The Role of Manual Therapy in Patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a respiratory condition associated with altered chest wall mechanics and musculoskeletal changes. In this narrative review, we describe the underlying musculoskeletal abnormalities in COPD, the reasons for applying manual therapy techniques, their method of application and clinical effects. A variety of manual therapy techniques have been applied in individuals with COPD, including soft tissue therapy, spinal and joint manipulation and mobilisation, and diaphragmatic release techniques. These have been prescribed in isolation and in conjunction with other treatments, including exercise therapy. When applied in isolation, transient benefits in respiratory rate, heart rate and symptoms have been reported. Combined with exercise therapy, including within pulmonary rehabilitation, benefits and their corresponding clinical relevance have been mixed, the extent to which may be dependent on the type of technique applied. The current practical considerations of applying these techniques, including intense therapist⁻patient contact and the unclear effects in the long term, may limit the broad use of manual therapy in the COPD population. Further high quality research, with adequate sample sizes, that identifies the characteristic features of those with COPD who will most benefit, the optimal choice of treatment approach and the longevity of effects of manual therapy is required.

Should lung transplant recipients routinely perform airway clearance techniques? A randomized trial.

BACKGROUND AND OBJECTIVE: Despite the widespread use of airway clearance (AC) techniques to clear excessive secretions and improve lung function, little is known about their efficacy following lung transplantation (LTx). This study compared the effects of two AC strategies (proactive vs reactive) on a range of clinical outcomes following LTx. METHODS: A prospective randomized trial was conducted. Uncomplicated patients were recruited 1 month postoperatively. Patients performed AC using positive expiratory pressure either twice daily (proactive strategy) or only in the presence chest infection (reactive strategy). Lung function (FEV(1) and FVC), CXR (Brasfield score) and bronchoscopic airway characteristics (anastomotic healing, patency and secretions) were assessed at 1, 2 and 3 months postoperatively. Adherence was measured. RESULTS: Of 60 consecutive patients, 36 (18 proactive, 18 reactive) were recruited and completed the study. Both groups improved lung function (FEV(1) 72 +/- 4% to 81 +/- 4%, P < 0.0001; FVC 69 +/- 3% to 81 +/- 3%, P < 0.0001) and Brasfield scores (17.8 +/- 0.5 to 19.8 +/- 0.5, P < 0.002) over the study period. No significant differences for any outcome were found between the two groups. The vast majority of patients had fully healed, 100% patent anastomoses without secretions at 3 months. There were no significant differences between the two groups in airway characteristics and the incidence of chest infection. Adherence to both strategies was high (84% proactive, 100% reactive). CONCLUSIONS: Proactive AC following lung transplantation was not associated with a reduced incidence of respiratory infection, alteration of CXR findings or improvement in airway characteristics.

Lung volume reduction surgery in Australia and New Zealand. Six years on: registry report.

BACKGROUND: Lung volume reduction surgery (LVRS) has been shown to improve lung function, exercise performance, and quality of life in highly selected individuals with severe emphysema; however, major questions regarding the efficacy and long-term outcomes of LVRS still remain unanswered. Pending the results of large randomized controlled trials (RCTs), the Australian and New Zealand LVRS Database was created to audit local clinical practice and patient outcomes. AIMS: To review patient selection, surgical activity, and patient outcomes related to LVRS in Australia and New Zealand. METHODS: Prospective data were voluntarily submitted by hospitals performing LVRS in Australia and New Zealand. Preoperative, surgical, perioperative, and follow-up variables were analyzed. RESULTS: Data were collected from 15 hospitals regarding 529 patients. Mean age (+/- SD) at surgery was 63 +/- 7 years. Preoperatively, FEV(1) was 29 +/- 9% predicted, total lung capacity (TLC) was 138 +/- 20% predicted, residual volume (RV) was 250 +/- 64% predicted, and 6-min walk (6MW) distance was 327 +/- 111 m. There has been a reduction in the overall number of cases and hospitals performing LVRS since 1999. Improvements in lung function following LVRS (ie, FEV(1) increase of 38%, RV decrease of 27%, TLC decrease of 17%) and exercise capacity (ie, 6MW distance increase of 24%) appear to be maintained for approximately 3 years. CONCLUSIONS: LVRS continues to be performed in Australia and New Zealand, predominantly in large tertiary teaching hospitals with similar outcomes to those described in the literature. It remains difficult to capture long-term lung function and survival outcomes in this population. Ongoing audit and RCTs are both required to resolve the confusion that still shrouds this procedure.