Safety of Rehabilitation Program for COPD Patients

Pleguezuelos, Eulogio; Guirao, Lluís; Moreno, Eva; Samitier, Beatriz; Ortega, Pilar; Vila, Xavier Sánchez; Majo, M.C.; González, Marı́a Victoria; Ovejero, Laura; Juanola, Jordi; Gómez, Alba; Miravitlles, Marc

doi:10.1016/j.arbres.2017.06.012

Cited by 14 publications

(5 citation statements)

References 6 publications

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“…Although it also appears to be able to ameliorate some of these outcomes in other chronic respiratory diseases, more studies are needed (241,242). When physical activity is insufficient for obtaining positive results, training programs should be recommended (243). These are able to improve cardiovascular and muscle function, increasing exercise capacity and reducing anxiety and depression symptoms (11,(244)(245)(246)(247)(248)(249)(250).…”

Section: Appropriate Level Of Physical Activity and Trainingmentioning

confidence: 99%

Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations

Gea¹,

Sancho-Muñoz²,

Chalela³

2018

J. Thorac. Dis.

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Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.

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Section: Appropriate Level Of Physical Activity and Trainingmentioning

confidence: 99%

Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations

Gea¹,

Sancho-Muñoz²,

Chalela³

2018

J. Thorac. Dis.

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“…The mean number of minutes walked per day was 83 (38), with a mean of 7,305 (3,900) steps per day. The median number of steps/day of the whole group was 6,503 (interquartile range [IQR] 4,825-10,163).…”

Section: Population Characteristicsmentioning

confidence: 99%

“…Patients who feared getting hurt or worsening their health while performing PA had low levels of activity. Health professionals must increase the confidence in PA of patients with COPD by ensuring them that under medical supervision PA is safe and they should not be afraid of experiencing increased dyspnea [25,38].…”

Section: Physical Environmentmentioning

confidence: 99%

Motivation and Confidence about Physical Activity in Chronic Obstructive Pulmonary Disease Patients: Health Benefits Matter to Patients

Aljama,

Granados,

Ramon

et al. 2024

Respiration

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Introduction: Physical activity (PA) has shown great benefits in patients with chronic obstructive pulmonary disease (COPD), however, their PA is below average. Motivational factors associated with PA in COPD have not been widely studied and could be a target for improving adherence to PA. The objective of our study was to identify and understand the different motivational and confidence factors related to low levels of PA in a COPD cohort. Method: Observational, prospective, multicentre study of COPD patients. Sociodemographic data, respiratory symptoms, comorbidities, spirometry and exercise capacity were collected. PA was measured using the Dynaport accelerometer and patient motivation and confidence in PA were assessed by a questionnaire previously used in a COPD population in the United States. Results: Eighty-six COPD patients were included, 68.6% being male, with a mean (SD) age of 66.6 (8.5) years and a mean forced expiratory volume in the first second (%) of 50.9% (17.3%). The mean walking time was 82.8 (37.8) minutes/day. Questions related to health benefits and enjoying exercise were ranked highest in the motivation questionnaire and statistically significant differences were found in PA measures between patients with low and high motivation. A lack of confidence regarding hot weather and health-related issues significantly influenced PA levels. Advice from third parties, including healthcare providers, was not associated with higher PA levels. Conclusions: Improving the health of COPD patients is their main motivation to perform PA. Lack of confidence when it is hot or when they fear for their health is related to low levels of PA. Advice from third parties, including healthcare professionals, is not associated with higher PA. These results are relevant for developing strategies to increase the adherence of COPD patients to PA programmes.

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“…5 However, respiratory rehabilitation has been shown to yield relevant clinical benefits to patients with a good efficacy/safety profile. [51][52][53][54][55][56] These findings have led clinicians to debate whether a step-up to a second LABD or the implementation of a respiratory rehabilitation program would be the best strategy for a patient with persistent symptoms despite receiving one LABD. Even considering the limitations of pulmonary rehabilitation in practice, ie the availability of resources, the percentage of responders and the long-term effect achieved, 57,58 evaluating the impact of exercise programs would probably help advance individualized therapy at the patient level better than double bronchodilation.…”

Section: Question 1: Should We Always Escalate?mentioning

confidence: 99%

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Lόpez-Campos¹,

Hernández²,

Ruiz-Duque³

et al. 2021

COPD

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Recent advances in inhaled drugs and a clearer definition of the disease have made the task of managing COPD more complex. Different proposals have been put forward which combine all the available treatments and the different clinical presentations in an effort to select the best therapeutic options for each clinical context. As COPD is a chronic progressive disease, the escalation of therapy has traditionally been considered the most natural way to tackle it. However, the notion of COPD as a constantly progressing disease has recently been challenged and, in specific areas, this points to the possibility of a deescalation in treatment. In this context, the clinician requires simple, specific recommendations to guide these changes in treatment in their daily clinical practice. To accomplish this, the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the patient's condition. Thereafter, the first escalation in therapy must be introduced with caution as the disease progresses, since clinical trials are not designed with clinical decision-making in mind. During this escalation, three possibilities are open to change the current treatment for a different one within the same family, to increase non-pharmacological interventions or to increase the pharmacological therapies. Beyond that point, a patient with persistent symptoms represents a complex clinical scenario which requires a specialized approach, including the evaluation of different respiratory and non-respiratory comorbidities. Unfortunately, there are few de-escalation studies available, and these are mainly observational in nature. The debate on de-escalation in pharmacological treatment, therefore, involves two main discussion points: the withdrawal of bronchodilators and the withdrawal of inhaled steroids. Altogether, the scheme for modifying treatment must be more personalized than just adding molecules, and the therapeutic response and its conditioning factors should be evaluated at each step before proceeding further.

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Safety of Rehabilitation Program for COPD Patients

Cited by 14 publications

References 6 publications

Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations

Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations

Motivation and Confidence about Physical Activity in Chronic Obstructive Pulmonary Disease Patients: Health Benefits Matter to Patients

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

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