Current status and trends of pulmonary rehabilitation in South Korea: National level data analysis using Health Insurance Review and Assessment Service (HIRA) database from 2016 to 2018.

In South Korea, there are few studies to understand the current status of pulmonary rehabilitation in clinical practice and develop it. This study aimed to assess the current status and annual changes in the number and pattern of prescriptions for pulmonary rehabilitation before and after its insurance coverage. The trends of pulmonary rehabilitation before and after its insurance coverage commencement were evaluated using the data of 24,380 patients during the 3-year period from 2016 to 2018 that were archived by the National Health Information Database of the Health Insurance Review and Assessment Service in South Korea. The annual total number of patients who received pulmonary rehabilitation was stratified by the type of prescription, sex, age, type of insurance, medical institution, and region. In addition, the frequencies of pulmonary rehabilitation for various diagnoses were investigated using the major codes of the Korean Standard Classification of Disease. The patients who received pulmonary rehabilitation increased by approximately 2 times from 5936 in 2016 (before insurance coverage) to 10,474 in 2019. Before 2017, most patients underwent simple pulmonary rehabilitation coded as MM290. However, since the insurance coverage of rehabilitation exercise for pulmonary disease (MM440), the proportions of patients receiving them increased. Men underwent pulmonary rehabilitation more often than women, and >70% of the patients were aged >60 years. Most patients received pulmonary rehabilitation at tertiary hospitals in Seoul. In 2016, pulmonary rehabilitation was prescribed more frequently for cerebral infarction; after 2017, it was prescribed more frequently for lung cancer. This study summarized the current status and trends of pulmonary rehabilitation in South Korea before and after National Health Insurance Service coverage, which commenced on January 1, 2017. A significant increase in the number of pulmonary rehabilitations was confirmed after the insurance coverage.

Effects of inspiratory muscle training on resting breathing pattern in patients with advanced lung disease.

AIM: The aim of this study was to evaluate the effects of interval high intensity inspiratory muscle training (IMT) on resting breathing pattern in patients with advanced lung disease. METHODS: IMT was performed daily and training load set at 50 % of the maximal inspiratory pressure. Participants were evaluated at pre-IMT, post 8 weeks of IMT and follow-up (3 months after the end of IMT). Breathing pattern (volume and time variables as well as percentages of contribution to tidal volume) was evaluated by Optoelectronic Plethysmography at rest. Friedman test was used to verify the differences between the three time-points (p < 0.05). RESULTS: Nineteen patients (54 ± 16 years old; 5 males) were evaluated at pre-IMT and post-IMT and fourteen were assessed at follow-up. There was no significant difference (p > 0.05) in any comparison for all evaluated breathing pattern variables at the three time-points. CONCLUSION: Resting breathing pattern was not significantly changed after 8 weeks of IMT in patients with advanced lung disease.

Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings.

Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.

Transition to Home-Based Treatment Plans for Center-Based Cardiac, Pulmonary, and Vascular Rehabilitation during COVID-19.

BACKGROUND: Traditional rehabilitation services, whether they are cardiac, pulmonary, or vascular, consist of 6-36 center-based, supervised sessions; however, due to COVID-19, in-person visits were suspended. This study sought to implement a transitional home-based treatment plan (HBTP) to patients. METHOD: Patients enrolled in a rehabilitation service at the Miriam Hospital during the time of temporary closure were provided with a HBTP that was individualized to their needs and multi-disciplinary in nature. Patients were called weekly for continual guidance and support. RESULTS: Of the 129 patients that received a HBTP, 115 (89%) participated in follow-up correspondence (63±12 years, 83% white, 66% male, 81% enrolled in cardiac rehab). Nearly 70% of patients continued to participate in regular exercise and upon re-opening, 69 (60%) of patients returned to center-based care. Psychosocial factors appeared to inhibit treatment adherence. CONCLUSIONS: Patients are receptive to an HBTP and subsequent follow-up throughout temporary closure of rehabilitation services.

The influence of speleotherapy combined with pulmonary rehabilitation on functional fitness in older adults - preliminary report.

OBJECTIVE: Our aim was to determine the influence of pulmonary rehabilitation conducted in therapeutic salt mine chambers on the functional fitness of older adults. METHODS: The study included 22 individuals of age >65 years with chronic respiratory conditions. The patients underwent the Fullerton test before and after a 3-week outpatient pulmonary rehabilitation in the "Wieliczka" Salt Mine Health Resort. RESULTS: After the rehabilitation stay, the results showed statistically significant improvements within five of the six parameters evaluated. In the Arm Curl, the mean number of repetitions within 30 s increased from 14.55 ± 3.63 to 16.68 ± 3.83 and in the Chair Stand from 11.86 ± 2.55 to 14.41 ± 2.95. Beneficial changes were observed in the Back Scratch, but without statistical significance. In Sit and Reach results increased from -2.3 ± 11.11cm to 2.14 ± 9.19 cm. Time for performing the 8-Foot Up and Go decreased from 6.63 ± 1.27 s to 5.8 ± 0.86 s and in 2-Minute Step results increased from 88.27 ± 20.64 to 96.55 ± 16.38 repetitions. CONCLUSION: Functional fitness of examined older adults with pulmonary disorders has increased after a rehabilitation and treatment stay in underground salt mine chambers. The reviews of this paper are available via the supplemental material section.

[Pulmonary rehabilitation in the in-hospital and outpatient phases]. / Rehabilitación pulmonar en fase hospitalaria y ambulatoria.

Pulmonary rehabilitation programmes aim to improve aerobic capacity and enhance quality of life in patients with chronic pulmonary disease, facilitating their participation and integration in different areas and activities of daily living, through the prescription and performance of physical exercise, as well as education on risk factors and healthy living. In multidisciplinary processes, various health professionals work together to support patients through the rehabilitation process, guiding lifestyle changes to improve their level of physical activity, nutritional factors, smoking cessation, diabetes management, medication adherence and weight loss, based on theories of behavioural change. The main objective of pulmonary rehabilitation programmes is to empower users in self-care and facilitate long-term management of chronic lung disease.

Pediatric pulmonary rehabilitation program at a Chilean public hospital. / Programa de rehabilitación respiratoria infantil en un hospital público de Chile.

INTRODUCTION: Pediatric pulmonary rehabilitation is relevant in the management of chronic respiratory diseases. In Chile, it is provided only at certain hospitals. Objective. To describe the outcomes of a pediatric pulmonary rehabilitation program after 3 months of rehabilitation. METHODOLOGY: Retrospective study of patients with chronic lung disease, neuromuscular disease, and other chronic conditions admitted to the program between June 2011 and June 2017. Assessments included general physical and respiratory muscle examination, and spirometry. General physical training and respiratory muscle training were planned according to facilitybased, mixed and home protocols. RESULTS: A total of 156 patients (11.45 ± 3.55 years old) were included, 68 had chronic lung disease (11.56 ± 4.6 years old, 43.5 %); 45, neuromuscular disease (11.4 ± 3.7 years old, 28.8 %); and 43, various chronic conditions (11.31 ± 3.9 years old). Out of all patients, 102 (65.4 %) followed training protocols; targeted (n = 27), mixed (n = 23), and home (n = 50); compliance was 69 %, 87.5 %, and 70 %, respectively. Peak inspiratory pressure increased by 19.3 % (p = 0.001); peak expiratory pressure, 14.5 % (p = 0.001); forced vital capacity, 12.9 % (p = 0.001); forced expiratory volume in 1 second, 11.6 % (p = 0.004); and the six-minute walk test, 17.6 meters (p = 0.036) after 3 months of rehabilitation. CONCLUSIONS: The intervention protocol improved cardiorespiratory functional capacity. Compliance was over 65 %.

Introducción. La rehabilitación respiratoria infantil es relevante en el manejo de enfermedades respiratorias crónicas. En Chile, se desarrolla solo en algunos hospitales. Objetivo. Describir los resultados de un programa de rehabilitación respiratoria infantil tras 3 meses de rehabilitación. Metodología. Estudio retrospectivo de los pacientes con enfermedad pulmonar crónica, enfermedad neuromuscular y otras patologías crónicas admitidos desde junio de 2011 a junio de 2017. Se realizó evaluación física general, evaluación de musculatura respiratoria y espirometría. Se planificó entrenamiento físico general y entrenamiento muscular respiratorio, con protocolos institucional, mixto y domiciliario. Resultados. Ingresaron al programa 156 pacientes (11,45 ± 3,55 años), 68 con enfermedad pulmonar crónica (11,56 ± 4,6 años, el 43,5 %), 45 con enfermedad neuromuscular (11,4 ± 3,7 años, el 28,8 %) y 43 con patologías crónicas diversas (11,31 ± 3,9 años). Del total, se entrenaron 102 (el 65,4 %); dirigido (n = 27), mixto (n = 23) y domiciliario (n = 50) con adherencia del 69 %, del 87,5 % y del 70 %, respectivamente. Aumentó el 19,3 % la presión inspiratoria máxima (p = 0,001), el 14,5 % la presión espiratoria máxima (p = 0,001), el 12,9 % la capacidad vital forzada (p = 0,001), el 11,6 % el volumen espiratorio forzado al primer segundo (p = 0,004) y 17,6 metros en el test de marcha de 6 minutos (p = 0,036) tras 3 meses de rehabilitación. Conclusiones. El protocolo de intervención incrementó el estatus funcional cardiorrespiratorio. La adherencia fue superior al 65 %.

The meaning of the name of 'pulmonary rehabilitation' and its influence on engagement with individuals with chronic lung disease.

Pulmonary rehabilitation (PR) is recommended for all individuals living with a lung condition and chronic breathlessness. This article considers how adopting an interdisciplinary, medical humanities approach to the term 'pulmonary rehabilitation' might unpack some of the misconceptions, misrepresentations or negative connotations surrounding it, which have been largely overlooked in explanations of the low uptake of this programme. Taking key insights from Wellcome Trust-funded Life of Breath project, including ethnographic research in community fitness groups in North East England and the 'Breath Lab' special interest group, this article outlines how the whole-body approach of PR is not easily understood by those with lung conditions; how experience can inform breath perception through the pacing of everyday life; and how stigma can impact rehabilitation. This article highlights the value of medical humanities in working through communicative challenges evident in the translation of PR between patient and clinical contexts and sets out two arts-based approaches (Singing for Lung Health and dance movement) as potential options that could be included in the PR referral. Finally, the article outlines the need for collaborative research exploring the communication and meaning of healthcare strategies and experiences at the interface of the arts, humanities and medical practice.

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial.

OBJECTIVE: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. DESIGN: Prospective randomized controlled trial. SETTING: Pulmonary Rehabilitation center. SUBJECTS: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. METHODS: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. RESULTS: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups ( P = 0.075). There was no change in spirometric variables in both groups. CONCLUSION: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

[The role of the respiratory and relaxation training in the treatment of the patients after the surgical treatment of non-specific pulmonary diseases].

The present study included 62 patients who had undergone the surgical intervention for the treatment of non-specific pulmonary diseases. All the patients were subjected to the psychological and spirometric examination. The study has demonstrated the relationship between the characteristics of the external respiration function on the one hand and the ability to handle stress, the levels of anxiety, tension, emotional instability and hypochondriacal mood on the other hand. It was shown that the respiratory and relaxation training improves the effectiveness of the treatment of the patients presenting with such symptoms due to the correction of their psychological status and optimization of the external respiration function. The highest effectiveness of the respiratory and relaxation training was documented in the patients suffering moderate neurotic disorders.

Acute hemodynamic and electrocardiographic responses to a session of inspiratory muscle training in cardiopulmonary rehabilitation.

BACKGROUND: Inspiratory muscle training (IMT) has been shown to generate significant benefits in different clinical conditions; however, there is scarce information regarding acute clinical and hemodynamic effects. AIM: The aim of this study was to evaluate clinical, hemodynamic and electrocardiographic responses during a single short IMT session in patients enrolled in cardiopulmonary rehabilitation program (CRP). DESIGN: Cross-sectional study. SETTING: Patients referred and regularly attending a non-hospital based medically-supervised exercise program. POPULATION: One hundred and sixty patients patients who regularly performed inspiratory muscle training METHODS: A convenience sample of 21 elderly patients (16 men; 60-87 years of age) had an ECG continuously recorded and heart rate (HR) and blood pressure (BP) measured before, during and one-minute after a single IMT session - two sets of 15 cycles with one-minute interval. RESULTS: Comparing values obtained before, during second set and one-minute after IMT, no differences were found to HR (bpm) - 68±2 vs. 70±2 vs. 66±3 (P=0.05) and in systolic and diastolic BP (mm Hg) values, respectively, - 105±3 vs. 111±4 vs. 108±3 (P=0.06) and - 68±2 vs. 72±3 vs. 68±2 (P=0.14); (before, during second set and one-minute after TMI). During IMT, seven (33%) of patients presented minor cardiac arrhythmias, most of them isolated premature ventricular contractions. Additionally, no abnormal signs or symptoms were found. CONCLUSION: Apart of minor and clinically irrelevant ECG abnormalities seen in 1/3 of the patients, a short IMT session did not induce significant hemodynamic responses or relevant clinical abnormalities. Based on these results, for elderly patients involved in CPR, IMT seems to be clinically safe and continuous ECG monitoring did not seem to add significant or relevant information. CLINICAL REHABILITATION IMPACT: For elderly patients participating in CPR, short IMT sessions do not induce major hemodynamic responses and seem to be clinically safe. This is potentially useful information if IMT is to be prescribed in home-based programs.

Psychological intervention - a critical element of rehabilitation in chronic pulmonary diseases.

Chronic pulmonary diseases represent a segment of pathology with an increasing prevalence worldwide, this requiring joint efforts from specialists in this field to (a) identify those factors insufficiently explored so far, but critical for their evolution and (b) address them via new therapies. This study aims to explore the existing data regarding the psychological factors involved in the dynamics of chronic pulmonary diseases and the main possibilities of psychological intervention, as a distinct part of pulmonary rehabilitation (PR). 49 articles published on this topic in peer-reviewed journals between 1979 and 2010, indexed in PubMed, ProQuest and EBSCO databases, were examined for evidence. Among psychological factors considered important by study authors were the following: 1) the deficient instruction of the patient, 2) decreased treatment motivation, 3) a marginal social role, 4) a disadaptive cognitive style and 5) psychiatric comorbidity (especially anxiety and depression). Efficient interventions were, for physicians, 1) patient education and 2) designing a personalized self-management plan, and for the clinical psychologists, 1) cognitive-behavioral therapy, 2) biofeedback, 3) family therapy, 4) relaxation and 5) hypnosis. Despite the undeniable effect of these methods in selected cases, the high heterogeneity of designs and personal affiliations of researchers do not allow new generalizations about their efficacy or their routine implementation into PR. Further research including larger samples, more uniform designs, construction of consensual international standards regarding the objectives of PR, and assessments done by experts from multiple study domains could contribute to a better understanding of the role psychological interventions could play in PR.

Effect of active pulmonary rehabilitation on pulmonary function in patients with brain lesion.

BACKGROUND: The patients with brain lesion have a high risk of pulmonary complication due to restrictive pulmonary impairment. OBJECTIVE: To investigate the effectiveness of active pulmonary rehabilitation on pulmonary functional improvement in these patients. METHODS: Twnety-two patients of hemiplegia or quadriplegia with brain lesion were recruited who had restrictive pulmonary impairment. The patients were randomly assigned to an experimental group that receive active pulmonary rehabilitation training and a control group without it. The active pulmonary rehabilitation training is composed of air-stacking exercise by ambu-bagging and functional electrical stimulation (FES) on phrenic nerve and abdominal muscle. We examined respiration function test of all patients composed of peak cough flow (PCF), pulmonary function test (PFT), diaphragmatic motion evaluation and oxygen saturation (SaO2) at the beginning and 4 weeks after treatment. RESULTS: There was no significant difference in pulmonary function between experimental group and control group at the beginning. After 4 weeks treatment, FVC and FEV1 of PFT, PCF, diaphragmatic motion, SaO2 have significantly improved (p < 0.05) in experimental group, but no significant changes were detected in control group. CONCLUSIONS: It is suggested that active pulmonary rehabilitation with air-stacking exercise and FES would be useful to improve pulmonary function in patients with brain lesion.

Pulmonary rehabilitation. Sociedad Española de Neumología y Cirugía Torácica (SEPAR).

Pulmonary rehabilitation (PR) has been shown to improve dyspnea, exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). PR has also shown benefits in diseases other than COPD but the level of evidence is lower. The fundamental components of PR programs are muscle training, education and chest physiotherapy. Occupational therapy, psychosocial support and nutritional intervention should also be considered. Home programs have been shown to be as effective as hospital therapy. The duration of rehabilitation programs should not be less than 8 weeks or 20 sessions. Early initiation of PR, even during exacerbations, has proven safe and effective. The use of oxygen or noninvasive ventilation during training is controversial and dependent on the patient's situation. At present, the best strategy for maintaining the benefits of PR in the long term is unknown. Longer PR programs or telemedicine could play a key role in extending the results obtained.

[The role of enteral oxygen-therapy in the correction of functional disturbances in the autonomic nervous system of the children presenting with chronic diseases of the respiratory organs].

BACKGROUND: Vegetative dysfunction is observed in 60-90% of the children presenting with chronic respiratory diseases. Its timely identification and correction increases the effectiveness of the combined rehabilitative treatment of such patients. MATERIAL AND METHODS: The vegetative regulation was dynamically evaluated by the analysis of the heart rate variability in 95 patients presenting with bronchial asthma and chronic nonspecific lung diseases. The age of the patients varied from 7 to 16 years. Sixty children received the combined treatment including enteral oxygen therapy, the control group was comprised of 35 patients. RESULTS: The enteral oxygen therapy eliminated the vegetative disbalance in 80.0% of the children with bronchial asthma and in 88,0% of those suffering from chronic nonspecific lung diseases. The results of the spectral analysis of heart rate variability indicate that the total spectrum power (TSP) was significantly increased in the patients of the study group. This effect was accompanied by the restructuring of wave frequency ranges pointing out to the enhancement of the activity of the sympathetic-adrenal system. The integral index of adaptive reserves (AR) increased from 2.0±0,6 to 4.7±0,6 points (p<0.001) under the influence of enteral oxygen therapy; this parameter remained practically unaltered in the patients of the control group where it varied from 1.7±0,8 to 2.0±0,9 points (p>0.05). More manifest pronounced positive dynamics was observed in the patients presenting with initial vagotonia and the severe or moderate form of the disease. CONCLUSION: The present study has demonstrated the favourable influence of enteral oxygen therapy on the vegetative regulation mechanisms and the adaptive potential of the organism. Analysis of the heart rate variability may be a screening method for the evaluation of the effectiveness of the proposed therapeutic modality.

How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD.

Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD) and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation.

OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47%) had pulmonary fibrosis, 13 (22%) had pulmonary emphysema, and 18 (31%) had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001), the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001), role-physical, up 10 (p = 0.045); vitality, up 10 (p < 0.001); social functioning, up 15 (p = 0.001); and mental health, up 8 (p = 0.001). CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.