Pulmonary rehabilitation ameliorates regional lung function in chronic obstructive pulmonary disease: a prospective single-arm clinical trial

Ma, Haiman; Dai, Meng; Wu, Shuo; Zhao, Zhanqi; Zhang, Yan; Zhang, Feng; Yang, Lin; Ti, Xinyu; Qu, Shuoyao

doi:10.21037/atm-22-3597

Cited by 6 publications

(5 citation statements)

References 33 publications

(52 reference statements)

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“…1 , 37 REAL included the two most common breathing exercises that have been shown to reduce breathing frequency, improving chest wall tidal volume and exercise capacity in patients with COPD. 31 , 37 , 38 We also found low levels of vaccination, with only 2.7–7.3% receiving influenza vaccination at each visit over the 12-month follow-up period. This was consistent with a 2022 cross-sectional study (1.7–10.9%) that recruited patients with COPD from eight hospitals across different tiers in China (tertiary, secondary or community hospitals).…”

Section: Discussionmentioning

confidence: 69%

“…1 Others have previously reported the benefits of nonpharmacological management, such as smoking intervention, pulmonary rehabilitation, breathing exercises and education programmes in reducing symptoms and mortality, as well as improving lung function and health-related quality of life in patients with COPD. 29 – 36 In this study, COPD education was provided to almost all patients, but optimal self-management behaviour was evident in a much smaller proportion. Moreover, COPD knowledge was poor.…”

Section: Discussionmentioning

confidence: 80%

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Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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Background: Underdiagnosis and undertreatment pose major barriers to optimal management of chronic obstructive pulmonary disease (COPD) in China. Objective: The REAL trial was performed to generate reliable information on real-world COPD management, outcomes and risk factors among Chinese patients. Here, we present study outcomes related to COPD management. Design: It is a 52-week, prospective, observational, multicentre study. Methods: Outpatients (aged ⩾40 years) enrolled from 50 secondary and tertiary hospitals across six geographic regions of China were followed up for 12 months, with two onsite visits and by telephone every 3 months following baseline. Results: Between June 2017 and January 2019, 5013 patients were enrolled and 4978 included in the analysis. Mean [standard deviation (SD)] age was 66.2 (8.9) years, the majority of patients were male (79.5%) and mean (SD) time since COPD diagnosis was 3.8 (6.2) years. The most common treatments at each study visit were inhaled corticosteroids/long-acting beta-agonists (ICSs/LABAs; 28.3–36.0%), long-acting muscarinic antagonists (LAMAs; 13.0–16.2%) and ICS/LABA + LAMA (17.5–18.7%), but up to 15.8% of patients at each visit received neither ICS nor long-acting bronchodilators. The use of ICS/LABA, LAMA and ICS/LABA + LAMA differed across regions and hospital tiers; up to fivefold, more patients received neither ICS nor long-acting bronchodilators in secondary (17.3–25.4%) versus tertiary hospitals (5.0–5.3%). Overall, rates of nonpharmacological management were low. Direct treatment costs increased with disease severity, but the proportion of direct treatment costs incurred due to maintenance treatment decreased with disease severity. Conclusion: ICS/LABA, LAMA and ICS/LABA + LAMA were the most frequently prescribed maintenance treatments for patients with stable COPD in China, although their use differed between region and hospital tier. There is a clear need for improved COPD management across China, particularly in secondary hospitals. Registration: The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362; https://clinicaltrials.gov/ct2/show/NCT03131362 ). Plain language summary Treatment patterns in patients with COPD in China Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and irreversible airflow limitation. In China, many patients with this disease do not receive a diagnosis or appropriate treatment. Objective: This study aimed to generate reliable information on the treatment patterns among patients with COPD in China to help inform future management strategies. Study design and methods: Patients (aged ⩾40 years) were enrolled from 50 hospitals across 6 regions of China and physicians collected data over the course of 1 year during routine outpatient visits. Results: The majority of patients were receiving long-acting inhaled treatments, which are recommended to prevent worsening of the disease. Up to 16% of patients in this study, however, did not receive any of these recommended treatments. The proportion of patients who received long-acting inhaled treatments differed across regions and hospital tiers; there were about five times more patients in secondary hospitals (about 25%) who did not receive these treatments compared with those in tertiary hospitals (about 5%). Guidelines recommend that pharmacological treatment should be complemented by nondrug treatment, but this was only received by a minority of patients in this study. Patients with higher disease severity incurred greater direct treatment costs compared with those with milder disease. Maintenance treatment costs made up a smaller proportion of overall direct costs for patients with higher disease severity (60–76%) compared with patients with milder disease (81–94%). Conclusion: Long-acting inhaled treatments were the most frequently prescribed maintenance treatments among patients with COPD in China, but their use differed between region and hospital tier. There is a clear need to improve disease management across China, especially in secondary hospitals.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 80%

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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“…Ideally, a longer follow-up period to depict the ventilation distribution change after surgery might help to better understand the influence of partial lung resection and recovery. EIT applications in respiratory rehabilitation have been proposed recently (Longhini et al 2020, Ma et al 2022. Further studies may include individualized rehabilitation programs to the subjects and evaluate the efficacy.…”

Section: Discussionmentioning

confidence: 99%

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

Xiao,

Yang,

Dai

et al. 2024

Physiol. Meas.

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Objective:The aim of the present study was to evaluate the influence of one-sided pulmonary nodule and tumour on ventilation distribution pre- and post- partial lung resection.Methods:A total of 40 consecutive patients scheduled for laparoscopic lung parenchymal resection were included. Ventilation distribution was measured with electrical impedance tomography (EIT) in supine and surgery lateral positions 72 hours before surgery (T1) and 48 hours after extubation (T2). Left lung to global ventilation ratio (Fl), the global inhomogeneity index (GI), standard deviation of regional ventilation delay (RVDSD) and pendelluft amplitude (Apendelluft) were calculated to assess the spatial and temporal ventilation distribution.Results:After surgery (T2), ventilation at the operated chest sides generally deteriorated compared to T1 as expected. For right-side resection, the differences were significant at both supine and left lateral positions (p<0.001). RVD was in general more heterogeneous. For left-side resection, RVDSD was worse at T2 compared to T1 at left lateral position (p=0.002). The other EIT-based parameters showed no significant differences between the two time points. No significant differences were observed between supine and lateral positions for the same time points respectively.

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“…However, EIT is gradually starting to be applied also in patients with chronic lung diseases who are typically examined by EIT in the sitting position while breathing spontaneously or performing specific ventilatory manoeuvres (Zhao et al 2013, Frerichs et al 2016, Vogt et al 2019, Lasarow et al 2021, Ma et al 2022. In these subjects, the breathing pattern is far less uniform than in ventilated patients and the EIT electrode plane is perpendicular to the gravity vector.…”

Section: Introductionmentioning

confidence: 99%

Distribution of regional lung function in upright healthy subjects determined by electrical impedance tomography in two chest examination planes

Frerichs,

Vogt,

Deuss

et al. 2024

Physiol. Meas.

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Objective.The variation in pulmonary gas content induced by ventilation is not uniformly distributed in the lungs. The aim of our study was to characterize the differences in spatial distribution of ventilation in two transverse sections of the chest using electrical impedance tomography (EIT).Approach.Twenty adult never-smokers, 10 women and 10 men (mean age ± SD, 31 ± 9 years), were examined in a sitting position with the EIT electrodes placed consecutively in a caudal (6th intercostal space) and a cranial (4th intercostal space) chest location. EIT data were acquired during quiet breathing, slow and forced full expiration manoeuvres. Impedance variations representing tidal volume (VT), vital capacity (VC), forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were calculated at the level of individual image pixels and their spatial distribution was determined using the following EIT measures: the centres of ventilation in ventrodorsal (CoVvd) and right-to-left direction (CoVrl), the dorsal and right fractions of ventilation, the coefficient of variation (CV) and the global inhomogeneity (GI) index.Main results.The sums of pixel ventilation-related impedance variations reproduced reliably the volumetric dissimilarities among VT, VC, FEV1 and FVC, with no significant differences noted between the two examination planes. Significant differences in ventilation distribution were found between the planes during tidal breathing and slow full expiration, mainly regarding the ventrodorsal direction, with higher values of CoVvd and dorsal fraction of ventilation in the caudal plane (p<0.01). No significant differences in the spatial distribution of FEV1 and FVC were detected between the examination planes. Significance. The spatial distribution of ventilation differed between the two examination planes only during the relaxed (quiet breathing and slow VC manoeuvre) but not during the forced ventilation. This effect is attributable to the differences in thoracoabdominal mechanics between these types of ventilation.

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Pulmonary rehabilitation ameliorates regional lung function in chronic obstructive pulmonary disease: a prospective single-arm clinical trial

Cited by 6 publications

References 33 publications

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

Distribution of regional lung function in upright healthy subjects determined by electrical impedance tomography in two chest examination planes

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