Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

Lin-Yu Liao, Kuei-Min Chen, Wei-Sheng Chung, Jung-Yien Chien, Lin-Yu Liao, Kuei-Min Chen, Wei-Sheng Chung, Jung-Yien Chien

Abstract

Clinical trials identifier: NCT02329873.

Background: Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed.

Objective: To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD.

Methods: A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10-30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day.

Results: All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05). Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth day (all P<0.05).

Conclusion: Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.

Keywords: COPD; exercise; older adults; respiratory diseases; severe early onset.

Figures

Figure 1
Figure 1
Flowchart of the Participants’ Selection Process of the Study.

References

    1. Jurado Gámez B, Feu Collado N, Jurado García JC, et al. Home intervention and predictor variables for rehospitalization in chronic obstructive pulmonary disease exacerbations. Arch Bronconeumol. 2013;49(1):10–14.
    1. Johnson MK, Stevenson RD. Management of an acute exacerbation of copd: are we ignoring the evidence? Thorax. 2002;57(suppl 2):II15–II23.
    1. MacIntyre N, Huang YC. Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):530–535.
    1. Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000;117(5 suppl 2):398S–401S.
    1. Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J. 2003;41:46s–53s.
    1. Carr SJ, Goldstein RS, Brooks D. Acute exacerbations of COPD in subjects completing pulmonary rehabilitation. Chest. 2007;132(1):127–134.
    1. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–365.
    1. Spruit MA, Gosselink R, Troosters T, et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003;58(9):752–756.
    1. Vermeeren MA, Schols AM, Wouters EF. Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD. Eur Respir J. 1997;10(10):2264–2269.
    1. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006;129(3):536–544.
    1. Garcia-Aymerich J, Farrero E, Félez MA, et al. Estudi del Factors de Risc d’Agudització de la MPOC Investigators Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax. 2003;58(2):100–105.
    1. Clini E, Venturelli E, Crisafulli E. Rehabilitation in COPD patients admitted for exacerbation. Pneumonol Alergol Pol. 2011;79(2):116–120.
    1. Greening NJ, Williams JE, Hussain SF, et al. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ. 2014;349:g4315.
    1. Puhan MA, Spaar A, Frey M, et al. Early versus late pulmonary rehabilitation in chronic obstructive pulmonary disease patients with acute exacerbations: a randomized trial. Respiration. 2012;83(6):499–506.
    1. Singh SJ, ZuWallack RL, Garvey C, American Thoracic Society/European Respiratory Society Task Force on Pulmonary Rehabilitation Learn from the past and create the future: the 2013 ATS/ERS statement on pulmonary rehabilitation. Eur Respir J. 2013;42:1169–1174.
    1. Costi S, Di Bari M, Pillastrini P, et al. Short-term efficacy of upper-extremity exercise training in patients with chronic airway obstruction: a systematic review. Phys Ther. 2009;89(5):443–455.
    1. Janaudis-Ferreira T, Hill K, Goldstein R, Wadell K, Brooks D. Arm exercise training in patients with chronic obstructive pulmonary disease: a systematic review. J Cardiopulm Rehabil. 2009;29(5):277–283.
    1. Enright SJ, Unnithan VB, Heward C, Withnall L, Davies DH. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Phys Ther. 2006;86(3):345–354.
    1. Fernandes M, Cukier A, Feltrim MI. Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2011;8(4):237–244.
    1. Hill K, Patman S, Brooks D. Effect of airway clearance techniques in patients experiencing an acute exacerbation of chronic obstructive pulmonary disease: a systematic review. Chron Respir Dis. 2010;7(1):9–17.
    1. Kodric M, Garuti G, Colomban M, et al. The effectiveness of a bronchial drainage technique (ELTGOL) in COPD exacerbations. Respirology. 2009;14(3):424–428.
    1. Seymour JM, Moore L, Jolley CJ, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65(5):423–428.
    1. Ko FW, Dai DL, Ngai J, et al. Effect of early pulmonary rehabilitation on health care utilization and health status in patients hospitalized with acute exacerbations of COPD. Respirology. 2011;16(4):617–624.
    1. Chow JS, Leung AS, Li WW, Tse TP, Sy HY, Leung TF. Airway inflammatory and spirometric measurements in obese children. Hong Kong Med J. 2009;15:346–352.
    1. Borg G. Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health. 1990;16(1):55–58.
    1. Skinner JS, Hutsler R, Bergsteinova V, Buskirk ER. The validity and reliability of a rating scale of perceived exertion. Med Sci Sports. 1973;5(2):94–96.
    1. Mutalithas K, Watkin G, Willig B, Wardlaw A, Pavord ID, Birring SS. Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis. Respir Med. 2008;102(8):1140–1144.
    1. Enright PL. The six-minute walk test. Respir Care. 2003;48:783–785.
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories American Thoracic Society statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111.
    1. Clini EM, Crisafulli E, Costi S, et al. Effects of early inpatient rehabilitation after acute exacerbation of COPD. Respir Med. 2009;103(10):1526–1531.
    1. Lareau SC, Yawn BP. Improving adherence with inhaler therapy in COPD. Int J Chron Obstruct Pulmon Dis. 2010;5:401–406.
    1. Nishimura K, Yasui M, Nishimura T, Oga T. Clinical pathway for acute exacerbations of chronic obstructive pulmonary disease: method development and five years of experience. Int J Chron Obstruct Pulmon Dis. 2011;6:365–372.
    1. Sridhar M, Taylor R, Dawson S, Roberts NJ, Partridge MR. A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2008;63(3):194–200.

Source: PubMed

3
S'abonner