Effects of a walking aid in COPD patients receiving oxygen therapy

STUDY OBJECTIVES: To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister. DESIGN: Randomized crossover trial. SETTING: Physiopathology laboratory of three rehabilitation centers. PATIENTS AND INTERVENTIONS: We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality). MEASUREMENTS AND RESULTS: The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline. CONCLUSIONS: This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity

Effect of pulmonary rehabilitation (PR) in subjects with normocapnic respiratory failure (NRF)

PR programmes are able to improve exercise capacity (EC), quality of life (QOL) and dispnoea (D) in stable COPD subjects. The efficacy of PR in subjects with RF is not fully clarified. The aim of our study was to evaluate the benefit of PR in subjects with NRF. Forty subjects were divided in two groups: 15 with FEV1> 40% (10M, age range 73 ± 4.69 yrs, Group A) and 25 with FEV1 < 40% (18 M, age range 69 ± 6.9 yrs, Group B). A four weeks of a PR programme carried out in an inpatient setting, included respiratory muscle stretch, exercise training, mucus evacuation techniques, and relaxation techniques. Medical Research Council Dispnoea scale (MRC), Maximal Inspiratory Pressure (MIP) Maximal Expiratory Pressure (MEP), St George Respiratory Questionnaire (SGRQ), and 6-Minutes Walking Distance (6-MWD, mt), were assessed on admission and discharge from IPR. In the Group A all outcomes significantly improved after PR. Results of Group B (pre and post PR) are shown as following: MRC (pre 4.24 ± 0.72; post 3.16 ± 0.99, p <0.001). MIP (pre 61 ± 23; post 83 ± 36, p < 0.001). MEP (pre 124 ± 37; post 153 ± 39, p < 0.001). SGRQ (pre 66 ± 14; post 62 ± 14, n.s.). 6-MWD (269 ± 108; post 310 ± 101, p < 0.05). Our study has shown that an inpatient PR is able to improve EC, D, respiratory muscle strength in all subjects with normocapnic chronic respiratory failure and QOL only in those with FEV1.> 40%. Future studies are needed in subjects with more severe bronchial obstruction and with hypercapnic respiratory failure