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Waghe VR, Lalwani L, Chilhate PK. The Impact of Pulmonary Rehabilitation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Case Report. Cureus 2024; 16:e55537. [PMID: 38576670 PMCID: PMC10993079 DOI: 10.7759/cureus.55537] [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: 01/16/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
This study focuses on a 56-year-old male laborer who presented to the respiratory department with grade III dyspnea persisting for 20 days, aggravated in the mornings, accompanied by chest pain over the last two days. The patient reported a productive cough producing yellowish sputum for 15 days and an ongoing fever during this period. With a two-year medical history of seasonal bronchial asthma, the patient had been using an inhaler three times daily for the past month. Additionally, a 20-year history of smoking, averaging five cigarettes per day, was disclosed. Investigations revealed hyperinflation of the lungs on X-ray, indicative of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The patient was prescribed a four-week pulmonary rehabilitation protocol, incorporating physiotherapy. Baseline assessments were conducted using outcome measures such as pulmonary function test (PFT), functional independence measure (FIM), and six-minute walk distance (6MWD) before initiating treatment to evaluate the patient's performance. Following the prescribed pulmonary rehabilitation regimen, notable improvements were observed in PFT, FIM, and 6MWD. These findings underscore significant enhancements in exercise tolerance and overall functional capacity. The results suggest that a structured pulmonary rehabilitation program can lead to meaningful clinical benefits in individuals experiencing AECOPD, particularly when tailored to individual patient needs and characteristics.
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Affiliation(s)
- Vaishnavi R Waghe
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lajwanti Lalwani
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka K Chilhate
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Shen H, Xu Y, Zhang Y, Ren L, Chen R. Correlation Between Diaphragmatic Excursion and Exercise Tolerance Improvement Following Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease-Obstructive Sleep Apnea Overlap Syndrome. Int J Chron Obstruct Pulmon Dis 2024; 19:63-75. [PMID: 38222322 PMCID: PMC10787556 DOI: 10.2147/copd.s437698] [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: 10/04/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose We assess the predictive value of diaphragm excursion (DE) in enhancing exercise tolerance following pulmonary rehabilitation (PR) among patients with COPD-OSA overlap syndrome. Material and Methods This prospective cohort study enrolled 63 patients diagnosed with COPD-OSA overlap syndrome who actively participated in a PR program from January 2021 to May 2023. Among these, 58 patients successfully completed the 20-week PR program, with exercise tolerance assessed through the measurement of six-minute walk distance (6MWD), and DE evaluated by ultrasonography. The responder to PR in terms of exercise ability was defined as a patient who showed an increase of >30m in 6MWD. The cutoff value for predicting PR response based on DE was determined using receiver operating characteristic (ROC) curves. Results Following the PR program, significant improvements were observed in mMRC, 6MWD, DE during deep breathing, and diaphragm thickness fraction (DTF). Of the participants, 33 patients (57%) were classified as responders, while 25 patients (43%) were considered non-responders. Baseline values of FEV1% predicted, 6MWD, DE during deep breathing, DTF, and PaO2 exhibited a significant elevation in responders as compared to non-responders. The changes of 6MWD were positively associated with the baseline values of DTF and DE during deep breathing, FEV1% predicted and PaO2, while negatively correlated with baseline value of mMRC. The predictive performance in terms of the area under the ROC curve for determining responder's DTF was found to be 0.769, accompanied by a sensitivity of 85% and specificity of 68%, using a cutoff value at 17.26%. Moreover, it was observed that DE during deep breathing could predict the area under the ROC curve for responders to be 0.753, with a sensitivity of 91% and specificity of 56% at a cutoff value of 3.61cm. Conclusion Diaphragm excursion serves as a valuable predictor for determining the enhancement of exercise tolerance following PR in patients with COPD-OSA overlap syndrome. Trial Registration ChiCTR1800020257, www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Honghua Shen
- Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Yiming Xu
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Yin Zhang
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Lei Ren
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Rui Chen
- Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
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Xu Y, Yang D, Lu B, Zhang Y, Ren L, Shen H. Efficacy of aerobic training and resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease: A randomized controlled study. Clin Rehabil 2023; 37:1479-1491. [PMID: 37122164 DOI: 10.1177/02692155231172005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy of aerobic training, resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease. DESIGN Randomized controlled trial. SETTING The Fourth Rehabilitation Hospital of Shanghai, China. PARTICIPANTS 82 (67.0 ± 6.5 years, 59.8% male) patients with stable chronic obstructive pulmonary disease were randomized to intervention group 1 (n = 27), intervention group 2 (n = 28), and control group (n = 27). INTERVENTION Intervention group 1 received aerobic and resistance training, while intervention group 2 received additional external diaphragm pacing. Control group received aerobic training only. MAIN MEASURES 1-year follow-up of physical activity, body composition, respiratory function and diaphragm function. RESULTS Intervention groups 1 and 2 showed statistically improvements in the difference value compared with control group in terms of 6-min walk distance (-95.28 ± 20.09 and -101.92 ± 34.91 vs -63.58 ± 23.38), forced expiratory volume in 1 s (-0.042 ± 0.027 and -0.130 ± 0.050 vs -0.005 ± 0.068), fat-free mass (-2.11 ± 3.74 and -3.82 ± 3.74vs 0.28 ± 1.49) and chronic obstructive pulmonary disease assessment test value (2.16 ± 0.85 and 2.38 ± 1.02 vs 1.50 ± 0.93). Intervention group 2 showed significant difference in arterial oxygen pressure (-4.46 ± 3.22 vs -1.92 ± 3.45), diaphragm excursion during deep breaths (-0.82 ± 0.74 vs -0.38 ± 0.29), and diaphragm thickness fraction (-8.77 ± 3.22 vs -4.88 ± 2.69) compared with control group. CONCLUSION The combination of aerobic training, resistance training, and external diaphragm pacing obtained significant improvements in physical activity, respiratory function, body composition, arterial oxygen pressure, and diaphragm function in patients with chronic obstructive pulmonary disease. TRIAL REGISTRATION ChiCTR1800020257, www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Yiming Xu
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Donghong Yang
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Beibei Lu
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yin Zhang
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Lei Ren
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Honghua Shen
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
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Al Chikhanie Y, Bailly S, Amroussa I, Veale D, Hérengt F, Verges S. Clustering of COPD patients and their response to pulmonary rehabilitation. Respir Med 2022; 198:106861. [DOI: 10.1016/j.rmed.2022.106861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
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Cortiula F, Hendriks LEL, van de Worp WRPH, Schols AMWJ, Vaes RDW, Langen RCJ, De Ruysscher D. Physical exercise at the crossroad between muscle wasting and the immune system: implications for lung cancer cachexia. J Cachexia Sarcopenia Muscle 2022; 13:55-67. [PMID: 35014216 PMCID: PMC8818640 DOI: 10.1002/jcsm.12900] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Cachexia is a syndrome characterized by involuntary weight loss and wasting of skeletal muscle mass. It is associated with worse overall survival and quality of life. The cancer-induced systemic inflammation and the consequent host derived catabolic stimuli, trigger cachexia by inhibiting muscle protein synthesis and enhancing muscle catabolism. The muscle itself may further promote chronic inflammation, introducing a vicious catabolic circle. Nutritional support alone plays a limited role in the treatment of cancer cachexia and should be combined with other interventions. Physical exercise lowers systemic inflammation and promotes muscle anabolism. It also attenuates the age-related physical decline in elderly and it might counteract the muscle wasting induced by the cancer cachexia syndrome. This review describes how cancer-induced systemic inflammation promotes muscle wasting and whether physical exercise may represent a suitable treatment for cancer-induced cachexia, particularly in patients with non-small cell lung cancer. We summarized pre-clinical and clinical studies investigating whether physical exercise would improve muscle performance and whether this improvement would translate in a clinically meaningful benefit for patients with cancer, in terms of survival and quality of life. Moreover, this review describes the results of studies investigating the interplay between physical exercise and the immune system, including the role of the intestinal microbiota.
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Affiliation(s)
- Francesco Cortiula
- Department of Radiation Oncology (MAASTRO), Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lizza E L Hendriks
- Department of Respiratory Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Wouter R P H van de Worp
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rianne D W Vaes
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ramon C J Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Saetan P, Chaiviboontham S, Pokpalagon P, Chansriwong P. The Effects of the Respiratory Rehabilitation Program on Perceived Self-Efficacy and Dyspnea in Patients with Lung Cancer. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:277-285. [PMID: 32916339 DOI: 10.1016/j.anr.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/13/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to examine the effects of the respiratory rehabilitation program on perceived self-efficacy and dyspnea in patients with lung cancer. METHODS This is a quasi-experimental research study with a two-group repeated measures design with the pretest and post-test at Week 4 and Week 8. The theory of self-efficacy by Bandura was used as the conceptual framework. The sample consisted of patients with non-small-cell lung cancer Stage 4 who visited the oncology clinic in a university hospital. Twenty-eight patients were enrolled and equally allocated to the control group and experimental group. The control group received routine nursing care only, whereas the experimental group received the respiratory rehabilitation program. The program comprised dyspnea educating, breathing exercise, using handheld fans, effective coughing, respiratory strengthening training, and follow-up by phone in the third and sixth week. Data for perceived self-efficacy and dyspnea were collected before the program start and reassessment in the fourth and eighth week. Instrumentation was composed of the respiratory rehabilitation program, demographic data, perceived self-efficacy assessment for respiratory rehabilitation, and the Cancer Dyspnea Scale. Data were analyzed using descriptive statistics and one-factor repeated measures analysis of variance and by comparing means between groups. RESULTS The result revealed that almost all of the patients in the sample were men, and the mean age of the experimental group and control group was 65.80 years (standard deviation = 8.80) and 73.00 years (standard deviation = 7.60), respectively. There was significant different in the mean score of perceived self-efficacy and dyspnea between the experimental group and the control group (p < .050). CONCLUSION Based on the findings of the study, the respiratory rehabilitation program should be used to promote self-efficacy and relieve dyspnea in patients with lung cancer.
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Affiliation(s)
- Pramote Saetan
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchira Chaiviboontham
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Piyawan Pokpalagon
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Chansriwong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Bordoni B, Simonelli M. Chronic Obstructive Pulmonary Disease: Proprioception Exercises as an Addition to the Rehabilitation Process. Cureus 2020; 12:e8084. [PMID: 32542139 PMCID: PMC7292710 DOI: 10.7759/cureus.8084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
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Wang Z, Hu X, Dai Q. Is it possible to reverse frailty in patients with chronic obstructive pulmonary disease? Clinics (Sao Paulo) 2020; 75:e1778. [PMID: 33146351 PMCID: PMC7561069 DOI: 10.6061/clinics/2020/e1778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
Abstract
In recent years, frailty has attracted increasing attention from clinicians and health care workers. The influence of frailty on the elderly, especially those with chronic diseases of the respiratory system, is highly significant. Frailty is particularly more common in patients with chronic obstructive pulmonary disease (COPD). Frailty and COPD share many risk factors and pathophysiological mechanisms. As a comprehensive interventional method for chronic respiratory diseases, pulmonary rehabilitation is an important basic measure for the management of patients with COPD. Frailty in these patients can be reversed using pulmonary rehabilitation by targeting five components of the frailty phenotype at the entry point. The present review discusses the benefits of pulmonary rehabilitation in patients with COPD complicated by frailty and provides a theoretical basis for pulmonary rehabilitation treatment in this population. In addition, the timing of pulmonary rehabilitation is also addressed, with the prefrail stage being the "golden" period. The implementation of pulmonary rehabilitation must vary among individuals, and individualized treatment strategies will help maximize benefits.
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Affiliation(s)
- Zhe Wang
- Department of Geriatrics Medicine I, Qinghai University Affiliated Hospital, Xining, People’s Republic of China
- *Corresponding author. E-mail:
| | - Xiaojing Hu
- Department of Geriatrics Medicine I, Qinghai University Affiliated Hospital, Xining, People’s Republic of China
| | - Qingxiang Dai
- Department of Geriatrics Medicine I, Qinghai University Affiliated Hospital, Xining, People’s Republic of China
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