Expert consensus on multi-disciplinary treatment, whole-course pulmonary rehabilitation management in patients with lung cancer and chronic obstructive lung disease.

Comorbidity of lung cancer and chronic obstructive pulmonary disease (COPD) is very common. Surgical operation is the initial treatment of lung cancer. But surgery operation will aggravate the symptoms of COPD, such as shortness of breath, chest tightness. On the other side, the COPD also increase the perioperative complications. Besides, the COPD may also influence the anti-cancer treatment and long-term survival of lung cancer patients. At present, there are guidelines for pulmonary rehabilitation (PR) of COPD or lung cancer respectively, but there is no reference expert consensus on the PR of patients with lung cancer who are comorbidity of COPD. Primary care has to satisfy the patient's complex needs holistically, and single-disease guidelines are unsuitable. In view of this, we organized experts from respiratory department, thoracic surgery department, oncology department, nursing department, etc., to write the expert consensus. We discussed the contents of the expert consensus through literature review, expert correspondence, expert meeting and discussion. This expert consensus contain five parts: introduction, respiratory assessment, timing of PR, PR strategies, perioperative PR management strategies in lung cancer patients with COPD. This expert consensus focuses on patients with COPD comorbid lung cancer and undergoing surgery operation, highlighting the concept of whole process management. For clinical medical staff, this expert consensus will promote the practice of PR in and out the hospital for this specific patient; for patients, this expert consensus is helpful to better understand PR and improve the enthusiasm of participating in PR in the whole process.

The effect of Tai Chi on the pulmonary rehabilitation of chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND: The effectiveness of Tai Chi for chronic obstructive pulmonary disease (COPD) so far is unclear. The present systematic review aimed to determine the influence of Tai Chi among people with COPD. METHODS: We searched six electronic databases for relevant studies in September, 2019. The methods of standard meta-analysis were used for identifying relevant studies, quality appraisal, and synthesis. The primary outcomes were six-minute walking distance (6MWD), percentage predicted forced expiratory flow volume in the first second (%PredFEV1), and St. George's Respiratory Questionnaire (SGRQ) score. RESULTS: A total of 23 studies including 1663 participants were included in the meta-analysis. The pooled data showed that the Tai Chi group was associated with a significant improvement in 6MWD [mean difference (MD) 40.83 m, 95% CI: 32.47 to 49.19], %PredFEV1 (MD 1.67%, 95% CI: 0.41 to 2.93), SGRQ score (MD -6.57, 95% CI: -10.17 to -2.98), and Chronic Respiratory Disease Questionnaire (CRQ) (MD 1.60, 95% CI: 0.89 to 2.30) relative to the blank control population. When compared with breathing exercises, the 6MWD was significantly enhanced with Tai Chi (MD 14.15 m, 95% CI: 3.76 to 24.53). Finally, when compared with breathing and walking exercises, Tai Chi was associated with a significant improvement in 6MWD (MD 7.68 m, 95% CI: 2.28 to 13.09 m) and SGRQ score (MD -6.31, 95% CI: -9.13 to -1.48). CONCLUSIONS: Tai Chi may have the potential to reduce dyspnoea, enhance exercise capacity, and improve the quality of life in COPD patients. People with COPD may obtain benefit from practicing Tai Chi.

Effects of neuromuscular electrical stimulation on exercise capacity and quality of life in COPD patients: a systematic review and meta-analysis.

Neuromuscular electrical stimulation (NMES) has been shown to produce benefits in the muscle function of chronic obstructive pulmonary disease (COPD) patients. The definite effectiveness of NMES, applied in isolation or concurrently with conventional pulmonary rehabilitation (PR) or exercise training, remains unclear. This review was to determine the effects of NMES on exercise capacity, functional performance, symptoms, and health-related quality of life (HRQoL) in COPD patients. Electronic databases (PubMed, Embase, Web of Science, the Cochrane Library) were searched for relevant randomized controlled trials (RCTs). Two investigators independently screened the eligible studies up to February 2020 that used NMES as the intervention group. The outcome measures were 6-min walking distance (6MWD), peak rate of oxygen uptake (VO2 peak), St George's Respiratory Questionnaire (SGRQ), and symptoms of dyspnoea and fatigue. Data were extracted using a predefined table and papers were appraised using Downs and Black tool. We analyzed 13 RCTs with 447 COPD patients. In the analysis of 6MWD, pooled estimates showed a significant increase in the NMES group, compared with the control group (mean difference (MD) = 27.05, 95% confidence interval (CI): 8.46-45.63, P<0.001). There were also improvements in symptoms of dyspnea or leg fatigue, and reduction in London Chest Activity of Daily Living (LCADL) scores. No statistically significant difference was observed in VO2 peak, peak power, and SGRQ. NMES could improve exercise capacity and reduce perceived sensation of dyspnea during exercise in patients with COPD, but not to be recommended as an effective alternative training modality in the rehabilitation of stable COPD patients.

Effects of Tai Chi training on the physical and mental health status in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND: Tai Chi is a systematic whole body movement developed in ancient China. It plays an increasingly important role in the field of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD). Our review aimed to explore the impact of Tai Chi on the physical and mental health of patients with COPD. METHODS: We searched several English and Chinese databases and used the combination of subject words and free words to search for available literature from the establishment of the library until August 28, 2018. Two researchers screened studies and collected the data independently. The study inclusion criteria included: (I) patients diagnosed with COPD; (II) Tai Chi or Tai Chi Qigong as an intervention in addition to routine treatment; (III) routine treatment with or without exercises as control group. The primary outcomes were lung function, exercise capacity and health status; (IV) randomized controlled trials. RESULTS: Sixteen articles were included from 2009 to 2018 (n=1,096). The average time duration of Tai Chi program was 53.4 minutes each session, 4.13 sessions a week for a total of 4.13 months. Comparing with control group, Tai Chi group improved some lung function (forced volume capacity: mean difference =0.12, 95% CI: 0.03-0.21), (forced expiratory volume in 1s: mean difference =0.15, 95% CI: 0.08-0.21), enhanced 6-minute walking distance score (mean difference =30.78, 95% CI: 15.15-46.42), decreased COPD Assessment Test score (mean difference =-5.00, 95% CI: -7.51 to -2.50), decreased St. George's Respiratory Questionnaire score (mean difference =-8.66, 95% CI: -14.60 to -2.72), enhanced Chronic Respiratory Disease Questionnaire score (mean difference =2.16, 95% CI: 1.49-2.83), decreased Hospital Anxiety and Depression Scale score(anxiety: mean difference =-1.04, 95% CI: -1.58 to -0.51; depression: mean difference =-1.25, 95% CI: -1.77 to -0.73). Comparing with exercise group, Tai Chi group statistically enhanced 6-minute walking distance score (mean difference =7.77, 95% CI: 2.63-12.91). CONCLUSIONS: Tai Chi may represent an appropriate alternative or complement to standard rehabilitation programs. However, whether Tai Chi is better than pulmonary rehabilitation exercise has not been determined.