Pulmonary rehabilitation (PR) is a non-pharmacologic therapy that has emerged as a standard of care for patients with chronic obstructive pulmonary disease (COPD). It is a comprehensive, multidisciplinary, patient-centered intervention that includes patient assessment, exercise training, self-management education, and psychosocial support. PR is usually given in inpatient, outpatient, community-based or home-based setting lasting 8-12 weeks. Positive outcomes from PR include increased exercise tolerance, reduced dyspnea and anxiety, increased selfefficacy, and improvement in health-related quality of life (QoL). Hospital admissions after exacerbations of COPD are also reduced with this intervention. The positive outcomes associated with PR are realized without demonstrable improvements in lung function. This paradox is explained by the fact that PR identifies and treats the systemic effects of the disease. This intervention should be considered in patients who remain symptomatic or have decreased functional status despite optimal medical management. Physical activity in patients with COPD is dependent on many factors, including physiologic, behavioral, social, environmental, and cultural factors. A strong inverse association between daily physical activity and dynamic hyperinflation, which correlates strongly with exertional dyspnea in COPD. Changing physical activity behavior inpatients with COPD needs an interdisciplinary approach, bringing together respiratory medicine, rehabilitation sciences, social sciences, and behavioral sciences. There is a need for more education and learning opportunities for primary care physicians, nurse practitioners, and all allied health care professionals about the process and benefits of PR. There is also a need for the sustainability and the safety of PR in the future study.
It was clear that LI during gait was effective at evaluating gait symmetry and balance. LI was indicated to be useful in evaluating gait in patients with stroke.
Mechanically assisted coughing (MAC) is an airway clearance method in which the thorax/abdomen is compressed in synchronization with mechanical insufflation-exsufflation (MI-E). MAC can be performed with manual assistance at the upper thorax (MAC-UT), lower thorax (MAC-LT), and upper thorax + abdomen (MAC-UT/A). This study aimed to determine the most effective approach under different conditions (air stacking or tracheostomy) in patients with neuromuscular disorders (NMDs). Methods: The study included 34 patients with NMDs. The patients were categorized into air stacking group (n= 15), no air stacking group (n=9), and tracheostomy/tracheostomy positive-pressure ventilation (TPPV) group (n=10). Results: In each group, the cough peak flow (CPF) at 75% of the forced vital capacity (!75), !50,!25, and!10 were investigated during the approaches. In the air stacking group, the CPF was higher with MAC-UT, MAC-LT, and MAC-UT/A than with MI-E (p < 0.05). Additionally, !75 was higher with MAC-LT and MAC-UT/A than with MI-E (p < 0.05 and p < 0.01, respectively). In the no air stacking group, !75 was higher with MAC-UT/A than with MI-E (p < 0.05). In the tracheotomy/TPPV group, there were no significant differences. Conclusions: MAC approaches, especially MAC-LT and MAC-UT/A, are preferred in air stacking patients. However, in tracheostomy/TPPV patients, the CPF might not increase with MAC.
BackgroundIndividuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left–right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left–right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients’ symmetry evaluation results and their physical function.Patients and methodsSixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD.ResultsThe average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients’ LI values were significantly correlated with their static balance.ConclusionThe LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD.
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