Rehabilitation therapies in stable chronic obstructive pulmonary disease

Abstract

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease. The pulmonary rehabilitation (PR) is a mutidisciplinary and comprehensive intervention in symptomatic patients with COPD. Objective. This review aims to synthesize evidence from available studies on the relative efficacies of different methods of rehabilitation therapies in patients with stable COPD. Material and Methods. A search was performed on the databases Pubmed, Embase, ResearchGate. Of the 410 articles retrieved from databases, only 20 met the inclusion criteria. Two reviewers independently reviewed selected eligible studies. Results. Rehabilitation is a multidisciplinary intervention in symptomatic patients with COPD, including speleotherapy, halotherapy, muscular training, soft tissue manual therapy and neuromuscular electrostimulation. All of the case-control studies using speleotherapy reported improved respiratory function to varying degrees and there were improvements in lung functional tests including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), oxygen saturation, partial pressure of oxygen in arterial blood, and partial pressure of carbon dioxide in arterial blood. In addition, halotherapy has been associated with relief of respiratory conditions such as COPD, asthma and cystic fibrosis by its bactericidal effect, improvement of immunity and rheological properties of secretions. Respiratory muscle training is a part of rehabilitation for COPD subjects. In patients who can not perform physical activity, neuromuscular electrostimulation (NMES) increased 6 minute walking distance and time to symptom limitation exercising at a submaximal intensity and reduced the severity of leg fatigue on completion of exercise testing. Conclusion. The management of COPD should include a multidisciplinary therapy, including rehabilitation therapies as an adjuvant to the medical treatment, especially because due to the high prevalence, mortality, and morbidity, COPD will be one of the biggest public health challenges in the next century.

Therapeutic alternatives with CPAP in obstructive sleep apnea

“…The association between OSA and chronic obstructive pulmonary disease (COPD), known as "overlap syndrome" from the early studies (23), has a prevalence of 1.0 to 3.6% in the general population, 8-56% in OSA patients, and 3-66% in COPD patients (24). In COPD patients who have consulted clinicians for pulmonary rehabilitation, a severe form of OSA has been diagnosed in 45% of the cases, with these patients having poor sleep quality and hypoventilation episodes during sleep (17,25). Moreover, overlapping patients have higher rates of mortality compared to OSA patients, and in this direction there is a protective effect of CPAP treatment (26).…”

Non Cystic Fibrosis Bronchiectasis-new clinical approach, management of treatment and pulmonary rehabilitation

“…However, it is not recommended in routine use because of its side effects with the decline of FEV1, higher rate of exacerbations, increased use of antibiotics and a greater rate of hospitalisations (73). On the other hand, inhaled corticosteroids are recommended to be used in the treatment of bronchiectasis together with rehabilitation programmes where there is co-existing obstructive airways disease such as asthma, COPD or ABPA (74).The British Thoracic Society (BTS) bronchiectasis guidelines recommend a trial of bronchodilator therapy if shortness of breath affects the patient's activities of daily living. In these situations it is worthwhile to perform a trial of shortacting beta-agonist (SABA) or short-acting muscarinic-antagonist (SAMA) initially and if there is clinical benefit then proceed to a long-acting bronchodilator (75).…”

Cardiovascular surgery complication and the benefits of pulmonary rehabilitation in preventing COPD exacerbation

“…Pulmonary rehabilitation (PR) consists in a multidisciplinary and comprehensive non-pharmacological intervention that is designed to improve health status in COPD patients (3)(4)(5). PR has also been shown to improve the diaphragmatic mobility in patients with different conditions that affect the diaphragm (6)(7)(8). The aim of the paper is to describe the clinical and functional features of a COPD case associated with unilateral paralysis of the phrenic nerve and the role of PR as a major component of the case management.…”