Adjunct therapy in chronic obstructive pulmonary disease

Abstract

There have been several studies of acceptable design in which neither subjective nor objective benefit of physiotherapy has been demonstrated. It is possible that the subjective benefit reported in unmatched groups reflects the patients' desire to satisfy a hard-working physiotherapist. Pursed lips breathing affords immediate benefit, but the question of long-term benefit has not been examined. Despite the well documented immediate effects of intermittent positive pressure breathing (IPPB), studies in which its long-term effects have been examined have failed to demonstrate either subjective or objective benefit to patients with chronic obstructive pulmonary disease in interval. IPPB, used as a more effective method of administering bronchodilator aerosols, has been shown repeatedly not to alter significantly the response obtained with voluntary inhalation of the aerosols. Similarly there has been no demonstration that inhalation of water or saline solution, droplets or aerosol (as opposed to humidification) has any measurable effect in the chronic phase of this disease other than immediate transitory increases in airway resistance. Exercise training appears to result in definite subjective improvement in exercise tolerance and in objective indirect improvement. No consistent direct effect on any measurable pulmonary function parameters has been observed. Since most of the studies on the effects of exercise to date suffer from the lack of a control group, or at least a control period, it is not certain which of the documented alterations after exercise training are specific responses to the training; however, current evidence suggests that training is a useful adjunct to therapy. The question of altered survival has not yet been examined in a controlled fashion. The usefulness of oxygen supplementation as an aid to an exercise program and to ameliorate long-term complications such as cor pulmonale and secondary polycythemia is well documented. Decreased mortality is implied, but we found no specific studies on the effects of oxygen therapy alone upon mortality.