Abstract
Patients with chronic obstructive pulmonary disease (COPD) show a persistent local and systemic inflammatory pattern which stimulates negative remodeling of the airways. Globally, chronic respiratory disease is the third leading cause of death. One of the rehabilitative strategies used to improve the symptoms of COPD patients is the use of lymphatic pump manipulation; this procedure aims to reduce the concentration of pro-inflammatory substances. However, research results relating to this technique are contradictory. This article reviews the mechanisms that determine lymphatic flow, lymphatic lung anatomy, and the lymphatic response to respiratory pathology. Also highlighted is the manual approach to the mediastinum which can be used to improve the lymphatic and inflammatory response in COPD. Finally, new manual strategies have been discussed with which lymphatic flow in patients with COPD can be improved.
Highlights
The pathological factors which lead to chronic obstructive pulmonary disease (COPD) are not fully understood
New manual strategies have been discussed with which lymphatic flow in patients with COPD can be improved
The article reviewed the anatomy of the lymphatic system, the lymphatic organization of the mediastinum, and discussed what happens to the lymphatic vessels and nodes in the presence of COPD
Summary
The pathological factors which lead to chronic obstructive pulmonary disease (COPD) are not fully understood. One of the rehabilitative strategies employed by physiotherapists and osteopaths is the active manual lymphatic pumping of the mediastinum The purpose of this technique is to improve pulmonary lymphatic drainage in the presence of respiratory pathology [39]. In this technique, the operator places himself behind the patient; the patient lies on his/her back, placing his/her hands on the anterior area of the mediastinum, from the surface just below the clavicle. The breathing of patients with COPD, and in particular those with medium and severe forms of the disease, cannot perform a deep inhalation due to diaphragmatic dysfunction and reduced parenchymal elasticity; trying to stimulate lymphatic outflow with deep breaths is not feasible. Further studies are needed to verify if this OMT protocol is able to positively influence the flow of the lymphatic system of the mediastinum
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