scholarly journals Response to Long Term Exercise Training in COPD

2021 ◽  
Vol 10 (11) ◽  
pp. 849-851
Author(s):  
Renukadevi Mahadevan ◽  
Chaya Sindaghatta ◽  
Vijay Samuel Raj Victor
Keyword(s):  
Exercise Training ◽  
Perceived Exertion ◽  
Exercise Intervention ◽  
Exercise Program ◽  
Home Exercise ◽  
Chronic Obstructive ◽  
Peripheral Oxygen Saturation ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

The patient is a 64-year-old male. He presented with difficulty in breathing and was diagnosed with COPD (chronic obstructive pulmonary disease) ten years back. He is a farmer and an active smoker, of 18 packs / year for 35 years. He began to experience dyspnoea when performing moderate exertion, dyspnoea grading of 3 as denoted by modified medical research council mMRC (Modified Medical Research Council) and productive cough with sputum, usually in the morning. He is on long-term oxygen therapy of 4 litres of oxygen for 16 hours per day for 2 years. He has a history of hospitalisation six times and 5 - 6 emergency consultations for acute exacerbation in the last 3 years. The patient was on regular treatment with long-acting inhaled beta-2 agonist (LABA) inhaler and long-acting anticholinergics or long-acting muscarinic receptor antagonists (LAMA) and corticosteroid (ICS) inhalers 200-400 micrograms (μg) three times a day and mometasone 400 μg, continuously. The patient’s body mass index (BMI) was 20.3 Kg / m2. His blood pressure was 140 / 80 mmHg, heart rate (HR) 74 bpm, respiratory rate (RR) 22 rpm and peripheral oxygen saturation (SpO2) at rest was 95 %. Pulmonary auscultation revealed a diffusely reduced breath sounds, and no alterations were found in cardiac auscultation. The patient’s post-bronchodilator pulmonary function test was 52.2 % of forced expiratory volume in 1 second (FEV1). In the six-minute walk test(6mwt), the patient walked a total distance of 294.4 meters, with variations in heart rate from 74bpm to 128bpm. Whenever peripheral oxygen saturation was reduced to 88 %, the patient had taken rest. The patient took rest two times, at the end of the second minute thirtyfive seconds and the end of the fourth minute forty-five seconds. The body-mass index, airflow obstruction, dyspnoea and exercise (BODE) mortality index were used to measure 4 years survival interpretation.1 Saint George’s Respiratory Questionnaire chronic obstructive pulmonary disease (COPD) version (SGRQ-C) was used to measure the quality of life (QoL). After the initial assessment, the patient was enrolled in the pulmonary rehabilitation program. The first three months were supervised, exercise training constituted weekly educational sessions and meeting with the psychology support group and nutrition advice before beginning the exercise intervention. 2 The patient visited the institution three days per week for exercise training. The exercise constituted aerobic on the treadmill and intensity, in the beginning, was 80 % of the 6MWT speed, and Borg’s scale of perceived exertion was 4 as prescribed by American Thoracic Society (ATS). 3 The components of the program were warm-up sessions, conditioning, resistance exercise and a cool-down session. The patient was also advised home exercise program, which included resistance training using weighted sandbags for three sessions per week. The resistance added was based on 1 repetition maximum (RM) and 10RM. 80 % of 10 RM was the training intensity for resistance training for a larger group of muscles. 4 The weight was added gradually and ensured their rated perceived exertion (RPE) was at 4 during exercise. The patient’s outcomes were recorded after three months of training. After 12 weeks of supervised outpatient exercise intervention, the patient was advised home exercise program for the next 6 months. 5

scholarly journals Reported dyspnea and fatigue using different scales during the physical effort in COPD

2017 ◽  
Vol 30 (2) ◽  
pp. 207-217 ◽  
Author(s):  
Alaís Camargo Corcioli ◽  
Bruna Varanda Pessoa-Santos ◽  
Glaucia Nency Takara ◽  
Valéria Amorim Pires Di Lorenzo ◽  
Mauricio Jamami
Keyword(s):  
Perceived Exertion ◽  
Random Order ◽  
Chronic Obstructive ◽  
Test Results ◽  
Peripheral Oxygen Saturation ◽  
Physical Effort ◽  
Obstructive Pulmonary Disease ◽  
Therapy Choice ◽  
Patient Reported ◽  
Positive Correlations

Abstract Introduction: Therapy choice and its progression for patients with Chronic Obstructive Pulmonary Disease (COPD) should be based on their symptoms and clinical condition according to reports of dyspnea and fatigue. Therefore patient-reported scales have presented a key role during the communication with the patient. Objective: To verify if patients with COPD prefer the Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Glasses Scale (GS), Faces Scale (FS) or Ratings of Perceived Exertion (RPE) during the six-minute walk test(6MWT), and to compare and correlate the scales with each other, with peripheral oxygen saturation (SpO2) and heart rate (HR). Methods: 28 patients with COPD (50% had mild to moderate COPD and 50% had severe to very severe) were evaluated by a respiratory and cognitive assessment. Additionally, they performed the 6MWT, in which the scales were applied simultaneously (random order) and patients reported their preference in the end of the test. Results: 57% of patients were illiterate or presented incomplete primary education and most of them (67%) chose the FS or GS. Significant positive correlations were observed between instruments for both dyspnea and fatigue in the end of the 6MWT, which the strongest was between MBS and FS (r = 0.95). Nevertheless, there was no correlation between the scales and SpO2 and HR. Conclusion: As the majority of patients preferred pictured to numerical scales we suggest their use as a resource for therapeutic evaluation; MBS might be replace by FS, even though they have different scores and not scaled proportionally. However, this change must be carefully considered because there is the risk of dubious interpretation.

scholarly journals Prognostic and Functional Impact of Perioperative LAＭA/LABA Inhaled Therapy In Patients With Lung Cancer and Chronic Obstructive Pulmonary Disease 

2021 ◽  
Author(s):  
Yoko Azuma ◽  
Atsushi Sano ◽  
Takashi Sakai ◽  
Satoshi Koezuka ◽  
Hajime Otsuka ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Postoperative Complications ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Background: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. The utility of several perioperative bronchodilators in patients with COPD requiring surgery for lung cancer has been reported, but the most suitable agent and its specific effect on postoperative long-term prognosis remain unclear. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.Methods: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical records. Patients were divided into 3 groups according to perioperative management: LAMA/LABA (n=64), LAMA (n=23) and rehabilitation only (no bronchodilator) (n=43). Results: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p<0.001 for both forced expiratory volume in 1 second (FEV1) and percentage of predicted forced expiratory volume in 1 second (FEV1 %pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, 223.1 mL vs 130.0 mL, ΔFEV1 %pred, 10.8% vs 6.8%; both p<0.05). There was a trend toward a lower incidence of postoperative complications in the LAMA/LABA group compared with the LAMA and rehabilitation-only groups. In patients with moderate to severe air flow limitation (n=61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with patients in the other groups. Perioperative LAMA/LABA therapy was also associated with lower recurrence rates. Conclusions: Patients who receive perioperative LAMA/LABA for moderate to severe COPD have improved prognosis and better pulmonary function with surgery for lung cancer. We believe this treatment combination is optimal for patients with lung cancer and COPD.

scholarly journals Beta-blockers in COPD: time for reappraisal

2016 ◽  
Vol 48 (3) ◽  
pp. 880-888 ◽  
Author(s):  
Brian Lipworth ◽  
Jadwiga Wedzicha ◽  
Graham Devereux ◽  
Jørgen Vestbo ◽  
Mark T. Dransfield
Keyword(s):  
Systolic Function ◽  
Beta Blockers ◽  
Potential Interaction ◽  
Dose Titration ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Safety Studies ◽  
Long Acting ◽  
Randomised Controlled

The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.

scholarly journals Pro/Con: A unified conclusion-Inhaled corticosteroids for chronic obstructive pulmonary disease

2019 ◽  
Vol 2 (1) ◽  
pp. 46-47
Author(s):  
Margaret F. Ragland ◽  
Donald A. Mahler ◽  
Barry J. Make
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Con A ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
The Right

ICS are like any other drug: they have benefits and they have risks.6,7 In the right patient, often the patient with frequent exacerbations and severe uncontrolled symptoms, an inhaler regimen, including dual long-acting bronchodilators and an ICS may be the right choice. For the patient with infrequent exacerbations, low symptom burden, and recent pneumonia that caused hospitalization, an inhaler regimen that contains an ICS may bring more risk than benefit. In addition, analysis of recent data, including the WISDOM8 trial, has provided evidence that ICS may be most beneficial in the immediate postexacerbation period. Further, ICS may be safely discontinued in patients with few exacerbations and stable symptoms.9 As with any long-term medication, a nuanced risk-benefit calculation by the prescribing physician and informed discussion with the patient are ultimately the best ways to balance the use of ICS that have benefits in some patients and risks in others.

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