scholarly journals Pulmonary rehabilitation and severe exacerbations of COPD: solution or white elephant?

2015 ◽  
Vol 1 (2) ◽  
pp. 00050-2015 ◽  
Author(s):  
William D-C. Man ◽  
Milo A. Puhan ◽  
Samantha L. Harrison ◽  
Rachel E. Jordan ◽  
Jennifer K. Quint ◽  
...  
Keyword(s):  
Exercise Training ◽  
Pulmonary Rehabilitation ◽  
Cochrane Review ◽  
Real Life ◽  
Chronic Obstructive ◽  
Psychological Consequences ◽  
Training And Education ◽  
Obstructive Pulmonary Disease ◽  
Intensity Of Exercise

Hospitalisations for severe exacerbations of chronic obstructive pulmonary disease are associated with significant physical and psychological consequences including an increase in symptom severity, severe reductions in physical activity, a deleterious effect on skeletal muscle, impaired exercise tolerance/ability to self-care, decline in quality of life, and increased anxiety and depression. As these consequences are potentially amenable to exercise training, there is a clear rationale for pulmonary rehabilitation in the peri/post-exacerbation setting. Although a 2011 Cochrane review was overwhelmingly positive, subsequent trials have shown less benefit and real-life observational studies have revealed poor acceptability. Qualitative studies have demonstrated that the patient experience is a determining factor while the presence of comorbidities may influence referral, adherence and response to pulmonary rehabilitation. Systematic reviews of less supervised interventions, such as self-management, have shown limited benefits in the post-exacerbation setting. The recent update of the Cochrane review of peri-exacerbation pulmonary rehabilitation showed that benefits were associated with the “comprehensive” nature of the intervention (the number of sessions received, the intensity of exercise training and education delivered, and the degree of supervision) but implementation is demanding. The challenge is to develop interventions that are deliverable and acceptable around the time of an acute exacerbation but also deliver the desired clinical impact.

scholarly journals Exercise Training and Pulmonary Rehabilitation in COPD

2021 ◽  
Author(s):  
Amira Permatasari Tarigan ◽  
Fannie Rizki Ananda
Keyword(s):  
Quality Of Life ◽  
Exercise Training ◽  
Pulmonary Rehabilitation ◽  
Normal Population ◽  
Training Session ◽  
Good Alternative ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
And Function

Systemic inflammation and deconditioning syndrome lead to loss of structural and function of body muscle, particularly in extremity muscle. Longer period of inactivity due to dyspnea worsen the destruction of muscle. Regular and gradually increase exercise training as part of pulmonary rehabilitation (PR) can improve the function of essential muscles in doing daily life so stable Chronic Obstructive Pulmonary Disease (COPD) patient can maintenance their daily activities with minimal limitations. Pulmonary rehabilitation consists of exercise training, nutritional support, smoking cessation, and self-management of COPD. The prescription of exercise training is mandatory. Assessment of clinical condition to adjust the type of training, duration, frequency, and intensity of training must be completed before beginning the training session. Regular and gradually increased training gives significant impact in improving lung function, dyspnea scale, and quality of life in patient with stable COPD. However, in this covid era, the restriction of hospital attending PR was significantly affect PR program. As immunocompromised population, COPD patient have higher risk for COVID19 infection and develops more severe complications compare with normal population. So, the modified supervised and unsupervised training was needed to revise the classic type of PR. Tele-rehabilitation with teleconference, phone calls, and interactive web based PR can be the good alternative in decreasing hospital admission and improving quality of life in patient with COPD.

scholarly journals Evaluation of the intervention of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 8 (2) ◽  
pp. 99-112
Author(s):  
Ye Zhang ◽  
Na-Ping Xu ◽  
Bei-Rong Mo ◽  
Xian-Liang Liu ◽  
Ya-Chang Lin
Keyword(s):  
Exercise Training ◽  
Low Cost ◽  
Real Life ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Low Intensity ◽  
Home Based ◽  
Limb Exercise

Abstract Objective Chronic obstructive pulmonary disease (COPD) can be prevented and treated, although presenting with persistent airflow restriction; the airflow restriction caused by COPD is mostly progressive. In recent years, more attention has been paid to the home-based pulmonary rehabilitation (PR) and its influence on COPD. Exercise training is the basic constituent of PR. However, it is not clear which exercise trainings are the ideal ways to deliver home-based PR. Methods In this review, we focus on the effect of home-based exercise training on patients with COPD. We searched literature, which was necessarily required to be randomized controlled trails (RCTs) from the establishment of the four respective databases (Medline, PubMed, Web of Science, and China National Knowledge Infrastructure) from January 2008 to January 2018. We used the Cochrane collaborative “risk of bias” tool to assess the quality of evidence. A total of 21 trials (1694 participants) were included. Through the analysis of the literature, we find that a simple, low-cost, and low-intensity family-based lung-rehabilitation plan to adapt to the real life may lead to the improvement of the ability to exercise, the reduction of the difficulty in breathing, and the improvement of carrying out daily activities. Results In the exercise training of home-based PR, lower limb exercise (LLE) training demonstrated a more perceptible effect in improving the quality of life of patients with COPD. At the same time, the combination of LLE training, breathing training, and upper limb exercise training is more obvious than the simple LLE training. In addition, home-based low-intensity aerobic training may sometimes be no less than the outpatient or center intervention to improve dyspnea, health status, and exercise tolerance. In conclusion, the simple and easy home-based PR exercise program is useful. Long-term home-based PR may require an enhanced need for maintenance. Conclusions A simple, low-cost, and low-intensity high blood pressure response (HBPR) plan to adapt to the real life may lead to an augmentation in the ability to exercise, a reduction of the difficulty in breathing, and an improvement in carrying out day-to-day activities. HBPR strategies can benefit patients (elderly patients with COPD at home) in the long term.

scholarly journals Safety and efficacy of inpatient pulmonary rehabilitation for patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e043377
Author(s):  
Kai Zhu ◽  
Jagdeep Gill ◽  
Ashley Kirkham ◽  
Joel Chen ◽  
Amy Ellis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Pulmonary Rehabilitation ◽  
Meta Analysis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Safety And Efficacy

IntroductionPulmonary rehabilitation (PR) following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) reduces the risk of hospital admissions, and improves physical function and health-related quality of life. However, the safety and efficacy of in-hospital PR during the most acute phase of an AECOPD is not well established. This paper describes the protocol for a systematic review with meta-analysis to determine the safety and efficacy of inpatient acute care PR during the hospitalisation phase.Methods and analysisMedical literature databases and registries MEDLINE, EMBASE, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, Canadian Agency for Drugs and Technologies in Health, CENTRAL, Allied and Complementary Medicine Database, WHO trials portal and ClinicalTrials.gov will be searched for articles from inception to June 2021 using a prespecified search strategy. We will identify randomised controlled trials that have a comparison of in-hospital PR with usual care. PR programmes had to commence during the hospitalisation and include a minimum of two sessions. Title and abstract followed by full-text screening will be conducted independently by two reviewers. A meta-analysis will be performed if there is sufficient homogeneity across selected studies or groups of studies. The Population, Intervention, Comparator, Outcomes and Study characteristics framework will be used to standardise the data collection process. The quality of the cumulative evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework.Ethics and disseminationAECOPD results in physical limitations which are amenable to PR. This review will assess the safety and efficacy of in-hospital PR for AECOPD. The results will be presented in a peer-reviewed publication and at research conferences. Ethical review is not required for this study.

Pulmonary rehabilitation

2003 ◽  
Vol 13 (3) ◽  
pp. 175-182 ◽  
Author(s):  
Dipankar Dutta ◽  
Richard JA Butland ◽  
Ruma R Dutta ◽  
Miriam C Casey
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Exercise Programme ◽  
Chronic Respiratory Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Multidisciplinary Education ◽  
Programme Of Care

Pulmonary rehabilitation is a multidisciplinary education and exercise programme of care for patients with chronic respiratory disease, particularly Chronic Obstructive Pulmonary Disease (COPD). It aims to reduce symptoms, decrease disability, increase participation in physical and social activities and improve overall quality of life in patients who may still be very disabled despite optimal pharmacological treatment. Pulmonary rehabilitation first began more than 30 years ago and is now established as an important part of the management of COPD.

scholarly journals Women's COPD

2022 ◽  
Vol 8 ◽  
Author(s):  
Maéva Zysman ◽  
Chantal Raherison-Semjen
Keyword(s):  
Disease Management ◽  
Pulmonary Rehabilitation ◽  
Clinical Presentation ◽  
Chronic Obstructive ◽  
Specific Population ◽  
Obstructive Pulmonary Disease ◽  
Medical Consultations ◽  
The Usa

Chronic obstructive pulmonary disease (COPD) is no longer a respiratory disease that predominantly affects men, to the point where the prevalence among women has equaled that of men since 2008, partly due to their increasing exposure to tobacco and to biomass fuels. Indeed, COPD has become the leading cause of death in women in the USA. A higher susceptibility of female to smoking and pollutants could explain this phenomenon. Besides, the clinical presentation appears different among women with more frequent breathlessness, anxiety or depression, lung cancer (especially adenocarcinoma), undernutrition and osteoporosis. Quality of life is also more significantly impaired in women. The theories advanced to explain these differences involve the role of estrogens, smaller bronchi, impaired gas exchange in the lungs and smoking habits. Usual medications (bronchodilators, ICS) demonstrated similar trends for exacerbation prevention and lung function improvement in men and women. There is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate global improvements in disease management (smoking cessation, pulmonary rehabilitation…) in half of the population. Nevertheless, important limitations to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. In conclusion there is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate globally improvements in disease management in this specific population.

scholarly journals Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

2019 ◽  
Vol 8 (9) ◽  
pp. 1460 ◽  
Author(s):  
Thomas Janssens ◽  
Zora Van de Moortel ◽  
Wolfgang Geidl ◽  
Johannes Carl ◽  
Klaus Pfeifer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Smoking Status ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Target Disease ◽  
Disease Specific

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.

scholarly journals Pulmonary rehabilitation in bronchiectasis: a propensity-matched study

2018 ◽  
Vol 53 (1) ◽  
pp. 1801264 ◽  
Author(s):  
Suhani Patel ◽  
Aaron D. Cole ◽  
Claire M. Nolan ◽  
Ruth E. Barker ◽  
Sarah E. Jones ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Real Life ◽  
Chronic Respiratory Disease ◽  
Control Group ◽  
Chronic Obstructive ◽  
Completion Rates ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Disease Questionnaire ◽  
Real Life Data ◽  
Matched Study

International guidelines recommend pulmonary rehabilitation for patients with bronchiectasis, supported by small trials and data extrapolated from chronic obstructive pulmonary disease (COPD). However, it is unknown whether real-life data on completion rates and response to pulmonary rehabilitation are similar between patients with bronchiectasis and COPD.Using propensity score matching, 213 consecutive patients with bronchiectasis referred for a supervised pulmonary rehabilitation programme were matched 1:1 with a control group of 213 patients with COPD. Completion rates, change in incremental shuttle walk (ISW) distance and change in Chronic Respiratory Disease Questionnaire (CRQ) score with pulmonary rehabilitation were compared between groups.Completion rate was the same in both groups (74%). Improvements in ISW distance and most domains of the CRQ with pulmonary rehabilitation were similar between the bronchiectasis and COPD groups (ISW distance: 70 versus 63 m; CRQ-Dyspnoea: 4.8 versus 5.3; CRQ-Emotional Function: 3.5 versus 4.6; CRQ-Mastery: 2.3 versus 2.9; all p>0.20). However, improvements in CRQ-Fatigue with pulmonary rehabilitation were greater in the COPD group (bronchiectasis 2.1 versus COPD 3.3; p=0.02).In a real-life, propensity-matched control study, patients with bronchiectasis show similar completion rates and improvements in exercise and health status outcomes as patients with COPD. This supports the routine clinical provision of pulmonary rehabilitation to patients with bronchiectasis.

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