The Effects of Controlled Breathing during Pulmonary Rehabilitation in Patients with COPD

Gestel, Arnoldus J.R. van; Kohler, Malcolm; Steier, Joerg; Teschler, Sebastian; Russi, Erich W.; Teschler, Helmut

doi:10.1159/000324449

Cited by 21 publications

(29 citation statements)

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“…Although the trials were of a small size, the heterogeneity was low (I 2 = 0%). Van Gestal et al 208 reported no difference in the CRQ at 4 weeks' follow-up (0.17, 95% CI -0.09 to 0.43 points) ( Figure 34; see also Figure 31). …”

Section: Breathing Techniquesmentioning

confidence: 94%

“…In the trials that provided data on the gender of the participants, males tended to be in the majority. Thirty-four trials 66,67,69,70,74,111,112,118,127,133,136,142,144,[151][152][153]168,185,192,195,199,[201][202][203][204][205]209,210,212,214,218,238,264,[270][271][272] did not report the FEV 1 % pred but reported the proportions within severity groups. Of the trials that did provide these data, the mean FEV 1 % pred of the trial participants ranged from 26.3% to 69.0%.…”

Section: Population Characteristicsmentioning

confidence: 99%

“…For individual components, the CRQ 'dyspnoea' and 'mastery components had the highest proportions of reported significant improvements (26.4% and 25.8%, respectively). 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 Length of intervention (weeks) 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 Leung 2010 165 Normandin 2002 208 Behnke 2000 64 Behnke 2000 64 Berry 2010 110 Berry 2010 110 Berry 2010 110 Mador 2009 197 Nguyen 2008 128 Nguyen 2008 (76) (100) 20/20 (100 …”

Section: All Trialsmentioning

confidence: 99%

See 2 more Smart Citations

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

Jordan

Majothi

Heneghan

et al. 2015

Health Technology Assessment

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BackgroundSelf-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective.ObjectivesTo undertake (1) a systematic review of the evidence for the effectiveness of SM interventions commencing within 6 weeks of hospital discharge for an exacerbation for COPD (review 1); (2) a systematic review of the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions (review 2); (3) a systematic review of the cost-effectiveness of SM support interventions within 6 weeks of hospital discharge for an exacerbation of COPD (review 3); (4) a cost-effectiveness analysis and economic model of post-exacerbation SM support compared with usual care (UC) (economic model); and (5) a wider systematic review of the evidence of the effectiveness of SM support, including interventions (such as pulmonary rehabilitation) in which there are significant components of SM, to identify which components are the most important in reducing exacerbations, hospital admissions/readmissions and improving quality of life (review 4).MethodsThe following electronic databases were searched from inception to May 2012: MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Science Citation Index [Institute of Scientific Information (ISI)]. Subject-specific databases were also searched: PEDro physiotherapy evidence database, PsycINFO and the Cochrane Airways Group Register of Trials. Ongoing studies were sourced through themetaRegister of Current Controlled Trials, International Standard Randomised Controlled Trial Number database, World Health Organization International Clinical Trials Registry Platform Portal and ClinicalTrials.gov. Specialist abstract and conference proceedings were sourced through ISI’s Conference Proceedings Citation Index and British Library’s Electronic Table of Contents (Zetoc). Hand-searching through European Respiratory Society, the American Thoracic Society and British Thoracic Society conference proceedings from 2010 to 2012 was also undertaken, and selected websites were also examined. Title, abstracts and full texts of potentially relevant studies were scanned by two independent reviewers. Primary studies were included if ≈90% of the population had COPD, the majority were of at least moderate severity and reported on any intervention that included a SM component or package. Accepted study designs and outcomes differed between the reviews. Risk of bias for randomised controlled trials (RCTs) was assessed using the Cochrane tool. Random-effects meta-analysis was used to combine studies where appropriate. A Markov model, taking a 30-year time horizon, compared a SM intervention immediately following a hospital admission for an acute exacerbation with UC. Incremental costs and quality-adjusted life-years were calculated, with sensitivity analyses.ResultsFrom 13,355 abstracts, 10 RCTs were included for review 1, one study each for reviews 2 and 3, and 174 RCTs for review 4. Available studies were heterogeneous and many were of poor quality. Meta-analysis identified no evidence of benefit of post-discharge SM support on admissions [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.52 to 1.17], mortality (HR 1.07, 95% CI 0.74 to 1.54) and most other health outcomes. A modest improvement in health-related quality of life (HRQoL) was identified but this was possibly biased due to high loss to follow-up. The economic model was speculative due to uncertainty in impact on readmissions. Compared with UC, post-discharge SM support (delivered within 6 weeks of discharge) was more costly and resulted in better outcomes (£683 cost difference and 0.0831 QALY gain). Studies assessing the effect of individual components were few but only exercise significantly improved HRQoL (3-month St George’s Respiratory Questionnaire 4.87, 95% CI 3.96 to 5.79). Multicomponent interventions produced an improved HRQoL compared with UC (mean difference 6.50, 95% CI 3.62 to 9.39, at 3 months). Results were consistent with a potential reduction in admissions. Interventions with more enhanced care from health-care professionals improved HRQoL and reduced admissions at 1-year follow-up. Interventions that included supervised or unsupervised structured exercise resulted in significant and clinically important improvements in HRQoL up to 6 months.LimitationsThis review was based on a comprehensive search strategy that should have identified most of the relevant studies. The main limitations result from the heterogeneity of studies available and widespread problems with their design and reporting.ConclusionsThere was little evidence of benefit of providing SM support to patients shortly after discharge from hospital, although effects observed were consistent with possible improvement in HRQoL and reduction in hospital admissions. It was not easy to tease out the most effective components of SM support packages, although interventions containing exercise seemed the most effective. Future work should include qualitative studies to explore barriers and facilitators to SM post exacerbation and novel approaches to affect behaviour change, tailored to the individual and their circumstances. Any new trials should be properly designed and conducted, with special attention to reducing loss to follow-up. Individual participant data meta-analysis may help to identify the most effective components of SM interventions.Study registrationThis study is registered as PROSPERO CRD42011001588.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Breathing Techniquesmentioning

confidence: 94%

Section: Population Characteristicsmentioning

confidence: 99%

Section: All Trialsmentioning

confidence: 99%

See 1 more Smart Citation

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

Jordan

Majothi

Heneghan

et al. 2015

Health Technology Assessment

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“…Five studies of low 26 and high 1,2,8,45 methodological quality reported the relationship between autonomic function and physical activity, physical fitness, and exercise capacity in subjects with COPD. Camillo et al 1 concluded that total daily energy expenditure, daily energy expenditure in activities requiring Ͼ3 metabolic equivalents, number of steps/d, and time spent daily in activities demanding Ͼ3 metabolic equivalents significantly affected SDNN (0.36 Ͻ r Ͻ 0.60, P Ͻ .05).…”

Section: Pulmonary Function and Respiratory Parametersmentioning

confidence: 99%

“…1 Patients with COPD have features that encompass several body systems, such as inflammation of the airways, cachexia or obesity, structural and functional changes in respiratory and peripheral muscles, arrhythmias, fatigue, dyspnea, poor quality of life (QOL), reduced exercise capacity, depression, anxiety, and sleep disturbances. [1][2][3][4][5][6][7][8] More recently, COPD has been reported to adversely affect the autonomic nervous system. 2,5,6 Consequently, autonomic function in patients with COPD has received a considerable amount of attention in the literature.…”

Section: Introductionmentioning

confidence: 99%

Evidence for Autonomic Function and Its Influencing Factors in Subjects With COPD: A Systematic Review

et al. 2015

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SummaryCardiovascular autonomic neuropathy is one of the factors implicated in the high morbidity and mortality rate in patients with COPD. Thus, several studies and nonsystematic reviews have increasingly reported autonomic function impairment in these subjects. For a better understanding, this systematic review was performed to evaluate not only the evidence for autonomic function impairment, but also factors influencing it. The results of the studies reviewed showed a strong level of evidence to support the impairment of heart rate variability in the time domain. A similar evidence level was also found to support impairment in baroreceptor sensitivity and muscle sympathetic nerve activity. Furthermore, this review identified physical activity level, muscle function, and circadian rhythm as the major influencing factors (strong evidence) of autonomic function in subjects with COPD. However, no definite conclusion could be reached for factors such as dyspnea, anxiety, body composition, pulmonary function, age, breathing frequency, ventilatory effort, quality of life, and disease severity due to limited, conflicting, or lack of existing evidence. The results of this review highlight relevant clinical messages for clinicians and other health-care providers regarding the role autonomic function can play as an important physiological marker for prognostication and stratification. Hence, autonomic function outcomes should be identified and considered during management of patients with COPD. Moreover, this review can serve as basis for future research aimed at assessing the interventions for autonomic function abnormalities in these patients.

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Breathing exercises for chronic obstructive pulmonary disease

Holland

Hill

Jones

et al. 2012

Cochrane Database of Systematic Reviews

132

113

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The Effects of Controlled Breathing during Pulmonary Rehabilitation in Patients with COPD

Cited by 21 publications

References 100 publications

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis

Evidence for Autonomic Function and Its Influencing Factors in Subjects With COPD: A Systematic Review

Breathing exercises for chronic obstructive pulmonary disease

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