Role Of Pulmonary Rehabilitation Research Articles

Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects.

Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes.

Role of pulmonary rehabilitation on extracellular matrix protein expression in vastus lateralis muscle in atrophic and non-atrophic patients with COPD

Role of pulmonary rehabilitation on extracellular matrix protein expression in vastus lateralis muscle in atrophic and non-atrophic patients with COPD

The Impact of Pulmonary Rehabilitation on Mental Health and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease (COPD): A Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a complex, prevalent, debilitating, and degenerative disease that affects a large population, and the treatment options for the patients are limited. Although progress has been made in COPD pathogenesis, etiology, and management, there is still an unmet need to develop novel therapies. COPD management has recently seen a focus on a multidisciplinary pulmonary rehabilitation approach to help patients manage the disease better. This review primarily focuses on the role of pulmonary rehabilitation as a novel therapeutic strategy for treating and managing COPD, which is known to decrease patients' quality of life. Disease management and the beneficial effects of pulmonary rehabilitation in COPD are discussed. Subsequently, different methods that are employed in pulmonary rehabilitation are examined, including oxygen therapy, exercise, meditation, and education, emphasizing how they can help patients better manage COPD. Pathophysiology and the effect of pulmonary rehabilitation on the cellular level, such as the release of perforins and Th1 and Th17 cytokines, are also explored. The link between exercise and meditation during pulmonary rehabilitation therapy, which promotes repairing affected organs, is emphasized. Future perspectives on personalized medicine and its use in conjunction with pulmonary rehabilitation are also outlined. In conclusion, pulmonary rehabilitation holds significant promise for the management of COPD by addressing the present limitations of treatment. However, further research is essential to overcome and optimize treatment strategies for COPD patients.

Annual progress in pulmonary rehabilitation 2022

Pulmonary rehabilitation can relieve dyspnea in patients, improve their healthy status and exercise tolerance. It is the most cost-effective comprehensive intervention. Although the role of pulmonary rehabilitation has been recognized and recommended in clinical guidelines, it is still underutilized worldwide. Therefore, how to improve the knowledge and awareness of pulmonary rehabilitation and to increase accessibility, thus promoting its application and completion, is the key point of clinical research. Related research has also made a series of important progress. This review summarized the latest research findings from September 2021 to October 2022, with the goal of increasing healthcare professionals' knowledge and awareness in order to improve patient referral to pulmonary rehabilitation.

Role of pulmonary rehabilitation in chronic obstructive pulmonary disease - a historical perspective.

Pulmonary rehabilitation is known as an effective therapy for patients with chronic obstructive pulmonary disease (COPD). This article is a brief introduction into the history of medical and pulmonary rehabilitation, presenting the evolution of applied therapies and methods from ancient to present times. It also highlights the role of physical effort in the prevention and treatment of lung diseases, with special consideration to COPD. For this literature review, the international databases Medline and Scopus were used to identify relevant articles, between January 1981 to December 2021; eighty articles were considered: thirty-six reviews, eight original research and six general articles which met the criteria for inclusion. A total of thirty references were excluded because they were not relevant. Available published data suggest a rich history of rehabilitation reaching for thousands of years even though it was developed as a medical branch only in the 20th century. Pulmonary rehabilitation is currently an important component of the management of COPD patients, with a positive impact on symptoms, frequency of exacerbations, severity and mortality rates. Even though this type of intervention is known to be beneficial for this type of patients more studies need to be conducted in this field.

Role of Pulmonary Rehabilitation in Patients with Pulmonary Arterial Hypertension

Role of Pulmonary Rehabilitation in Patients with Pulmonary Arterial Hypertension

Role of Pulmonary Rehabilitation in Advanced Non-small Cell Lung Cancer Patients Undergoing Chemotherapy: A Pilot Study

Role of Pulmonary Rehabilitation in Advanced Non-small Cell Lung Cancer Patients Undergoing Chemotherapy: A Pilot Study

Is there a role of pulmonary rehabilitation in extrapulmonary diseases frequently encountered in the practice of physical medicine and rehabilitation?

There is a group of diseases such as low back pain, osteoporosis, fibromyalgia and obesity for which pulmonary rehabilitation can be applied. Although these diseases do not directly impact the lungs, respiratory dysfunction occurs through various mechanisms during the disease process and complicates the underlying primary disease. Respiratory dysfunction and spirometric abnormalities have been observed from the early stages of these diseases, even without obvious signs and symptoms. These patients should be carefully evaluated for pulmonary problems as a sedentary lifestyle may hide the presence of respiratory symptoms. Once pulmonary problems have been detected, pulmonary rehabilitation should be added to the routine treatment of the primary disease.

Role of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease

Aims and objectives- To determine the impact of pulmonary rehabilitation program in patients with COPD regarding Clinical symptoms Status of exercise tolerance Status of physical and social performance Quality of life Method- 50 patients with stable COPD, who were willing to participate, were included in study. All patients were taught chest physiotherapy, bronchial hygiene, education about disease and its management and proper nutrition. All patients were assessed regarding any psychological problems. Daily 30-35 minute sessions were conducted at institute for initial 4 weeks and then home care was taught. Patient was assessed periodically for symptoms, quality of life and spirometric findings. All variables were recorded at baseline and after completion. Statistical analysis were performed using student’s‘t’ test and p values observed. Result- Dyspnea scale measured by Modified Medical Research Council (MMRC) (3.0 ± 0.66) improved after program (1.89 ± 0.83, p value less than 0.0001) which is statistically very significant. Health related quality of life measured by using St. George’s Respiratory Questionnaire 49.74 ± 5.17 improved significantly 40.92 ± 4.87 after program (p value less than 0.0001) 6 minute walk distance (280.9 ± 18.04) improved significantly after program (303 ± 17.34) (‘p’ value less than 0.0001) Spirometric parameters like FVC (p value 0.02), FEV1 (p value 0.17) and FEV1 / FVC ratio (p value 0.76) do not show any statistically significant changes after program.

The Role of Pulmonary Rehabilitation in Patients with Tuberculosis Sequelae

The Role of Pulmonary Rehabilitation in Patients with Tuberculosis Sequelae

Role of pulmonary rehabilitation in inhalation instruction

Role of pulmonary rehabilitation in inhalation instruction

Factors Associated with Duration of Intercostal Chest Drainage in Patients with Primary Spontaneous Pneumothorax and the Role of Pulmonary Rehabilitation.

PurposePrimary spontaneous pneumothorax (PSP) is an urgent/emergency condition. Treatment with intercostal chest drainage (ICD) is necessary, particularly in symptomatic patients or those with tension. A previous study found that systematic breathing exercise significantly reduced ICD duration when compared with controls. This study aimed to evaluate if pulmonary rehabilitation can reduce the duration of ICD treatment in patients with PSP.Patients and MethodsThis was a retrospective study of patients diagnosed with PSP treated with ICD. Duration of ICD treatment was recorded from patients’ medical charts. Factors associated with ICD duration were calculated using linear regression analysis.ResultsThere were 66 patients who met the study criteria, with average (SD) age and body mass index of 31.68 (13.53) years and 20.94 (2.72) kg/m2. The majority of the patients were male (72.73%), and average (SD) duration of ICD treatment was 9.90 (7.83) days. Three factors remained in the final model: body mass index, systolic blood pressure, and recurrent PSP. Two factors were independently associated with longer ICD duration: systolic blood pressure and recurrent PSP, with adjusted coefficients of 0.21 (p value 0.041) and 7.69 (p value 0.039), respectively. Pulmonary rehabilitation was not included in the final model.ConclusionPatients with a history of recurrent PSP or high systolic blood pressure at presentation may require longer ICD duration. Pulmonary rehabilitation was not associated with the duration of ICD treatment.

Pulmonary rehabilitation for COVID-19: A living systematic review protocol.

This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. This is the protocol of a living systematic review. We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

The Role of Pulmonary Rehabilitation in Pulmonary Tuberculosis and Pneumothorax on Functional Activity: a Case Report

Exertional dyspnea is among the most frequently experienced symptoms of pulmonary disease and leads to physical disability and functional impairment. Secondary pneumothorax is one of pulmonary tuberculosis (TB) complication and also life threatening. Pulmonary rehabilitation is proven effective for decreasing exertional dyspnea and improving functional activity. The goal is to improve the inspiration capacity. A 24-years-old female with pulmonary tuberculosis on OAT and left pneumothorax with shortness of breath (SOB). She came first with bedridden (METS 1), pulmonary function, exertional dyspnea with Borg Scale (9), chest expansion 1 cm, single-breath counting (SBC) test 17 s, SpO2 95%, BI 30. The pulmonary rehabilitation programs were deep breathing, chest expansion exercise and cardiorespiratory endurance training using ergocycle. After 1 week got pulmonary rehabilitation there were improvement of SOB, Borg Scale, chest expansion, SBC test, and Barthel Index. Patient came to hospital with wheelchair and standing with parallel bar (METS 1,2). The Borg Scale was improved (8), chest expansion was improve to 1,2 cm, SBC test was improved to 20 s and BI 60. After 3-week, patient were undergo 6-MWT (120 m, METS 2,76) with Borg Scale 7, chest expansion 2 cm, SBC test was 23 s, and BI 85. Pulmonary rehabilitation programs is great to improve respiratory function & functional activity, even in the condition of patients with pneumothorax that have not improved in outpatient with SOB dt. Pulmonary Tuberculosis and Pneumothorax.

The impact of home-based pulmonary rehabilitation on people with mild chronic obstructive pulmonary disease: A randomised controlled trial.

People with mild chronic obstructive pulmonary disease (COPD) experience exercise intolerance, dyspnoea and poor quality of life. However, the role of pulmonary rehabilitation (PR) in this group is unclear. This randomised controlled trial aimed to explore the effects of home-based PR in people with mild COPD. People with mild COPD (FEV1 /FVC<70%; FEV1 >80%predicted) with a smoking history of ≥10 packet years were randomised to either 8 weeks of home-based PR (one home visit and seven once-weekly telephone calls) or standard care (weekly social telephone calls). Six minute walk distance (6MWD), and Modified Medical Research Council Dyspnoea Scale (mMRC) and Chronic Respiratory Disease Questionnaire (CRQ) scores were compared. A total of 58 participants (34 males, mean age 68 (SD 9) years, FEV1 %predicted 90 (7), 6MWD 496 (105)m) were included with 31 participants randomised to home-based PR. Participants attended an average of 6.8 of the 8 scheduled sessions, ranging from 3 to 8sessions. Both groups showed improvements in exercise capacity, symptoms and health-related quality of life (HRQoL) over time, however there was no difference in 6MWD at end-intervention (mean difference -3m, 95% confidence interval (CI) -64 to 58) or 6months (7m, 95% CI -59 to 72). At 6 months home-based PR participants were more likely to have clinically important improvements in CRQ emotional function (50% of home PR vs 0% control, P<0.001) and CRQ total score (45% vs 17%, P=0.05). For people with mild COPD, home-based PR did not improve exercise capacity more than standard care. The trial was registered at the Australia New Zealand clinical trial registry (https://www.anzctr.org.au, Trial ID: ACTRN12616000965404).

Subjective and Objective Outcomes in Patients With COPD After Pulmonary Rehabilitation - The Impact of Comorbidities.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with multiple systemic manifestations and comorbidities, which contribute independently to its total morbidity and mortality. Pulmonary rehabilitation is an evidence-based intervention that is indicated for COPD patients who remain symptomatic, despite optimal pharmacological therapy. Although it is well documented in pure COPD, the role of pulmonary rehabilitation is uncertain in coexisting comorbidities. The aim of the present study was to clarify the effect of a pulmonary rehabilitation program in COPD patients with concomitant comorbidities.Methods: Thirty two patients with COPD were evaluated before and after a comprehensive pulmonary rehabilitation program, in terms of dyspnea, quality of life (QOL), pulmonary function tests and exercise capacity. The patients were also divided into two groups, according to the presence or the absence of comorbidities. Patients with none or only one comorbidity (Group 1, n = 11) were compared to those who had two or more comorbidities (Group 2, n = 21).Results: All patients significantly improved in dyspnea, as expressed by modified Medical Research Council scale and the COPD assessment Test (p < 0.001), QOL as assessed by the St. George respiratory questionnaire (p < 0.001) and exercise tolerance in six minute walking test (p < 0.001). Peak oxygen uptake relatively increased and body mass decreased in Group 1 compared to Group 2 (p < 0.05).Conclusion: Pulmonary rehabilitation in COPD seems to be beneficial for all patients, independently of the presence, the number or the nature of their comorbidities. Thus, the presence of comorbidities must not represent an exclusion criterion for patients that are referred to pulmonary rehabilitation programs.Trial Registration: Current controlled trials ISRCTN14648515 Retrospectively registered 15 February 2018.

Outpatient pulmonary rehabilitation for severe asthma with fixed airway obstruction: Comparison with COPD

Background: The benefit of exercise has been demonstrated in asthma, but the role of pulmonary rehabilitation (PR) in people with severe asthma, especially with airway obstruction, has been less investigated. The activity limitation mechanisms differ in asthma and COPD, so the effect of a PR program not specific to asthma is unclear. Methods: We retrospectively compared the effect of an ambulatory PR program in nonsmoking patients with severe asthma and airway obstruction (FEV1/FVC ratio <70% and FEV1 < 80% measured twice, not under an exacerbation) and sex-, age-, FEV1-, and BMI-matched COPD controls. Results: We included 29 patients, each with asthma and COPD. Airway obstruction was moderate (median FEV1 57% [44–64]). VO2 at peak was higher for asthma than COPD patients (19.0 [15.7–22.2] vs 16.1 [15.3–19.6] ml.min−1.kg−1, p = 0.05). After PR, asthma and COPD groups showed a significant and similar increase in constant work cycling test of 378 [114–831] s and 377 [246–702] s. Changes in Hospital Anxiety and Depression Scale (HAD) total score were similar (–2.5 [–7.0 to 0.0] vs –2.0 [–5.0 to 2.0], p > 0.05). Quality of life on the St. George’s Respiratory Questionnaire (SGRQ) was significantly improved in both groups (–14.0 [–17.7 to –2.0], p < 0.005 and –8.3 [–13.0 to –3.6], p < 0.0001). Conclusion: Outpatient PR is feasible and well tolerated in patients with severe asthma with fixed airway obstruction. A nondedicated program strongly improves HAD and SGRQ scores and constant work-rate sub-maximal cycling, with similar amplitude as with COPD.

Supplementation with Qter® and Creatine improves functional performance in COPD patients on long term oxygen therapy.

Skeletal muscle dysfunction and poor functional capacity are important extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), especially in COPD patients on long-term O2 therapy (LTOT). Beside the role of pulmonary rehabilitation, the effect of nutritional interventions is still controversial, and there are knowledge gaps on the effective role of nutraceutical supplementation on hard endpoints. The aim of this study was to investigate the effects of nutritional supplementation with Coenzyme Q10 (QTer®) - a powerful antioxidant with the potential to reduce oxidative stress and improve mitochondrial function - and Creatine on functional, nutritional, and metabolomic profile in COPD patients on long-term O2 therapy. One-hundred and eight patients with COPD from 9 Italian hospitals were enrolled in this double-blinded randomized placebo-controlled clinical study. At baseline and after 2 months of therapy, the patients underwent spirometry, 6-minute walk test (6MWT), bioelectrical impedance analysis, and activities of daily living questionnaire (ADL). Also, dyspnea scores and BODE index were calculated. At both time points, plasma concentration of CoQ10 and metabolomic profiling were measured. Ninety patients, who randomly received supplementation with QTer® and Creatine or placebo, completed the study. Compared with placebo, supplemented patients showed improvements in 6MWT (51 ± 69 versus 15 ± 91 m, p < 0.05), body cell mass and phase angle, sodium/potassium ratio, dyspnea indices and ADL score. The CoQ10 plasma concentration increased in the supplementation group whereas it did not change in the placebo group. The metabolomics profile also differed between groups. Adverse events were similar in both groups. These results show that in patients with COPD, dietary supplementation with CoQ10 and Creatine improves functional performance, body composition and perception of dyspnea. A systemic increase in some anti-inflammatory metabolites supports a pathobiological mechanism as a reason for these benefits. Further trials should help clarifying the role of QTer® and Creatine supplementation in patients with COPD.

Role of pulmonary rehabilitation in patients with pulmonary arterial hypertension

Role of pulmonary rehabilitation in patients with pulmonary arterial hypertension

Pulmonary Function Testing and Role of Pulmonary Rehabilitation in the Elderly Population with Pulmonary Diseases

With an aging population worldwide, the incidence and prevalence of certain pulmonary conditions such as chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are increasing. Pulmonary function tests (PFTs) are helpful tools to confirm pulmonary disorders. However, in the elderly population, age-associated changes in PFTs increase the risk for over diagnosis of obstructive lung disease. Therefore, an individualized approach to diagnosis of pulmonary disorders is essential for optimal management. For patients with established pulmonary disorders, pulmonary rehabilitation is a valuable but underutilized therapeutic intervention which has been shown to improve patient’s quality of life, exercise tolerance, and overall prognosis. Recent evidence confirms that benefits of pulmonary rehabilitation are similar between the elderly and younger populations.