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1.
Cochrane Database Syst Rev ; 1: CD013040, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33511633

RESUMO

BACKGROUND: Pulmonary rehabilitation is a proven, effective intervention for people with chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and bronchiectasis. However, relatively few people attend or complete a program, due to factors including a lack of programs, issues associated with travel and transport, and other health issues. Traditionally, pulmonary rehabilitation is delivered in-person on an outpatient basis at a hospital or other healthcare facility (referred to as centre-based pulmonary rehabilitation). Newer, alternative modes of pulmonary rehabilitation delivery include home-based models and the use of telehealth. Telerehabilitation is the delivery of rehabilitation services at a distance, using information and communication technology. To date, there has not been a comprehensive assessment of the clinical efficacy or safety of telerehabilitation, or its ability to improve uptake and access to rehabilitation services, for people with chronic respiratory disease. OBJECTIVES: To determine the effectiveness and safety of telerehabilitation for people with chronic respiratory disease. SEARCH METHODS: We searched the Cochrane Airways Trials Register, and the Cochrane Central Register of Controlled Trials; six databases including MEDLINE and Embase; and three trials registries, up to 30 November 2020. We checked reference lists of all included studies for additional references, and handsearched relevant respiratory journals and meeting abstracts. SELECTION CRITERIA: All randomised controlled trials and controlled clinical trials of telerehabilitation for the delivery of pulmonary rehabilitation were eligible for inclusion. The telerehabilitation intervention was required to include exercise training, with at least 50% of the rehabilitation intervention being delivered by telerehabilitation. DATA COLLECTION AND ANALYSIS: We used standard methods recommended by Cochrane. We assessed the risk of bias for all studies, and used the ROBINS-I tool to assess bias in non-randomised controlled clinical trials. We assessed the certainty of evidence with GRADE. Comparisons were telerehabilitation compared to traditional in-person (centre-based) pulmonary rehabilitation, and telerehabilitation compared to no rehabilitation. We analysed studies of telerehabilitation for maintenance rehabilitation separately from trials of telerehabilitation for initial primary pulmonary rehabilitation. MAIN RESULTS: We included a total of 15 studies (32 reports) with 1904 participants, using five different models of telerehabilitation. Almost all (99%) participants had chronic obstructive pulmonary disease (COPD). Three studies were controlled clinical trials. For primary pulmonary rehabilitation, there was probably little or no difference between telerehabilitation and in-person pulmonary rehabilitation for exercise capacity measured as 6-Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) -10.82 m to 10.94 m; 556 participants; four studies; moderate-certainty evidence). There may also be little or no difference for quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD -1.26, 95% CI -3.97 to 1.45; 274 participants; two studies; low-certainty evidence), or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI -0.13 to 0.40; 426 participants; three studies; low-certainty evidence). Participants were more likely to complete a program of telerehabilitation, with a 93% completion rate (95% CI 90% to 96%), compared to a 70% completion rate for in-person rehabilitation. When compared to no rehabilitation control, trials of primary telerehabilitation may increase exercise capacity on 6MWD (MD 22.17 m, 95% CI -38.89 m to 83.23 m; 94 participants; two studies; low-certainty evidence) and may also increase 6MWD when delivered as maintenance rehabilitation (MD 78.1 m, 95% CI 49.6 m to 106.6 m; 209 participants; two studies; low-certainty evidence). No adverse effects of telerehabilitation were noted over and above any reported for in-person rehabilitation or no rehabilitation. AUTHORS' CONCLUSIONS: This review suggests that primary pulmonary rehabilitation, or maintenance rehabilitation, delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre-based pulmonary rehabilitation, with no safety issues identified. However, the certainty of the evidence provided by this review is limited by the small number of studies, of varying telerehabilitation models, with relatively few participants. Future research should consider the clinical effect of telerehabilitation for individuals with chronic respiratory diseases other than COPD, the duration of benefit of telerehabilitation beyond the period of the intervention, and the economic cost of telerehabilitation.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Transtornos Respiratórios/reabilitação , Telerreabilitação/métodos , Viés , Doença Crônica , Ensaios Clínicos Controlados como Assunto/estatística & dados numéricos , Dispneia/reabilitação , Tolerância ao Exercício/fisiologia , Humanos , Internet/estatística & dados numéricos , Ensaios Clínicos Controlados não Aleatórios como Assunto/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Telefone/estatística & dados numéricos , Telerreabilitação/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos , Teste de Caminhada/estatística & dados numéricos
2.
Medicine (Baltimore) ; 99(51): e23646, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371099

RESUMO

ABSTRACT: This study identified the effects of pursed-lip breathing (PLB), forward trunk lean posture (FTLP), and combined PLB and FTLP on total and compartmental lung volumes, and ventilation in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with mild to moderate COPD performed 2 breathing patterns of quiet breathing (QB) and PLB during FTLP and upright posture (UP). The total and compartmental lung volumes and ventilation of these 4 tasks (QB-UP, PLB-UP, QB-FTLP, PLB-FTLP) were evaluated using optoelectronic plethysmography. Two-way repeated measures ANOVA was used to identify the effect of PLB, FTLP, and combined strategies on total and compartmental lung volumes and ventilation. End-expiratory lung volume of ribcage compartment was significantly lower in PLB-UP than QB-UP and those with FTLP (P < .05). End-inspiratory lung volume (EILV) and end-inspiratory lung volume of ribcage compartment were significantly greater during PLB-FTLP and PLB-UP than those of QB (P < .05). PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELVAB ) end-expiratory lung volume, EILVAB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05). UP significantly increased tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation and decreased EELVAB, end-expiratory lung volume, and EILVAB than FTLP (P < .05). In conclusion, combined PLB with UP or FTLP demonstrates a positive change in total and compartmental lung volumes in patients with mild to moderate COPD.


Assuntos
Exercícios Respiratórios , Postura , Doença Pulmonar Obstrutiva Crônica/reabilitação , Ventilação Pulmonar , Terapia Respiratória/métodos , Idoso , Estudos Transversais , Humanos , Medidas de Volume Pulmonar , Pessoa de Meia-Idade
3.
Int J Chron Obstruct Pulmon Dis ; 15: 2127-2133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982205

RESUMO

Pulmonary rehabilitation (PR) is an important, evidence-based treatment that improves outcomes for people with COPD. Individualized exercise programmes aim to improve exercise capacity; self-management education and psychological support are also provided. Translating increased exercise capacity into sustained behavioural change of increased physical activity is difficult. Other unresolved problems with PR programmes include improving uptake, completion, response and sustaining long-term benefit. We offer a different perspective drawn from clinical experience of PR, quantitative and qualitative studies of singing groups for people with COPD, and stroke rehabilitation research that gives psychological factors a more central role in determining outcomes after PR. We discuss Take Charge; a simple but effective psychological intervention promoting self-management--that could be used as part of a PR programme or in situations where PR was declined or unavailable. This may be particularly relevant now when traditional face-to-face group programmes have been disrupted by COVID-19 precautions.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Pesquisa de Reabilitação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sistemas de Apoio Psicossocial , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Projetos de Pesquisa , Autogestão/métodos , Autogestão/psicologia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(38): e22111, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957331

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a lung disease with the highest incidence and high mortality in the world. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can significantly accelerate the progression of the disease. Pulmonary rehabilitation is one of the effective treatment methods in COPD patients, but few studies have focused on the effect of pulmonary rehabilitation in AECOPD patients. Liuzijue can improve the pulmonary function and relieve symptoms of COPD patients. However, due to the influence of disease and non-invasive ventilation (NIV), AECOPD patients have poor compliance with getting out of bed at the early stage. Sitting and lying Liuzijue is more suitable in AECOPD patients with NIV. Therefore, this study will evaluate the effect of sitting and lying Liuzijue for lung function, exercise endurance, and quality of life in AEOPD patients with NIV. METHODS: This study is a clinical randomized controlled trial. Sixty four AECOPD patients with NIV will be randomly divided into the experimental group and the control group. All participants will be treated with routine treatment and nursing according to their specific condition. The experimental group will be combined with sitting and lying Liuzijue on the basis of the control group. The duration of the exercise will be 3 months. The primary outcomes are the pulmonary function test and 6-minute walking test (6MWT). The secondary outcome measures include blood gas parameters, dyspnea index (the Modified Medical Research Council Dyspnea Scale [mMRC]), the body-mass, airflow obstruction, dyspnea and exercise capacity (BODE) index, anxiety, and depression (Hospital Anxiety and Depression Scale [HADS]), and quality of life (St·George Respiratory Questionnaire [SGRQ]). The measurement of outcomes will be evaluated at week 13. DISCUSSION: It's imperative to focus on pulmonary rehabilitation in AECOPD patients. The purpose of this study is to evaluate the effect of sitting and lying Liuzijue for pulmonary rehabilitation in AECOPD patients with NIV. TRIAL REGISTRATION: ChiCTR2000034530, Registered on July 8th, 2020.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qigong , Postura Sentada , Decúbito Dorsal , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes de Função Respiratória
5.
Medicine (Baltimore) ; 99(38): e22131, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957334

RESUMO

INTRODUCTION: In activities involving upper limbs, patients with chronic obstructive pulmonary disease (COPD) report an increase in dyspnea. For this reason, the authors of the recommendations about pulmonary rehabilitation propose to perform upper limbs muscle strengthening in patients with COPD. However, the modalities of strengthening are not clearly established.The aim of this study is to compare the effects of upper limbs endurance strengthening versus upper limbs force strengthening, in patients with COPD during a pulmonary rehabilitation program. METHODS: This study is a randomized, open-label, bi-center controlled trial in parallel groups distributed in a ratio (1:1) comparing upper limbs force strengthening (group F) to the upper limbs endurance strengthening (group E) during a pulmonary rehabilitation program in patients with COPD stages 2 to 4 (A-D).After randomization, patients will be allocated to follow: A 4 weeks pulmonary rehabilitation program with upper limbs resistance strengthening (group F). A 4 weeks pulmonary rehabilitation program with upper limbs endurance strengthening (group E).The primary outcome is dyspnea measured with the London Chest Activity of daily Living questionnaire. The secondary outcomes are dyspnea (using Modified Medical Research Council dyspnea Scale, dyspnea-12 questionnaire, multidimensional dyspnea profile questionnaire), upper limb exercise capacity (using the 6-minute Peg Board and Ring Test), Maximal voluntary strength of deltoid, biceps, and brachial triceps.The sample size calculated is 140 patients per group, or 280 in total. DISCUSSION: The modalities of upper limb strengthening are not very well known, and evidence based is lacking to recommend endurance or resistance upper limb strengthening.We anticipate that the results of this study will be of relevance to clinical practice. They will bring information about the best modality of upper limb strengthening to use during a pulmonary rehabilitation program. TRIAL REGISTRATION: IdRCB n°2018-A00955-50; V1.1 du 11/07/2018; REHABSUP, clinical trial.gov (NCT03611036), registered August 02, 2018, https://clinicaltrials.gov/ct2/show/NCT03611036.


Assuntos
Dispneia/reabilitação , Doença Pulmonar Obstrutiva Crônica/reabilitação , Treinamento de Resistência/métodos , Extremidade Superior , Dispneia/fisiopatologia , Humanos , Estudos Multicêntricos como Assunto , Força Muscular/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Rehabilitación (Madr., Ed. impr.) ; 54(3): 191-199, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-196735

RESUMO

Los programas de rehabilitación pulmonar están diseñados para promover la capacidad aeróbica y el mejoramiento de la calidad de vida de pacientes con deficiencias pulmonares crónicas, facilitando la participación y la integración en sus diferentes áreas de desempeño y en las actividades de la vida diaria mediante la prescripción y la ejecución de ejercicio físico, así como la educación relacionada con los factores de riesgo y vida saludable. Se considera un proceso multidisciplinar donde interactúan diferentes profesionales del área de la salud que durante el acompañamiento al paciente a través de su proceso de rehabilitación tienen como objetivo orientar cambios en su estilo de vida encaminados a mejorar los niveles de actividad física, los factores nutricionales, el ejercicio y el manejo de la diabetes, disminuir el peso corporal y lograr adherencia a los medicamentos y la cesación de tabaco, basados en las teorías del cambio comportamental. El objetivo principal de los programas de rehabilitación pulmonar es empoderar al usuario de su autocuidado y facilitar el manejo de la enfermedad pulmonar crónica


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


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Pneumopatias/reabilitação , Exercícios Respiratórios/métodos , Modalidades de Fisioterapia , Capacidade Pulmonar Total/fisiologia , Avaliação de Resultado de Intervenções Terapêuticas
8.
Clin Chest Med ; 41(3): 513-528, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32800203

RESUMO

Pulmonary rehabilitation (PR) is an essential intervention in the management of patients with chronic obstructive pulmonary disease. To guide health care professionals in the implementation and evaluation of a PR program, this article discusses the current key concepts regarding exercise testing, prescription, and training, as well as self-management intervention as essential parts of PR and post-rehabilitation maintenance. Moreover, new approaches (alternative forms of organization and delivery, tele-rehabilitation, exercise adjuncts) and unique and challenging situations (patients experiencing acute exacerbations, advanced disease) are thoroughly reviewed. Finally, validated point-of-care resources and online tools are provided.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida/psicologia , Humanos
9.
Codas ; 32(4): e20190036, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32756854

RESUMO

PURPOSE: To verify the relationship between the risk of dysphagia and health status in patients with Chronic Obstructive Pulmonary Disease (COPD). METHOD: Cross-sectional study with convenience sample. Twenty-three individuals with a diagnosis of COPD according to GOLD 2019 criteria. The individuals participated in a pulmonary rehabilitation program, clinically stable (without exacerbations of at least 30 days) and in optimized drug treatment were included. The study analyzed anthropometric measures (BMI), peak expiratory flow (PEF), mental status (MEEM), eating assessment tool (EAT-10), and health status (COPD Assessment Test -CAT). The mean age was 60.39 ± 9.90 years, 11 individuals were female and eutrophic. RESULTS: We observed a positive and moderate association (r = 0.57, p = 0.004) between the CAT and EAT-10 scores in the sample studied. CONCLUSION: The results demonstrated relationship between the risk of dysphagia and the health status in individuals with COPD.


Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/reabilitação , Testes de Função Respiratória , Inquéritos e Questionários
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1014-1020, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741163

RESUMO

Objective: To understand the situation of respiratory rehabilitation and oxygen inhalation therapy in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China, and provide basic information for the development of pulmonary rehabilitation. Methods: The data were from 2014-2015 COPD surveillance in China. Chinese residents aged 40 years or older were recruited through a complex multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities). Standardized face to face electronic questionnaires were used to collect information about respiratory rehabilitation and oxygen inhalation therapy of the patients. Spirometry was performed on all participants, and patients with post- bronchodilator FEV(1)/FVC<70% were diagnosed with COPD. The number of defined COPD patients was 9 134. Based on the complex sampling design, the respiratory rehabilitation treatment rate and oxygen inhalation therapy rate of COPD patients aged 40 years old or older in China were estimated, and the influencing factors were analyzed. Results: A total of 9 118 COPD patients aged 40 years or older were included in the analysis. The rate of respiratory rehabilitation was 0.8% (95CI: 0.6%-1.0%), and the rate of oxygen inhalation therapy was 2.5% (95%CI: 2.0%-2.9%). Among patients with severe symptoms or high risk of acute exacerbation (combined COPD assessment groups B, C, D), the rate of respiratory rehabilitation was 1.4% (95%CI: 0.9%-1.9%), and the rate of oxygen inhalation therapy was 5.4% (95%CI: 4.4%-6.4%). Multivariate logistic regression analysis showed that urban or rural residences, geographic area, awareness of COPD, history of acute exacerbation and severity of airflow restriction had influences on the respiratory rehabilitation rate in the COPD patients. Gender, geographic area, awareness of COPD, history of acute exacerbation, mMRC scores and severity of airflow restriction had influences on the patients' oxygen inhalation therapy rate. Conclusions: The rate of respiratory rehabilitation and oxygen inhalation therapy in COPD patients aged 40 years or older was relatively low in China. It is necessary to explore an effective model of pulmonary rehabilitation and COPD management, so that more COPD patients may have access to scientific pulmonary rehabilitation treatment.


Assuntos
Oxigenoterapia/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Adulto , China/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espirometria
11.
Respir Investig ; 58(5): 355-366, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32660900

RESUMO

Pulmonary rehabilitation (PR) is recommended as an effective treatment for patients with chronic obstructive pulmonary disease (COPD). Previous meta-analyses showed that PR improves exercise capacity and health-related quality of life (HRQOL). However, they did not evaluate the effect of PR on the sensation of dyspnea. We searched six databases in May 2019 for randomized controlled trials (RCTs) that examined PR, including supervised lower limb endurance training as a minimal essential component that was continued for 4-12 weeks, in patients with stable COPD, with changes from baseline dyspnea as a primary outcome. Secondary outcomes were changes in exercise capacity, HRQOL, activity of daily life (ADL), physical activity (PA), and adverse events. We calculated the pooled weighted mean difference (MD) using a random effects model. We identified 42 studies with 2150 participants. Compared with the control, PR improved dyspnea, as shown using the British Medical Research Council (MRC) questionnaire (MD, -0.64; 95% CI, -0.99 to -0.30; p = 0.0003), transitional dyspnea index (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001), modified Borg score during exercise (MD, -0.62; 95% CI, -1.10 to -0.14; p = 0.01), and Chronic Respiratory Questionnaire (CRQ) dyspnea score (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007). PR significantly increased exercise capacity measured by the 6 min walking distance time, peak workload, and peak VO2. It improved HRQOL measured by the St. George's Respiratory Questionnaire and CRQ, but not on PA or ADL. These results indicated that PR programs including lower limb endurance training improve dyspnea, HRQOL, and exercise capacity in patients with stable COPD.


Assuntos
Dispneia/fisiopatologia , Dispneia/reabilitação , Treino Aeróbico , Extremidade Inferior , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Dispneia/etiologia , Tolerância ao Exercício , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Inquéritos e Questionários , Resultado do Tratamento , Teste de Caminhada
12.
Medicine (Baltimore) ; 99(23): e20625, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502040

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common high-burden and highly disabling lung disease. The quality of life and exercise endurance of patients with COPD is often low because of atrophy of the respiratory and skeletal muscles. Although recommended by the global initiative for chronic obstructive lung disease guidelines, pulmonary rehabilitation (PR) has not been used widely because of its inherent limitations. Tuna-Hui-Chun-Gong (TNHCG) is a popular traditional exercise used to treat COPD in China. We aim to evaluate the safety and efficacy of TNHCG for PR of COPD. METHODS: The provided protocol is for a single-blind randomized controlled trial in which 120 COPD patients will be randomly and equally divided into the experimental or control group. The control group will be treated with standard COPD drugs while the experimental group will perform TNHCG exercises apart from standard drug treatment. The duration of treatment will be 24 weeks and a follow-up for 48 weeks. The primary outcome will be the 6-Minute Walk Test. The secondary outcomes will include the pulmonary function test, St George's respiratory questionnaire, COPD assessment test, modified medical research council dyspnea scale, Hospital Anxiety and Depression Scale, and exacerbation frequency. A safety assessment will also be performed during the trial. DISCUSSION: Our study will provide evidence to support TNHCG exercise as an additional measure for PR of COPD. TRIAL REGISTRATION: ChiCTR1900028332, Registered December 29, 2019. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Sichuan Traditional Chinese Medicine Regional Ethics Review Committee (No. 2019KL-050).


Assuntos
Tolerância ao Exercício , Exercício Físico , Medicina Tradicional Chinesa/métodos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Resultado do Tratamento , Teste de Caminhada
13.
Mayo Clin Proc ; 95(6): 1169-1183, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32498773

RESUMO

OBJECTIVE: To evaluate the effectiveness and adverse events of nonpharmacologic interventions in patients with exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We searched Embase, MEDLINE, Cochrane databases, Scopus, and clinicaltrials.gov from database inception to January 2, 2019, for randomized controlled trials that enrolled adults with exacerbation of COPD and evaluated the effect of nonpharmacologic interventions on clinical outcomes and/or lung function. RESULTS: We included 30 randomized controlled trials with 2643 participants. Improvement in 6-minute walking test distance was associated with resistance training (weighted mean difference [WMD], 74.42; 95% CI, 46.85 to 101.99), pulmonary rehabilitation (WMD, 20.02; 95% CI, 12.06 to 28.67), whole body vibration (WMD, 89.42; 95% CI, 45.18 to 133.66), and transcutaneous electrical nerve stimulation (WMD, 64.54; 95% CI, 53.76 to 75.32). Improvement in quality of life was associated with resistance training (WMD, 18.7; 95% CI, 5.06 to 32.34), combined breathing technique and range of motion exercises (WMD, 14.89; 95% CI, 5.30 to 24.50), whole body vibration (WMD, -12.02; 95% CI, -21.41 to -2.63), and intramuscular vitamin D (WMD, -4.67; 95% CI, -6.00 to -3.35 at the longest follow-up). Oxygen titration with a target oxygen saturation range of 88% to 92% was associated with reduced mortality compared with high flow oxygen (odds ratio, 0.36; 95% CI, 0.14 to 0.88). All findings were based on low strength of evidence. CONCLUSION: In patients hospitalized for exacerbation of COPD, exercise interventions and pulmonary rehabilitation programs may ameliorate functional decline. Oxygen should be titrated with a target oxygen saturation of 88% to 92% in these patients. TRIAL REGISTRATION: PROSPERO Identifier: CRD42018111609.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Progressão da Doença , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Respiratória/métodos
14.
Enferm. clín. (Ed. impr.) ; 30(supl.5): 164-167, jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196660

RESUMO

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease characterized by obstruction or obstruction of airflow in a reversible or partial nonreversible airway. Dyspnea is a common symptom in COPD sufferers; this can cause problems with oxygen saturation, or the oxygen saturation value is below normal. Non-pharmacological actions given in the form of breathing exercises can be done by a nurse to help reduce shortness of breath in COPD patients. The exercise is given by adjusting the resting position that is comfortable and comfortable so that the extra breath muscles can work well. The position that can do the position of the tripod with Active Cycle of Breathing and Pursed lips are breathing so that shortness of breath is reduced and SaO2 can have increased so that more oxygen has obtained in Lung Hospital, West Sumatra. This research is quantitative research, with quasi-experimental research methods. They used two pre-test-posttest design groups. The sample in this study amounted to 30 people with quota sampling technique. In this study showed that there was a difference in the increase in oxygen saturation of COPD patients which was effective in the tripod position group with Active Cycle Breathing Technique (ACBT) with a p-value of 0.00 while in the tripod position group with the Active Respiratory and Lip Cycle there was a difference of p-value 0.023. It has concluded that the tripod position with ACT and PBLT could increase oxygen saturation and nasal breathlessness reduced, but the tripod position with ACT is more effective in COP patients because with chronic respiratory patients who are short of breath due to sputum buildup, then with ACT will clean the airway and the flow of the road effective breathing so that shortness of breath have reduced and oxygen saturation increases. Furthermore, it has recommended that in hospitals, especially nurses, in dealing with COPD patients in addition to the correct position of breathing exercises with ACT to help patients


No disponible


Assuntos
Humanos , Resultado do Tratamento , Doença Pulmonar Obstrutiva Crônica/enfermagem , Exercícios Respiratórios/métodos , Terapia Respiratória/enfermagem , Doença Pulmonar Obstrutiva Crônica/reabilitação , Exercícios Respiratórios/enfermagem , Drenagem Postural/métodos
15.
Thorax ; 75(7): 539-546, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32409612

RESUMO

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) are four times more likely to fall than healthy peers, leading to increased morbidity and mortality. Poor balance is a major risk factor for falls. This review aims to quantify the extent of balance impairment in COPD, and establish contributing clinical factors, which at present are sparse. METHODS: Five electronic databases were searched, in July 2017 and updated searches were performed in March 2019, for studies comparing balance in COPD with healthy controls. Meta-analyses were conducted on sample mean differences (MD) and reported correlations between balance and clinical factors. Meta-regression was used to quantify the association between mean difference in percentage predicted forced expiratory volume in 1 s (FEV1) and mean balance impairment. Narrative summaries were provided where data were insufficient for meta-analysis. RESULTS: Twenty-three studies were included (n=2751). Meta-analysis indicated COPD patients performed worse than healthy controls on timed up and go (MD=2.77 s, 95% CI 1.46 s to 4.089 s, p=<0.005), single leg stance (MD=-11.75 s, 95% CI -15.12 s to -8.38 s, p=<0.005) and berg balance scale (MD=-6.66, 95% CI -8.95 to -4.37, p=<0.005). The pooled correlation coefficient between balance and reduced quadriceps strength was weak-moderate (r=0.37, 95% CI 0.23 to 0.45, p=<0.005). The relationship between differences in percentage predicted FEV1 and balance were negligible (r2 =<0.04). CONCLUSIONS: Compared with healthy controls, people with COPD have a clinically meaningful balance reduction, which may be related to reduced muscle strength, physical activity and exercise capacity. Our findings support a need to expand the focus of pulmonary rehabilitation to include balance assessment and training, and further exploration of balance impairment in COPD. PROSPERO registration number CRD4201769041.


Assuntos
Avaliação da Deficiência , Exercício Físico/fisiologia , Nível de Saúde , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Volume Expiratório Forçado/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
16.
JAMA ; 323(18): 1813-1823, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32396181

RESUMO

Importance: Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge. Objective: To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival. Design, Setting, and Patients: This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015. Exposures: Initiation of pulmonary rehabilitation within 90 days of hospital discharge. Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality. Results: Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD], -6.7% [95% CI, -7.9% to -5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD, -4.6% [95% CI, -5.9% to -3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD, -11.1% [95% CI, -13.2% to -8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01). Conclusions and Relevance: Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Idoso , Estudos de Coortes , Planos de Pagamento por Serviço Prestado , Feminino , Hospitalização , Humanos , Masculino , Medicare , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/mortalidade , Análise de Regressão , Estudos Retrospectivos , Análise de Sobrevida , Tempo para o Tratamento , Estados Unidos
17.
Clin Interv Aging ; 15: 557-566, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32368022

RESUMO

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation in the elderly. Airflow limitation is partially reversible and progressive. COPD not only causes a gradual decline in lung function but also affects the function of other systems throughout the body; it also has adverse effects on the central nervous system that can lead to cognitive impairment, especially in elderly patients. Therefore, understanding the influencing factors of cognitive impairment in elderly patients with COPD and applying early intervention are crucial in improving the quality of life of patients and reducing the burden on their families and society. This article mainly discusses the related factors of cognitive impairment in elderly patients with COPD and expands the possible mechanism of exercise in improving cognitive impairment in patients with COPD to provide a reference for the clinical prevention and treatment of cognitive impairment in elderly patients with COPD.


Assuntos
Disfunção Cognitiva/reabilitação , Terapia por Exercício/métodos , Exercício Físico , Doença Pulmonar Obstrutiva Crônica/reabilitação , Atividades Cotidianas , Idoso , Disfunção Cognitiva/etiologia , Comportamentos Relacionados com a Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Caminhada
18.
Artigo em Russo | MEDLINE | ID: mdl-32356630

RESUMO

AIM: Of this study is to substantiate the effectiveness of continuous-cycle technology of rehabilitation of patients with chronic obstructive pulmonary disease (COPD) on an outpatient basis. MATERIAL AND METHODS: 140 patients with moderate to severe (stage II-III) COPD were examined: 82% with chronic bronchitis phenotype and 18% - with emphysema phenotype. 44% of patients had frequent exacerbations. Patients were admitted to outpatient rehabilitation after stages I and II because of the exacerbation of the disease. 2 comparable groups were formed: the primary group included 68 patients who were engaged in active physical rehabilitation according to a continuous-cycle technique for 10-12 months; the comparison group consisted of 72 patients receiving only basic drug therapy. Continuous-cycle technique included: regular exercise therapy, cycling and procedures that improve tolerance to them (hardware chest vibration, chlorpromazine electrophoresis), oxygen cocktail, general ultraviolet radiation in the unfavorable period of the year. Diagnostics of early signs of an exacerbation of the disease and prophylactic prescription of physiotherapeutic procedures were carried out. RESULTS AND DISCUSSION: During the year of observation during treatment, only 4 cases failed to prevent full exacerbation of the disease. During the year, in the patients of the primary group, in contrast to the comparison group, there was a significant improvement in the clinical signs of the disease, an increase in VC, an improvement in bronchial patency, an increase in physical performance and exercise tolerance, and a decrease in the activity of systemic inflammation. A year later, we registered an improvement in the course of the disease n 70% of patients of the primary group, and only stabilization of the process - in 82% of the comparison group. Frequency of exacerbations in the primary group decreased 5.1 times, which was 3.9 times more significant than in the comparison group.


Assuntos
Terapia por Exercício , Doença Pulmonar Obstrutiva Crônica , Tolerância ao Exercício , Humanos , Pacientes Ambulatoriais , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Raios Ultravioleta
19.
Thorax ; 75(7): 547-555, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376732

RESUMO

RATIONALE: Dietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with COPD. We aimed to assess whether it could enhance the effect of pulmonary rehabilitation (PR) in COPD. METHODS: This double-blind, placebo-controlled, parallel group, randomised controlled study performed at four UK centres, enrolled adults with Global Initiative for Chronic Obstructive Lung Disease grade II-IV COPD and Medical Research Council dyspnoea score 3-5 or functional limitation to undertake a twice weekly 8-week PR programme. They were randomly assigned (1:1) to either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate), or placebo nitrate-deplete BRJ, consumed 3 hours prior to undertaking each PR session. Allocation used computer-generated block randomisation. MEASUREMENTS: The primary outcome was change in incremental shuttle walk test (ISWT) distance. Secondary outcomes included quality of life, physical activity level, endothelial function via flow-mediated dilatation, fat-free mass index and blood pressure parameters. RESULTS: 165 participants were recruited, 78 randomised to nitrate-rich BRJ and 87 randomised to placebo. Exercise capacity increased more with active treatment (n=57) than placebo (n=65); median (IQR) change in ISWT distance +60 m (10, 85) vs +30 m (0, 70), estimated treatment effect 30 m (95% CI 10 to 40); p=0.027. Active treatment also impacted on systolic blood pressure: treatment group -5.0 mm Hg (-5.0, -3.0) versus control +6.0 mm Hg (-1.0, 15.5), estimated treatment effect -7 mm Hg (95% CI 7 to -20) (p<0.0005). No significant serious adverse events or side effects were reported. CONCLUSIONS: Dietary nitrate supplementation appears to be a well-tolerated and effective strategy to augment the benefits of PR in COPD. TRIAL REGISTRATION NUMBER: ISRCTN27860457.


Assuntos
Suplementos Nutricionais , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Nitratos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Administração Oral , Idoso , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Resultado do Tratamento
20.
Thorax ; 75(5): 413-421, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32229541

RESUMO

RATIONALE: Pulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the benefits achieved through alternative approaches, such as pulmonary tele-rehabilitation (PTR). OBJECTIVE: To investigate whether PTR is superior to conventional PR on 6 min walk distance (6MWD) and secondarily on respiratory symptoms, quality of life, physical activity and lower limb muscle function in patients with COPD and FEV1 <50% eligible for routine hospital-based, outpatient PR. METHODS: In this single-blinded, multicentre, superiority randomised controlled trial, patients were assigned 1:1 to 10 weeks of groups-based PTR (60 min, three times weekly) or conventional PR (90 min, two times weekly). Assessments were performed by blinded assessors at baseline, end of intervention and at 22 weeks' follow-up from baseline. The primary analysis was based on the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS: The primary outcome was change in 6MWD from baseline to 10 weeks; 134 participants (74 females, mean±SD age 68±9 years, FEV1 33%±9% predicted, 6MWD 327±103 metres) were included and randomised. The analysis showed no between-group differences for changes in 6MWD after intervention (9.2 metres (95% CI: -6.6 to 24.9)) or at 22 weeks' follow-up (-5.3 metres (95% CI: -28.9 to 18.3)). More participants completed the PTR intervention (n=57) than conventional PR (n=43) (χ2 test p<0.01). CONCLUSION: PTR was not superior to conventional PR on the 6MWD and we found no differences between groups. As more participants completed PTR, supervised PTR would be relevant to compare with conventional PR in a non-inferiority design. Trial registration number ClinicalTrials.gov (NCT02667171), 28 January 2016.


Assuntos
Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Telemedicina , Idoso , Ansiedade/etiologia , Depressão/etiologia , Exercício Físico , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Reabilitação/métodos , Método Simples-Cego , Avaliação de Sintomas , Teste de Caminhada
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