End Of Pulmonary Rehabilitation Research Articles

Efectos de la rehabilitación pulmonar en pacientes con EPOC según la clasificación GOLD 2020 en Cali, Colombia

IntroductionChronic obstructive pulmonary disease has a guide in charge of prevention and treatment, called the Global Initiative for Chronic Lung Disease, which is annually updated and catalogs pulmonary rehabilitation, within the treatment options. ObjectiveTo describe the effects on clinical variables, functional capacity, anxiety/depression and health-related quality of life in patients with chronic obstructive pulmonary disease, after a pulmonary rehabilitation program, according to the GOLD 2020 classification in a Cali clinic. Materials and methodsDescriptive, longitudinal study where 79 patients divided into 3 groups were included (B, C and D). ResultsThe mean age was 70 years, 69% men. The number of hospitalized days was greater for groups C and D with an average of 8 and 13 days, respectively (p≤0.000). The functional capacity showed a greater distance in group C (421m) and the shortest distance for group D (328m), p≤0.006. In anxiety and depression, group D managed to obtain improvements as well as in the quality of life questionnaire. ConclusionGroup C presented greater functional capacity and better quality of life, group B had better results in clinical variables, and group D had worse clinical condition, functional capacity and quality of life. At the end of pulmonary rehabilitation, group D presented greater changes in functional capacity and quality of life.

Impacto de la rehabilitación pulmonar en pacientes con enfermedad pulmonar restrictiva

IntroductionRestrictive lung diseases present alterations in thoracic-pulmonary mechanics, reduced functional capacity and lung function. Intrinsic and extrinsic alterations can be found where the interstitium, thoracic expandability and even lung parenchymal conditions are altered. Pulmonary rehabilitation could benefit patients with the restrictive condition and improve their functional condition. ObjectiveEstablish the impact of pulmonary rehabilitation in patients with intrinsic and extrinsic restrictive respiratory compromise on dyspnea, functional capacity, anxiety/depression and health-related quality of life. MethodsLongitudinal descriptive study with 50 patients with restrictive lung disease who performed pulmonary rehabilitation in a clinic in the city of Cali, Colombia. The participants linked to the study were separated into two groups, the first with intrapulmonary restrictive disease (IRD) and the second group with extrapulmonary restrictive disease (ERD). ResultsThe mean age of the patients was 53.3years. Among the restrictive intrapulmonary diseases there were: diffuse interstitial lung disease (ILD), post-condition pneumonia and/or acute respiratory distress syndrome (ARDS) and sequelae of pulmonary tuberculosis. Extrapulmonary respiratory diseases: lung resection, pulmonary lobe resection, and wedge resection. At the end of pulmonary rehabilitation, the IRD group presented statistically significant improvements in distance covered, estimated oxygen consumption (VO2e), dyspnea, anxiety, and quality of life. The ERD group presented a significant increase in the distance traveled and VO2e. ConclusionPatients with restrictive lung disease improve the distance traveled, VO2e, dyspnea, anxiety and quality of life; patients with extrapulmonary respiratory disease show improvements in functional capacity.

Effects of Pulmonary Rehabilitation in Men Compared to Women with Chronic Obstructive Pulmonary Disease in Colombia

Objective: To determine the effects of pulmonary rehabilitation in men and women with a COPD diagnosis in a Colombian clinic. Method: A longitudinal and descriptive study was conducted with 75 COPD patients who entered a pulmonary rehabilitation program during 2018 and 2019. The population was divided into groups according to gender and some sociodemographic characteristics were assessed, such as spirometry expressed in percentage of the predicted value, body mass index, mMRC dyspnea, and capacity for physical exercise, as well as some physiological variables with the six-minute walk test, anxiety-depression (HADS) and quality of life (SGRQ). A p-value<0.05 was considered statistically significant. Results: The cigarette packs smoked per year index was higher in men, 34±29.11 (p<0.001), whereas the exposure to firewood smoke was five times higher in women (p=0.037). All the variables related to the capacity for physical exercise improved significantly (p<0.021), with distance covered standing out: 63.26±60.03 vs. 51.53±61.02 in favor of women. mMRC dyspnea was initially higher in women when compared to men, 0.709±0.287, and presented a greater change in women with 1.294±0.415 when compared to men, 0.736±0.880, at the end of pulmonary rehabilitation. Conclusion: Pulmonary rehabilitation in women shows an increase of 63.26 meters in the distance covered and a 1.294-point reduction in dyspnea; while, for men, these figures were 51.53 meters and 0.736 points, respectively, as well as an improvement in quality of life in men by 11.47 SGRQ points when compared to women: 0.600.

Inflammatory responses to acute exercise during pulmonary rehabilitation in patients with COPD

ObjectivePulmonary rehabilitation is a cornerstone treatment in the management of chronic obstructive pulmonary disease (COPD). Acute bouts of exercise can lead to short bursts of inflammation in healthy individuals. However, it is unclear how COPD patients respond to acute bouts of exercise. This study assessed inflammatory responses to exercise in COPD patients at the start (phase 1) and end (phase 2) of pulmonary rehabilitation.MethodsBlood samples were collected before and after an acute exercise bout at the start (phase 1, n = 40) and end (phase 2, n = 27) of pulmonary rehabilitation. The primary outcome was change in fibrinogen concentrations. Secondary outcomes were changes in CRP concentrations, total/differential leukocyte counts, markers of neutrophil activation (CD11b, CD62L and CD66b), and neutrophil subsets (mature, suppressive, immature, progenitor).ResultsAcute exercise (phase 1) did not induce significant changes in fibrinogen (p = 0.242) or CRP (p = 0.476). Total leukocyte count [mean difference (MD), 0.5 ± 1.1 (109 L−1); p = 0.004], neutrophil count [MD, 0.4 ± 0.8 (109 L−1); p < 0.001], and immature neutrophils (MD, 0.6 ± 0.8%; p < 0.001) increased post-exercise. Neutrophil activation markers, CD11b (p = 0.470), CD66b (p = 0.334), and CD62L (p = 0.352) were not significantly altered post-exercise. In comparison to the start of pulmonary rehabilitation (phase 2), acute exercise at the end of pulmonary rehabilitation led to a greater fibrinogen response (MD, 84 mg/dL (95% CI − 14, 182); p = 0.045).ConclusionAn acute bout of exercise does not appear to induce significant alterations in the concentrations of inflammatory mediators but can increase white blood cell subsets post-exercise. A greater fibrinogen response to acute exercise is seen at the end of pulmonary rehabilitation when compared to the start. Further research is required to understand the clinical context of these acute inflammatory responses to exercise.

Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation.

The study aimed to determine the effects of adding cognitive behavioural therapy (CBT) to pulmonary rehabilitation to treat patients with chronic lung disease and comorbid anxiety and/or depression symptoms. An open, parallel group, randomised controlled trial (RCT) was conducted, with longitudinal follow-up of 12 months. CBT was delivered in 2 face-to-face sessions and 4 phone sessions to patients with depression or anxiety undergoing pulmonary rehabilitation. The main outcome measures were change in Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI); secondary outcomes were St. Georges Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT) and pulmonary rehabilitation attendance. A total of 65 patients were randomized to Intervention (n=24) and Control (n=41) groups. Of the 24 patients in the Intervention group, 6 patients (25%) withdrew and 4 patients (12.5%) failed to attend more than 2 CBT sessions, which was significantly more than the Control group. The majority of patients (75.4%) had chronic obstructive pulmonary disease. Fourteen (21.5%) had symptoms of depression only, 12 (18.4%) had symptoms of anxiety only, and 39 (60.0%) had symptoms of both anxiety and depression. In the Intervention group, GDS significantly improved at the end of pulmonary rehabilitation (mean difference -3.1, 95% CI: -4.39 to -1.70; P=0.0001), 3 months follow-up (mean difference -1.5, 95% CI: -4.17 to -0.75; P=0.008), and at 12 months follow-up (mean difference -1.6, 95% CI: -3.29 to -0.03, P=0.04), compared to baseline. The Control group demonstrated improvement in GDS by the end of pulmonary rehabilitation (mean difference -1.3, 95% CI: -2.4 to -0.27; P=0.01) which was not maintained at 3 months (P=0.14) and 12 months (P=0.25). GAI significantly improved by the end of rehabilitation in both the Intervention (mean difference -2.6, 95% -4.69 to -0.57; P=0.01) and Control groups (mean difference -2.6, 95% -4.16 to -1.14; P=0.001) and there was no significant improvement at 3 and 12 months. No statistically significant differences in changes in GDS or GAI were observed between the Intervention and Control groups at any time point. There was no significant improvement in SGRQ or 6MWT. There was a significant increase in attended pulmonary rehabilitation sessions in the Intervention group, compared to the Control group (mean difference 1.59; 95% CI: 0.11 to 3.07; P=0.03). In this RCT of patients with chronic lung diseases attending pulmonary rehabilitation, there was no evidence found for improved symptoms of anxiety or depression or health-related quality of life with the addition of CBT given in a mixed face-to-face and telephone format, compared to usual care. Slower than anticipated recruitment, leading to a smaller than planned sample size, and a high dropout rate in the group allocated to CBT may have limited the effectiveness of the behavioural intervention approach in this study.

The Relationship Between Weather and Objectively Measured Physical Activity Among Individuals With COPD.

Although daily variation in weather impacts physical activity (PA) levels among relatively healthy individuals, it is largely unknown whether this relationship occurs for those living with chronic obstructive pulmonary disease (COPD). The purpose of this study was to examine how daily variation in temperature, rain, and snow is related to objectively measured PA among patients with COPD, and whether demographic or clinical characteristics moderate these relationships. Patients with COPD completed a questionnaire and wore a pedometer for 7 days at baseline, end of pulmonary rehabilitation (PR), and 3 and 9 months after completing PR (28 days in total). Hierarchal linear modeling showed that daily mean temperature and total daily rainfall, but not snowfall, independently predicted steps/day, controlling for demographic and clinical covariates in 189 patients in PR. Specifically, an increase of 10°C translates into 316 more steps (6.6% of mean steps/day) whereas a rainfall of 10 mm translates to 175 less steps (3.6% of mean steps/day). Furthermore, those with higher income had more steps/day on warmer days. These results add to converging evidence that weather plays an important role in determining PA among individuals with COPD.

Does pulmonary rehabilitation alleviate depression in older patients with chronic obstructive pulmonary disease.

Objectives:To identify if pulmonary rehabilitation can achieve a clinically significant alleviation in the level of depression among chronic obstructive pulmonary disease (COPD) patients older than 70 years.Methods:We conducted a retrospective secondary analysis of the patients’ electronic records from a major pulmonary rehabilitation center in Cleveland, OH, United States between 2010 and 2014. Profiles of 105 participants who had completed more than 6 pulmonary rehabilitation sessions and were older than 70 years at the time of enrollment in the program were included. The Beck Depression Inventory scores at the baseline and the end of the pulmonary rehabilitation sessions were compared.Results:There was a statistically and clinically significant reduction in mean scores of depression from the baseline to the end of pulmonary rehabilitation: mean± SD: 104±5.6; p=0.00. The mean±SD depression score at the end was 9±4.3 compared with the baseline 17±7.8. Seventy-seven (73%) participants showed clinically significant improvement in depression; however, 20 participants (27%) had no clinically significant improvement, and 8 (8%) had worse depression at the end of pulmonary rehabilitation. Participants with higher depression scores at the baseline were 1.3 times more likely to achieve clinically significant alleviation in depression at the end of rehabilitation (odds ratio = 1.3, p=0.00).Conclusion:Pulmonary rehabilitation induced clinically significant alleviation in depression among participants with COPD aged over 70 years.

Core Muscle Size Predicts Postoperative Outcome in Lung Transplant Candidates

Careful patient selection is the prerequisite to raise transplant benefit. In lung transplant (LT) candidates, the effect of body mass index (BMI) on postoperative outcome remains controversial, possibly due to the inaccuracy of BMI in discriminating between fat and muscle mass. We therefore hypothesized that assessment of body composition by muscle mass measures is more accurate than by BMI regarding postoperative outcome. All LT recipients from 2011 to 2014 were included and retrospectively analyzed. Lean psoas area (LPA) was assessed from pretransplant computed tomography scans, and associations with postoperative outcomes were investigated. Included were 103 consecutive LT recipients with a mean pre-LT BMI of 22.0 ± 4.0 kg/m(2) and a mean LPA of 22.3 ± 8.3 cm(2). LPA was inversely associated with length of mechanical ventilation (p = 0.03), requirement of tracheostomy (p = 0.035), and length of stay in the intensive care unit (p = 0.02), while controlling for underlying disease, BMI, sex, age, and procedure; in contrast, BMI was not (p = 0.25, p = 0.54, and p = 0.42, respectively.). Multiple regression analysis revealed that the 6-minute walk distance at the end of pulmonary rehabilitation was significantly associated with LPA (p = 0.02). LPA can easily be assessed in LT candidates as part of pretransplant evaluation and was significantly associated with short-term outcome, whereas BMI was not. Assessment of LPA may provide additional information on body composition beyond BMI. However, the clinical utility has to be further evaluated.

An experimental assessment of the influence of exercise versus social implementation intentions on physical activity during and following pulmonary rehabilitation

Techniques to increase physical activity among pulmonary rehabilitation patients outside of the rehabilitation context are warranted. Implementation intentions are a strategy used to initiate goal-directed behaviour, and have been found to be useful in other populations. This study compared the long-term effects of exercise and social implementation intentions interventions on objectively measured physical activity in 40 pulmonary rehabilitation patients randomly assigned to condition. Repeated measures ANOVAs found that those in the exercise implementation intentions group took more steps (p=.007) at the end of pulmonary rehabilitation than those in the social implementation intentions group. Improvements attained by the exercise group during the intervention were not maintained 6-months following rehabilitation. Implementation intentions targeting physical activity appear to have positive short term effects on physical activity, although the long term effects are less consistent. This may be due in part to methods used to assess physical activity behaviour.

Influence of Body Mass Index on Changes in Disease-Specific Quality of Life of Veterans Completing Pulmonary Rehabilitation

Body mass index (BMI) has prognostic value in patients with chronic lung disease. Pulmonary rehabilitation improves quality of life. This study investigated whether BMI predicts change in disease-specific quality of life following pulmonary rehabilitation. Subjects (N = 61), who completed pulmonary rehabilitation, were classified by BMI as low (<23 kg/m), middle (> or =23 and <33 kg/m), or high (> or =33 kg/m). Outcomes were changes in disease- specific quality of life measured by the following domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR): dyspnea, mastery, emotion, and fatigue. Subjects completed CRQ-SR at the start and end of pulmonary rehabilitation. Multivariable regression was used to compare change in CRQ-SR scores of each domain by BMI group controlling for forced expiratory volume in 1 second. Subjects were 68.9 +/- 9.0 years old and were all white men. At baseline, the low-BMI group had lower mean forced expiratory volume in 1 second (0.96 +/- 0.28) than the middle (1.29 +/- 0.48, P = .02) and high (1.37 +/- 0.38, P = .01) BMI groups. Collectively, subjects improved on CRQ-SR dyspnea (P < .004), mastery (P < .008), emotion (P < .03), and fatigue (P < .005). In multivariable models, the high-BMI group had greater improvement on the CRQ-SR domains for fatigue (beta = 3.5 +/- 1.0, P = .0008) and mastery (beta = 4.8 +/- 1.6, P = .003) than the middle-BMI group. Pulmonary rehabilitation results in improved disease-specific quality of life. BMI influences this improvement and should be considered in the assessment, plan of care, and outcomes in response to pulmonary rehabilitation for patients with chronic respiratory disease.