Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection

Abstract

Objective: To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. Methods: This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). Results: All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis ( n = 6), pneumonia ( n = 1), respiratory failure ( n = 1), and pulmonary embolism ( n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor ( p = 0.001). Conclusions: Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

“…Early in-hospital pulmonary rehabilitation should be considered as a minimum of clinical stability is achieved. Prolonged physical activities in home-based settings after patients discharge would be potentially beneficial [114][115][116][117][118]. Finally, despite optimized medical treatment, some patients with end-stage COVID-19 pneumonia progress to irreversible loss of lung function [119].…”

Usefulness of Pulmonary Rehabilitation in Non-Small Cell Lung Cancer Patients Based on Pulmonary Function Tests and Muscle Analysis Using Computed Tomography Images

“…Pulmonary rehabilitation is useful for patients with NSCLC who are scheduled to undergo lung surgery because it can help preserve lung function and the respiratory muscles. Rehabilitation reduces postoperative complications [ 24 ] and enables the performance of lung surgery in patients with poor lung function [ 11 ]. Rehabilitation, whether performed only before surgery, only after surgery, or both before and after surgery, is helpful to patients [ 10 ].…”

“…Rehabilitation reduces postoperative complications [24] and enables the performance of lung surgery in patients with poor lung function [11]. Rehabilitation, whether performed only before surgery, only after surgery, or both before and after surgery, is helpful to patients [10].…”

Implications of the Adiponectin System in Non-Small Cell Lung Cancer Patients: A Case-Control Study

“…Evidence from studies of thiazolidinediones, fenofibrate, renin-angiotensin inhibitors, and mineralocorticoid receptor blockers have documented positive correlations with adiponectin serum level expression. In addition, as adipokines homeostasis appears to be modulated by physical training and pulmonary rehabilitation, this should also be explored in NSCLC cohorts [15,26,[46][47][48][49]. The down-regulation of T-cadherin in lung cancer tissues has been reported to be associated with an up-regulation of T-cadherin in the vasculature that could partially determine a reduction in Acrp30 production by the local infiltrating adipose tissue; this decrease of local Acrp30 in turn determines AdipoR1 up-regulation.…”

“…Evidence from studies of thiazolidinediones, fenofibrate, renin-angiotensin inhibitors, and mineralocorticoid receptor blockers have documented positive correlations with adiponectin serum level expression. In addition, as adipokines homeostasis appears to be modulated by physical training and pulmonary rehabilitation, this should also be explored in NSCLC cohorts [ 15 , 26 , 46 , 47 , 48 , 49 ].…”