Exercise Training and Pulmonary Rehabilitation in COPD

Systemic inflammation and deconditioning syndrome lead to loss of structural and function of body muscle, particularly in extremity muscle. Longer period of inactivity due to dyspnea worsen the destruction of muscle. Regular and gradually increase exercise training as part of pulmonary rehabilitation (PR) can improve the function of essential muscles in doing daily life so stable Chronic Obstructive Pulmonary Disease (COPD) patient can maintenance their daily activities with minimal limitations. Pulmonary rehabilitation consists of exercise training, nutritional support, smoking cessation, and self-management of COPD. The prescription of exercise training is mandatory. Assessment of clinical condition to adjust the type of training, duration, frequency, and intensity of training must be completed before beginning the training session. Regular and gradually increased training gives significant impact in improving lung function, dyspnea scale, and quality of life in patient with stable COPD. However, in this covid era, the restriction of hospital attending PR was significantly affect PR program. As immunocompromised population, COPD patient have higher risk for COVID19 infection and develops more severe complications compare with normal population. So, the modified supervised and unsupervised training was needed to revise the classic type of PR. Tele-rehabilitation with teleconference, phone calls, and interactive web based PR can be the good alternative in decreasing hospital admission and improving quality of life in patient with COPD

The Correlation between Levels of Transforming Growth Factor-β with Pulmonary Fibrosis in Post Pulmonary Tuberculosis in Medan, North Sumatera – Indonesia

BACKGROUND: Untreated or undertreated, pulmonary tuberculosis could cause severe complications until death. After treatment, residual lesions might occur. The presence of residual lesions is varied, including fibrosis, cavity, bronchiectasis and calcification. Transforming growth factor-β (TGF-β) is a cytokine associated with lung inflammation, which plays a role in lung fibrosis. However, only a few studies have assessed the serum level of TGF-β in post-treatment tuberculosis patients. AIM: The main objective of this study was to determine the correlation between TGF-β levels and pulmonary fibrosis in patients with pulmonary tuberculosis. DESIGN: A group of 51 patients that had undergone anti-tuberculosis treatment were observed, consisting of 31 men, 20 women. Of all patients, there were 26 people with a smoking history, including 25 men and 1 woman. All patients had been recovered, confirmed by the clinical state, laboratory and radiology examination. The ELISA test was performed to measure TGF-β level, while the chest X-ray was used to look for the occurrence of pulmonary fibrosis. RESULTS: The mean level of TGF-β in patients with a lesion (+) was 7628.02 (SD: ± 4928.38) while the mean level of TGF-β in patients with a lesion (-) was 2315.11 (SD: ± 505.83). The statistical test showed a significant relationship between TGF-β level and fibrosis lesion (p < 0.001). CONCLUSION: TGF-β level was significantly higher in post-tuberculosis patients with pulmonary fibrosis

The Impact of Short-term Combination of Limb Training and Pursed-lip Breathing in Chronic Obstructive Pulmonary Disease

AIM: The aim of this study is to determine the impact of short-term combination of upper and lower limb training on lung functions, functional capacity, and quality of life in stable chronic obstructive pulmonary disease (COPD). METHODS: This quasi-experimental study held in 2017 and included 20 participants diagnosed with COPD (forced expiratory volume in 1 second/forced volume capacity [FEV1/FVC] ≤70%). Combination of limb training with pursed-lip breathing held twice a week for 8 weeks. Lung functions, functional capacity, dyspnea scale, and quality of life were measured before, 1 month, and 2 months after training. RESULTS: In this study, there was a significant improvement of FVC after 2 months after training (p-value: 0.04), but not in FEV1. There was a significant improvement of CAT (p-value: 0.00) and modified medical research council (p-value: 0.04) after 1 month of training. There was a significant improvement of 6-min walking test mean after 2 months of training (p-value: 0.00). CONCLUSIONS: Short-term combination of limb training and pursed-lip breathing impacted positively on FVC, functional capacity, dyspnea scale, and quality of life in patients with COPD, but not in FEV1

The role of oncogenes and tumor suppressor genes in determining survival rates of lung cancer patients in the population of North Sumatra, Indonesia [version 2; peer review: 2 approved]

Background: Gaining a better understanding of molecular alterations in the pathogenesis of lung cancer reveals a significant change in approach to the management and prognosis of lung cancer. Several oncogenes and tumor suppressor genes have been identified and have different roles related to survival rates in lung cancer patients. This study aims to determine the role of KRAS, EGFR, and TP53 mutations in the survival rate of lung cancer patients in the population of North Sumatra. Methods: This is a retrospective cohort study involving 108 subjects diagnosed with lung cancer from histopathology specimens. DNA extractions were performed using FFPE followed by PCR examinations for assessing the expressions of EGFR, RAS, and TP53 protein. Sequencing analysis was carried out to determine the mutations of EGFR exon 19 and 21, RAS protein exon 2, and TP53 exon 5-6 and 8-9. Data input and analysis were conducted using statistical analysis software for Windows. The survival rate analysis was presented with Kaplan Meier. Results: 52 subjects completed all procedures in this study. Most of the subjects are male (75%), above 60 years old (53.8%), heavy smokers (75%), and suffer from adenocarcinoma type of lung cancer (69.2%). No subjects showed KRAS exon 2 mutations. Overall survival rates increased in patients with EGFR mutations (15 months compared to 8 months; p=0.001) and decreased in patients with TP53 mutations (7 months compared to 9 months; p=0.148). Also, there was increasing Progression-Free Survival in patients with EGFR mutations (6 months compared to 3 months) (p=0.19) and decreasing PFS in patients with TP53 mutations (3 months compared to 6 months) (p=0.07). Conclusions: There were no KRAS mutations in this study. EGFR mutations showed a higher survival rate, while TP53 mutations showed a lower survival rate in overall survival and progression-free survival

The Correlation between Hemostatic Parameters and Mortality Rate in Patients with Non-Small Cell Lung Cancer

The increasing level of hemostatic parameters and tumor markers were associated with cancer progression and poor prognosis, particularly in NSCLC. The objective of this study is to determine whether there was a correlation between hemostatic parameters and mortality rate in patients with NSCLC. This was a prospective analytical study with a pretest-posttest design which included 41 patients with diagnosis of NSCLC. Plasma levels of PT, APTT, TT, D-dimer, and fibrinogen were measured before initiation of chemotherapy and remeasured after 4 cycles or 6 cycles of chemotherapy, based on the clinical condition of patients. Then, patients were followed up for 1 year to evaluate the mortality rate. The majority of subjects were male (85.4%) with adenocarcinoma (75.6%). There was no significant difference in mean between adenocarcinoma and squamous cell carcinoma (p > 0.05). Most patients died after one month of follow up (61%). The parameters which could predict high mortality rate in NSCLC were prolonged PT and the increased of D-dimer with RR > 1, although they had not significant in statistical analysis (p > 0.05). There is no correlation between hemostatic parameters and mortality rate in patients with NSCLC

The The Impact of Upper Limb Training with Breathing Maneuver in Lung Function, Functional Capacity, Dyspnea Scale, and Quality of Life in Patient with Stable Chronic Obstructive of Lung Disease

BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429) CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients