Effects of Pulmonary Rehabilitation on Exacerbation Rate, Hospitalizations, Length of Hospital Stay and Public Health Economics in Patients With Moderate-to-Severe Chronic Obstructive Pulmonary Disease

Kosmas, Epaminondas; Vey, Helen; Fraggou, Maria-Konstantina; Papaneofytou, Irene; Athanassa, Zoi; Koutsoukou, Antonia; Vogiatzis, Ioannis; Georgiadou, Olga; Koulouris, Νikolaos; Orfanidou, Dora; Roussos, Charis

doi:10.1378/chest.128.4_meetingabstracts.254s

Cited by 4 publications

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“…The sample size calculation for this RCT is based on the identification of a minimal relevant clinical difference in exacerbation frequency between the experimental and the control group. The difference in exacerbation rate is expected to be 22% (based on exacerbation rates found in previous studies with rehabilitation programmes) [ 37 , 38 ]. The probability that the study will detect a treatment difference is 80% at a two-sided 5% significance level.…”

Section: Methodsmentioning

confidence: 99%

Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial

Beekman

Mesters

Hendriks³

et al. 2014

BMC Pulm Med

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BackgroundPhysical exercise training aims at reducing disease-specific impairments and improving quality of life in patients with chronic obstructive pulmonary disease (COPD). COPD exacerbations in particular negatively impact COPD progression. Physical therapy intervention seems indicated to influence exacerbations and their consequences. However, information on the effect of physical therapy on exacerbation occurrence is scarce. This study aims to investigate the potential of a protocol-directed physical therapy programme as a means to prevent or postpone exacerbations, to shorten the duration or to decrease the severity of exacerbations in patients with COPD who have recently experienced an exacerbation. Besides, this study focuses on the effect of protocol-directed physical therapy on health status and quality of life and on cost-effectiveness and cost-utility in patients with COPD who have recently experienced an exacerbation.Methods/DesignA prospective cohort of 300 COPD patients in all GOLD stages will be constructed. Patients will receive usual multidisciplinary COPD care including guideline-directed physical therapy. Patients in this cohort who have GOLD stage 2 to 4 (post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80% of predicted), who receive reimbursement by health insurance companies for physical therapy (post-bronchodilator Tiffeneau-index < 0.6) and who experience a COPD exacerbation will be asked within 56 days to participate in a cohort-nested prospective randomised controlled trial (RCT). In this RCT, the intervention group will receive a strict physical therapy programme for patients with COPD. This protocol-directed physical therapy (pdPT) will be compared to a control group that will receive sham-treatment, meaning no or very low-intensity exercise training (ST). An economic evaluation will be embedded in the RCT. Anthropometric measurements, comorbidities, smoking, functional exercise capacity, peripheral muscle strength, physical activity level, health related quality of life, patients’ perceived benefit, physical therapy compliance, motivation level, level of effective mucus clearance, exacerbation symptoms and health care contacts due to COPD will be recorded. Follow-up measurements are scheduled at 3 and 6 weeks, 3, 6, 12 and 24 months after inclusion.DiscussionWays to minimise potential problems regarding the execution of this study will be discussed.Trial registrationThe Netherlands National Trial Register NTR1972.

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Section: Methodsmentioning

confidence: 99%

Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial

Beekman

Mesters

Hendriks³

et al. 2014

BMC Pulm Med

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“…Steroids may have an effect on the eosinophilic episodes, whereas long-acting β 2 -agonists and long-acting antimuscarinic agents may maintain airway patency, especially in episodes where bronchoconstriction would be a feature. Pulmonary rehabilitation has also been shown to have a benefit in preventing some episodes and to cause a significant reduction in frequency and duration of hospitalisations [52]. Influenza vaccination has been reported to be beneficial [53], but there is no data to support the use of pneumococcal vaccination, although this is recommended in the GOLD guidelines.…”

Section: Preventive Measuresmentioning

confidence: 99%

Causes and management of exacerbations of COPD

Vijayasaratha

Stockley

2007

Breathe

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Diagnosis of exacerbations of COPD is based largely on key symptoms (increasing sputum purulence and volume, and breathlessness) and the severity depends on the level of healthcare resource utilisation. Aetiology is varied, although infection is the major causative factor. Neutrophilic inflammation is a major pathological event, but eosinophils are also implicated, suggesting an "asthmatic" aetiology. Airflow limitation and dynamic hyperinflation are the physiological changes, which can result in deterioration in gas exchange and respiratory failure. Antibiotics are reserved for purulent exacerbations, with the exception of the presence of pneumonia and prophylaxis during ventilation. Steroids are recommended for all hospitalised patients and outpatients with a significant increase in breathlessness. Controlled oxygen therapy is central to management and is guided by arterial blood gas measurements. Noninvasive ventilation is the preferred management for patients with acidotic respiratory failure when the arterial pH is 7.25-7.35 despite the standard initial therapy. Prevention of exacerbations is aided by influenza vaccination and the institution of regular inhaled long-acting bronchodilators and inhaled corticosteroids.

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“…Έχει διαπιστωθεί πως οι συμμετέχοντες και πλήρως ενταγμένοι σε προγράμματα αποκατάστασης χρησιμοποιούν λελογισμένα τις υπηρεσίες υγείας με λιγότερες μέρες νοσηλείας και επισκέψεις στα επείγοντα, καθόσον έχουν γνώση και ελέγχουν συστηματικά την πορεία της νόσου τους. Η πρόληψη των παροξύνσεων και τέλος οι σαφώς λιγότερες χαμένες εργατο-ώρες με τη σειρά τους αποτελούν σημαντικό οικονομικό όφελος και μειώνουν συνολικά το κόστος σε πανελλήνιο (140) και διεθνές επίπεδο (141,142,140,144,145) .…”

Section: αποτελέσματα πνευμονικής αποκατάστασηςunclassified

Επίδραση Του Προγράμματος Της Πνευμονικής Αποκατάστασης Στον Περιορισμό Εκπνευστικής Ροής Κατά Τη Διάρκεια Της Άσκησης Και Στη Δυναμική Υπερδιάταση Σε Ασθενείς Με Χρόνια Αποφρακτική Πνευμονοπάθεια

Θεοδωρακοπούλου¹

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Υποθέσαμε ότι οι ασθενείς με σοβαρή ΧΑΠ, που παρουσιάζουν το φαινόμενο του περιορισμού της εκπνευστικής ροής μπορεί να ωφεληθούν μετά την εφαρμογή ενός προγράμματος Πνευμονικής Αποκατάστασης. Μελετήσαμε 42 ασθενείς με σταθερή ΧΑΠ στην ηρεμία και κατά τη διάρκεια της άσκησης. Ο περιορισμός της εκπνευστικής ροής και η δυναμική υπερδιάταση καταγράφηκαν χρησιμοποιώντας τη μέθοδο της αρνητικής εκπνευστικής πίεσης (NEP) και της μανούβρας της εισπνευστικής χωρητικότητας αντίστοιχα. Η ποιότητα ζωής των ασθενών εκτιμήθηκε με το ερωτηματολόγιο Saint George και η δύσπνοια με την κλίμακα MMRC. Πριν την αποκατάσταση 16 ασθενείς παρουσίασαν το φαινόμενο του περιορισμού της εκπνευστικής ροής στην ηρεμία ή/και στην άσκηση. Μετά την αποκατάσταση ο περιορισμός της εκπνευστικής ροής εξαλήφθηκε στους 15 εκ των 16 ασθενών, οι οποίοι παρουσίασαν και μια σημαντική αύξηση στις τιμές της εισπνευστικής χωρητικότητας. Αυτό κυρίως επιτεύχθηκε μέσω της μεταβολής του τύπου της αναπνοής. Στους 26 ασθενείς που δεν είχαν περιορισμό εκπνευστικής ροής δεν παρατηρήθηκε αύξηση στην εισπνευστική τους χωρητικότητα. Ωστόσο και οι δύο ομάδες των ασθενών μας – τόσο οι με περιορισμό εκπνευστικής ροής, όσο και οι χωρίς- βελτίωσαν την ικανότητα για άσκηση, την ποιότητα ζωής τους και το βαθμό της δύσπνοιας τους μετά το πέρας του προγράμματος της Πνευμονικής Αποκατάστασης.

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Effects of Pulmonary Rehabilitation on Exacerbation Rate, Hospitalizations, Length of Hospital Stay and Public Health Economics in Patients With Moderate-to-Severe Chronic Obstructive Pulmonary Disease

Cited by 4 publications

References 0 publications

Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial

Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial

Causes and management of exacerbations of COPD

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