protein D, interleukin (IL)-6, IL-8 and tumor necrosis factor α, complement factor C5a), angiogenesis factors as a part of the pathogenetic aspect in this disease (vascular endothelial growth factor, angiogenin, and IL-8), and matrix degradation biomarkers. Troponin and natriuretic peptides are presented as biomarkers of cardiac involvement in the light of COPD comorbidities. Trials based on research on known clinical variables such as FEV1, BODE, and 6MWT in combination with biomarkers from lung and blood specimens will probably clarify part of the prognosis and natural history of the disease. This will also represent an additional step in COPD phenotyping and new treatment possibilities.
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Butts JF, Belfer MH, Gebke KB. Exercise for patients with COPD: an integral yet underutilized intervention. PHYSICIAN SPORTSMED 2013; 41:49-57. [PMID: 23445860 DOI: 10.3810/psm.2013.02.1999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) was the third leading cause of mortality in the United States in 2009 and accounts for millions of dollars in health care expenses annually. It is characterized by slow declines in functional ability and exercise tolerance, which are strongly predictive of poor health-related quality of life and survival. The cycle of physical, social, and psychosocial consequences of COPD is more easily prevented than remedied; therefore, maintaining baseline respiratory function is a key goal of early treatment. Although medical management of COPD is generally well understood and implemented by most primary care physicians, multidisciplinary approaches that include nonpharmacologic modalities (eg, exercise training) are not often used. Exercise training can alleviate dyspnea and improve exercise tolerance and health-related quality of life in patients with mild-to-severe COPD. Pulmonary rehabilitation, which includes exercise training, nutritional and psychological counseling, and patient education, is an important component of COPD treatment and management programs, and is currently underutilized in the United States. This article addresses the role of exercise as part of a multidisciplinary approach to the management of COPD, especially with regard to pulmonary rehabilitation.
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Affiliation(s)
- Jessica Favero Butts
- Department of Family Medicine and Sports Medicine, Indiana University, Indianapolis, IN, USA.
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Pulmonary Rehabilitation in COPD: A Reappraisal (2008-2012). Pulm Med 2013; 2013:374283. [PMID: 23365741 PMCID: PMC3556894 DOI: 10.1155/2013/374283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 01/10/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a complex pathological condition associated with an important reduction in physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life. Pulmonary rehabilitation is aimed to eliminate or at least attenuate these difficulties, mainly by promoting muscular reconditioning. The scope of this paper has been the analysis of the literature on pulmonary rehabilitation in COPD patients has appeared in the last five years, focusing on the principal outcomes obtained. The results demonstrate that pulmonary rehabilitation has a beneficial effect on dyspnoea relief, improving muscle strength and endurance. Moreover, pulmonary rehabilitation appears to be a highly effective and safe treatment for reducing hospital admissions mortality and improving health-related quality of life in COPD patients. It represents, therefore, a very important therapeutic option that, along with standard pharmachological therapy, can be used to obtain the best patient management. The favourable results obtained with pulmonary rehabilitation programs should stimulate researchers to improve our understanding of the mechanisms that form the basis of the beneficial effects of this therapeutic intervention. This would in turn increase the effectiveness of pulmonary rehabilitation in COPD patients.
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Bhatt SP, Luqman-Arafath TK, Gupta AK, Mohan A, Stoltzfus JC, Dey T, Nanda S, Guleria R. Volitional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity. Chron Respir Dis 2012; 10:5-10. [PMID: 23149383 DOI: 10.1177/1479972312464244] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pursed lips breathing (PLB) is used by a proportion of patients with chronic obstructive pulmonary disease (COPD) to alleviate dyspnea. It is also commonly used in pulmonary rehabilitation. Data to support its use in patients who do not spontaneously adopt PLB are limited. We performed this study to assess the acute effects of PLB on exercise capacity in nonspontaneously PLB patients with stable COPD. We performed a randomized crossover study comparing 6-min walk test (6MWT) at baseline without PLB with 6WMT using volitional PLB. Spirometry, maximal inspiratory and expiratory mouth pressures, and diaphragmatic excursion during tidal and vital capacity breathing using B-mode ultrasonography were measured at baseline and after 10 min of PLB. A Visual Analog Scale (VAS) assessed subjective breathlessness at rest, after 6MWT and after 6MWT with PLB. p ≤ 0.01 was considered significant. Mean ± SD age of patients was 53.1 ± 7.4 years. Forced expiratory volume in 1 second was 1.1 ± 0.4 L/min (38.4 ± 13.2% predicted). Compared with spontaneous breathing, all but one patient with PLB showed a significant increment in 6MW distance (+34.9 ± 26.4 m; p = 0.002). There was a significant reduction in respiratory rate post 6MWT with PLB compared with spontaneous breathing (-4.4 ± 2.8 per minute; p = 0.003). There was no difference in VAS scores. There was a significant correlation between improvement in 6MWT distance and increase in diaphragmatic excursion during forced breathing. The improvement was greater in patients who had poorer baseline exercise performance. PLB has an acute benefit on exercise capacity. Sustained PLB or short bursts of PLB may improve exercise capacity in stable COPD.
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Affiliation(s)
- Surya P Bhatt
- University of Iowa Hospital, Pulmonary and Critical Care Medicine, Iowa City, IA 52242, USA.
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Elmorsy AS, Mansour AE, Okasha AE. Effect of upper limb, lower limb and combined training on exercise performance, quality of life and survival in COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2012. [DOI: 10.1016/j.ejcdt.2012.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Yoshimi K, Ueki J, Seyama K, Takizawa M, Yamaguchi S, Kitahara E, Fukazawa S, Takahama Y, Ichikawa M, Takahashi K, Fukuchi Y. Pulmonary rehabilitation program including respiratory conditioning for chronic obstructive pulmonary disease (COPD): Improved hyperinflation and expiratory flow during tidal breathing. J Thorac Dis 2012; 4:259-64. [PMID: 22754664 PMCID: PMC3378196 DOI: 10.3978/j.issn.2072-1439.2012.03.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/23/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pulmonary rehabilitation has generally relieved symptoms, strengthened exercise endurance and improved health-related quality of life (QOL) in patients with COPD, but recovery of pulmonary function remains questionable. This analysis of our innovative rehabilitation program is directed at documenting changes in patients' expiratory airflow limitation, pulmonary symptoms and QOL. This program is designed to provide "respiratory conditioning", a physical therapist-assisted intensive flexibility training that focuses on stretching and rib cage mobilization. METHODS Thirty-one patients with COPD who attended rehabilitation sessions at Juntendo University Hospital from 1999 to 2006 were analyzed. Pulmonary function, expiratory flow limitation during tidal breathing, six minute walk distance (6MWD), respiratory muscle strength, and St. George Respiratory Questionnaire (SGRQ) were measured before and after pulmonary rehabilitation. RESULTS In participants ages 68±7 years, the FEV(1)% predicted was 39.3±15.7%. 6MWD, SGRQ and respiratory muscle strength were significantly improved after pulmonary rehabilitation. Although neither FEV(1)% predicted nor FEV(1)/FVC was affected to a significant extent, indicating little effect on airflow limitation, expiratory flow limitation in supine as well as seated during tidal breathing improved significantly. Moreover, rehabilitation significantly diminished TLC% predicted, FRC% predicted, RV% predicted and RV/TLC values, thus indicating a reduction of hyperinflation of the lungs at rest. CONCLUSIONS The present results suggest that our rehabilitation program with respiratory conditioning significantly lowered the hyperinflation of lungs at rest as well as the expiratory flow limitation during tidal breathing. In patients with COPD, overall pulmonary function improved, exercise endurance increased and health-related QOL was enhanced.
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Affiliation(s)
- Kaku Yoshimi
- Department of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Jun Ueki
- Juntendo University School of Health Care and Nursing, 2-5-1, Takasu, Urayasu-City, Chiba, 279-0023, Japan; Departments of
| | - Kuniaki Seyama
- Department of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | | | | | | | - Shinji Fukazawa
- Inhalation therapy, Juntendo University Hospital, 3-1-3, Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan
| | - Yukiko Takahama
- Inhalation therapy, Juntendo University Hospital, 3-1-3, Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan
| | - Masako Ichikawa
- Department of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yoshinosuke Fukuchi
- Department of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Chao PW, Ramsdell J, Renvall M, Vora C. Does a history of exercise in COPD patients affect functional status? A study using a lifetime physical activity questionnaire investigates a correlation between exercise and functional status as evidenced by six-minute walk distance. COPD 2012; 8:429-36. [PMID: 22149403 DOI: 10.3109/15412555.2011.623736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies have shown strong associations between chronic exercise and improved spirometric values. Building on these findings, we investigated whether habitual lifetime exercise influences six-minute walk test performance (6MWT) in subjects with at least 10 pack-years smoking history. The 6MWT was chosen for its correlation with performance on activities of daily living and predictive value for inactivity, morbidity and mortality in individuals with chronic obstructive pulmonary disease (COPD) versus spirometric values, which are less adept at predicting functional status. Because COPD is a global cause of disability, therapeutic measures that delay symptom-induced immobility are more cost-effective versus late-stage interventional therapies. Among 49 subjects, we compared lifetime exercise assessed with a validated physical activity questionnaire with six-minute walk distances (6MWD). The American College of Sports Medicine's (ACSM) recommended exercise levels (30 minutes/day, 1000 kcal/week) were used as a benchmark. Among subjects with spirometry-determined lung obstruction (n = 21), those who have not met at least half of ACSM guidelines (500 kcal/week) were classified as "Inactive," while others were "Active." A significant difference in 6MWD was found between Inactive and Active subjects: (1123.86ft vs. 1468.25ft, STDev = 210.07 vs. 240.25, p = 0.0045). This difference was not found in subjects without lung obstruction. Pack-years was a significant covariate: subjects who smoked less walked farther distances. No relation was found between exercise and predicted FEV(1)%. In summary, our case-control study suggests that meeting even half of ACSM exercise guidelines could improve functional status in smokers if habitual exercise is adopted early in life.
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Affiliation(s)
- Peter Weiyen Chao
- University of California-San Diego, 1919 S. Grand Blvd., St. Louis, MO 63104, USA.
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Castro AAM, Kümpel C, Rangueri RC, Oliveira MD, Dornelles RA, Brito ER, Seki TM, Porto EF. Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients. Clinics (Sao Paulo) 2012; 67:319-25. [PMID: 22522756 PMCID: PMC3317254 DOI: 10.6061/clinics/2012(04)04] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/12/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.
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Affiliation(s)
- Antonio A M Castro
- Pulmonary Rehabilitation Center, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Gopalakrishna A, Vaishali K, Prem V, Aaron P. Normative values for maximal respiratory pressures in an Indian Mangalore population: A cross-sectional pilot study. Lung India 2011; 28:247-52. [PMID: 22084536 PMCID: PMC3213709 DOI: 10.4103/0970-2113.85684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of the pilot study is to obtain normal maximal inspiratory and expiratory pressures for individuals in the age group 20-70 years in the Mangalore population and to predict normal values according to age, sex, height, and weight using the regression equation. Materials and Methods: Two hundred and fifty subjects were selected through a convenient method of sampling. Fifty subjects each were enrolled in the following age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 70. Each group had 50 subjects (males-25 and females-25). Baseline data such as height, weight, body mass index were recorded. Maximal inspiratory pressure (PI) and expiratory pressure (PE) were determined following standardized protocol. Result: With regard to PI max and PE max, the measured values were significantly lower than those recorded in previous studies for both males (30%) and females (20%). We found that age served as the best factor for the prediction of PI max and PE max in both genders. Conclusion: The results of this study can be used to predict respiratory muscle strength in healthy adult subjects, and the strategy employed in this study will serve as a useful, simple, reproducible, rapid assessment of respiratory muscle function and also aid the planning of treatment.
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Affiliation(s)
- A Gopalakrishna
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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Abstract
The burden of chronic obstructive pulmonary disease (COPD) has increased recently in developing countries. On the other hand, structured or non-structured rehabilitation services for COPD patients are not routinely available in these countries. We, therefore, planned this review to re-emphasize the emerging benefits of pulmonary rehabilitation in COPD population. Aim of this review is to stimulate pulmonary physicians in India and other resource-poor areas of the world so that they start using pulmonary rehabilitation or its components more often. The search included standard english literature PubMed citation of relevant original articles, review articles and practice guidelines. The articles and reviews were searched including standard MeSH terms - Rehabilitation (TIAB) and pulmonary disease, chronic obstructive/therapy (MAJOR) and guidelines (TIAB). Available 58 articles in English including 23 reviews from July 2001 to October 2010 were screened for evidence-based benefits regarding respiratory rehabilitation as a whole or its different components. The cross references and current citations relating to primary articles were also included for description. No attempt was done to make a systematic analysis because our purpose was not to derive evidence-based recommendations from database and because sufficient evidence is already available for benefits of selected components of pulmonary rehabilitation in COPD patients. Pulmonary rehabilitation has emerged as an important modality as an adjunct to other therapies in patients of COPD. Limited and more cost-effective protocols are to be developed and executed by healthcare providers, especially in developing countries like India.
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Affiliation(s)
- Bharat Bhushan Sharma
- Division of Allergy and Pulmonary Medicine, Department of Medicine, SMS Medical College, Jaipur, India
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Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease--practical issues: a Canadian Thoracic Society Clinical Practice Guideline. Can Respir J 2011; 17:159-68. [PMID: 20808973 DOI: 10.1155/2010/425975] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pulmonary rehabilitation (PR) participation is the standard of care for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite bronchodilator therapies. However, there are questions about specific aspects of PR programming including optimal site of rehabilitation delivery, components of rehabilitation programming, duration of rehabilitation, target populations and timing of rehabilitation. The present document was compiled to specifically address these important clinical issues, using an evidence-based, systematic review process led by a representative interprofessional panel of experts. The evidence reveals there are no differences in major patient-related outcomes of PR between nonhospital- (community or home sites) or hospital-based sites. There is strong support to recommend that COPD patients initiate PR within one month following an acute exacerbation due to benefits of improved dyspnea, exercise tolerance and health-related quality of life relative to usual care. Moreover, the benefits of PR are evident in both men and women, and in patients with moderate, severe and very severe COPD. The current review also suggests that longer PR programs, beyond six to eight weeks duration, be provided for COPD patients, and that while aerobic training is the foundation of PR, endurance and functional ability may be further improved with both aerobic and resistance training.
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Kumar SP, Jim A. Physical therapy in palliative care: from symptom control to quality of life: a critical review. Indian J Palliat Care 2011; 16:138-46. [PMID: 21218003 PMCID: PMC3012236 DOI: 10.4103/0973-1075.73670] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients’ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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Chan AWK, Lee A, Suen LKP, Tam WWS. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial. Complement Ther Med 2011; 19:3-11. [PMID: 21296261 DOI: 10.1016/j.ctim.2010.12.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 08/10/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a Tai chi Qigong (TCQ) program in enhancing respiratory functions and activity tolerance in clients with chronic obstructive pulmonary disease (COPD). DESIGN A single-blind, randomized controlled trial. SETTING Five general outpatient clinics in Hong Kong. INTERVENTION In total, 206 COPD clients were randomly assigned into one of the three groups, namely, TCQ, exercise, and control group. Subjects in the TCQ group received a TCQ program consisting of two 60-min sessions each week for three months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group were instructed to maintain their usual activities. Data collection was performed at baseline and at the 6-week and 3-month marks. OUTCOMES Lung functions, 6-min walk test, and COPD exacerbation rate. RESULTS Results of repeated measures of analysis of covariance demonstrated that there were significant interaction effects between time and group in forced vital capacity (p=.002, η(2)=.06), forced expiratory volume in 1s (p<.001, η(2)=.02), walking distance (p<.001), and exacerbation rate (p=.006, η(2)=.06) at 3 months. Improvements were noted in the TCQ group. No changes were observed in the exercise group, while a decline in lung functions was noticed in the control group. CONCLUSION Tai chi Qigong was able to improve respiratory functions and activity tolerance level in COPD clients. The breathing and walking exercise helped maintain lung functions and slow down disease progression.
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Affiliation(s)
- Aileen W K Chan
- The Nethersole School of Nursing, Faculty of Medicine, Esther Lee Building, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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Bazargani RH, Besharat MA, Hadi, Ehsan B, Nejatian M, Hosseini K. The Efficacy of Chronic Disease Self Management Program and Tele- Health on Adherence by Increasing Self Efficacy in Patients with CABG. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.sbspro.2011.10.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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