Advances in Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease and Associated Conditions

Pulmonary rehabilitation (PR) is an evidenced-based, proven treatment as mentioned recent guidelines in patients with chronic obstructive pulmonary disease (COPD). Exercise training is a cornerstone of PR programs, Inspiratory muscle training, neuromuscular electrical stimulation (NMES) are effective in selected patients. Water-based rehabilitation and tai chi are well tolerated recent modalities. Although there is an absence of a specific PR protocol for special conditions, PR is recommended before and also after endobronchial volume reduction (EBVR), lung volume reduction surgery (LVRS), both before and after lung transplantation periods, before, after surgery, during the intensive care unit (ICU) period, the chemotherapy period and as a component of palliative care. After COPD exacerbation, it is recommended within 3 weeks of hospital discharge. Modifying PR programs while considering comorbidities might lead to greater improvement in outcomes. After PR, the important points are to follow prescribed home exercise programs, control programs in the PR center/unit, and being more active in daily living life for the purpose of preserving improvements. Tele-PR is an alternative to conventional modalities due to similar improvements. Although PR is effective, it is an under-utilized resource. The awareness of PR should be increased in patients and among health professionals

Efficacy of pulmonary rehabilitation for bronchiectasis and related factors: which patients should receive the most treatment?

Introduction: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis.Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program.Results: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = -0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = -0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = -0.563) and ΔSGRQ (p < 0.001, r = -0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = -0.176) and Δanxiety (p = 0.007, r = -0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = -0.267) and ΔSGRQ (p < 0.001, r = -0.648). Conclusions: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program

Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Chance for a Multidisciplinary Treatment Approach

Objectives: Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ventilation capacity, dyspnea, and finally reduced exercise intolerance. All of these have a significant negative impact on functional capacity and quality of life. In this study, we aim to evaluate the effects of pulmonary rehabilitation (PR) in IPF and assess the predictors of success. Methods: Data from 17 IPF patients who completed the program from the total of 27 patients who applied to PR were used in our study. We evaluated their pulmonary function tests, exercise capacity, peripheral-respiratory muscle strength, body composition, quality of life, and psychological states before and after PR. Results: Following the PR program, improvements over the minimal clinically important differences were observed in almost all parameters compared to the baseline; however, statistically significant improvements were only observed in the medical research council (P=0.020), the St. George respiratory questionnaire (P=0.002), the maximal inspiratory pressure (P=0.024), the anxiety score (P=0.001), the depression score (P=0.002), and the right quadriceps muscle strength (P=0.046). There was only a statistically significant negative correlation between the initial forced vital capacity and the forced expiratory volume in one-second value with the increase in patients’ maximal inspiratory pressure values after PR.  Discussion: After a multidisciplinary, comprehensive PR program, dyspnea sensation, exercise capacity, endurance time, quality of life, respiratory and peripheral muscle strengths, and psychological status were improved regardless of age, gender, antifibrotic treatment, and comorbidities. Therefore, patients should be referred to PR units before the deterioration in the quality of life in the early stages of the disease

The Reasons for Non-Adherence in Pulmonary Rehabilitation Programs

Objective: Pulmonary Rehabilitation (PR), a multidisciplinary treatment modality, is recommended in management of COPD. Structure, experience of units /centers, contents of the program are as important as patient-specific factors.To our knowledge, there is no data regarding the success of PR in Turkey. This study was performed in order to determine the reasons for nonadherence in patients who underwent PR programs in Turkey. Methods: Demographic data, initial assessment parameters of 143 patients were collected retrospectively, examined. Age, smoking history, FEV1%, health related quality of life, dyspnea score, body composition and psychological status of all patients who were divided into two group according to completion of PR were compared. The reasons of non-completion were asked from patients who did not complete PR by phone, their answers were recorded. Results: Thirty two patients did not complete (22.3%) multidisciplinary, comprehensive, an individualized outpatient PR program.The most common reason for non-adherence except all medical conditions including exacerbations was inability to comprehend efficacy and contents of PR program. While mean walking distance of patients who completed PR was 241±128.9, other group’s distance was 183.4±119.9 m, endurance time was 7.03±6.32, 4.89±5.3 min (respectively, p=0.02). Although total SGRQ and all domains’ scores of patients who did not complete PR were higher, only impact domain scores, MRC scores were significantly higher (p=0.045, 0.01 respectively). Body composition, psychosocial status of patients did not differ significantly. Conclusion: Patients with advanced dyspnea, decreased exercise capacity should be continuously, vigorously informed of possible gains in order to increase success rate of programs, adherence to programs should be reinforced by patient-specific individualized PR programs

Influenza and pneumonia vaccination rates in patients hospitalized with acute respiratory failure

Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded. Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations. Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients

Efficacy of Pulmonary Rehabilitation for Bronchiectasis and Related Factors: Which Patients Should Receive the Most Treatment?

Introduction: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. Results: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = −0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = −0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = −0.563) and ΔSGRQ (p < 0.001, r = −0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = −0.176) and Δanxiety (p = 0.007, r = −0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = −0.267) and ΔSGRQ (p < 0.001, r = −0.648). Conclusions: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program

The Efficacy of Supervised Home-based Pulmonary Rehabilitation in Patients with Chronic Respiratory Disorders

Objective: Pulmonary rehabilitation (PR) programs can be carried out in hospital or home basis with a different organizational aspect and program content. This study aimed to evaluate the efficacy of a multidisciplinary supervised home-based PR program in patients with chronic respiratory disorders. Methods: Forty patients with chronic respiratory disorders who admitted to our center between September 2007 and May 2012 were enrolled. In all patients before and after PR, dyspnea was assessed with Medical Research Council (MRC) dyspnea scale, exercise capacity with Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT), health related quality of life with St. Geoerge Respiratory Questionnaire (SGRQ), psychosocial evaluation with hospital anxiety and depression scale (HAD), the body composition with bioelectrical impedance method. Ten patients did not complete home-based PR for various reasons. Results: In patients with Chronic Obstructive Pulmonary Disease (COPD), dyspnea sensation (p=0.026), exercise capacity (p=0.001), quality of life (p=0.001), body composition (p=0.012), anxiety and depression score (p=0.001) improvements were statistically significant. In all patients with COPD and non-COPD perception of dyspnea, exercise capacity, quality of life, anxiety and depression score improvements were above minimal clinically important differences. Conclusion: In this study supervised home-based pulmonary rehabilitation has been shown as an effective and safe modality when applied by an experiencied and multidisciplinary team in selected severe COPD or non-COPD patients

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study

WOS: 000366030500001PubMed ID: 26622176Objective: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in > 70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient = 0.993, P < 0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient = 0.237, P < 0.0001) were noted. Conclusion: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected.Novartis Pharmaceuticals TurkeyThe study is funded by Novartis Pharmaceuticals Turkey. We thank Cagla Ayhan, MD and Prof Sule Oktay, MD, PhD from KAPPA Consultancy Training Research Ltd, Istanbul who provided editorial support and Mehmet Berktas, MD, MICR from KAPPA Consultancy Training Research Ltd, Istanbul who performed statistical analysis funded by Novartis Pharmaceuticals Turkey

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study

Objective: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods: A total of 1,610 COPD patients (mean {[}standard deviation] age: 62.6 {[}9.9] years, 85.7\% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results: Overall, 41.1\% of patients were assigned to GOLD A, while 13.2\% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0\%). Over-treatment was noted in > 70\% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient = 0.993, P < 0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient = 0.237, P < 0.0001) were noted. Conclusion: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected