Does a Low-Density Gas Mixture or Oxygen Supplementation Improve Exercise Training in COPD?

Scorsone, Debora; Bartolini, Stefano; Saporiti, Riccardo; Braido, Fulvio; Baroffio, Michele; Pellegrino, Riccardo; Brusasco, Vito; Crimi, Emanuele

doi:10.1378/chest.10-0120

Cited by 45 publications

(73 citation statements)

References 30 publications

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“…The studies did not find additional benefits in their heliox arm when heliox (60% helium) was compared with supplemental oxygen,171 or heliox (79% helium) was compared with bi-level pressure support NIV156 or pulmonary rehabilitation alone 156. These trials were small and the study groups were heterogeneous in baseline function and response to rehabilitation.…”

Section: Evidencementioning

confidence: 97%

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

Bolton

Bevan-Smith

Blakey

et al. 2013

Thorax

557

341

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Section: Evidencementioning

confidence: 97%

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

Bolton

Bevan-Smith

Blakey

et al. 2013

Thorax

557

341

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“…88 Only 6 small, randomized controlled trials have assessed the effects of supplemental oxygen on exercise training and performance for patients with or without exertional desaturation who were undergoing pulmonary rehabilitation. 80,[89][90][91][92][93] The results of these studies have been inconsistent, but no clear beneficial effect emerges. 94 Moreover, we do not have data on the interaction between supplemental oxygen and other supportive adjuncts, such as noninvasive ventilation, on the physiological adaptations to exercise in this patient population, 69 nor do we have knowledge of the effects of oxygen during exercise for patients with different COPD phenotypes.…”

Section: Oxygen Benefits During Exercisementioning

confidence: 99%

The Story of Oxygen

Heffner

2012

Respir Care

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The history of oxygen from discovery to clinical application for patients with chronic lung disease represents a long and storied journey. Within a relatively short period, early investigators not only discovered oxygen but also recognized its importance to life and its role in respiration. The application of oxygen to chronic lung disease, however, took several centuries. In the modern era, physiologists pursued the chemical nature of oxygen and its physiologic interaction with cellular metabolism and gas transport. It took brazen clinicians, however, to pursue oxygen as a therapeutic resource for patients with chronic lung disease because of the concern in the 20th century of the risks of oxygen toxicity. Application of ambulatory oxygen devices allowed landmark investigations of the long-term effects of continuous oxygen that established its safety and efficacy. Although now well established for hypoxic patients, many questions remain regarding the benefits of oxygen for varying severity and types of chronic lung disease.

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“…It is generally recommended that COPD patients who are already hypoxaemic at rest should use oxygen during exercise, aiming at a rather arbitrary oxygen saturation of .90%. As far as we know, six randomised controlled trials have been published on the effect of oxygen in COPD patients with or without desaturation during exercise training (table 1) [23][24][25][26][27][28].…”

Section: Nocturnal Ventilatory Support In Addition To Exercise Trainingmentioning

confidence: 99%

“…Endurance time and peak work load improved in all treatment arms, with no difference between the arms. SCORSONE et al [28] studied 30 COPD patients with an FEV1 of ,60% pred and a mean DL,CO of 85% pred. Subjects underwent cycling training three times a week for 8 weeks with either room air, 40% oxygen or heliox (60%/40%).…”

Section: Helioxmentioning

confidence: 99%

New tools in pulmonary rehabilitation

Wijkstra¹,

Wempe²

2011

Eur Respir J

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In patients with more severe chronic obstructive pulmonary disease (COPD), the benefits of rehabilitation might not be clear and, therefore, new treatment options have been developed to increase the benefits of rehabilitation. This review provides an overview of new approaches being developed as an addition to exercise training. In turn, the benefits of adding ventilatory support, oxygen, anabolics or neuromuscular stimulation to a rehabilitation programme will be discussed. While positive benefits for a number of these approaches have been found, many questions remain unsolved. Therefore, at present, we cannot recommend these new tools as part of the routine management of patients with COPD who start a rehabilitation programme.KEYWORDS: Anabolics, neuromuscular stimulation, oxygen, rehabilitation, ventilatory support C urrent literature has shown that pulmonary rehabilitation is effective in patients with chronic obstructive pulmonary disease (COPD) by improving dyspnoea, exercise tolerance and quality of life [1][2][3]. However, in patients with more severe COPD the benefits of rehabilitation might be less; therefore, new treatment options have been developed to increase rehabilitation results. In this review, we will provide an overview of the new approaches to pulmonary rehabilitation that are an addition to exercise training. VENTILATORY SUPPORT DURING EXERCISE OR EXERCISE TRAININGAdvanced COPD is generally characterised by severe airflow limitation, which is frequently associated with hyperinflation. This will especially worsen during exercise when the absence of any flow reserve requires the subject to breath at a higher lung volume to adjust to the increased ventilatory requirements. The work of breathing will be increased, primarily to overcome the intrinsic positive end-expiratory pressures. As during exercise, the increased ventilatory requirements are difficult to sustain, new approaches are needed to assist patients with the mechanical output during exercise. During recent decades, a number of studies have investigated this topic by applying different types of ventilator support during exercise. In 1990, PETROF et al.[4] demonstrated that continuous positive airway pressure (CPAP) reduced inspiratory muscle effort, as indicated by the pressure-time integral of transdiaphragmatic and oesophageal pressure. In addition, they found that dyspnoea improved with CPAP in five out of the eight patients and that the amelioration of dyspnoea was directly related to reductions in the pressure-time integral of the oesophageal pressure. O'DONNELL et al. [5] showed that by applying 4-5 cmH 2 O of CPAP to patients with COPD (mean forced expiratory volume in 1 s (FEV1) 1.2 L), less breathlessness was experienced during steady-state submaximal exercise. In addition, they showed that similar levels of CPAP administered to patients with even more severe COPD (mean FEV1 0.9 L) improved the patient's endurance capacity during constant power cycle exercise by 48% [6]. A study comparing inspiratory pressure suppo...

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Does a Low-Density Gas Mixture or Oxygen Supplementation Improve Exercise Training in COPD?

Cited by 45 publications

References 30 publications

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

The Story of Oxygen

New tools in pulmonary rehabilitation

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