Pulmonary Rehabilitation In COPD Research Articles

Successful Pulmonary Rehabilitation in COPD During COVID-19 Pandemic Era: A Case Report

Successful Pulmonary Rehabilitation in COPD During COVID-19 Pandemic Era: A Case Report

Review of the Evidence for Pulmonary Rehabilitation in COPD: Clinical Benefits and Cost-Effectiveness.

COPD is a common and lethal chronic condition, recognized as a leading cause of death worldwide. COPD is associated with significant morbidity and disability, particularly among older adults. The disease course is marked by periods of stability and disease exacerbations defined by worsening respiratory status resulting in a high burden of health care utilization and an increased risk of mortality. Treatment is focused on pharmacologic therapies, but these are not completely effective. Pulmonary rehabilitation (PR) represents a key medical intervention for patients with chronic respiratory diseases, including COPD. PR provides individualized and progressive exercise training, education, and self-management strategies through a comprehensive and multidisciplinary program. PR has been associated with improvement in exercise capacity, health-related quality of life, and dyspnea in patients living with COPD. Moreover, PR has been associated with improvements in hospital readmission and 1-y survival. In addition to the clinical benefits, PR is estimated to be a cost-effective medical intervention. Despite these benefits, participation in PR remains low. We will review the evidence for PR in each of these benefit domains among patients with stable COPD and in those recovering from a COPD exacerbation.

Virtual reality as an adjunct to pulmonary rehabilitation of patients with chronic obstructive pulmonary disease: a protocol for systematic review and meta-analysis

IntroductionChronic obstructive pulmonary disease (COPD) is a prevalent chronic lung disease characterised by persistent and progressive airflow obstruction resulting from tracheal and/or alveolar lesions. Patients afflicted with COPD endure a...

High Prevalence of Non-Responders Based on Quadriceps Force after Pulmonary Rehabilitation in COPD.

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.

Virtual Group Pulmonary Rehabilitation in COPD Facilitated by a Peer Coach.

Virtual Group Pulmonary Rehabilitation in COPD Facilitated by a Peer Coach.

Freedive Training Gives Additional Physiological Effect Compared to Pulmonary Rehabilitation in COPD.

Introduction: Pulmonary rehabilitation (PR) is beneficial for lung mechanics, chest kinematics, metabolism, and inspiratory and peripheral muscle function. Freediving training (FD) can be effective in sportsmen and can improve breath-holding time. Aims: We sought to determine the effectiveness of freediving training in the pulmonary rehabilitation of COPD patients. Patients and methods: Twenty-three COPD patients (15 men and 8 women; median age 63 years; FEV1: 41% pred; BMI: 28 kg/m2) participated in the FD + PR group (3 weeks PR and 3 weeks FD + PR) and 46 patients with COPD (25 men and 21 women; median age 66 years; FEV1: 43% pred; BMI: 27 kg/m2) participated in an inpatient PR program (6 weeks). Patients performed comfort zone breath holding for 30 min/day. Patients increased their breath-holding time within their comfort zone for 30 min. We detected lung function, chest expansion (CWE), inspiratory muscle pressure (MIP), peripheral muscle function (GS), and exercise capacity (6MWD), and we included breath-holding time (BHT), quality of life score (COPD Assessment Test (CAT)), modified Medical Research Dyspnea Scale (mMRC) score, and the severity of the disease assessed by the BODE index (FEV1, BMI, 6MWD, and mMRC) and an alternative scale (FEV1, BMI, 6MWD, and CAT). Result: There were significant differences in the characteristics of the two groups. Significant improvement was detected in all functional and quality of life parameters except lung function in both groups. Significantly higher improvement was detected in CWE, GS, 6MWD, BHT, CAT, mMRC, alternative scale, and MIP. The improvement in forced vital capacity (FVC) was not significant. There were no side effects of FD training. Conclusion: The FD method can potentiate the effect of PR, improving not only BHT but also other parameters. Trial registration: ISRCTN ISRCTN13019180. Registered 19 December 2017.

Physiological changes related to 10 weeks of singing for lung health in patients with COPD.

BackgroundSinging for Lung Health (SLH) was non-inferior to physical exercise training in improving 6-minute walking test distance (6MWD) and quality of life (St. George’s Respiratory Questionnaire (SGRQ)) within a 10-week pulmonary rehabilitation (PR) programme for COPD in our recent randomised controlled trial (RCT) (NCT03280355). Previous studies suggest that singing improves lung function, respiratory control and dyspnoea, however this has not yet been convincingly confirmed. Therefore, this study aimed to explore the impact of SLH on physiological parameters and the associations with achieving the minimal important difference (MID) in 6MWD and/or SGRQ.MethodsWe conducted post hoc, per-protocol analyses mainly of the SLH group of the RCT, exploring associations with 6MWD and SGRQ results by stratifying into achieving versus not-achieving 6MWD-MID (≥30 m) and SGRQ-MID (≤−4 points): changes in lung function, inspiratory muscle strength/control, dyspnoea, and heart rate response using logistic regression models. Further, we explored correlation and association in achieving both 6MWD-MID and SGRQ-MID (or in neither/nor) using Cohen’s κ and Cochran-Mantel-Haenszel Test.ResultsIn the SLH study group (n=108), 6MWD-MID was achieved by 31/108 (29%) and in SGRQ by 53/108 (49%). Baseline factors associated with achieving MID in either outcome included short baseline 6MWD and high body mass index. Achieving 6MWD-MID was correlated with improved heart rate response (OR: 3.14; p=0.03) and achieving SGRQ-MID was correlated with improved maximal inspiratory pressure (OR: 4.35; p=0.04). Neither outcome was correlated with significant spirometric changes. Agreement in achieving both 6MWD-MID and SGRQ-MID was surprisingly insignificant.ConclusionsThis explorative post hoc study suggests that SLH is associated with physiological changes after short-term PR for COPD. Future physiological studies will help us to understand the mechanisms of singing in COPD. Our study furthermore raises concern about poor agreement between subjective and objective benefits of PR despite state-of-the-art tools.

Evaluation of YouTube Videos as a Source of Information on Pulmonary Rehabilitation for COPD.

The use of YouTube for providing medical information is increasing, and patients with COPD are likely to use digital media to obtain information for their conditions. This study aimed to analyze the reliability and quality of the videos that were most frequently viewed by patients with COPD who searched YouTube for information on pulmonary rehabilitation. A YouTube search was conducted by using the keyword "pulmonary rehabilitation." All the videos were categorized into 2 groups according to source and purpose. For evaluating the reliability and quality, the modified DISCERN score and the pulmonary rehabilitation for COPD-specific score (PRSS) were used, respectively. Differences of the variables between the groups and associations across the groups were examined. The influence of the variables of the videos on the engagement of viewers and viewership was analyzed. In total, 62 videos were analyzed. Most of the videos (54/62 [87%]) were uploaded by professionals and the remainder (8/62 [13%] by non-professionals. According to their purposes, 35 of 62 (56%) were informational and 27 of 62 (44%) were non-informational. The mean ± SD modified DISCERN score and the mean ± SD total the PRSS were 3.76 ± 1.04 and 4.13 ± 3.73, respectively. When comparing the videos according to professionalism, significant differences only in the modified DISCERN scores were observed. The engagement of viewers, viewership, mean modified DISCERN, mean total of the PRSS were significantly higher in the informational group than in the non-informational group. Video duration was positively correlated with engagement of viewers and viewership. Popular YouTube videos on pulmonary rehabilitation for COPD were reliable; however, they were biased and of low quality in terms of providing content. Given YouTube's advantage of easy accessibility and disadvantage of vulnerability to poor-quality information, professionals should pay more attention to uploading comprehensive high-quality videos for informational purposes.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Blood Eosinophils and Pulmonary Rehabilitation in COPD.

Background Blood eosinophils predict the response to therapy, risk of exacerbation, and readmission in COPD. This study investigates whether blood eosinophils predict pulmonary rehabilitation (PR) outcomes in COPD. Methods We categorized patients into eosinophilic (blood eosinophils ≥300 cells/ml) or noneosinophilic (<300 cells/ml). In a retrospective design, we compared changes within and between the two groups on BODE index, 6-minute walk test (6MWT), FEV1, and mMRC dyspnea scale. Results Of 206 patients enrolled, 176 were included for analysis; 90 were eosinophilic. BODE index improved in both groups: (MD −1.25; 95% CI (−0.45, −4.25), P ≤ 0.001) in the eosinophilic and (MD −1.33; 95% CI (−1.72, −0.94), P ≤ 0.001) in the noneosinophilic, but a higher BODE index remained in the eosinophilic (4.98); adjusted mean change (β): 0.7 (95% CI (0.15, 1.26), P=0.01). 6MWT improved by 29.3 m in the eosinophilic (95% CI (14.2, 44.4), P ≤ 0.001) vs. 115.1 m in the noneosinophilic (95% CI (−30.4, 260.6), P=0.12). FEV1 did not change in the eosinophilic (MD −0.6; 95% CI (−2.64, 1.48), P=0.58), but improved by 2.5% in the noneosinophilic (MD 2.5; 95% CI (0.77, 4.17), P=0.005). There were no significant between-group differences in 6MWT and FEV1; adjusted mean changes (β) were −9.69 m (95% CI (−39.51, 20.14), P=0.52) and −2.31% (95% CI (−5.69, 1.08), P=0.18), respectively. There were no significant within- or between-group changes in the mMRC scale. Conclusion Although PR improves the BODE index in both eosinophilic and noneosinophilic COPD, a higher eosinophil count (≥300 cells/ml) is associated with a higher (worse) BODE index. Blood eosinophils may predict PR outcomes.

P7‐23: Effectiveness of combination therapy with selective beta‐1 blockers and pulmonary rehabilitation for COPD

P7‐23: Effectiveness of combination therapy with selective beta‐1 blockers and pulmonary rehabilitation for COPD

Adherence to walking exercise prescription during pulmonary rehabilitation in COPD with a commercial activity monitor: a feasibility trial

BackgroundRegular exercise is important in the management of COPD. Pulmonary rehabilitation (PR) facilitates a more physically active lifestyle through exercise participation, ideally without compromising non-exercise physical activity (PA). During PR patients are advised to perform exercise defined by duration and intensity. The extent to which PR attendees participate in unsupervised exercise bouts and their adherence to the exercise prescription provided during PR is unclear. Commercially available devices have the potential to support patients to exercise at their individually prescribed intensity. Study aims were to (1) assess how adherent patients are to their prescribed walking intensity; (2) examine the pattern of overall PA and walking exercise during the course of PR; (3) determine the feasibility of prescribing exercise to PR attendees using an activity monitor; and (4) explore the relationship between exercise and non-exercise PA with routine PR outcome measures.Methods19 patients wore an activity monitor during routine walking tests and 6 weeks of PR, recording in a diary when they exercised. Exercise intensity (cadence) was prescribed from the Endurance Shuttle Walk Test. Patients completed questionnaires, walking tests and a lower limb strength test before and after PR. Repeated ANOVA compared changes in outcomes between weeks 1–6.ResultsPatients wore the monitor every day during PR (median 42 days). Exercise steps increased by 56% (Δ332 [95% CI 54–611] steps/day, p = 0.009) between weeks 1 and 6, with no significant change in non-exercise steps (Δ79 [95% CI − 22 to − 179] steps/day, p = 0.13). Patients reported exercising on 70% of days. Adherence to prescribed cadence was achieved 55% of time spent exercising, and did not change across the 6 weeks (p = 0.907). Change in total daily steps was associated with improved dyspnea (p = 0.027), Chronic Respiratory Questionnaire (CRQ) Dyspnea domain (p = 0.019), CRQ Emotional Functioning domain (p = 0.001) and CRQ Mastery domain scores (p = 0.001) but not with exercise capacity or lower limb muscle strength.ConclusionsImprovements in exercise participation, not at the expense of non-exercise PA, throughout a PR course was observed in attendees provided with a commercially available activity monitor. Wearable technology may be able to support effective remote walking exercise prescription and participation during PR.Trial registration (retrospectively registered): http://www.isrctn.com/ISRCTN15892972.

Walking exercise alters protein digestion, amino acid absorption, and whole body protein kinetics in older adults with and without COPD.

Gut-related symptoms and an increase in markers of gut dysfunction have been observed in patients with chronic obstructive pulmonary disease (COPD). It remains unclear whether exercise, in relation to inducing hypoxia, plays a role in disturbances in protein digestion and amino acid absorption and whole body protein kinetics. Sixteen clinically stable patients with moderate-to-very severe COPD and 12 matched healthy subjects completed the study. Protein digestion and amino acid absorption, whole body protein kinetics were measured in the postabsorptive state via a continuous infusion of stable tracers in combination with orally administered stable tracer sips during 20 min of walking exercise and up to 4 h post exercise. In addition, concentrations of short-chain fatty acid (SCFA) and amino acids were measured. Patients with COPD completed one study day, walking at maximal speed, whereas healthy subjects completed two, one matched to the speed of a patient with COPD and one at maximal speed. The patients with COPD tolerated 20 min of vigorous intensity walking with an elevated heart rate (P < 0.0001) and substantial desaturation (P = 0.006). During exercise, we observed lower protein digestion (P = 0.04) and higher SCFA acetate (P = 0.04) and propionate (P = 0.02) concentrations on max speed study days, lower amino acid absorption (P = 0.004) in subjects with oxygen desaturation, and lower net protein breakdown (P = 0.03) and propionate concentrations (P = 0.04) in patients with COPD. During late recovery from exercise, amino acid absorption (P = 0.02) and net protein breakdown (P = 0.02) were lower in patients with COPD. Our data suggest that 20 min of walking exercise is sufficient to cause perturbations in gut function and whole body protein metabolism during and up to 4 h post exercise in older adults and in patients with COPD with exercise-induced hypoxia.NEW & NOTEWORTHY Gut function is disturbed in older adults with COPD. As exercise is the cornerstone of pulmonary rehabilitation in COPD, knowledge of the response of the gut to aerobic exercise is of importance.

Pulmonary rehabilitation for COPD: improves outcomes at acceptable cost

Pulmonary rehabilitation for COPD: improves outcomes at acceptable cost

Methodological insights from pre-pilot phases of two complex respiratory interventions (IMP2ART; TANDEM)

Introduction: Complex behavioural interventions, often encounter implementation issues in real-world application. Enhancing the MRC framework for developing and evaluating complex interventions, we included a real-world pre-pilot before formal piloting of two complex interventions: IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) which is developing a whole-systems implementation strategy to improve supported asthma self-management in primary care, and Tailored intervention for ANxiety and DEpression Management in COPD (TANDEM), which uses a cognitive behavioural approach to manage anxiety and depression before attendance at pulmonary rehabilitation in COPD. Methods: Following extensive development, feasibility testing and refining, each study tested the multi-level components of their interventions with up to 4 ‘real-world sites’ to optimise design for the trial. Qualitative feedback from key stakeholders was reviewed by the development groups and integrated into the final design. Results: There were many lessons learnt. In IMP2ART we changed delivery of professional education from facilitated use of a team e-learning module to a more open facilitated team session and individual access to the module. In TANDEM, training of respiratory professionals was made less threatening by replacing role-play with actors to an individual video-recorded session. Conclusion: Real-world pre-pilots resulted in significant changes to the delivery of IMP2ART and TANDEM and should be considered before formal piloting of complex interventions. Method: IMP2ART NIHR PGfAR (RP-PG-1016-20008); TANDEM: M+NIHR HTA (13/146/02)

Pulmonary Rehabilitation in COPD

Pulmonary Rehabilitation in COPD

Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC a multicentre, double-blind, placebo-controlled, randomised parallel group study

RationaleDietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with COPD. We aimed to assess whether it could enhance...

Handgrip Strength: A Determinant of Improved Exercise Endurance Time After Pulmonary Rehabilitation in COPD

Handgrip Strength: A Determinant of Improved Exercise Endurance Time After Pulmonary Rehabilitation in COPD

Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study

Home-based exercise has been proposed as an equivalent treatment strategy to supervised outpatient pulmonary rehabilitation (PR), but it is not known whether its implementation into clinical practice produces similar benefits...

Cardiovascular Effects of Pulmonary Rehabilitation in COPD

Cardiovascular Effects of Pulmonary Rehabilitation in COPD