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Zhu Y, Zhang Z, Du Z, Zhai F. Mind-body exercise for patients with stable COPD on lung function and exercise capacity: a systematic review and meta-analysis of RCTs. Sci Rep 2024; 14:18300. [PMID: 39112599 PMCID: PMC11306772 DOI: 10.1038/s41598-024-69394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. Mind-body exercises like Tai Chi and Yoga are suggested as non-pharmacological interventions for COPD management. This meta-analysis evaluates mind-body exercises' impact on lung function and exercise capacity in stable COPD patients, aiming to assess their effectiveness in rehabilitation. A systematic search across various databases identified relevant randomized controlled trials until April 2024. Primary outcomes included lung function tests (FEV1, FVC, FEV1/FVC, FEV1%) and Six-Minute Walk Test (6MWT) results. The Standardized Mean Difference (SMD) measured intervention effects. Fifteen studies with 1047 participants were analyzed. Mind-body exercises significantly improved FEV1 (SMD = 0.87), FEV1/FVC (SMD = 0.19), FEV1% (SMD = 0.43), and 6MWT (SMD = 1.21) compared to standard care. Sensitivity and subgroup analyses confirmed result stability despite some heterogeneity.In conclusion, Mind-body exercises enhance lung function and exercise capacity in stable COPD patients. Integrating them into comprehensive rehabilitation programs is advisable. Further research should explore the specific impacts of different exercise types and intensities.
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Affiliation(s)
- Yutong Zhu
- College of Physical Education, China University of Mining and Technology, Xuzhou, Jiangsu, China
| | - Zhihao Zhang
- Collge of Education, National University of Malaysia, Bangi, Selangor, Malaysia
| | - Zhihao Du
- College of Physical Education, China University of Mining and Technology, Xuzhou, Jiangsu, China.
| | - Feng Zhai
- College of Physical Education, China University of Mining and Technology, Xuzhou, Jiangsu, China.
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Oliveira MR, Hoffman M, Jones AW, Holland AE, Borghi-Silva A. Effect of Pulmonary Rehabilitation on Exercise Capacity, Dyspnea, Fatigue, and Peripheral Muscle Strength in Patients With Post-COVID-19 Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1559-1570. [PMID: 38311096 DOI: 10.1016/j.apmr.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To establish the effects of pulmonary rehabilitation (PR) in patients with persistent symptoms after COVID-19 infection. In addition, to compare the modalities of PR services (face-to-face and telerehabilitation) and the duration of PR in weeks (4-8 weeks and >8 weeks). DATA SOURCES PubMed/MEDLINE, Embase (Elsevier), Central/Cochrane Library, SciELO Citation Index (Web of Science), and CINAHL. STUDY SELECTION Studies determining the effects of PR in patients with post-COVID-19 syndrome were included and grouped according to PR delivery modality. DATA EXTRACTION Data extraction and quality assessment were independently performed by 2 reviewers. The methodological quality was assessed using the Cochrane Risk of Bias Tool 1 (RoB-1). DATA SYNTHESIS The literature search retrieved 1406 articles, of which 7 studies explored the effects of PR on patients with post-COVID-19 syndrome, with 188 patients randomized to PR. The mean age of participants was 50 years and 49% were women. Meta-analysis showed an increase in exercise capacity with PR compared with control (6-minute walking test: mean difference: 60.56 m, 95% confidence interval: 40.75-80.36), a reduction in fatigue (Fatigue Severity Scale: -0.90, -1.49 to -0.31) but no change in dyspnea (-0.57, -1.32 to 0.17) and muscle strength (3.03, -1.89 to 7.96). There were no differences between telerehabilitation and face-to-face PR regarding effects on peripheral muscle strength (P=.42), dyspnea (P=.83), and fatigue (P=.34). There were no differences between programs 4-8 weeks and >8 weeks regarding exercise capacity (P=.83), peripheral muscle strength (P=.42), and dyspnea (P=.76). CONCLUSIONS PR improves exercise capacity and reduces fatigue in patients with post-COVID-19 syndrome. Duration of PR (4-8 weeks vs > 8 weeks) or PR modality (telerehabilitation vs face-to-face) did not affect outcomes but data were limited and based on subgroup analysis. Further evidence is required to determine the optimal delivery mode and duration of PR for post-COVID-19 syndrome.
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Affiliation(s)
- Murilo Rezende Oliveira
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, Brazil; Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil.
| | - Mariana Hoffman
- Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil
| | - Arwel W Jones
- Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil
| | - Anne E Holland
- Respiratory Research@Alfred, Monash University, São Carlos (SP), Brazil; Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, Brazil; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL
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Muñoz Montiel A, Ruiz-Esteban P, Doménech Del Río A, Valdivielso P, Sánchez Chaparro MÁ, Olveira C. The effect of pulmonary rehabilitation on cardiovascular risk, oxidative stress and systemic inflammation in patients with COPD. Respir Med 2024; 232:107740. [PMID: 39009098 DOI: 10.1016/j.rmed.2024.107740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a leading cause of death, and cardiovascular (CV) comorbidities play a role. Evidence of the pulmonary rehabilitation (PR) effect in reducing the CV risk (CVR) in COPD patients is limited. In this study, we aimed to determine the impact of an 8-week PR program (PRP) on the CVR of the overall population and to compare the impact on the exacerbator versus non-exacerbator patients. PATIENTS AND METHODS This was a prospective study that included adults who had post-bronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) ratio <70 % and FEV1 <80 % predicted, had quit smoking for at least 1 year and had a history of tobacco consumption greater than 10 packs/year, and were clinically stable in the last 8 weeks. Pre- and post-PRP assessments included respiratory function evaluation, laboratory tests, and exercise capacity assessment (6-min walking test [6MWT]). CVR was assessed using different risk prediction models. RESULTS A total of 50 patients (28 exacerbators and 22 non-exacerbators) completed the PRP (median age: 64.5 years, men: 72 %; arterial hypertension: 70 %, dyslipidemia: 30 %, diabetes: 20 %; CV disease (CVD): 24 %. After the PRP, exacerbator patients showed a significant decrease in the CVR calculated by the COPDCoRi model (p < 0.001); patients with ≥30-m increase on the 6MWT showed statistically significant lower levels of glucose (p = 0.004), HbA1c (p = 0.004) and BODE index score (p = 0.026) compared to patients with <30-m increase. CONCLUSIONS PR reduced certain modifiable CVR factors and CVD risk, especially in exacerbator patients.
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Affiliation(s)
- Ana Muñoz Montiel
- Pulmonology Service/Unit, Monographic COPD Consultation. Regional University Hospital of Malaga, Malaga, Spain
| | - Pedro Ruiz-Esteban
- Nephrology Department, Regional University Hospital of Malaga, University of Malaga, The Biomedical Research Institute of Malaga (IBIMA), RICORS2040 (RD21/0005/0012), Malaga, Spain.
| | - Adolfo Doménech Del Río
- Pulmonology Service/Unit, Monographic COPD Consultation. Regional University Hospital of Malaga, Malaga, Spain
| | - Pedro Valdivielso
- Laboratory of Lipids and Atherosclerosis, Medico-Sanitarias Research Center (IBIMA), University of Malaga, Malaga, Spain; Internal Medicine, University Hospital Virgen de la Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand. University of Malaga, Malaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine, University Hospital Virgen de la Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand. University of Malaga, Malaga, Spain
| | - Casilda Olveira
- Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand. University of Malaga, Malaga, Spain
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Akinci B, Emirza Cilbir C, Kocyigit A, Kuran Aslan G. Respiratory Muscle Training in Para-Athletes: A Systematic Review on the Training Protocols and Effects on Reported Outcomes. J Sport Rehabil 2024:1-9. [PMID: 38996453 DOI: 10.1123/jsr.2023-0301] [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: 09/12/2023] [Revised: 02/20/2024] [Accepted: 04/16/2024] [Indexed: 07/14/2024]
Abstract
CONTEXT AND OBJECTIVES Respiratory muscle training (RMT) is considered an effective tool to improve cardiorespiratory limitations in athletes. The goals of this systematic review were to explore the role of RMT and its implementation within sport rehabilitation programs in para-athletes. EVIDENCE ACQUISITION Several databases were searched until January 2024. Eligible studies were independently reviewed by 2 reviewers. Quality assessment was made using the PEDro scale and version 2 of the Cochrane Risk-of-Bias Tool for Randomized Trials. Eight studies (a total of 108 participants) were selected for the analysis. EVIDENCE SYNTHESIS Five studies preferred using resistive loading, while 2 studies used normocapnic hyperpnea, and 1 study used threshold inspiratory muscle training. Respiratory functions (respiratory muscle strength and endurance, spirometry measures) and exercise performance were assessed as the main outcomes. Significant increases in respiratory muscle strength were reported in 5 studies. Two studies observed improvement in respiratory muscle endurance and 3 studies reported increased exercise capacity. CONCLUSIONS This review suggests that although RMT can enhance respiratory muscle strength and endurance, it should not be considered the primary method for boosting the exercise performance of para-athletes. Additional research is necessary to explore the impact of various RMT techniques on different outcomes from the perspective of sport rehabilitation in para-athletes.
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Affiliation(s)
- Buket Akinci
- Department of Physiotherapy and Rehabilitation (English), Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Cigdem Emirza Cilbir
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Kocyigit
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Goksen Kuran Aslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Koopman M, Posthuma R, Vanfleteren LEGW, Simons SO, Franssen FME. Lung Hyperinflation as Treatable Trait in Chronic Obstructive Pulmonary Disease: A Narrative Review. Int J Chron Obstruct Pulmon Dis 2024; 19:1561-1578. [PMID: 38974815 PMCID: PMC11227310 DOI: 10.2147/copd.s458324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Lung hyperinflation (LH) is a common clinical feature in patients with chronic obstructive pulmonary disease (COPD). It results from a combination of reduced elastic lung recoil as a consequence of irreversible destruction of lung parenchyma and expiratory airflow limitation. LH is an important determinant of morbidity and mortality in COPD, partially independent of the degree of airflow limitation. Therefore, reducing LH has become a major target in the treatment of COPD over the last decades. Advances were made in the diagnostics of LH and several effective interventions became available. Moreover, there is increasing evidence suggesting that LH is not only an isolated feature in COPD but rather part of a distinct clinical phenotype that may require a more integrated management. This narrative review focuses on the pathophysiology and adverse consequences of LH, the assessment of LH with lung function measurements and imaging techniques and highlights LH as a treatable trait in COPD. Finally, several suggestions regarding future studies in this field are made.
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Affiliation(s)
- Maud Koopman
- Research and Development, Ciro+, Horn, the Netherlands
- NUTRIM, Institute of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Rein Posthuma
- Research and Development, Ciro+, Horn, the Netherlands
- NUTRIM, Institute of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Lowie E G W Vanfleteren
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Sami O Simons
- NUTRIM, Institute of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Frits M E Franssen
- Research and Development, Ciro+, Horn, the Netherlands
- NUTRIM, Institute of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Thakkar D, Singh S, Wairkar S. Advanced Delivery Strategies of Nintedanib for Lung Disorders and Beyond: A Comprehensive Review. AAPS PharmSciTech 2024; 25:150. [PMID: 38954161 DOI: 10.1208/s12249-024-02869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Nintedanib, a primary treatment for lung fibrosis, has gathered substantial attention due to its multifaceted potential. A tyrosine kinase inhibitor, nintedanib, inhibits multiple signalling receptors, including endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR), and fibroblast growth factor receptor (FGFR) and ultimately inhibits fibroblast proliferation and differentiation. Therefore, nintedanib has been studied widely for other ailments like cancers and hepatic fibrosis, apart from lung disorders. Commercially, nintedanib is available as soft gelatin capsules for treatment against idiopathic pulmonary fibrosis. Since it has very low oral bioavailability (4.7%), high doses of a drug, such as 100-150 mg, are administered, which can cause problems of gastrointestinal irritation and hepatotoxicity. The article begins with exploring the mechanism of action of nintedanib, elucidating its complex interactions within cellular pathways that govern fibrotic processes. It also emphasizes the pharmacokinetics of nintedanib, clinical trial insights, and the limitations of conventional formulations. The article mainly focuses on the emerging landscape of nanoparticle-based carriers such as hybrid liposome-exosome, nano liquid crystals, discoidal polymeric, and magnetic systems, offering promising avenues to optimize drug targeting, address its efficacy issues and minimise adverse effects. However, none of these delivery systems are commercialised, and further research is required to ensure safety and effectiveness in clinical settings. Yet, as research progresses, these advanced delivery systems promise to revolutionise the treatment landscape for various fibrotic disorders and cancers, potentially improving patient outcomes and quality of life.
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Affiliation(s)
- Dhruti Thakkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, Maharashtra, 400056, India
| | - Sanskriti Singh
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, Maharashtra, 400056, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, Maharashtra, 400056, India.
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Wang Z, Zhu Z, Sun Y, Wang T, Lu Y, Che W, Liu W, Xu Y. The Rehabilitation Efficacy of the Novel Metronomic Breathing Technique for Gerontic Patients After Percutaneous Coronary Intervention for Acute Myocardial Infarction-A Pilot Study. Clin Interv Aging 2024; 19:1029-1039. [PMID: 38863479 PMCID: PMC11166167 DOI: 10.2147/cia.s458675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
Background The respiratory rehabilitation technique is a crucial component of early cardiac recovery in geriatric patients with acute myocardial infarction (AMI). This study primarily investigated the effectiveness of a novel respiratory rehabilitation technique, metronomic breathing (MB), on geriatric patients after percutaneous coronary intervention for AMI and compliance with home-based rehabilitation compared to traditional respiratory rehabilitation. Methods From June 2022 to March 2023, 75 acute myocardial infarction (AMI) patients admitted to the Shanghai Tenth People's Hospital Cardiovascular Department were consecutively enrolled. Ultimately, 46 patients completed the follow-up in this study-26 in the MB group and 20 in the control group-who underwent the novel MB technique and conventional abdominal breathing training. The primary endpoint of the study was left ventricular function measured by noninvasive hemodynamics three months after discharge. The secondary endpoints were compliance and quality of life after three months of home rehabilitation. Results After the intervention, several cardiac functional parameters (SV, SVI, CO, CI, LCW, and LCWI), myocardial contractility parameters (VI), and systemic vascular resistance parameters (SVR and SVRI) were significantly greater in the MB group than in the preintervention group (P < 0.05). Furthermore, post-treatment, the MB group exhibited greater SV, SVI, CO, CI, and VI; lower SVR, SVRI, and SBP; and a lower readmission rate three months later than did the control group. The SF-36 scores after three months of MB intervention, PE, BP, GH, VT, SF, RE, and MH, were all significantly greater than those before treatment (P < 0.05). Moreover, the MB group displayed greater compliance with home-based cardiac rehabilitation (P < 0.05). Conclusion Compared to conventional respiratory rehabilitation training methods, short-term metronomic respiratory therapy is more effective for reducing systemic vascular resistance, enhancing left ventricular ejection function, enhancing quality of life, and increasing home-based rehabilitation compliance in geriatric patients following AMI with PCI.
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Affiliation(s)
- Zeyu Wang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Zhaoxin Zhu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Yifan Sun
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Ting Wang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Yunlan Lu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Weijing Liu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
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Saha R, Singh VP, Samuel SR, Vishak Acharya K, Acharya PR, Vijaya Kumar K. Effect of Home-Based Pulmonary Rehabilitation on Pulmonary Fibrosis. Multidiscip Respir Med 2024; 19:950. [PMID: 38836339 PMCID: PMC11186438 DOI: 10.5826/mrm.2024.950] [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: 12/14/2023] [Accepted: 04/08/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Pulmonary fibrosis is a chronic, progressive lung condition that involves lung tissue scarring and thickening. The effects of home-based pulmonary rehabilitation (PR) in post-covid pulmonary fibrosis (PCPF) and other forms of fibrosis together have not been evaluated. This study aims to evaluate the effectiveness of home-based pulmonary rehabilitation on pulmonary function, functional capacity, and health-related quality of life in people with pulmonary fibrosis (post-COVID pulmonary fibrosis, pulmonary fibrosis secondary to pulmonary tuberculosis (TB), pulmonary fibrosis secondary to interstitial lung disease (ILD), pulmonary fibrosis secondary to bronchiectasis). METHODS A single-group pretest-posttest experimental study was performed after recruiting 98 pulmonary fibrosis subjects from K.M.C hospitals. After being screened for the inclusion and exclusion criteria, 45 subjects were analyzed, and 6 subjects were lost to follow-up. A home-based pulmonary rehabilitation program was carried out for 8 weeks (warm-up, stretching exercises, aerobic exercise, strength training for upper limb and lower limb, breathing exercises mainly involved; others: energy saving techniques, controlled coughing techniques, dyspnea relieving positions). The program was supervised via weekly phone calls. Pulmonary function (Pulmonary function test), exercise capacity (6-minute walk test), dyspnea (modified Borg scale), and health-related quality of life (SF-36) were evaluated before and after the intervention. During the enrollment and after the 6-minute walk test, saturation of peripheral oxygen (SPO2) level was also evaluated pre-intervention and after the 8-weeks program. RESULTS Pulmonary function [FVC(L) t = -12.52, p<0.05; FEV1(L) t = -2.56, p<0.05; FEV1/FVC t = 7.98, p<0.05 and DLCO (ml/min/mmHg) t = -5.13, p<0.05], 6MWD [MD 88.66; p<0.05] and HRQOL measured by SF-36 scores (p<0.05) were improved significantly. Both the baseline SPO2 level before the 6MWT [MD 1.07, p<0.05] and the SPO2 level after the 6MWT [MD 1.16, p<0.05] showed a significant improvement. The rating of perceived exertion(dyspnea) [MD 1.30, p<0.05] was reduced significantly after the 8-week program. CONCLUSION Our study shows that home-based pulmonary rehabilitation is an effective option for improving lung function and physical functional capacity by reducing dyspnea perception and improving the saturation of peripheral oxygen (SPO2) level, and enhancing the quality of life in people with pulmonary fibrosis.
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Affiliation(s)
- Rashmita Saha
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India
| | - Vijay Pratap Singh
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India
| | - Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India
| | - K Vishak Acharya
- Department of Pulmonary Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, India
| | - Preetam Rajgopal Acharya
- Department of Pulmonary Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, India
| | - K. Vijaya Kumar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India
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Blanco Loures J, Guimarães Assis M, Pereira HLA, Mancuzo EV, Parreira VF. Perception of patients with interstitial lung diseases submitted to inspiratory muscle training. Physiother Theory Pract 2024; 40:1317-1325. [PMID: 36326066 DOI: 10.1080/09593985.2022.2141598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although inspiratory muscle training reduces dyspnea in patients with chronic respiratory diseases, it was not yet evaluated in a sample composed exclusively of patients with interstitial lung diseases. OBJECTIVE To discuss the perception of patients with interstitial lung diseases about inspiratory muscle training intervention. METHODS This is a qualitative study. Data were collected using semi-structured interviews, transcribed, and analyzed by thematic analysis. RESULTS Fourteen patients (64 ± 7 years) with interstitial lung disease were interviewed. Average participation in the inspiratory muscle training program was 90% (range, 66-100%). Three themes were elaborated: 1) dyspnea and other symptoms in daily life (e.g. "I could not carry out a bag; I was very uncomfortable"); 2) less symptom and greater performance (e.g. "I wash and change my clothes, house cleaning, do everything without feeling anything"); and 3) IMT: a time dedicated to my health (e.g. "For me it was great because I saw my evolution every day"). CONCLUSION Patients noticed improvements in symptoms and performance related to daily activities. Despite initial difficulties, patients continued training as planned.
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Affiliation(s)
- Jéssica Blanco Loures
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcella Guimarães Assis
- Department of Occupacional Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Eliane Viana Mancuzo
- Department of Medical Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Naqvi M, Hannah J, Lawrence A, Myall K, West A, Chaudhuri N. Antifibrotic therapy in progressive pulmonary fibrosis: a review of recent advances. Expert Rev Respir Med 2024; 18:397-407. [PMID: 39039699 DOI: 10.1080/17476348.2024.2375420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Progressive pulmonary fibrosis (PPF) is a manifestation of a heterogenous group of underlying interstitial lung disease (ILD) diagnoses, defined as non-idiopathic pulmonary fibrosis (IPF) progressive fibrotic ILD meeting at least two of the following criteria in the previous 12 months: worsening respiratory symptoms, absolute decline in forced vital capacity (FVC) more than or equal to 5% and/or absolute decline in diffusing capacity for carbon monoxide (DLCO) more than or equal to 10% and/or radiological progression. AREAS COVERED The authors subjectively reviewed a synthesis of literature from PubMed to identify recent advances in the diagnosis and characterisation of PPF, treatment recommendations, and management challenges. This review provides a comprehensive summary of recent advances and highlights future directions for the diagnosis, management, and treatment of PPF. EXPERT OPINION Recent advances in defining the criteria for PPF diagnosis and licensing of treatment are likely to support further characterisation of the PPF patient population and improve our understanding of prevalence. The diagnosis of PPF remains challenging with the need for a specialised ILD multidisciplinary team (MDT) approach. The evidence base supports the use of immunomodulatory therapy to treat inflammatory ILDs and antifibrotic therapy where PPF develops. Treatment needs to be tailored to the specific underlying disease and determined on a case-by-case basis.
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Affiliation(s)
- Marium Naqvi
- Guy's and St Thomas' NHS Trust, Guy's Hospital, London, UK
| | - Jennifer Hannah
- Department of Rheumatology, Kings' College Hospitals NHS Trust, Orpington Hospital, Orpington, UK
| | | | - Katherine Myall
- Department of Respiratory Medicine, King's College London, London, UK
| | - Alex West
- Guy's and St Thomas' NHS Trust, Guy's Hospital, London, UK
| | - Nazia Chaudhuri
- Department of Health and Life Sciences, School of Medicine, Ulster University, Derry-Londonderry, UK
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Toprak Celenay S, Secer E, Ozer Kaya D. Effects of 16-week circuit training on physical fitness parameters, pulmonary function, and quality of life in healthy women. J Sports Med Phys Fitness 2024; 64:516-525. [PMID: 38358367 DOI: 10.23736/s0022-4707.24.15707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Circuit training (CT) is an important type of training that can combine different types of exercises in a single form of training. This study aimed to investigate the effects of 16-week CT on physical fitness parameters, pulmonary function, and quality of life in healthy women. METHODS Twenty-nine healthy women (median age: 37.00 [31.50/39.50] years) were included in the study. CT was applied to the participants for a total of 16 weeks. Participants' body composition with the Bioelectrical Impedance Analysis System, knee flexor and extensor muscle strength with the Biodex System-4 Pro, flexibility with the sit-and-reach test, pulmonary function with a spirometer device, and quality of life with Short Form-36 were assessed. RESULTS A significant difference was found between the participants' pretest and posttest median and interquartile range values of waist-hip ratio, body mass index, right/left knee flexor/extensor mean peak torque (60°/s,180°/s), right hamstring/quadriceps (H/Q) ratio (60°/s), flexibility, and SF-36 Mental Health Score (P˂0.050). There was no significant difference between the participants' pretest and posttest median and interquartile range values of total body fat, fat percentage, right H/Q ratio (180°/s), left H/Q ratio (60°/s,180°/s), pulmonary function, and Short Form-36 Physical Function Score (P˃0.050). CONCLUSIONS CT decreased waist-hip ratio and body mass index, increased knee flexor/extensor strength and flexibility, and improved mental health. The 16-week CT may be an alternative approach to improve physical fitness parameters and mental health without any positive effects on body fat and pulmonary functions in healthy women.
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Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Türkiye
| | - Erhan Secer
- Department of Physiotherapy and Rehabilitation, Manisa Celal Bayar University, Manisa, Türkiye -
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Türkiye
- Physiotherapy and Rehabilitation Research and Application Center, Izmir Katip Celebi University, Izmir, Türkiye
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12
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Jakobsson J, Stoffels AAF, van Hees HWH, De Brandt J, Nyberg A, Klijn P. Quality of aerobic training description and its relation to intervention efficacy in chronic obstructive pulmonary disease trials: study protocol for a systematic review, meta-analysis and meta-regression. BMJ Open 2024; 14:e084296. [PMID: 38803267 PMCID: PMC11129019 DOI: 10.1136/bmjopen-2024-084296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a major global health concern, characterised by ventilatory constraints, decreased cardiovascular fitness and reduced limb muscle function, profoundly affecting patients' quality of life. Aerobic training plays a crucial role in the treatment of COPD, but the variability in methodologies and incomplete reporting of key components in aerobic training trials limits the assessment of their effectiveness. This systematic review aims to critically evaluate the application of training principles and reporting of key components in aerobic training trials in randomised controlled trials (RCTs) in the COPD literature. METHODS AND ANALYSIS The protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol guidelines. The review will include RCTs utilising aerobic training in individuals with COPD. A comprehensive search, following a predefined search strategy will identify studies published from 2007 to 2024 in English from MEDLINE, Embase, CINAHL, CENTRAL and PEDro. Studies including people with COPD and any aerobic training intervention will be included. Two reviewers will independently screen abstracts and titles for inclusion. Two reviewers will independently conduct the screening of full-text documents and data extraction. Study quality will be assessed using the Tool for the assESsment of sTudy quality and bias in Exercise, specifically developed for exercise training studies. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. A systematic synthesis will be provided, with meta-analyses and meta-regression when appropriate. ETHICS AND DISSEMINATION As this review will involve the analysis of published data, ethical approval is not required. The findings of this review will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021247343.
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Affiliation(s)
- Johan Jakobsson
- Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden
| | - Anouk A F Stoffels
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Hieronymus W H van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Jana De Brandt
- Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden
| | - André Nyberg
- Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden
| | - Peter Klijn
- Merem Pulmonary Rehabilitation Center, Hilversum, Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
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13
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Singh P. Commentary on Schertzer et al. 1. Physiother Can 2024; 76:218-219. [PMID: 38725593 PMCID: PMC11078253 DOI: 10.3138/ptc-2021-0135-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Prashna Singh
- Certified Respiratory Educator Pulmonary Rehabilitation Coordinator, Trillium Health Partners, Mississauga, Ontario, Canada;
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14
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Colombo V, Mondellini M, Fumagalli A, Aliverti A, Sacco M. A virtual reality-based endurance training program for COPD patients: acceptability and user experience. Disabil Rehabil Assist Technol 2024; 19:1590-1599. [PMID: 37272556 DOI: 10.1080/17483107.2023.2219699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To investigate the acceptability and user experience of an in-hospital endurance training program based on the Virtual Park, a semi-immersive Virtual Reality (VR) system for patients with Chronic Obstructive Pulmonary Disease (COPD).Materials and methodsPatients performed 20 min of cycling two times/day for around ten days. The evaluation included adherence, exercise capacity, physical performance, and user experience. RESULTS Fourteen patients (6 F/8 M; age = 71.29 ± 6.93 years) with mild/moderate COPD participated. The adherence rate was satisfying: 85.71% of patients attended the program without adverse events; the individual attendance rate (86.85% ± 27.43) was also high. The exercise capacity assessed before and after the training significantly improved in our group (6MWT pre-post: t(11)= -5.040, p < 0.05), as happens in standard PR programs. The physical performance metrics of each session indicate that all participants could sustain the proposed training protocol over the whole period. Patients judged the VR experience positively (User Experience Questionnaire = 1.84 ± 0.22) and were highly engaged in the activity for the whole period (Short Flow State Scale pre-post: 4.61 ± 0.27/4.40 ± 0.36). CONCLUSIONS Our preliminary results open the possibility for further investigations on long-term motivation and clinical effectiveness of more immersive VR interventions for COPD.
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Affiliation(s)
- Vera Colombo
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Lecco, Italy
- Department of Electronics, Information, and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Marta Mondellini
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Lecco, Italy
| | | | - Andrea Aliverti
- Department of Electronics, Information, and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Marco Sacco
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Lecco, Italy
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15
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Singh S, Wairkar S. Revolutionizing the Treatment of Idiopathic Pulmonary Fibrosis: From Conventional Therapies to Advanced Drug Delivery Systems. AAPS PharmSciTech 2024; 25:78. [PMID: 38589751 DOI: 10.1208/s12249-024-02793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/16/2024] [Indexed: 04/10/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive interstitial lung disease that has been well-reported in the medical literature. Its incidence has risen, particularly in light of the recent COVID-19 pandemic. Conventionally, IPF is treated with antifibrotic drugs-pirfenidone and nintedanib-along with other drugs for symptomatic treatments, including corticosteroids, immunosuppressants, and bronchodilators based on individual requirements. Several drugs and biologicals such as fluorofenidone, thymoquinone, amikacin, paclitaxel nifuroxazide, STAT3, and siRNA have recently been evaluated for IPF treatment that reduces collagen formation and cell proliferation in the lung. There has been a great deal of research into various treatment options for pulmonary fibrosis using advanced delivery systems such as liposomal-based nanocarriers, chitosan nanoparticles, PLGA nanoparticles, solid lipid nanocarriers, and other nanoformulations such as metal nanoparticles, nanocrystals, cubosomes, magnetic nanospheres, and polymeric micelles. Several clinical trials are also ongoing for advanced IPF treatments. This article elaborates on the pathophysiology of IPF, its risk factors, and different advanced drug delivery systems for treating IPF. Although extensive preclinical data is available for these delivery systems, the clinical performance and scale-up studies would decide their commercial translation.
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Affiliation(s)
- Sanskriti Singh
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, 400056, Maharashtra, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, 400056, Maharashtra, India.
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16
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Hussain A, Khurana AK, Goyal A, Kothari SY, Soman RK, Tej S, Pakhare A. Effect of pulmonary rehabilitation in patients with post-tuberculosis sequelae with functional limitation. Indian J Tuberc 2024; 71:123-129. [PMID: 38589115 DOI: 10.1016/j.ijtb.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Pulmonary rehabilitation improves dyspnea, functional limitation and quality of life in patients with chronic respiratory disease especially Chronic obstructive pulmonary disease (COPD). Whether Pulmonary rehabilitation (PR) will have similar effect in patients with post-tuberculosis sequelae or not and whether the two morphological variants will respond similarly or not was the purpose of our study. METHODS Adult patients fulfilling the inclusion criteria of a diagnosis of post-tuberculosis sequelae with functional limitation (modified medical research council [mMRC] grade 1 or more) were recruited over a period of two years. A baseline health assessment in the different domains of health was done at the beginning and repeated just after the completion of the rehabilitation program at 6 weeks. RESULTS 26 patients completed the PR protocol of our study. Dyspnea improved from an mMRC grade of 1.5 to 0.7 post-PR (p < 0.001). 6MWD increased by 34 meters from a baseline value of 408.6 meters to 442.7 meters post-PR. (p-value 0.3) St. George's Respiratory Questionnaire (SGRQ) symptom score decreased by 13 points, SGRQ activity score decreased by 18 points, SGRQ impact score decreased by 18 and SGRQ total score decreased by 17 points with p-values of 0.037, 0.002, 0.004 and 0.002 for SGRQ symptom score, SGRQ activity score, SGRQ impact score, SGRQ total score respectively. Depression Anxiety Stress Scale (DASS) Stress score decreased by 6.7, DASS Anxiety score decreased by 6.6, and DASS Depression score decreased by 5.5 points. Intergroup comparison revealed both bronchiectasis predominant group and fibrosis predominant group responded similarly to PR. CONCLUSION PR improved parameters assessing dyspnea, quality of life and mental health indices significantly. Improvement in functional capacity was not statically significant. Both the morphological variants responded similarly to the PR.
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Affiliation(s)
- Aqeel Hussain
- Pulmonary, Critical Care & Sleep Medicine, AIIMS Bhopal, India.
| | | | - Abhishek Goyal
- Pulmonary, Critical Care & Sleep Medicine, AIIMS Bhopal, India.
| | - S Y Kothari
- Physical Medicine & Rehabilitation, AIIMS Bhopal, India.
| | | | - Sai Tej
- Pulmonary, Critical Care & Sleep Medicine, AIIMS Bhopal, India.
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Gabada R, Yadav V, Nikhade D. Transformative Physiotherapy Approach in an 80-Year-Old Female: A Case Report of Managing Obstructive Sleep Apnea for Improved Quality of Life. Cureus 2024; 16:e57481. [PMID: 38707025 PMCID: PMC11066711 DOI: 10.7759/cureus.57481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Obstructive sleep apnea (OSA) presents a significant challenge to patients' overall health and well-being, characterized by upper airway collapse during sleep leading to fragmented and non-restorative sleep patterns. This case report describes an 80-year-old female patient presenting with breathlessness, obesity (BMI: 43 kg/m2), sleep disturbances, fatigue, attention deficits, reduced chest compliance, and a history of type 2 diabetes mellitus. Clinical findings revealed ongoing sleep disruptions, worsening breathlessness, progressive weakness, and decreased oxygen saturation levels. The therapeutic intervention involved a comprehensive physiotherapy program targeting respiratory muscle training, lung function improvement, peripheral muscle strengthening, and relaxation exercises. The discussion highlights studies supporting physiotherapeutic interventions such as thoracic extension exercises, neuromuscular stimulation, and oropharyngeal exercises for managing OSA symptoms. Overall, this case underscores the importance of tailored physiotherapy interventions in addressing the multifaceted challenges of OSA, aiming to improve patient outcomes and quality of life.
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Affiliation(s)
- Rishika Gabada
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vaishnavi Yadav
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Dhanshri Nikhade
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Zamparelli SS, Lombardi C, Candia C, Iovine PR, Rea G, Vitacca M, Ambrosino P, Bocchino M, Maniscalco M. The Beneficial Impact of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Review of the Current Literature. J Clin Med 2024; 13:2026. [PMID: 38610791 PMCID: PMC11012394 DOI: 10.3390/jcm13072026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and irreversible fibrotic disease whose natural history is characterised by a progressive worsening of the pulmonary function, exertional dyspnoea, exercise intolerance, reduced physical activity, and health-related quality of life (HRQOL) impairment. Pulmonary rehabilitation (PR) is a comprehensive, multi-disciplinary programme that uses a combination of strength training, teaching, counselling, and behaviour modification techniques to reduce symptoms and optimise functional capacity in patients with chronic lung disease. Based on the well-documented effectiveness of PR in chronic obstructive pulmonary disease (COPD), over the years supportive evidence of its benefits for other respiratory diseases has been emerging. Although the latest rehabilitation guidelines recognised PR's efficacy for interstitial lung disease (ILD) and IPF in particular, this comprehensive approach remains underused and under-resourced. In this review, we will discuss the advantages and beneficial effects of PR on IPF, analysing its impact on exercise capacity, disease-related symptoms, cardiovascular outcomes, body composition, and HRQOL.
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Affiliation(s)
| | - Carmen Lombardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Claudio Candia
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
| | - Paola Rebecca Iovine
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Lumezzane Institute, 25065 Lumezzane, Italy;
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
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19
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Chuang ML, Wang YH, Lin IF. The contribution of estimated dead space fraction to mortality prediction in patients with chronic obstructive pulmonary disease-a new proposal. PeerJ 2024; 12:e17081. [PMID: 38560478 PMCID: PMC10981412 DOI: 10.7717/peerj.17081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Mortality due to chronic obstructive pulmonary disease (COPD) is increasing. However, dead space fractions at rest (VD/VTrest) and peak exercise (VD/VTpeak) and variables affecting survival have not been evaluated. This study aimed to investigate these issues. Methods This retrospective observational cohort study was conducted from 2010-2020. Patients with COPD who smoked, met the Global Initiatives for Chronic Lung Diseases (GOLD) criteria, had available demographic, complete lung function test (CLFT), medication, acute exacerbation of COPD (AECOPD), Charlson Comorbidity Index, and survival data were enrolled. VD/VTrest and VD/VTpeak were estimated (estVD/VTrest and estVD/VTpeak). Univariate and multivariable Cox regression with stepwise variable selection were performed to estimate hazard ratios of all-cause mortality. Results Overall, 14,910 patients with COPD were obtained from the hospital database, and 456 were analyzed after excluding those without CLFT or meeting the lung function criteria during the follow-up period (median (IQR) 597 (331-934.5) days). Of the 456 subjects, 81% had GOLD stages 2 and 3, highly elevated dead space fractions, mild air-trapping and diffusion impairment. The hospitalized AECOPD rate was 0.60 ± 2.84/person/year. Forty-eight subjects (10.5%) died, including 30 with advanced cancer. The incidence density of death was 6.03 per 100 person-years. The crude risk factors for mortality were elevated estVD/VTrest, estVD/VTpeak, ≥2 hospitalizations for AECOPD, advanced age, body mass index (BMI) <18.5 kg/m2, and cancer (hazard ratios (95% C.I.) from 1.03 [1.00-1.06] to 5.45 [3.04-9.79]). The protective factors were high peak expiratory flow%, adjusted diffusing capacity%, alveolar volume%, and BMI 24-26.9 kg/m2. In stepwise Cox regression analysis, after adjusting for all selected factors except cancer, estVD/VTrest and BMI <18.5 kg/m2 were risk factors, whereas BMI 24-26.9 kg/m2 was protective. Cancer was the main cause of all-cause mortality in this study; however, estVD/VTrest and BMI were independent prognostic factors for COPD after excluding cancer. Conclusions The predictive formula for dead space fraction enables the estimation of VD/VTrest, and the mortality probability formula facilitates the estimation of COPD mortality. However, the clinical implications should be approached with caution until these formulas have been validated.
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Affiliation(s)
- Ming-Lung Chuang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Div. Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - I-Feng Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
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20
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Luo N, Dai F, Wang X, Hu B, Zhang L, Zhao K. Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer. Cancer Control 2024; 31:10732748241255824. [PMID: 38764164 PMCID: PMC11104028 DOI: 10.1177/10732748241255824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024] Open
Abstract
INTRODUCTION Cough is a major complication after lung cancer surgery, potentially impacting lung function and quality of life. However, effective treatments for managing long-term persistent postoperative cough remain elusive. In this study, we investigated the potential of a pulmonary rehabilitation training program to effectively address this issue. METHODS Between January 2019 and December 2022, a retrospective review was conducted on patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and lymph node dissection via video-assisted thoracoscopic surgery (VATS) at Daping hospital. Based on their postoperative rehabilitation methods, the patients were categorized into 2 groups: the traditional rehabilitation group and the pulmonary rehabilitation group. All patients underwent assessment using the Leicester cough questionnaire (LCQ) on the third postoperative day. Additionally, at the 6-month follow-up, patients' LCQ scores and lung function were re-evaluated to assess the long-term effects of the pulmonary rehabilitation training programs. RESULTS Among the 276 patients meeting the inclusion criteria, 195 (70.7%) were in the traditional rehabilitation group, while 81 (29.3%) participated in the pulmonary rehabilitation group. The pulmonary rehabilitation group showed a significantly lower incidence of cough on the third postoperative day (16.0% vs 29.7%, P = .018) and higher LCQ scores in the somatic dimension (5.09 ± .81 vs 4.15 ± 1.22, P = .007) as well as in the total score (16.44 ± 2.86 vs 15.11 ± 2.51, P = .018, whereas there were no significant differences in psychiatric and sociological dimensions. At the 6-month follow-up, the pulmonary rehabilitation group continued to have a lower cough incidence (3.7% vs 12.8%, P = .022) and higher LCQ scores across all dimensions: somatic (6.19 ± .11 vs 5.75 ± 1.20, P = .035), mental (6.37 ± 1.19 vs 5.85 ± 1.22, P = .002), sociological (6.76 ± 1.22 vs 5.62 ± 1.08, P < .001), and total (18.22 ± 2.37 vs 16.21 ± 2.53, P < .001). Additionally, lung function parameters including FVC, FVC%, FEV1, FEV1%, MVV, MVV%, DLCO SB, and DLCO% were all significantly higher in the pulmonary rehabilitation group compared to the traditional group. CONCLUSION Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.
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Affiliation(s)
- Nanzhi Luo
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
- Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Fuqiang Dai
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xintian Wang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Binbin Hu
- Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Zhang
- Department of Stomatology, Daping Hospital, Army Medical University, Chongqing, China
| | - Kejia Zhao
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
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Xu J, Li X, Zeng J, Zhou Y, Li Q, Bai Z, Zhang Y, Xiao J. Effect of Baduanjin qigong on postoperative pulmonary rehabilitation in patients with non-small cell lung cancer: a randomized controlled trial. Support Care Cancer 2023; 32:73. [PMID: 38158422 DOI: 10.1007/s00520-023-08194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to explore the effect of Baduanjin qigong on improving lung function and postoperative quality of life of patients with non-small cell lung cancer (NSCLC) and to find an effective home-based pulmonary rehabilitation method. METHODS A randomised controlled trial was carried out from July 2019 to October 2021, which included 216 NSCLC postoperative participants from Beijing China-Japan Friendship Hospital and Cancer Hospital of Chinese Academy of Medical Science. Participants were randomly divided into two groups, including the observation (n = 108) group and the control group (n = 108). The control group was given routine lung rehabilitation training, while the observation group was given Baduanjin qigong. Both groups were trained for 12 weeks.The patient's age, sex, smoking history, lung cancer stage, pathological type were recorded. Related indicators of lung function, 6-min walk distance(6MWD), Piper fatigue Scale, and Borg dyspnea score before and after intervention were recorded. RESULTS Compared with these indicators before indicators, lung function, 6MWD, Piper fatigue Scale score and Borg score were significantly better in the two groups after intervention (P < 0.05). There were no significant differences in FVC%, 6MWD and Borg score between the two groups (P > 0.05), whereas FEV1% and Piper fatigue Scale scores in the observation group were better than that in the control group (P < 0.05). CONCLUSION Both Baduanjin qigong and traditional pulmonary rehabilitation methods can improve the postoperative lung function and quality of life of patients with NSCLC; and compared with traditional pulmonary rehabilitation training, Baduanjin Qigong may have certain advantages in relieving cancer-related fatigue and FEV1%, and may be another new method of home-based pulmonary rehabilitation for patients with NSCLC. TRIAL REGISTRATION Clinical Trial No.: ChiCTR1900025121.
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Affiliation(s)
- Jilai Xu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xia Li
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Jing Zeng
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Yanfen Zhou
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Qiyan Li
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China
| | - Zhenmin Bai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yuxuan Zhang
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China.
| | - Jun Xiao
- Guangzhou Special Service Recuperation, Center PLA Rocket Force, Guangzhou, China.
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Yao X, Li J, He J, Zhang Q, Yu Y, He Y, Wu J, Tang W, Ye C. A Kano model-based demand analysis and perceived barriers of pulmonary rehabilitation interventions for patients with chronic obstructive pulmonary disease in China. PLoS One 2023; 18:e0290828. [PMID: 38109304 PMCID: PMC10727440 DOI: 10.1371/journal.pone.0290828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has been recognized to be an effective therapy for chronic obstructive pulmonary disease (COPD). However, in China, the application of PR interventions is still less promoted. Therefore, this cross-sectional study aimed to understand COPD patients' intention to receive PR, capture the potential personal, social and environmental barriers preventing their willingness of receiving PR, and eventually identify demanding PR services with the highest priority from patients' point of view. METHODS In total 237 COPD patients were recruited from 8 health care facilities in Zhejiang, China. A self-designed questionnaire was applied to investigate patients' intention to participate in PR and potentially associated factors, including personal dimension such as personal awareness, demographic factors, COPD status and health-related literacy/behaviors, as well as social policies and perceived environmental barriers. The demand questionnaire of PR interventions based on the Kano model was further adopted. RESULTS Among the 237 COPD patients, 75.1% of COPD patients were willing to participate in PR interventions, while only 62.9% of the investigated patients had heard of PR interventions. Over 90% of patients believed that the cost of PR services and the ratio of medical insurance reimbursement were potential obstacles hindering them from accepting PR services. The multiple linear regression analysis indicated that the PR skills of medical staff, knowledge promotion and public education levels of PR in the community, patients' transportation concerns and degree of support from family and friends were significantly associated with willingness of participation in PR interventions. By using the Kano model, the top 9 most-requisite PR services (i.e., one-dimensional qualities) were identified from patients' point of view, which are mainly diet guidance, education interventions, psychological interventions and lower limb exercise interventions. Subgroup analysis also revealed that patients' demographics, such as breathlessness level, age, education and income levels, could influence their choice of priorities for PR services, especially services related to exercise interventions, respiratory muscle training, oxygen therapy and expectoration. CONCLUSIONS This study suggested that PR-related knowledge education among patients and their family, as well as providing basic package of PR services with the most-requisite PR items to COPD patients, were considerable approaches to promote PR attendance in the future.
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Affiliation(s)
- Xinmeng Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jinmei Li
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jialu He
- Department of Epidemiology and Biostatistics, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Qinzhun Zhang
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yi Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yinan He
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jinghua Wu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Weihong Tang
- Department of Gastroenterology, Hangzhou Children's Hospital, Hangzhou, Zhejiang, China
| | - Chengyin Ye
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Mohan A, Iyer VA, Kumar D, Batra L, Dahiya P. Navigating the Post-COVID-19 Immunological Era: Understanding Long COVID-19 and Immune Response. Life (Basel) 2023; 13:2121. [PMID: 38004261 PMCID: PMC10672162 DOI: 10.3390/life13112121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 11/26/2023] Open
Abstract
The COVID-19 pandemic has affected the world unprecedentedly, with both positive and negative impacts. COVID-19 significantly impacted the immune system, and understanding the immunological consequences of COVID-19 is essential for developing effective treatment strategies. The purpose of this review is to comprehensively explore and provide insights into the immunological aspects of long COVID-19, a phenomenon where individuals continue to experience a range of symptoms and complications, even after the acute phase of COVID-19 infection has subsided. The immune system responds to the initial infection by producing various immune cells and molecules, including antibodies, T cells, and cytokines. However, in some patients, this immune response becomes dysregulated, leading to chronic inflammation and persistent symptoms. Long COVID-19 encompasses diverse persistent symptoms affecting multiple organ systems, including the respiratory, cardiovascular, neurological, and gastrointestinal systems. In the post-COVID-19 immunological era, long COVID-19 and its impact on immune response have become a significant concern. Post-COVID-19 immune pathology, including autoimmunity and immune-mediated disorders, has also been reported in some patients. This review provides an overview of the current understanding of long COVID-19, its relationship to immunological responses, and the impact of post-COVID-19 immune pathology on patient outcomes. Additionally, the review addresses the current and potential treatments for long COVID-19, including immunomodulatory therapies, rehabilitation programs, and mental health support, all of which aim to improve the quality of life for individuals with long COVID-19. Understanding the complex interplay between the immune system and long COVID-19 is crucial for developing targeted therapeutic strategies and providing optimal care in the post-COVID-19 era.
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Affiliation(s)
- Aditi Mohan
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Sector-125, Noida 201313, Uttar Pradesh, India; (A.M.); (V.A.I.)
| | - Venkatesh Anand Iyer
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Sector-125, Noida 201313, Uttar Pradesh, India; (A.M.); (V.A.I.)
| | - Dharmender Kumar
- Department of Biotechnology, Deenbandhu Chhotu Ram University of Science &Technology, Murthal, Sonipat 131309, Haryana, India;
| | - Lalit Batra
- Regional Biocontainment Laboratory, Center for Predictive Medicine, University of Louisville, Louisville, KY 40222, USA
| | - Praveen Dahiya
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida Sector-125, Noida 201313, Uttar Pradesh, India; (A.M.); (V.A.I.)
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24
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Hu W, Wu WN, Qiao Q. Occupational survey-based evidence of health status and welfare problems of workers with pneumoconiosis in China. Front Public Health 2023; 11:1142161. [PMID: 37719739 PMCID: PMC10501603 DOI: 10.3389/fpubh.2023.1142161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Pneumoconiosis is the most dangerous occupational disease in China. According to unofficial records, nearly million migrant workers were affected by pneumoconiosis in 2011, with the number increasing annually. Among them, a large number of migrant workers suffering from pneumoconiosis were not medically diagnosed. Therefore, fundamental questions remain unanswered: what is the background of workers who receive a diagnosis of pneumoconiosis, and how does pneumoconiosis affect their future and well-being? Methods In this study, we identified and surveyed 1,134 workers with pneumoconiosis in seven selected regions in China with substantially high incidences of pneumoconiosis by using a combination of cluster sampling, convenience sampling, and snowball sampling. We used demographic, medical, and rehabilitation conditions and welfare questionnaires to collect the data. Results The findings highlighted the socioeconomic status of patients with pneumoconiosis. The majority of workers with pneumoconiosis were adult men who had received no higher education, who lived in rural households, and who were employed in mining or manufacturing industries. Among these workers, 52.8% had been exposed to dust at work for more than 10 years, and 53.1% received a diagnosis of stage II or III pneumoconiosis. More than half of the workers (569 workers, 50.2%) did not receive comprehensive, routine treatment; 33.4% (379 workers) visited a doctor when they experienced physical discomfort, and 6.6% (75 workers) never received treatment. Only 156 workers (13.8%) received rehabilitation services, whereas 978 workers (86.2%) never did. The study results also revealed the severe financial difficulties faced by patients with pneumoconiosis. Only 208 workers (18.3%) had access to work-related injury insurance, with the cost of pneumoconiosis treatment being a substantial burden for 668 workers (60.6%). Conclusion In this study, we explored the existing health and welfare problems faced by workers with pneumoconiosis in China and identified the social injustice and health disparities that these workers experience. We also clarified the primary challenges in implementing safety, health, and welfare policies for these workers and those who are exposed to high-risk environments, such as those working in mining.
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Affiliation(s)
- Wenxiu Hu
- Centre for Population and Development Policy Studies, Fudan University, Shanghai, China
| | - Wei-Ning Wu
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Qingmei Qiao
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
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Kubincová A, Takáč P, Demjanovič Kendrová L, Joppa P. Predictors of Quality-of-Life Improvement at Different Minimum Clinically Important Difference Values in Patients with Chronic Obstructive Pulmonary Disease after Climatic Rehabilitation Treatment. Life (Basel) 2023; 13:1763. [PMID: 37629620 PMCID: PMC10455286 DOI: 10.3390/life13081763] [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: 06/30/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The minimum clinically important difference (MCID) for the St George's Respiratory Questionnaire (SGRQ) is debated in chronic obstructive pulmonary disease (COPD) quality-of-life (QoL) assessments. This study aimed to determine whether there is a difference in predictors of clinically significant improvement between the traditional (value of 4) and newly proposed MCID SGRQ (value of 7) after climatic rehabilitation treatment. Climatic rehabilitation treatment consists of two main parts: climatotherapy, which typically involves the controlled exposure of individuals to natural environmental elements, and climatic rehabilitation, which includes other therapeutic factors such as physical activities as well as educating the patient to change their lifestyle. METHODS This study included 90 consecutive patients diagnosed with COPD who underwent structured complex pulmonary rehabilitation in High Tatras, part of the Carpathian Mountains. The examination before and after treatment included spirometry, QoL assessment using the SGRQ, 6 min walk test (6-MWT), and the Borg, Beck and Zung scale. RESULTS Patients showed statistically significant improvement after the intervention in FEV1, FEV1/FVC, 6-MWT, (p < 0.001), anxiety scores, depression, and improvement in dyspnoea both before and after the 6-MWT (p < 0.001). For both MCID for SGRQ levels 4 and 7, we confirmed the same predictors of clinical improvement for bronchial obstruction grade (spirometry) and exercise capacity (6-MWT), for quality of life in activity score and total score. CONCLUSION The results suggest that both the proposed MCID for SGRQ values could be sufficient to assess the clinical significance of the achieved change in health status when assessing the need for pulmonary rehabilitation comprising climatotherapy in patients with COPD.
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Affiliation(s)
- Anna Kubincová
- Department of Physical Medicine, Balneology and Medical Rehabilitation, Medical Faculty of P. J. Šafárik University and L. Pasteur University Hospital in Košice, 04190 Košice, Slovakia;
| | - Peter Takáč
- Department of Physical Medicine, Balneology and Medical Rehabilitation, Medical Faculty of P. J. Šafárik University and L. Pasteur University Hospital in Košice, 04190 Košice, Slovakia;
| | | | - Pavol Joppa
- Department of Pneumology and Phtiseology, Medical Faculty of P. J. Šafárik University and L. Pasteur University Hospital in Košice, 04190 Košice, Slovakia;
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Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, Bhatt SP, Bourbeau J, Burtin C, Camp PG, Cascino TM, Dorney Koppel GA, Garvey C, Goldstein R, Harris D, Houchen-Wolloff L, Limberg T, Lindenauer PK, Moy ML, Ryerson CJ, Singh SJ, Steiner M, Tappan RS, Yohannes AM, Holland AE. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2023; 208:e7-e26. [PMID: 37581410 PMCID: PMC10449064 DOI: 10.1164/rccm.202306-1066st] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
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27
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Tonga KO, Oliver BG. Effectiveness of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Therapy: Focusing on Traditional Medical Practices. J Clin Med 2023; 12:4815. [PMID: 37510930 PMCID: PMC10381859 DOI: 10.3390/jcm12144815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and serious disease that is characterized by dyspnea, fatigue, decreased exercise tolerance, peripheral muscle dysfunction, and mood disorders. These manifestations are successfully treated with pulmonary rehabilitation, a comprehensive intervention and holistic approach designed to improve the physical and psychological condition of people with COPD. Exercise is a big component of pulmonary rehabilitation programs, but the efficacy of non-traditional forms of exercise as used in alternative medicine is poorly understood. Here, we aim to address this gap in knowledge and summarize the clinical evidence for the use of traditional exercise regimens in the pulmonary rehabilitation of COPD patients.
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Affiliation(s)
- Katrina O Tonga
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- Saint Vincent's Hospital Sydney, Darlinghurst, NSW 2010, Australia
| | - Brian G Oliver
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- School of Life Sciences, University of Technology Sydney, Sydney, NSW 2007, Australia
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28
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Shigdel R, Johannessen A, Lin H, Peddada S, Gómez Real F, Ringel-Kulka T, Svanes C, Bertelsen RJ. Oral bacterial composition associated with lung function and lung inflammation in a community-based Norwegian population. Respir Res 2023; 24:183. [PMID: 37438766 DOI: 10.1186/s12931-023-02491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The oral cavity is the gateway to the bacteria community in the lung. Disruption of the symbiotic balance of the oral microbiota has been associated with respiratory diseases. However, little is known about the relationship between oral bacteria and respiratory outcomes in the general population. We aimed to describe the associations between oral bacteria, lung function, and lung inflammation in a community-based population. METHODS Oral (gingival) samples were collected concurrently with spirometry tests in 477 adults (47% males, median age 28 years) from the RHINESSA study in Bergen, Norway. Bacterial DNA from the 16S rRNA gene from gingival fluid were sequenced by Illumina®MiSeq. Lung function was measured using spirometry and measurement of fractional exhaled nitric oxide (FeNO) were performed to examine airway inflammation. Differential abundance analysis was performed using ANCOM-BC, adjusting for weight, education, and smoking. RESULTS The abundance of the genera Clostridiales, Achromobacter, Moraxella, Flavitalea and Helicobacter were significantly different among those with low FEV1 (< lower limit of normal (LLN)) as compared to normal FEV1 i.e. ≥ LLN. Twenty-three genera differed in abundance between among those with low FVC < LLN as compared to normal FEV1 ≥ LLN. The abundance of 27 genera from phyla Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria and Sacchribacteria differed significantly between elevated FeNO levels (≥ 50 ppb) compared to FeNO ≤ 25 ppb. CONCLUSION Oral bacterial composition was significantly different for those with low FEV or FVC as compared to those with normal lung function equal to or higher than LLN. Differential bacterial composition was also observed for elevated FeNO levels.
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Affiliation(s)
- Rajesh Shigdel
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway.
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Huang Lin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Shyamal Peddada
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Tamar Ringel-Kulka
- UNC Gillings School of Global Public Health, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Randi Jacobsen Bertelsen
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Xu Q, Shen ZQ, Feng KP, Xu C, Ding C, Li C, Ju S, Chen J, Pan S, Zhao J. The efficacy of three-ball breathing apparatus exercise based on the concept of pulmonary rehabilitation in patients after lung cancer surgery. J Cardiothorac Surg 2023; 18:218. [PMID: 37415230 DOI: 10.1186/s13019-023-02307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Postoperative patients with lung cancer mostly experience different degrees of dyspnea and decreased activity tolerance, and these symptoms all significantly affect postoperative quality of life. The concept of pulmonary rehabilitation applicable to patients with chronic respiratory diseases is also applicable to patients with postoperative lung cancer. The current application of postoperative pulmonary rehabilitation for lung cancer is inconsistent, and reliable guidelines are lacking. The purpose of this study was to further verify the efficacy and feasibility of postoperative pulmonary rehabilitation for lung cancer patients, and to find a suitable local pulmonary rehabilitation program for postoperative patients with lung cancer that is clinically promoted in our department through this study. METHODS We collected the clinical data of patients undergoing video-assisted thoracoscopic surgery (VATS) wedge resection or lobectomy. The patients were divided into rehabilitation group (using three-ball breathing apparatus after discharge) and control group (routine follow-up after discharge) according to whether the patients were trained with three-ball breathing apparatus after operation. The detailed method using three-ball apparatus is as follows. To begin with, patients are required to put themselves in a comfortable position. Then, after the three-ball breathing apparatus put on the same plane of their eyes, patients hold the tube in their mouth closely and control their breath slowly. When patients inhale to their largest extent, the balls will rise up accordingly. Then they exhale. The evaluation results of pulmonary function, activity tolerance, anxiety scores and others were collected. All data was gathered at the First Affiliated Hospital of Soochow University. The effects of pulmonary rehabilitation training on wedge resection and lobectomy were compared. RESULTS A total of 210 patients were included in this study, including 126 patients with VATS wedge resection and 84 patients with VATS lobectomies. No discrepancy was noticed when FEV1 loss between two groups were compared in the wedge resection patients, and the same results were also shown in patients undergoing lobectomy (12.8% ± 2.0% vs. 12.7% ± 1.9%, P = 0.84, wedge resection; 12.6% ± 2.9% vs. 12.1% ± 1.8%, P = 0.37, lobectomy). The loss of FVC in the control group was greater than that in the rehabilitation group for patients undergoing lobectomy (11.7% ± 5.2%, vs. 17.1% ± 5.6%, P < 0.001, lobectomy). No difference was found in the wedge resection patients between the control and rehabilitation groups (6.6% ± 2.8%, vs. 6.4% ± 3.2%, P = 0.76, lobectomy). Moreover, all patients showed no significant difference in 6MWD regardless of surgical procedure and with or without breathing exercises at T3 (392.6 ± 50.6 m, rehabilitation group vs. 394.0 ± 46.6 m, control group. P = 0.87, wedge resection; 381.3 ± 38.9 m, rehabilitation group vs. 369.1 ± 49.3 m, control group. P = 0.21, lobectomy). CONCLUSIONS For patients after thoracoscopic pulmonary wedge resection, the use of three-ball apparatus did not significantly improve postoperative pulmonary function and activity tolerance, dyspnea, and anxiety symptoms. In patients after thoracoscopic lobectomy, respiratory trainers were able to improve postoperative lung function but were unable to significantly improve dyspnea and anxiety symptoms. There was a significant benefit for the use of three-ball apparatus in patients after thoracoscopic lobectomy, whereas there was no significant benefit for the use of respiratory trainers after wedge resection. Registry: Medical Ethics Committee of the First Affiliated Hospital of Soochow University. REGISTRATION NUMBER no. 2022455.
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Affiliation(s)
- Qiang Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zi-Qing Shen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kun-Peng Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Ju
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shu Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Desachy M, Alexandre F, Varray A, Molinier V, Four E, Charbonnel L, Héraud N. High Prevalence of Non-Responders Based on Quadriceps Force after Pulmonary Rehabilitation in COPD. J Clin Med 2023; 12:4353. [PMID: 37445388 DOI: 10.3390/jcm12134353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Pulmonary rehabilitation (PR) in patients with COPD improves quality of life, dyspnea, and exercise tolerance. However, 30 to 50% of patients are "non-responders" (NRs) according to considered variables. Surprisingly, peripheral muscle force is never taken into account to attest the efficacy of PR, despite its major importance. Thus, we aimed to estimate the prevalence of force in NRs, their characteristics, and predictors of non-response. In total, 62 COPD patients were included in this retrospective study (May 2019 to December 2020). They underwent inpatient PR, and their quadriceps isometric maximal force (QMVC) was assessed. The PR program followed international guidelines. Patients with a QMVC increase <7.5 N·m were classified as an NR. COPD patients showed a mean improvement in QMVC after PR (10.08 ± 12.97 N·m; p < 0.001). However, 50% of patients were NRs. NRs had lower pre-PR values for body mass, height, body mass index, PaO2, and QMVC. Non-response can be predicted by low QMVC, high PaCO2, and gender (when male). This model has a sensitivity of 74% and specificity of 81%. The study highlights the considerable number of NRs and potential risk factors for non-response. To systematize the effects, it may be interesting to implement blood gas correction and/or optimize the programs to enhance peripheral and central effects.
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Affiliation(s)
- Marion Desachy
- EuroMov Digital Health in Motion, University Montpellier, IMT Mines Ales, Montpellier, France
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - François Alexandre
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - Alain Varray
- EuroMov Digital Health in Motion, University Montpellier, IMT Mines Ales, Montpellier, France
| | - Virginie Molinier
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - Elodie Four
- Clinique du Souffle Les Clarines, Inicea, France
| | | | - Nelly Héraud
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
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Xiong T, Bai X, Wei X, Wang L, Li F, Shi H, Shi Y. Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits. Int J Chron Obstruct Pulmon Dis 2023; 18:1251-1266. [PMID: 37362621 PMCID: PMC10289097 DOI: 10.2147/copd.s408325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.
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Affiliation(s)
- Ting Xiong
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Xinyue Bai
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Xingyi Wei
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Lezheng Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Fei Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yue Shi
- School of Athletic Performance, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
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Chen M, Zhang Y, Mao Y, Lian Y, Ye P, Liu C, Zhang Z, Fu X. Bibliometric Analysis of Exercise and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1115-1133. [PMID: 37313499 PMCID: PMC10259624 DOI: 10.2147/copd.s406955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/30/2023] [Indexed: 06/15/2023] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is the leading cause of death in the world. Pulmonary rehabilitation includes, but is not limited to, exercise training and education, which aim to improve the physical and psychological conditions of patients with chronic respiratory diseases through self-management interventions. Objective The aim of this study was to perform a bibliometric analysis of studies on exercise and COPD published from 2000 to 2021 using VOSviewer and CiteSpace. Methods All included literature was obtained from the Web of Science core collection. VOSviewer was used to analyze country or region, institution, major co-cited journals, and keywords. CiteSpace was used to analyze centrality, author and co-cited authors, journals, the strongest citation bursts of references, and keywords. Results A total of 1889 articles meeting the criteria were obtained. The United States has the largest number of publications. The American Journal of Respiratory and Critical Care Medicine is the most influential in this field, and the most published research institution is Queen's University. Denis E. O'Donnell has made significant contributions to exercise and COPD research. Association, impact, and statement are hot spots of research in this field. Conclusion A bibliometric analysis of exercise interventions for COPD over the past 22 years provides direction for future research.
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Affiliation(s)
- Mengtong Chen
- Department of Infectious Diseases Unit, Panyu Central Hospital, Guangzhou, People’s Republic of China
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Yuting Zhang
- Department of Infectious Diseases Unit, Panyu Central Hospital, Guangzhou, People’s Republic of China
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Yuqiao Mao
- Department of Infectious Diseases Unit, Panyu Central Hospital, Guangzhou, People’s Republic of China
| | - Yunwen Lian
- Department of Infectious Diseases Unit, Panyu Central Hospital, Guangzhou, People’s Republic of China
| | - Peng Ye
- Department of Infectious Diseases Unit, Panyu Central Hospital, Guangzhou, People’s Republic of China
| | - Chunlong Liu
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Zhijie Zhang
- Department of Rehabilitation, Luoyang Orthopedics Hospital of Henan Province, Luoyang, People’s Republic of China
| | - Xihua Fu
- Department of Infectious Diseases Unit, Panyu Central Hospital, Guangzhou, People’s Republic of China
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Hamilton A, Tetzlaff K. Editorial: Exercise intervention for prevention, management of and rehabilitation from chronic obstructive pulmonary disease (COPD). Front Physiol 2023; 14:1228431. [PMID: 37346487 PMCID: PMC10280736 DOI: 10.3389/fphys.2023.1228431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Alan Hamilton
- COPD Foundation, Miami, FL, United States
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kay Tetzlaff
- Department of Sports Medicine, University of Tübingen, Tübingen, Baden-Württemberg, Germany
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Demeke D, Tesfa E. Prevalence of obstructive lung patterns and actual spirometric result at different workplaces in Ethiopia: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1359. [PMID: 37359412 PMCID: PMC10288973 DOI: 10.1002/hsr2.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/12/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aims Burdens of occupational exposure like insoluble dust particles and chemicals in the respiratory tract leads to impaired clearance. This study aims to assess the prevalence of obstructive lung patterns and actual spirometric result in Ethiopia at different workplaces. Methods Five electronic databases such as: PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online were searched in studies conducted from 2010 to 2021. In this study, we used STATA 14 software for data analysis and the quality of included studies were appraised using the New Castle Ottawa quality assessment tool. The pooled prevalence of obstructive lung patterns and actual spirometric results were estimated using effect size and standardized mean differences (SMD). Results A total representative of 3511 participants was included in this study. The pooled prevalence of obstructive lung patterns in occupational exposure at different workplaces was found 13.04% (95% CI: 7.96, 18.12, I 2 = 89.2%). On the other hand, the pooled prevalence of obstructive lung patterns in controls was 4.10% (95% CI: 1.86, 6.34, I 2 = 76.8%). SMD of spirometric results was significantly decreased in cases as compared to the controls. The SMD of FVC in a litter (L) at 95% of CI: -0.50 (-0.70, -0.30, I 2 = 87.7%), SMD of FEV1 in (L) at 95% CI: -0.54 (-0.72, -0.36, I 2 = 84.9%), SMD of FEF25%-50% in litter per second (L/s) at 95% of CI: -0.42 (-0.67, -0.17, I 2 = 81.9%) and SMD of PEFR in L/s at 95% CI: -0.45 (-0.68, -0.21, I 2 = 78.4%) were significantly decreased in cases as compared to the controls. Conclusion The pooled prevalence of obstructive lung pattern was higher in people who are working at different workplace that generating dusts and chemicals. The SMD of actual spirometric results were reduced in cases than controls. Therefore, to alleviate this problem appropriate preventive measure would be warranted for those people who are working in different dust and chemical generating environments.
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Affiliation(s)
- Dessalegn Demeke
- Department of Physiology, College of Medicine and Health Sciences Bahir Dar University Bahir Dar Ethiopia
| | - Endalamaw Tesfa
- Department of Biochemistry, College of Medicine and Health Sciences Bahir Dar University Bahir Dar Ethiopia
- Health Biotechnology Division, Institute of Biotechnology Bahir Dar University Bahir Dar Ethiopia
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An R, Zhang S, Huang X, Lan Y, Cao T, Wan Q. Physical activity trajectories and their determinants in patients with chronic obstructive pulmonary disease: A cohort study. J Clin Nurs 2023. [PMID: 37243430 DOI: 10.1111/jocn.16771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
AIMS AND OBJECTIVES The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio-ecological model. BACKGROUND PA has been linked to poor long-term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. DESIGN Cohort study. METHODS We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group-based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow-up. A STROBE checklist was used to guide the reporting of this study. RESULTS Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow-up. CONCLUSIONS This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. RELEVANCE TO CLINICAL PRACTICE It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. NO PATIENT OR PUBLIC CONTRIBUTION A national cohort study was used and no patients or the public were involved in the design and implementation of this study.
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Affiliation(s)
- Ran An
- School of Nursing, Peking University, Beijing, China
| | - Shifang Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xiuxiu Huang
- School of Nursing, Peking University, Beijing, China
| | - Yue Lan
- School of Nursing, Peking University, Beijing, China
| | - Ting Cao
- School of Nursing, Peking University, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
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Wang J, Li R, Chang J, Wang Y, Lai Y, Dong Y, Che G. Quality of life between home-based and outpatient pulmonary rehabilitation in patients after surgical resection for lung cancer: protocol for a prospective, single-blind, randomised controlled trial. BMJ Open 2023; 13:e067845. [PMID: 37156593 PMCID: PMC10174035 DOI: 10.1136/bmjopen-2022-067845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Lung cancer remains a highly fatal disease. Surgical resection has been proven to be the most effective treatment for early-stage lung cancer. The conventional hospital-based pulmonary rehabilitation (PR) is shown to reduce symptoms, improve exercise capacity and impact the quality of life (QoL) for lung cancer patients. To date, scientific evidence on the effectiveness of home-based PR for patients with lung cancer following surgery is scarce. We aim to explore if home-based PR is non-inferior to outpatient PR for patients with lung cancer following surgical resection. METHODS AND ANALYSIS This study is a two-arm, parallel-group, assessor-blind, single-centre, randomised controlled trial. Participants will be recruited from West China Hospital, Sichuan University and randomly allocated to either an outpatient group or a home-based group at a ratio of 1:1. The PR programme involves self-management and exercises. The exercise includes warm-up (10 min), aerobic training (20 min), resistance training (15 min) and cool-down (10 min), lasting 4 weeks, with two sessions per week either at home or in the outpatient setting. The intensity will be adjusted according to the modified Borg rating of perceived exertion and heart rate before and after each exercise session. The primary outcome is QoL measured by EORTC QLQ-C30 & LC 13 after an intervention. Secondary outcomes include physical fitness measured by a 6 min walk test and stair-climbing test and symptom severity measured by patient-reported questionnaires and pulmonary function. The main hypothesis is that home-based PR is non-inferior to outpatient PR for patients with lung cancer following surgical resection. ETHICS AND DISSEMINATION The trial has been approved by the Ethical Committee of West China Hospital and is also registered with the Chinese Clinical Trial Registry. The results of this study will be disseminated through peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100053714.
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Affiliation(s)
- Jiao Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ran Li
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Junke Chang
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yan Wang
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yutian Lai
- Lung Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yingxian Dong
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Guowei Che
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Lung Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Cheng SWM, McKeough ZJ, McNamara RJ, Alison JA. Pulmonary Rehabilitation Using Minimal Equipment for People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Phys Ther 2023; 103:pzad013. [PMID: 37140475 PMCID: PMC10158642 DOI: 10.1093/ptj/pzad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of pulmonary rehabilitation to a greater number of people with chronic obstructive pulmonary disease (COPD). The effectiveness of minimal equipment programs in people with COPD is unclear. This systematic review and meta-analysis aimed to determine the effects of pulmonary rehabilitation using minimal equipment for aerobic and/or resistance training in people with COPD. METHODS Literature databases were searched up to September 2022 for randomized controlled trials (RCTs) comparing the effect of minimal equipment programs with usual care or with exercise equipment-based programs for exercise capacity, health-related quality of life (HRQoL), and strength. RESULTS Nineteen RCTs were included in the review and 14 RCTs were included in the meta-analyses, which reported low to moderate certainty of evidence. Compared with usual care, minimal equipment programs increased 6-minute walk distance (6MWD) by 85 m (95% CI = 37 to 132 m). No difference in 6MWD was observed between minimal equipment and exercise equipment-based programs (14 m, 95% CI = -27 to 56 m). Minimal equipment programs were more effective than usual care for improving HRQoL (standardized mean difference = 0.99, 95% CI = 0.31 to 1.67) and were not different from exercise equipment-based programs for improving upper limb strength (6 N, 95% CI = -2 to 13 N) or lower limb strength (20 N, 95% CI = -30 to 71 N). CONCLUSION In people with COPD, pulmonary rehabilitation programs using minimal equipment elicit clinically significant improvements in 6MWD and HRQoL and are comparable with exercise equipment-based programs for improving 6MWD and strength. IMPACT Pulmonary rehabilitation programs using minimal equipment may be a suitable alternative in settings where access to gymnasium equipment is limited. Delivery of pulmonary rehabilitation programs using minimal equipment may improve access to pulmonary rehabilitation worldwide, particularly in rural and remote areas and in developing countries.
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Affiliation(s)
- Sonia Wing Mei Cheng
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zoe J McKeough
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Renae J McNamara
- Department of Physiotherapy, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Sydney, Australia
| | - Jennifer A Alison
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Allied Health Professorial Unit, Sydney Local Health District, Sydney, Australia
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Kotejoshyer R, Eve J, Priya A, Mazor K, Spitzer KA, Pekow PS, Pack QR, Lindenauer PK. Strategies to Improve Enrollment and Participation in Pulmonary Rehabilitation Following a Hospitalization for COPD: RESULTS OF A NATIONAL SURVEY. J Cardiopulm Rehabil Prev 2023; 43:192-197. [PMID: 36137210 PMCID: PMC10148891 DOI: 10.1097/hcr.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) improves outcomes for patients with chronic obstructive pulmonary disease (COPD); however, very few patients attend. We sought to describe strategies used to promote participation in PR after a hospitalization for COPD. METHODS A random sample of 323 United States based PR programs was surveyed. Using a positive deviance approach, a 39-item survey was developed based on interviews with clinicians at hospitals demonstrating high rates of participation in PR. Items focused on strategies used to promote participation as well as relevant contextual factors. RESULTS Responses were received from 209 programs (65%), of which 88% (n = 184) were hospital-based outpatient facilities. Most (91%, n = 190) programs described enrolling patients continuously, and 80% (n = 167) reported a wait time from referral to the initial PR visit of <4 wk. Organization-level strategies to increase referral to PR included active surveillance (48%, n = 100) and COPD-focused staff (49%, n = 102). Provider-level strategies included clinician education (45%, n = 94), provider outreach (43%, n = 89), order sets (45%, n = 93), and automated referrals (23%, n = 48). Patient-level strategies included bedside education (53%, n = 111), flyers (49%, n = 103), motivational interviewing (33%, n = 69), financial counseling (64%, n = 134), and transportation assistance (35%, n = 73). Fewer than one-quarter (18%, n = 38) of PR programs reported using both bedside education and automatic referral, and 42% (n = 88) programs did not use either strategy. CONCLUSIONS This study describes current practices in the United States, and highlights opportunities for improvement at the organization, provider, and patient level. Future research needs to demonstrate the effectiveness of these strategies, alone or in combination.
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Affiliation(s)
- Rajashree Kotejoshyer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield (Drs Kotejoshyer, Eve, Spitzer, Pekow, Pack, and Lindenauer and Ms Priya); University of Massachusetts Chan Medical School, Worcester (Dr Mazor); and UMass Donahue Institute, Amherst, Massachusetts (Dr Spitzer)
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Nyberg A, Sondell A, Lundell S, Marklund S, Tistad M, Wadell K. Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis. JMIR Hum Factors 2023; 10:e43269. [PMID: 36995743 PMCID: PMC10131608 DOI: 10.2196/43269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/13/2022] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management. OBJECTIVE The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice. METHODS This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach. RESULTS The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis. CONCLUSIONS This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis. TRIAL REGISTRATION ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.
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Affiliation(s)
- André Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Sondell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sara Lundell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Ashra F, Jen HJ, Liu D, Lee TY, Pien LC, Chen R, Lin HC, Chou KR. Effectiveness of respiratory rehabilitation in patients with COVID-19: A meta-analysis. J Clin Nurs 2023. [PMID: 36945127 DOI: 10.1111/jocn.16692] [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: 11/08/2022] [Revised: 01/04/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
AIM Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients. DESIGN Meta-analysis. METHODS R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I2 . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. DATA SOURCES A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022. RESULTS Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. CONCLUSIONS Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. IMPACT These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients. IMPLICATIONS FOR THE PROFESSION Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients. REPORTING METHOD PRISMA guideline was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Fauzi Ashra
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Prima Nusantara Bukittinggi University, Bukittinggi, Indonesia
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Rajan SK, Cottin V, Dhar R, Danoff S, Flaherty KR, Brown KK, Mohan A, Renzoni E, Mohan M, Udwadia Z, Shenoy P, Currow D, Devraj A, Jankharia B, Kulshrestha R, Jones S, Ravaglia C, Quadrelli S, Iyer R, Dhooria S, Kolb M, Wells AU. Progressive pulmonary fibrosis: an expert group consensus statement. Eur Respir J 2023; 61:2103187. [PMID: 36517177 PMCID: PMC10060665 DOI: 10.1183/13993003.03187-2021] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
This expert group consensus statement emphasises the need for standardising the definition of progressive fibrosing interstitial lung diseases (F-ILDs), with an accurate initial diagnosis being of paramount importance in ensuring appropriate initial management. Equally, case-by-case decisions on monitoring and management are essential, given the varying presentations of F-ILDs and the varying rates of progression. The value of diagnostic tests in risk stratification at presentation and, separately, the importance of a logical monitoring strategy, tailored to manage the risk of progression, are also stressed. The term "progressive pulmonary fibrosis" (PPF) exactly describes the entity that clinicians often face in practice. The importance of using antifibrotic therapy early in PPF (once initial management has failed to prevent progression) is increasingly supported by evidence. Artificial intelligence software for high-resolution computed tomography analysis, although an exciting tool for the future, awaits validation. Guidance is provided on pulmonary rehabilitation, oxygen and the use of non-invasive ventilation focused specifically on the needs of ILD patients with progressive disease. PPF should be differentiated from acute deterioration due to drug-induced lung toxicity or other forms of acute exacerbations. Referral criteria for a lung transplant are discussed and applied to patient needs in severe diseases where transplantation is not realistic, either due to access limitations or transplantation contraindications. In conclusion, expert group consensus guidance is provided on the diagnosis, treatment and monitoring of F-ILDs with specific focus on the recognition of PPF and the management of pulmonary fibrosis progressing despite initial management.
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Affiliation(s)
- Sujeet K Rajan
- Bombay Hospital Institute of Medical Sciences and Bhatia Hospital, Mumbai, India
| | - Vincent Cottin
- National French Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INRAE, Member of ERN-LUNG, Lyon, France
| | | | - Sonye Danoff
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Anant Mohan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Padmanabha Shenoy
- Department of Rheumatology, Centre for Arthritis and Rheumatism Excellence, Kochi, India
| | | | - Anand Devraj
- Department of Radiology, Royal Brompton Hospital, London, UK
| | | | - Ritu Kulshrestha
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Steve Jones
- European Idiopathic Pulmonary Fibrosis Federation (EU-IPFF), Peterborough, UK
| | - Claudia Ravaglia
- Pulmonology Unit, GB Morgagni Hospital/University of Bologna, Forlì, Italy
| | | | - Rajam Iyer
- Bhatia Hospital and PD Hinduja Hospital, Mumbai, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Martin Kolb
- Firestone Institute for Respiratory Heath, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
- Co-senior authors
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Co-senior authors
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Rehabilitation in der Allergologie. ALLERGO JOURNAL 2023. [DOI: 10.1007/s15007-023-5690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Choi HE, Kim TH, Jang JH, Jang HJ, Yi J, Jung SY, Kim DW, Lee JH. The Efficacy of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis. Life (Basel) 2023; 13:life13020403. [PMID: 36836759 PMCID: PMC9963601 DOI: 10.3390/life13020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Background: This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) on functional performance, exercise-related oxygen saturation, and health-related quality of life among patients with idiopathic pulmonary fibrosis (IPF). Methods: A total of 25 patients with IPF (13 in the PR group and 12 in the non-PR group) were enrolled between August 2019 and October 2021 at Haeundae-Paik Hospital in the Republic of Korea. A cardiopulmonary exercise test (CPET), six-minute walk test (6MWT), pulmonary function test (PFT), Saint George's Respiratory Questionnaire (SGRQ), muscle strength test, and bioelectrical impedance analysis were performed in each group at baseline and after eight weeks of PR. Results: The mean age was 68 years of age and most subjects were male. Baseline characteristics were similar between the two groups. The distance during 6MWT after PR was significantly improved in the PR group (inter-group p-value = 0.002). VO2max and VE/VCO2 slopes showed a significant difference after eight weeks only in the PR group, but the rate of change did not differ significantly from the non-PR group. Total skeletal muscle mass, PFT variables, and SGRQ scores did not differ significantly between the groups. Conclusions: PR improved exercise capacity, as measured using CPET and 6 MWT. Further studies in larger samples are needed to evaluate the long-term efficacy of PR in IPF patients.
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Affiliation(s)
- Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Tae Hoon Kim
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Ji Hoon Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Hang-Jea Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Jisook Yi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - So Young Jung
- Division of Dermatology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Dae-Wook Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
- Correspondence: ; Tel./Fax: +82-51-797-2210
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Xu Z, Han Z, Ma D. Efficacy and safety of long-term use of a positive expiratory pressure device in chronic obstructive pulmonary disease patients, a randomized controlled trial. BMC Pulm Med 2023; 23:17. [PMID: 36647057 PMCID: PMC9841661 DOI: 10.1186/s12890-023-02319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Exercise intolerance is among the most common symptoms experienced by patients with chronic obstructive pulmonary disease (COPD), which is associated with lung dynamic hyperinflation (DH). There was evidence that positive expiratory pressure (PEP), which could be offered by less costly devices, could reduce DH. The purpose of this study was to evaluate the efficacy and safety of long-term domiciliary use of PEP device in subjects with COPD. METHODS A randomized controlled trial was conducted and 25 Pre-COPD or mild-to-very severe subjects with COPD were randomized to intervention group (PEP device, PEP = 5 cmH2O, n = 13) and control group (Sham-PEP device, PEP = 0 cmH2O, n = 12). PEP device was a spring-loaded resistor face mask. Subjects were treated 4 h per day for a total of 2 months. Six-minute walk test (6MWT), pulmonary function, the Modified British Medical Research Council score, and partial pressure of end-tidal carbon dioxide were evaluated at baseline and after two months. RESULTS The 6MWD (- 71.67 ± 8.70 m, P < 0.001), end-dyspnea (P = 0.002), and end-fatigue (P = 0.022) improved significantly in the intervention group when compared with the control group. All subjects in the intervention group reported that 4 h of daily use of the PEP device was well tolerated and accepted and there were no adverse events. CONCLUSION Regular daily use of PEP device is safe and may improve exercise capacity in subjects with COPD or pre-COPD. PEP device could be used as an add-on to pulmonary rehabilitation programs due to its efficacy, safety, and low cost. TRIAL REGISTRATION The study was prospectively registered on ClinicalTrials.gov (NCT04742114).
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Affiliation(s)
- Zhaoning Xu
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Shandong University, Jinan, 250012 Shandong China
| | - Zhuo Han
- grid.27255.370000 0004 1761 1174Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China
| | - Dedong Ma
- grid.27255.370000 0004 1761 1174Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, 250012 Shandong China
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van der Braak K, Wald J, Tansey CM, Paes T, Sedeno M, Selzler AM, Stickland MK, Bourbeau J, Janaudis-Ferreira T. Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study. Chron Respir Dis 2023; 20:14799731231179105. [PMID: 37471305 PMCID: PMC10363903 DOI: 10.1177/14799731231179105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. METHODS Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS Reach: 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program. CONCLUSIONS The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.
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Affiliation(s)
- Kim van der Braak
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Joshua Wald
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - Catherine M Tansey
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Thais Paes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Maria Sedeno
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- RESPIPLUS, Mont-Royal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anne-Marie Selzler
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Alhotye M, Daynes E, Gerlis C, Singh SJ. Symptoms burden and rehabilitation preference after an episode of COVID-19: A patients survey. Chron Respir Dis 2023; 20:14799731231177316. [PMID: 37192536 DOI: 10.1177/14799731231177316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND After COVID-19 infection, individuals can experience a variety of symptoms that might require further treatment. Early data showed the value of adapted pulmonary rehabilitation programmes and technology-based interventions. To develop appropriate services, it is important to understand the symptom burden and the preferred mode of rehabilitation delivery. METHODS Post-hospital discharge (H) and post-community-managed (C) individuals received a follow-up call. A survey was completed to assess the most burdensome symptoms for which the patients would require support and their preference for the mode of rehabilitation delivery. RESULTS Overall, 160 individuals who received a follow-up call completed the survey (51.2% male, mean [SD] age 54 [15] years) and 126 (78.8%) were post-hospital, while 34 (21.3%) had community-managed infections. A total of 101 (63.1%) reported that COVID-19-related symptoms were affecting their daily activities, and 106 (66.3%) reported their desire to be more active. The most common symptoms identified as needing support were fatigue and shortness of breath. Both groups expressed a preference for a face-to-face group programme (C: 54.8%; H: 46.8%), while (38.7%) of post-community-managed individuals and (40.3%) post-hospital patients preferred a supported digital rehabilitation programme. Few opted a non-digital home-based programme (C: 3.2%; H:12.9%, respectively). CONCLUSION The survey responses indicated a significant symptom burden that may benefit from an intervention such as rehabilitation. Preferences for rehabilitation indicated that a face-to-face intervention was preferred by the majority, with a large proportion preferring digital intervention.
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Affiliation(s)
- Munyra Alhotye
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Therapy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Enya Daynes
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science (CERS), University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charlotte Gerlis
- Centre for Exercise and Rehabilitation Science (CERS), University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science (CERS), University Hospitals of Leicester NHS Trust, Leicester, UK
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Reinert G, Müller D, Wagner P, Martínez-Pozas O, Cuenca-Záldivar JN, Fernández-Carnero J, Sánchez Romero EA, Corbellini C. Pulmonary Rehabilitation in SARS-CoV-2: A Systematic Review and Meta-Analysis of Post-Acute Patients. Diagnostics (Basel) 2022; 12:diagnostics12123032. [PMID: 36553039 PMCID: PMC9776761 DOI: 10.3390/diagnostics12123032] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Pulmonary Rehabilitation (PR) was initially developed for the management of Chronic Obstructive Pulmonary Disease (COPD) and is now recognized as a core management of COVID-19 patients. This systematic review and meta-analysis examined the efficacy of PR in patients with post-acute COVID-19 infection. METHODS A literature search was conducted in PubMed, the Web of Science (WoS), and the Cochrane Library from their inceptions until October 2022, and randomized controlled trials and observational studies were considered. The outcomes measured included dyspnea, physical function, and quality of life. RESULTS Eleven studies including 677 participants with post-acute COVID-19 were included in this analysis. From a qualitative point of view and analyzing the studies separately, PR improves dyspnea, physical function, and quality of life in patients with post-acute COVID-19. However, in pooling the data of all the studies, no significant changes pre-postintervention, compared to the control, were found among the experimental studies included in the analysis in any outcome measures, due to the high heterogeneity between the studies, as well as no significant improvements being found in the observational studies. A subgroup analysis revealed significant differences in all the included outcomes. Future studies should include the same scale to assess the actual efficacy of PR. CONCLUSION From a qualitative analysis point of view, PR is effective in improving physical function, reducing dyspnea, and improving quality of life in patients with post-acute COVID-19. However, an exploratory meta-analysis was performed to evaluate, by subgroups, the efficacy of PR, and positive results were found in favor of PR.
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Affiliation(s)
- Glenn Reinert
- Hopitaux Robert Schuman-Centre Médical Clinique Sainte Marie, Rue Wurth-Paquet 7, 4350 Esch-sur-Alzette, Luxembourg;
- Physiotherapy Masters of Science Programme, LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg; (D.M.); (P.W.)
| | - Daniel Müller
- Physiotherapy Masters of Science Programme, LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg; (D.M.); (P.W.)
- Physiotherapy Unit, Centre Hospitalier de Luxembourg, Rue Ernest Barble 4, 1210 Luxembourg, Luxembourg
| | - Pit Wagner
- Physiotherapy Masters of Science Programme, LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg; (D.M.); (P.W.)
| | - Oliver Martínez-Pozas
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
- Correspondence: (O.M.-P.); (J.N.C.-Z.); (E.A.S.R.)
| | - Juan Nicolás Cuenca-Záldivar
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute—Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain
- Physical Therapy Unit, Primary Health Care Center “El Abajón”, 28231 Las Rozas de Madrid, Spain
- Correspondence: (O.M.-P.); (J.N.C.-Z.); (E.A.S.R.)
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
| | - Eleuterio A. Sánchez Romero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (O.M.-P.); (J.N.C.-Z.); (E.A.S.R.)
| | - Camilo Corbellini
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg;
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Jiang J, Zhang D, Huang Y, Wu Z, Zhang W. Exercise rehabilitation in pediatric asthma: A systematic review and network meta-analysis. Pediatr Pulmonol 2022; 57:2915-2927. [PMID: 36103241 DOI: 10.1002/ppul.26134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This systematic review delineates various exercise-based pulmonary rehabilitation (PR) designs and quantifies how they may be optimized in pediatric asthma treatment. DESIGN Comprehensive systematic review, network meta-analysis, and quality analyses using PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Medline searches. INTERVENTIONS Discrete and combined endurance, respiratory, resistance, strength, and interval training. MAIN OUTCOME MEASURES Forced expiratory volume at 1 s to predicted value ratio (FEV1 % pred), forced vital capacity to predicted value ratio (FVC% pred), forced expiratory flow between 25% and 75% of vital capacity ratio (FEF25%-75%), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 6-min walk test (6MWT). RESULTS Twenty-four randomized controlled trials (RCTs) involving a combined 1031 patients were included. Endurance training was the most common form of PR (58.3%), typically conducted through outpatient clinics (29.2%). Network meta-analysis showed that compared with other PR, interval training significantly improved PAQLQ total scores, and activity, symptom, and emotional domains. Interval training also had a significant effect on the 6MWT. No adverse events were reported. Exercise training did not have a significant effect on FEV1 % pred; however, combined endurance and respiratory training significantly improved both FVC% pred and FEF25%-75%. CONCLUSIONS Exercise-based PR is safe and effective in childhood asthma treatment. Interval training may be a core component for improving quality of life and exercise capacity in this patient population, while combined respiratory and endurance training may significantly affect lung function. The clinical efficacy of these results should be confirmed through high-quality RCTs.
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Affiliation(s)
- Jing Jiang
- School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
| | - Dong Zhang
- School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yapan Huang
- Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
| | - Zhenguo Wu
- School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
| | - Wei Zhang
- Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
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49
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Zhang H, Hu D, Xu Y, Wu L, Lou L. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med 2022; 54:262-273. [PMID: 35037535 PMCID: PMC8765243 DOI: 10.1080/07853890.2021.1999494] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The present systematic review and meta-analysis of randomized clinical trials (RCTs) aimed to investigate the effects of pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). METHODS The RCTs of pulmonary rehabilitation programs published between 1999 and 2021 were retrieved from electronic databases (PubMed, Cochrane Library, and Embase). Two reviewers independently assessed the topical relevance and trial quality and extracted data for meta-analysis using the Stata software version 14.0. RESULTS A total of 39 trials involving 2,397 participants with COPD were evaluated. We found that patients who received pulmonary rehabilitation program had significant improvement in the 6-min walk test (6MWT), St. George Respiratory Questionnaire score, and the modified British Medical Research Council score as compared to those who received usual care. Yoga and Tai Chi showed significant improvement in the forced expiratory volume (FEV1)% in 1 s predicted value. However, no significant difference was detected in the modified Borg score, forced vital capacity (FVC), and FEV1/FVC predicted value between the pulmonary rehabilitation and usual care groups. CONCLUSION Yoga and Tai Chi showed a significant improvement in the FEV1% predicted value. Also, pulmonary rehabilitation program improved the exercise capacity, the quality of life, and dyspnoea in patients with COPD.Key messagesA total of 39 trials involving 2,397 participants with COPD were evaluated.We found that patients who received pulmonary rehabilitation program had significant improvement in the 6MWT, St. George Respiratory Questionnaire score, and the modified British Medical Research Council score as compared to those who received usual care.Yoga and Tai Chi showed significant improvement in the FEV1% predicted value.No significant difference was detected in the modified Borg score, FVC, and FEV1/FVC predicted value between the pulmonary rehabilitation and usual care groups.
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Affiliation(s)
- Hong Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dandan Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yikai Xu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lixia Wu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Liming Lou
- Department of Respiratory Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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50
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McLoughlin RF, Clark VL, Urroz PD, Gibson PG, McDonald VM. Increasing physical activity in severe asthma: a systematic review and meta-analysis. Eur Respir J 2022; 60:2200546. [PMID: 35896208 PMCID: PMC9753478 DOI: 10.1183/13993003.00546-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Physical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity in reducing the risk of these outcomes, little is known about optimal interventions for increasing physical activity in those with severe disease. This systematic review and meta-analysis evaluates the effectiveness of interventions in increasing physical activity in severe asthma. METHODS MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, Informit, SPORTDiscus and Cochrane databases were searched up to September 2021 for physical activity-based intervention studies that assessed physical activity outcomes (e.g. steps per day, time spent undertaking physical activity) in adults with severe asthma. Data on asthma-related (e.g. asthma control) and health-related outcomes (e.g. HRQoL) were assessed as secondary outcomes. The revised Cochrane Risk of Bias tool was used to assess risk of bias. Random-effects meta-analyses synthesised data where possible. RESULTS Four randomised controlled trials (all 12 weeks in duration) including 176 adults with moderate-to-severe asthma were included. An increase in physical activity was reported with a moderate-vigorous intensity aerobic and resistance training intervention (steps per day and time spent undertaking physical activity), and an unsupervised pedometer-based intervention (steps per day). Meta-analyses showed that physical activity interventions had an overall positive effect on steps per day (mean difference (MD) 1588, 95% CI 399-2778; p=0.009, I2=23), asthma control (MD -0.65, 95% CI -0.95--0.35; p<0.0001, I2=0%) and HRQoL (MD 0.56, 95% CI 0.10-1.01; p=0.02, I2=16%) compared to control. CONCLUSION While there is some evidence supporting the effectiveness of interventions in improving physical activity in adults with severe asthma, higher-quality, large-scale studies of longer duration are needed to determine the optimal intervention.
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Affiliation(s)
- Rebecca F McLoughlin
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Vanessa L Clark
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Paola D Urroz
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Peter G Gibson
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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