Rehabilitation In Chronic Obstructive Pulmonary Disease Patients Research Articles

Modern approaches of rehabilitation in COPD patients

Chronic Obstructive Pulmonary Disease (COPD) presents a significant challenge to public health, impairing the quality of life for affected individuals. Traditionally, the management of COPD primarily involved pharmacological interventions and symptom management, but a shift towards comprehensive rehabilitation programs has been observed in recent times. This study focuses on exploring these modern approaches to COPD rehabilitation, including exercise training, education, psychosocial support, and self-management strategies. By emphasizing patient-centered and multidisciplinary methodologies, modern rehabilitation approaches aim to address the individual needs of COPD patients. Previous studies affirm the positive impacts of these comprehensive programs, including improved exercise capacity, reduced symptoms, and enhanced overall well-being. This current investigation aims to further analyze the effects of various pulmonary rehabilitation methods on COPD management within a modern medical context. By critically evaluating literature and research databases like SCOPUS, PubMed, SciELO, Google Scholar, and Cochrane Library, this study seeks to provide unique insights into the efficacy and benefits of pulmonary rehabilitation for COPD patients. The implications of this research could contribute significantly to evidence-based practices, assisting healthcare professionals in optimizing the selection and implementation of pulmonary rehabilitation interventions for improved patient outcomes.

Effectiveness of Planned Teaching Programme on Knowledge regarding Pulmonary Rehabilitation in Copd patients among Nursing Students in selected Nursing colleges

Background and Purpose of the study: Pulmonary rehabilitation for patients with COPD is well established and widely accepted as a means to alleviate symptoms and optimize functional status, increase participation, and reduce health care costs by stabilizing or reversing systemic manifestations of the disease. It is a form of rehabilitation dealing with respiratory disorders and limited participation in daily life. Pulmonary rehabilitation includes patient education, exercise training, psychosocial support and advice on nutrition. Pulmonary rehabilitation has been shown to improve exercise capacity, reduce breathlessness, improve health-related quality of life, and decrease healthcare utilization. Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD4. Patients with chronic obstructive pulmonary disease (COPD) often decrease their physical activity because exercise can worsen dyspnea. The progressive deconditioning associated with inactivity initiates a vicious cycle, with dyspnea becoming problematic at ever lower physical demands. Pulmonary rehabilitation aims to break the cycle. Objectives: 1) To assess the level of knowledge regarding pulmonary rehabilitation in COPD patients among nursing students. 2) To find out the effectiveness of planned teaching programme regarding pulmonary rehabilitation in COPD patients among nursing students. 3) To find out the association between the pre-test knowledge regarding pulmonary rehabilitation in COPD patients with selected socio demographic variables. Approach: Evaluative approach was selected for the study. Design: Quasi-experimental (one group pretest and posttest) was selected for the study. Subjects: 50 nursing students. Sampling Technique: A purposive sampling technique was used to select the sample for study. Data Collection Tool: A structured questionnaire was used to collect data from the subjects. Data Analysis: The obtained data was analyzed using descriptive and inferential statistics and interpreted in terms of objectives and hypothesis of the study. The level of significance was set at 0.05 levels. Results: 88% of the nursing students obtained adequate level of information and 6% had a moderate level of knowledge. None of the staff nurses possessed inadequate level of knowledge Conclusion: In the pretest the subjects had an inadequate knowledge where as in the post test all the subjects had gained adequate knowledge. The study findings indicate that PPT was effective enhancing the knowledge of nursing students regarding pulmonary rehabilitation in COPD patients.

Challenges in pulmonary rehabilitation: COVID-19 and beyond.

Pulmonary rehabilitation is a comprehensive multidisciplinary intervention requiring a team involving an expert chest physician, an exercise training specialist, a nutritional expert, a psychologist, a social worker, and an occupational therapist, who together aim at improving respiratory functional capacity in patients with chronic obstructive pulmonary disease (COPD). We aimed at evaluating the effectiveness of pulmonary rehabilitation in a large number of trials, systematic reviews, and meta‑analyses in pre-COVID-19 conditions, and the impact of pulmonary rehabilitation during the COVID‑19 pandemic was estimated based on results of abundant available studies. As many as 34 studies were selected to assess the global results of pulmonary rehabilitation in COPD patients before the pandemic, and 40 studies were selected from the literature concerning pulmonary rehabilitation during the COVID‑19 pandemic.A large number of systematic reviews and meta‑analyses reported on the efficacy of rehabilitation in COPD patients, based on the improvement in inspiratory muscle strength, exercise capacity, dyspnea, and quality of life. The response to rehabilitation in patients with COVID‑19 is also satisfactory. The effectiveness of pulmonary rehabilitation in COPD patients shows an evolving need for health care professionals to design an individually tailored pulmonary rehabilitation program for patients with COVID-19 to alleviate the chronic symptoms and reduce complications.

Different Responses to Pulmonary Rehabilitation in COPD Patients with Different Work Efficiencies.

BackgroundChronic obstructive pulmonary disease (COPD) often involves the cardiopulmonary dysfunction that deteriorates health-related quality of life (HRQL) and exercise capacity. Work efficiency (WE) indicates the efficiency of overall oxygen consumption (VO2) during exercise. This study investigated whether different WEs have different effects on pulmonary rehabilitation (PR).MethodsForty-five patients with stable COPD were scheduled for PR. The PR programs consisted of twice-weekly sessions for three months. These patients were comprehensively evaluated by cardiopulmonary exercise testing and COPD assessment test (CAT) before and after PR. We compared these parameters between patients with a normal versus poor WE.ResultsTwenty-one patients had a normal WE and twenty-four patients had a poor WE (<8.6 mL/min/watt). Patients with a poor WE had earlier anaerobic metabolism, a poorer oxygen pulse, lower exercise capacity, more exertional dyspnea, and a poorer HRQL than those with a normal WE. PR improved exercise capacity, HRQL, anaerobic threshold, exertional dyspnea and leg fatigue in patients with either normal or poor WE. However, significant improvement of WE, oxygen pulse, respiratory frequency (Rf) during exercise, chest tightness, activity and sleepiness by CAT were noted only in patients with a poor WE. Among the patients with a poor WE, 29% patients had WE returned to normal after PR.ConclusionPatients with different WE had different responses to PR. PR improved exercise capacity and HRQL regardless of a normal or poor WE. However, WE, oxygen pulse, Rf during exercise, chest tightness, activity and sleepiness were only improved in patients with a poor WE.

Predictors of changes in 6-min walking distance following pulmonary rehabilitation in COPD patients: a retrospective cohort analysis.

Pulmonary rehabilitation (PR) is fundamental in chronic obstructive pulmonary disease (COPD) management but not all patients may show functional benefits from PR. The aim of this study was to identify predictors of non-response in functional capacity to PR. Observational study. Inpatient pulmonary rehabilitation center. COPD patients. This single center study is a retrospective analysis of data in COPD patients admitted to a PR center between January 2012 and December 2017. Post-PR change in 6-min walking distance (6MWD) was used to determine the functional response to PR. Patients characteristics and pre-PR 6-min walking test responses were analyzed to determine factors associated with post-PR changes in 6MWD. Data from 835 patients were analyzed as well as a subgroup of 190 patients with additional variables available. Eighty percent of the patients showed clinically significant 6MWD improvement post-PR. The predictors of 6MWD response to PR were age, pre-PR 6MWD, pre-PR end-of-test dyspnea and long-term oxygen therapy. Older patients, longer pre-PR 6MWD, higher pre-PR end-of-test dyspnea score and the use of oxygen supplementation were associated with lesser post-PR 6MWD improvement. This study identified four important clinical variables predicting a lack of 6MWD response to PR. Patients with such clinical characteristics may require specific PR modalities to improve their functional benefit.

Benefits of pulmonary rehabilitation in COPD patients with mild cognitive impairment – A pilot study

BackgroundCognitive impairment might interfere with the efficacy of Pulmonary Rehabilitation (PR) in Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify differential responses to PR between cognitively impaired (CI) and cognitively normal (CN) COPD patients by assessing health status and exercise capacity. MethodsSixty patients (FEV1: 47 ± 15%) were classified as CI or CN according to the Montreal Cognitive Assessment (MoCA ≤25points) and completed a 3-week inpatient PR program. Cognitive function (neuropsychological battery), health-status (36-Item Short Form Survey [SF-36]), and exercise capacity (6-min walk test [6MWT], cycle-endurance test [CET]) were assessed before and after PR. Responsiveness to PR was estimated by mean change (delta-value [Δ]) and the d-Effect Size (ES). ResultsTwenty-five COPD patients (42%) presented evidence of mild CI prior to PR. Both, CI and CN patients significantly improved global cognitive function, health status (the majority of SF-36 components), and exercise capacity (6MWT and cycle endurance) in response to PR. Compared to CN, CI patients did not improve SF-36 subdomains of “role emotional” and “bodily pain”, and demonstrated a lower magnitude of improvement in 6MWT ([Δ]: 25 m; ES: 0.21) compared to CN ([Δ]: 46 m; ES: 0.54). ConclusionsPR has favorable effects on global cognitive function, health status, and exercise capacity in both CI and CN COPD patients. There was no concrete evidence to indicate interference of cognitive impairment to PR effectiveness.

The application value of chronic disease self-management project in promoting pulmonary rehabilitation of patients with chronic obstructive pulmonary disease

Objective: To explore the role of chronic disease self-management program (CDSMP) in promoting pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD) . Methods: In June 2017 and December 2018, 380 COPD patients were selected from the health management center of Qilu Hospital of Shandong University during the same period. They were randomly divided into the experimental group and the control group. At the end of the study, 17 cases were lost to follow-up and 5 cases were withdrawn from the study. Finally, 175 and 183 patients in the experimental group and the control group completed the study. The experimental group was treated with CDSMP for 6 months, while the control group was not intervened. Lung function and blood gas analysis results, lung rehabilitation related indicators and SF-36 scores were compared between the two groups before and after intervention. The measurement data were expressed by Mean±SD, and the comparison between the two groups was performed by t test. The count data were expressed by frequency and constituent ratio (%) . Chi square test or rank sum test was used for comparison between groups. Results: After CDSMP intervention, compared with the control group, the 6MWD, weekly moderate intensity exercise time, weekly moderate intensity exercise frequency and self exercise efficacy score of the experimental group were significantly increased, and the single exercise duration was longer, the difference was statistically significant (P<0.05) . The physiological function score, general health score, physical energy score, mental health score and total score of the experimental group were higher, and the differences were statistically significant (P<0.05) . Conclusion: CDSMP may have a certain effect in promoting lung rehabilitation in COPD patients.

Efficiency of High-Flow Nasal Cannula on Pulmonary Rehabilitation in COPD Patients: A Meta-Analysis.

Introduction The clinical benefit of high-flow nasal cannula (HFNC) on factors related to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients remains unclear. This meta-analysis aimed at synthesizing the available evidence on the efficacy of HFNC on exercise capacity, lung function, and other factors related to pulmonary rehabilitation in COPD patients. Methods Electronic databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science) were searched for randomized trials comparing with conventional oxygen therapy (COT) or noninvasive ventilation (NIV). Primary outcomes were respiratory rate, FEV1, tidal volume, oxygen partial pressure, total score of St. George's respiratory questionnaire, 6-minute walk test, and exercise endurance time. Results Ten trials met the criteria for inclusion. Combined data from six studies showed that HFNC showed a lower respiratory rate in COPD patients [mean difference -1.27 (95% CI: -1.65–(-0.89)]. Combined data from three studies showed a lower forced expiratory volume in one second (FEV1) in the group of HFNC. No difference in tidal volume was showed between the HFNC and control groups in COPD patients. No significant oxygen improvement between the HFNC groups and control groups. The total score of St. George's respiratory questionnaire was improved by the subgroup analysis of HFNC versus COT but no NIV. Two multicenter RCTs showed the six-minute walk test, and statistical results showed that the length of the six-minute walk capacity was increased after usage of HFNC compared to the control group [mean difference -8.65 (95% CI: -9.12–(-8.19)]. No increase of exercise capacity after usage of HFNC (mean difference -12.65). Conclusion In the first meta-analysis of the area, the current evidence did not show so much positive effect on tidal volume or oxygen improvement in COPD patients. Length of the six-minute walk capacity was increased after using HFNC, while other pulmonary rehabilitation parameters, namely, the score of St. George's respiratory questionnaire and exercise capacity show no increase in the group of HFNC. The variance in the quality of the evidence included in this meta-analysis highlights the need for this evidence to be followed up with further high-quality and more randomized trials.

Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.

BackgroundPulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease.ObjectiveThis study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients.MethodsCOPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George’s Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function.ResultsIn total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation.ConclusionsmHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management.Trial RegistrationClinicalTrials.gov NCT04479930; https://clinicaltrials.gov/ct2/show/NCT04479930

Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection.

To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis (n = 6), pneumonia (n = 1), respiratory failure (n = 1), and pulmonary embolism (n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor (p = 0.001). Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

Dual use of bronchodilators versus monotherapy, and its impact on pulmonary rehabilitation in COPD patients

IntroductionLong-acting bronchodilators are the therapy with the best evidence for treating stable chronic obstructive pulmonary disease (COPD). Long-acting combinations of β2 agonists and anticholinergics (LABA-LAMA) are recommended in advanced stages when monotherapy has not generated the desired effects. Pulmonary Rehabilitation (PR) is an effective non-pharmacological strategy. The aim of this study was to compare the results obtained in patients with COPD who received monotherapy versus dual bronchodilator therapy in terms of functional aerobic capacity, symptoms and quality of life. Materials and methodsProspective non randomized intervention study; the patients were divided into two groups: in one group patients were treated with LAMA (Tiotropium Bromide, 5 μg every 24 h) and in the other group patients were treated with LABA + LAMA (Indacaterol/Glycopyrronium, 110/50 μg once a day). After receiving the concept of pulmonology, patients were intervened with 8 weeks of PR. The study was approved by the committee of the Clinica Neumológica del Pacifico in Cali and the Institución Universitaria Escuela Nacional del Deporte, Colombia. To determine the differences, t pair test for intragroup, and t-test was performed for intergroup analysis. For all tests, a p-value <0.05 was considered as statistically significant. Results53 patients participated in this study, of which 20 were assigned to the LAMA group and 33 to the LAMA + LABA group. Patients in both groups presented changes in the distance of the 6MWT, in the VO2e, dyspnea and in all the SGRQ domains. Regarding the comparison between groups, there were found no differences in the variables at the beginning of the PR and significant differences (p < 0.05) at the end of the 8 week-period in favor of the LABA + LAMA group, in symptoms with the mMRC scale, functional aerobic capacity with the 6 min walking test and in health related quality of life specifically in the symptoms domain, where the dual therapy group obtained better results. ConclusionThe addition of LABA to the treatment with LAMA showed better response results compared with the monotherapy in patients with COPD who attended PR.

Efficacy and safety of acupoint autohemotherapy in treating stable chronic obstructive pulmonary disease: Protocol for a systematic review and meta-analysis.

Background:Chronic Obstructive Pulmonary Disease (COPD) is a clinically common chronic disease with the characteristic of recurrent attacks, difficulty of cure and high morbidity, disability, death rates. COPD exerts a great burden on patients, families and society. Acupoint Autohemotherapy (AA) is a traditional Chinese medicine (TCM) treatment by taking the patient's own venous blood and injecting them at acupoints, combined with the continuous stimulation of blood and the specific efficacy of the acupoint itself. It has been proved to be useful in pulmonary treatment and rehabilitation of COPD patients. However, the efficacy of AA on COPD patients has not been fully statistically evaluated. In this study, we aim to systematically examine the efficacy and safety of AA for COPD patients.Methods:Data from all English and Chinese databases, including Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database and Chongqing VIP information, will be used to conduct a systematic and comprehensive literature search. The range of date is from inception to July 2019. Randomized controlled trials (RCTs) related to AA and western medicine in the treatment of COPD will be included. Quality of included trials will be assessed according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the certainty of the evidence of estimates derived from meta-analysis. RevMan 5.3 will be used for data synthesis, sensitivity analysis, meta-regression analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias, and Begg and Egger tests will be used to assess funnel plot symmetries. Grading of recommendations assessment, development and evaluation system will be utilized to assess the quality of evidence.Results:This systematic review and meta-analysis aims to summarize the direct and indirect outcomes for AA and western medicine on COPD patients and evaluate its efficacy and safety. The results will be submitted to a peer-reviewed journal once completed.Conclusion:The systematic review will provide evidence to assess the efficacy and safety of AA and western medicine in the treatment of COPD patients.PROSPERO registration number:PROSPERO CRD42019137189

Use of i-BODE index to determine efficacy of pulmonary rehabilitation in COPD patients.

Pulmonary rehabilitation (PR) is well-proven approach on improving dyspnea, exercise intolerance which are two components of BODE index. But, PR is known to have minimal effect on pulmonary function which is another component of BODE index. There are few studies evaluating PR efficacy by using i-BODE index. Our aim was to evaluate efficacy of PR in patients with chronic obstructive pulmonary disease (COPD) with i-BODE index and to investigate changes in i-BODE index according to GOLD 2011 combined assessment. A total of 228 stable COPD patients who completed a comprehensive 8 week duration PR program were enrolled into this retrospective study. The patients were with mean age of 63.3 ± 8.6 years and mean FEV1% was 38.6 ± 16.2%. According to combined assessment of COPD, 23 patients were group A, 30 patients were B, 31 patients were C and 144 patients were D. Baseline i-BODE scores correlated with body compositions, pulmonary function, dyspnea, exercise capacity, psychological status, quality of life, and age. i-BODE index score decreased from 4.7 ± 2.2 to 3.5 ± 1.8 after PR (p<0.001), improved by 26%. Significant improvements were found in dyspnea, quality of life and i-BODE index in more symptomatic patients (group B and D). This study highlights that changes in i-BODE scores after PR significantly correlated with improvements in dyspnea, exercise capacity and quality of life. i-BODE score could be a better predictor of efficacy of PR than some individual variables such as BMI or FEV1. Significant improvements in dyspnea sensation, quality of life and i-BODE index could be seen symptomatic patients in after PR.

Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial

Background Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease (COPD) is not fully reversed by exercise training. Antioxidants are critical for muscle homeostasis and adaptation to training. However, COPD patients experience antioxidant deficits that worsen after training and might impact their muscle response to training. Nutritional antioxidant supplementation in combination with pulmonary rehabilitation (PR) would further improve muscle function, oxidative stress, and PR outcomes in COPD patients. Methods Sixty-four COPD patients admitted to inpatient PR were randomized to receive 28 days of oral antioxidant supplementation targeting the previously observed deficits (PR antioxidant group; α-tocopherol: 30 mg/day, ascorbate: 180 mg/day, zinc gluconate: 15 mg/day, selenomethionine: 50 μg/day) or placebo (PR placebo group). PR consisted of 24 sessions of moderate-intensity exercise training. Changes in muscle endurance (primary outcome), oxidative stress, and PR outcomes were assessed. Results Eighty-one percent of the patients (FEV1 = 58.9 ± 20.0%pred) showed at least one nutritional antioxidant deficit. Training improved muscle endurance in the PR placebo group (+37.4 ± 45.1%, p < 0.001), without additional increase in the PR antioxidant group (-6.6 ± 11.3%; p = 0.56). Nevertheless, supplementation increased the α-tocopherol/γ-tocopherol ratio and selenium (+58 ± 20%, p < 0.001, and +16 ± 5%, p < 0.01, respectively), muscle strength (+11 ± 3%, p < 0.001), and serum total proteins (+7 ± 2%, p < 0.001), and it tended to increase the type I fiber proportion (+32 ± 17%, p = 0.07). The prevalence of muscle weakness decreased in the PR antioxidant group only, from 30.0 to 10.7% (p < 0.05). Conclusions While the primary outcome was not significantly improved, COPD patients demonstrate significant improvements of secondary outcomes (muscle strength and other training-refractory outcomes), suggesting a potential “add-on” effect of the nutritional antioxidant supplementation (vitamins C and E, zinc, and selenium) during PR. This trial is registered with NCT01942889.

COMPARING THE EFFECT OF RESISTIVE INSPIRATORY MUSCLE TRAINING AND INCENTIVE SPIROMETRY ON RESPIRATORY PATTERN OF COPD PATIENTS

Background: Resistive Inspiratory Muscle Training (RIMT) is a well-known technique for rehabilitation of patients with Chronic Obstructive Pulmonary Disease (COPD). Incentive spirometry is another technique with potential viability for this application, but there is limited evidence in support of its efficacy in the rehabilitation of COPD patients. Aim: The objective of this study was to compare the effect ofresistive inspiratory muscle training and incentive spirometry on respiratory pattern of COPD patients. Method: This study was a randomized clinical trial on 30 patients with moderate COPD who were referred, in 2011, to the pulmonary clinic of Emamreza Hospital of Mashhad (Iran). The patients were randomly divided into the RIMT and the IS treatment group. In both groups, exercise regimen consisted of two 15-minute sessions of exercise per day, in the morning and evening, four days a week for 4 weeks. Respiratory pattern (respiratory rate and depth) and dyspnea (at rest and during activity) were measured before and after exercise. Data was analyzed with the Mann-Whitney and ratio difference tests using SPSS v.11.5. Results: The average age was 50.8±10.7 in the IS group and 51±10.8 in the RIMT group. The statistical tests found no significant difference between the groups in terms of post-intervention exertional dyspnea, dyspnea at rest, tidal volume, and respiratory rate (P>0.05); but post-intervention maximal inspiratory pressure and maximal voluntary ventilation in the two groups were found to be significantly different (P <0.05). Implications for Practice: despite statistically superior performance of resistive training in improving the maximal voluntary ventilation and maximal inspiratory pressure, the difference between its results and the results of incentive spirometry is not clinically important, therefore positive clinical outcomes of incentive spirometry are sufficiently significant to encourage its use in COPD rehabilitation programs.

만성폐쇄성폐질환자의 가정호흡재활 프로그램 효과에 대한 체계적 고찰: 무작위시험설계

Purpose: The purpose of this study was to review systematically the effects of home based pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients using qualitative synthesis. Methods: Studies designed randomized controlled trials were identified to extract data and to assess the quality of studies in 8 domestic and 3 foreign search engines, and hand search reference reviews. Results: A total of 9 studies met the inclusion criteria. Overall, the methodological quality of the studies ranged from average to poor. Home based pulmonary rehabilitation consisted of exercise, education, and psychosocial interventions. Several exercises such as aerobic, strength, respiratory muscle training, and flexibility were used in home based pulmonary rehabilitation for COPD patients. Upper muscle exercise and walking were the most frequently used exercises. The most common topics for education were 'knowledge of the illness' and 'drug management'. Walking distance test (WDT) and quality of life (QoL) were the most frequently measured as the dependent variables to evaluate rehabilitation outcomes, followed by pulmonary function test (PFT) and dyspnea. WDT was the most effective outcome, followed by dyspnea, QoL and PFT. Conclusion: This study informed about the details of scientific and effective home based rehabilitation programs in COPD patients for future researchers and clinicians. These findings can help expand the recognition and accessibility of home based rehabilitation in COPD patients.

Learning impact of education during Pulmonary Rehabilitation program. An observational short-term cohort study

Among the several components constituting a pulmonary rehabilitation (PR) course, education may contribute to an individual's recognition of symptoms and worsening of the disease. However, the specific benefits of education is far greater than can be clearly documented to the health care providers. The aim of our preliminary study was to assess the learning impact of educational sessions (ES) in Chronic Obstructive Pulmonary Disease (COPD) patients referred to standard PR. Six ES on 3 areas (Symptoms-Therapies, Aids, Mood) were applied during PR at our clinic. The learning effect was prospectively evaluated by a specific questionnaire (ESQ) in 285 COPD patients (age 69 +/- 8 years, FEV1 53 +/- 14 % pred), then grouped into those who have completed ES (Completers group, n = 226) or who did not (mean 2 +/- 1 ES) (Control group, n = 59). Total and partial ESQ scores, and PR outcomes (6-minute walking test-6MWD, effort-dyspnoea at Medical Research Council scale-MRC, and health-related quality of life scale-SGRQ) were assessed in a pre (T0) to post (Tend) design. Similar improvement in PR outcomes was recorded in both groups at Tend, whereas ESQ total and partial scores significantly increased in 'Completers' only (p < 0.001). ESQ-Aids score improved to a greater extent in Completers than in Control (+0.60 +/- 1.03 vs +0.27 +/- 1.27 point respectively, p = 0.036). A higher proportion of Completers improved above the median change of both ESQ total and aids scores (p < 0.05). Attending educational sessions produces a specific short-term learning effect during rehabilitation of COPD patients.

Physiological Factors Relevant to Exercise Tests in Pulmonary Rehabilitation of COPD Patients

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality in the world special in United States. Patients with COPD often complain of dyspnea and fatigue in exercise intolerance, also significantly impede quality of life of them. Main propose in this study is comparison all of Physiological Factors in reports and results of researches in relevance to Cardiopulmonary Rehabilitation in COPD patients with exercise approach. In this study with style of Theoretical basic research and data calculate of digital resources, PubMed, Science direct, Scopus, Guidelines of ERS/ATS with Bibliographic method. Our approach is comparison all of physiological factors in investigations relevant to exercise tests in cardiopulmonary rehabilitation of COPD patients include: VO2Max, VCO2, VE, HR, FEV1, FVC, assessment of perceptual responses e.g. dysfunctions in muscle, dyspnea, leg discomfort, fatigue and such as exercise-related arterial oxygen desaturation, dynamic hyperinflation and limb-muscle strength. In many researches more improved of VO2max in Cardiovascular limitation than Ventilate limitation in COPD patients. In Cycle ergometer testing, COPD patients had less in elicit O2 desaturation that might occur in during lung ambulation. By using maximal incremental treadmill exercise test protocols can be developed and increased tolerance exercise in COPD patients. Treadmill testing have more physiological limitations than cycle ergometer and COPD patients often in treadmill tests have more limiting factors: dyspnea and coughing.

Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD.

BackgroundThe diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), using a fluoroscopy-guided chest X-ray.Patients and methodsAmong 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.ResultsThere were significant improvements (2,022.8±1,548.3 mm2 to 3,010.7±1,495.6 mm2 and 2,382.4±1,475.9 mm2 to 3,315.9±1,883.5 mm2; right side P=0.001 and left side P=0.019, respectively) in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.ConclusionThe study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary rehabilitation in COPD patients in terms of cost and time savings compared with computed tomography or magnetic resonance imaging.

The Role of Inspiratory Muscle Training in the Process of Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) adversely affects the quality of life and life expectancy of patients. Shortness of breath, cough, and fatigue in lower limbs are the main reasons limiting physical activities of patients. The lack of physical activity results in poorer muscle strength. The latest guidelines regarding breathing rehabilitation in COPD patients emphasize a significant role of inspiratory muscle exercises. The objective of the present study was to evaluate the effects of an 8-week long inspiratory muscle training, interval training on a cycle ergometer, and training combining both kinds of rehabilitation, on pulmonary function, health-related quality of life, and the tolerance to exercise in patients with COPD. The study was conducted in a group of 43 patients with diagnosed COPD stage II and III according to GOLD. They were randomly divided into four training groups: inspiratory muscle training (Group 1), cycle ergometer training (Group 2), cycle ergometer and inspiratory muscle training (Group 3), control group - patients who did not participate in any rehabilitation programs (Group 4 - control). Before the rehabilitation process and after its completion the patients were medically examined, they completed a health-related quality of life questionnaire, performed a 6-min walk test, spirometry, and a treadmill exercise test according to the modified Bruce protocol. The results demonstrate a significant improvement in the quality of life measured for Group 3 in comparison with the control group.