慢性阻塞性肺病患者呼吸形态异常和呼吸锻炼

浅促呼吸和胸腹矛盾呼吸运动在慢性阻塞性肺病（慢阻肺）患者通气衰竭和换气衰竭病理生理中起重要作用。改善呼吸形态是慢阻肺冶疗和康复的途径。呼吸锻炼包括深慢呼吸、腹式呼吸、缩唇呼气和负荷呼吸锻炼等。近年文献表明，这些方法能提高呼吸效率，协调胸腹呼吸运动，减少气道陷闭，改善通气和换气功能。呼吸形态异常的原因及其对机体的影响气道阻力是慢阻肺患者呼吸肌负他的决定因素。吸气肌在吸气过程中必须维持一定的张力。吸气压力时间指数（PTI）是一项反映吸气肌耐力的综合指标；P’TI一wrca山／＊IPXl／Dot，公式中平静吸气压…     

我国基层医疗卫生机构慢性阻塞性肺疾病呼吸康复的实施现状及展望

当前中国慢性阻塞性肺疾病（简称慢阻肺）患者数量庞大,给国家及患者的家庭带来了沉重的经济负担。呼吸康复是有效的慢阻肺管理策略,与药物治疗相比,具有显著的成本-效益优势,但目前在中国尚未得到普遍开展。基层医疗卫生机构是慢阻肺管理的重要关卡之一,但当前中国基层医疗卫生机构慢阻肺规范化管理基础薄弱,呼吸康复作为慢阻肺最具有成本...     

重视慢性阻塞性肺疾病康复的研究

自ATS于1974年首次提出呼吸康复的概念以来,呼吸康复治疗的有效性已得到大量临床试验结果的证实.呼吸康复能改善COPD患者的呼吸困难症状,提高健康相关生命质量,减少住院次数及住院时间[1].呼吸康复对于严重呼吸损害的患者在药物治疗的同时起到了积极的辅助作用.呼吸康复这一治疗策略的应用已成为COPD患者完整治疗中不可或缺的一部分.     

肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用研究

目的 分析探讨肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用效果.方法 选择2018年1月至2020年3月间收治的80例慢阻肺稳定期患者,随机分为常规治疗组和肺呼吸康复治疗组.常规治疗组予以常规治疗,肺呼吸康复治疗组在常规治疗基础上,采用呼吸训练器进行吸气和呼气训练.观察比较两组患者出院随访4周后的肺功能、生活质量...     

现代肺康复常用方法

呼吸康复也称为肺康复,在慢性呼吸系统疾病尤其是慢性阻塞性肺疾病( 慢阻肺) 方面的作用已引起国外研 究者广泛的关注和认同,而目前中国对肺康复认识还存在不足和滞后情况。文章综述了近年来国内外肺康复常用方 法,介绍了目前肺康复在慢阻肺患者中实施的方案和常见问题,旨在提高医生对肺康复应用认识,促进肺康复发展。     

术前肺康复治疗中重度阻塞性肺功能障碍患者肺功能变化研究

<正>肺康复可以减轻慢性阻塞性肺疾病(慢阻肺)患者的呼吸困难症状,提高呼吸耐力,改善生活质量,提高患者的社会适应能力~([1])。然而,在重度和极重度慢阻肺患者中,肺康复的收益较少,大约40%的患者达不到推荐的运动数量和(或)质量。因此,需要探索新的方法来提高肺康复在中重度肺功能障碍患者中的效果~([2]),我国肺康复尚处于起步阶段,日常治疗偏重于药物,制定高效、高依从性肺康复方案迫在眉睫~([3])。肺功能作为术前风险评估的重要手段     

简易呼吸训练器在AECOPD康复治疗中的疗效观察

目的观察简易呼吸训练器在慢性阻塞性肺疾病(简称慢阻肺)急性加重期呼吸康复治疗中的疗效,探讨其在呼吸康复治疗中的可行性。方法选取2018年1月-2018年12月在福建医科大学附属协和医院呼吸科门诊及住院的慢阻肺急性加重期患者60例,分为治疗组和对照组。治疗组在镇咳、祛痰、抗感染、支气管扩张剂、糖皮质激素、吸入剂、雾化、氧疗等常规治疗的前提下给予简易呼吸训练器进行呼吸功能锻炼,两组的治疗前后评估第一秒用力呼气流量(FEV₁%)、6分钟步行试验(6MWT)、CAT评分(COPD assessment test)和改良英国MRC呼吸困难指数(mMRC评分)。结果治疗后两组患者6MWT、CAT及mMRC评分指标均较治疗前有改善(P<0.05),治疗后治疗组6MWT、CAT评分的改善程度优于同期对照组水平(P<0.05)。治疗后两组患者FEV 1%值与治疗前相比,差异无统计学意义(P>0.05),与同期对照组组间比较无统计学意义(P>0.05)。患者对呼吸锻炼的满意度评分为90.45±7.08分。结论采用简易呼吸训练器对慢阻肺急性加重期患者进行呼吸功能锻炼是安全有效、满意度高,适用于临床推广、应用。     

无创通气在慢性阻塞性肺疾病肺康复中的应用

慢性阻塞性肺疾病( 慢阻肺) 是常见病、多发病,在中国的发病率持续升高;因其致残率高,给全社会增加了 巨大的负担。如何能够提高慢阻肺患者的生活质量,延长生存期,是亟待解决的问题。对慢阻肺患者的肺康复治疗 值得关注与尝试。无创正压通气正逐步在慢阻肺患者的肺康复中得到应用,并获得肯定疗效。但呼吸病学界对无 创正压通气的作用还有不同的认知。无创正压通气在肺康复中的地位还有待提高。文章从慢阻肺肺康复治疗和无 创正压通气在肺康复中的作用两个方面做一综述。     

茚达特罗与噻托溴铵对强迫振荡技术测定慢阻肺患者呼吸力学参数的影响对比

目的评估并比较茚达特罗和噻托溴铵单药治疗对慢性阻塞性疾病(简称"慢阻肺")患者气流限制和呼吸阻抗的影响。方法选取2014年3月至2015年1月于我院诊断为慢阻肺患者78例(平均年龄为72.4岁,平均FEV1预计值为61.6%),随机分为两组,每组各39例,分别接受茚达特罗或噻托溴铵治疗。在药物治疗开始及治疗8周后,对患者进行肺功能测试、慢阻肺评估测试(CAT)和多频强迫振荡技术测试。在全呼吸、吸气和呼气阶段测定5 Hz和20 Hz振动频率时的粘性阻力(R_5和R-20),5 Hz时电抗(X——5)和共振频率(Fres)及低频电抗面积(ALX)。结果茚达特罗与噻托溴铵均可改善慢阻肺患者的气流受限情况,平均FEV1值分别提高170 m L和90 m L。患者接受茚达特罗药物治疗后CAT得分由11.2±4.3降为7.5±2.3,治疗前后具有显著性差异(P0.001)。与噻托溴铵相比,茚达特罗可明显改善患者的FEV1值,FEV1百分比预计值及CAT得分(P分别为0.042,0.008和0.027)。对于呼吸阻抗,两种药物在全呼吸、吸气和呼气阶段都可改变患者的R_5、X_5、Fres及ALX值。茚达特罗组R_5、R_5-R_20、X_5、Fres及ALX值的变化与FEV1变化显著相关。结论茚达特罗可显著改善慢阻肺患者的气流受限情况和症状。对于呼吸阻抗,茚达特罗和噻托溴铵两种支气管扩张药物改善强迫振荡技术参数的程度相似,均可用于慢阻肺患者的临床治疗。     

缩唇呼吸对于慢性阻塞性肺疾病康复的研究进展

缩唇呼吸是慢性阻塞性肺病（COPD）康复的重要方法之一。它可以改善患者气喘及呼吸困难症状,减小呼气末肺容积,改善肺功能及提高血氧,并且有利于缓解呼吸肌疲劳。但是目前对于缩唇呼吸方法学,以及缩唇呼吸对于呼吸生理的影响还需要深入研究。     

Improvement of physical activity in chronic obstructive pulmonary disease by pulmonary rehabilitation and pharmacological treatment

Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients.This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.     

Rehabilitation in chronic respiratory diseases: In‐hospital and post‐exacerbation pulmonary rehabilitation

Exacerbations of chronic obstructive pulmonary disease (COPD) that require hospitalization are important events for patients. Functional impairment and skeletal muscle dysfunction can increase the risk of hospitalization and readmission, independent of lung function. In addition, once a patient is admitted, multiple factors can lead to worsening outcome including immobility, systemic inflammation and nutritional depletion. These non‐pulmonary factors are potentially amenable to exercise therapy, as part of pulmonary rehabilitation (PR). Peri‐exacerbation PR has an important role in the management of exacerbations of COPD. In this review, we explore how functional limitation and skeletal muscle dysfunction affect patients having a severe exacerbation of COPD, the systemic impact of hospitalization on patients including potential aetiologies and the role of PR around the time of an exacerbation. This includes rehabilitation during the inpatient phase, post‐exacerbation rehabilitation and rehabilitation bridging hospital discharge. We also describe potential future developments in peri‐exacerbation PR.     

Effect of a 2-year pulmonary rehabilitation on the 7-year prognosis in patients with advanced chronic obstructive pulmonary disease

Pulmonary rehabilitation (PR) improve the quality of life in COPD patients, however, little has been known whether it may improve the survival. We assessed 7-year prognosis in 46 patients with advanced COPD, 27 of which completed successfully 2-year course of PR whereas 19 COPD patients made a control (C) group. At the end of 7-year observation 41.3% of total number of patients survived, among them 12 (42.8%) PR patients and 7 (38%) C patients. COPD progression was the main (80%) reason of mortality in both groups. The survivors had better results of baseline FVC, FEV1 and treadmill exercise test. They did not differ from non-survivors with age, baseline results of the weight, PaO2, PaCO2 and the number of PR patients. The Cox proportional hazard analysis showed that neither of baseline parameters influenced significantly the 7-year prognosis in this group of COPD patients. In conclusion, PR failed to improve 7-year prognosis in the studied group of patients with advanced COPD.     

Developing the model of pulmonary rehabilitation for chronic heart failure

Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional symptoms of breathlessness and fatigue. The similar systemic manifestations of the conditions, including skeletal muscle dysfunction, are a major contributing factor to the limitation in exercise capacity. A period of exercise training has been shown to improve exercise performance and health-related quality of life for both conditions. Exercise training is a key component of pulmonary rehabilitation (PR) which is now a standard of care for patients with COPD and is symptom based. Although it may be assumed that patients with CHF could be incorporated into cardiac rehabilitation, this is predominantly a secondary prevention programme for patients who are largely asymptomatic. It has been shown that patients with CHF can be successfully trained together with patients with COPD by the same therapists within PR. There are comparable outcome measures that can be used for both COPD and CHF. Many patients with CHF still do not have access to an exercise rehabilitation programme and incorporating them into the PR model of care could be one solution. This article reviews the (1) similar symptoms, mechanisms and consequences between COPD and CHF, (2) rationale and evidence for exercise training in CHF, (3) model of PR, (4) safety of exercise training in CHF, (5) evidence for combined exercise rehabilitation for CHF and COPD, (6) adaptations necessary to include patients with CHF into PR, (7) the chronic care model and (8) summary.     

Effect of pulmonary rehabilitation on quality of life in patients with COPD: the use of SF-36 summary scores as outcomes measures

PURPOSE: Pulmonary rehabilitation (PR) is an accepted therapy for patients with chronic obstructive pulmonary disease (COPD), improving both exercise capacity and quality of life (QOL). Generic measures of QOL have been criticized as being insensitive to detecting the improvement in QOL after PR in contrast to disease-specific instruments. The authors looked at the Medical Outcomes Survey Short Form 36-item questionnaire (SF-36), a generic QOL measure, to detect changes in QOL in COPD patients after completion of PR. METHODS: Patients with COPD who participated in a PR program completed the QOL questionnaire before and after completion of PR. Exercise tolerance was assessed by the 6-minute walking test. Quality of life was assessed by the SF-36; the authors calculated its eight dimensions as well as mental (MCS) and physical (PCS) component summary scores. RESULTS: The patients realized a significant improvement in exercise tolerance; 6-minute walking test distance increased from 470 +/- 104 m (mean +/- standard deviation) to 536 +/- 133 m (P = 0.0006) after PR. Quality of life also improved in nearly all dimensions and in both summary scores; PCS improved from 26.1 +/- 8.0 before PR to 30.5 +/- 9.0 after PR (P = 0.008) and MCS improved from 27.9 +/- 7.0 before PR to 34.1 +/- 5.0 after PR (P = 0.0002). CONCLUSION: The SF-36 and its summary scores are sensitive instruments to detect improvement in QOL in COPD patients after PR.     

Chronic obstructive pulmonary disease stage and 6-minute walk outcome

PURPOSE: Although physicians generally reserve pulmonary rehabilitation (PR) referral for patients in later stages of chronic obstructive pulmonary disease (COPD), there is no evidence to suggest that PR programs are more effective for these persons than for those in earlier stages of the disease. This study examined the relationship between 6-minute walk change and COPD stage in patients completing PR. METHODS: The sample consisted of 76 patients who enrolled in the University of Alabama at Birmingham's Cardiopulmonary Rehabilitation Program with a primary diagnosis of COPD between January 1996 and June 2000. Data was collected on 6-minute walk upon entry into the program and upon program completion. Patients were stratified according to COPD stage using the American Thoracic Society staging system. RESULTS: There were significant differences among the three stages with regard to initial and ending 6-minute walk distances such that persons in later stages of the disease have shorter initial and ending 6-minute walk distances. However, all three stages show significant improvements in the 6-minute walk after PR. There were no significant differences in the median change among groups indicating that the median change was not better (or worse) for patients in any particular COPD stage. CONCLUSIONS: This study suggests that PR is equally effective in increasing physical performance for all patients regardless of COPD stage. This type of information can be used to support the recommendation of PR for patients early in the disease process.     

Improvements in exercise capacity during a 4-weeks pulmonary rehabilitation program for COPD patients do not correspond with improvements in self-reported health status or quality of life

Ninety-two patients with moderate or severe chronic obstructive pulmonary disease (COPD) were assessed for walking tolerance, lung function, perceived health status (HS), perceived quality of life (QoL) and anxiety before and after a four weeks inpatient pulmonary rehabilitation (PR) program. There were significant improvements on all outcomes except anxiety, although the effect sizes were small or moderate. The largest improvement was observed on the walking test, but patients also improved on perceived health status (HS) and perceived quality of life (QoL). Relations between outcome indicators were analyzed cross-sectionally and longitudinally. Cross-sectional correlations were in line with earlier studies. However, improvements on the walking test were generally unrelated to changes in lung function, HS and QoL. Different patients improve on different outcome measures following PR, and this could have implications for the planning and designs of PR programs.     

Current best practice in pulmonary rehabilitation for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a chronic condition that negatively affects several patient-centered outcomes. Among these, exercise capacity, dyspnea, and quality of life are the most relevant. In this article, factors contributing to exercise limitation, increase in exercise-induced dyspnea, quality of life deterioration, and other pathophysiological aspects in patients with COPD are analyzed in detail. Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. PR has been clearly shown to induce favorable and long-lasting effects on all patient-centered outcomes. In addition, PR appears to have positive (even if not conclusively demonstrated) effects on other important outcomes in patients with COPD: number and severity of exacerbations, healthcare resource utilization, and survival. The organization of PR treatment, its components, outcome assessment, and future directions are discussed in light of the most robust scientific evidence.     

Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease

PURPOSE: To determine whether there is any difference in the effect of pulmonary rehabilitation (PR) on outcomes in patients with and without chronic obstructive pulmonary disease (COPD). METHODS: Retrospective analysis of medical records of all patients enrolling in PR over a 5-year period. RESULTS: A total of 422 patients enrolled in a multidisciplinary PR program from August 1999 to April 2004. Three hundred nine patients had COPD and 113 patients had diagnoses other than COPD. Three hundred seventy-nine patients completed the program. PR was conducted according to currently accepted guidelines. Measurements included the 6-minute walk distance (6MW) performed at the beginning and end of the program and quality of life as determined by the Chronic Respiratory Questionnaire (CRQ) at the beginning and end of the program. Both groups had significant improvements in the 6MW and all domains of the CRQ following PR. There was no significant difference in any of these outcomes between the 2 groups. The baseline forced expiratory volume in 1 second (FEV1) was not correlated with improvement in the 6MW in either group. CONCLUSIONS: There is no significant difference in improvement in exercise tolerance or quality of life following PR in COPD versus non-COPD patients. Baseline lung function does not predict improvement in exercise tolerance. PR is effective for patients with disability due to any chronic respiratory disease and not just COPD.     

Occupational therapy and pulmonary rehabilitation of disabled COPD patients

BACKGROUND: Occupational therapy (OT) has been defined as a task of rehabilitation for disabled patients, giving them maximal function and independence to sustain specific activities of daily living. OBJECTIVES: To evaluate the effectiveness of OT as an adjunctive measuring during pulmonary rehabilitation (PR) of hospitalized COPD patients. METHODS: A prospective clinical trial with parallel groups was undertaken in severely disabled COPD patients (n = 71, age 73 +/- 5 years). They were assigned to either OT+PR (n = 47, FEV1 46 +/- 21%pred.) or PR (n = 24, FEV1 44 +/- 12%pred.). PR consisted of eighteen 3-hour daily sessions, whilst OT (domestic activities) was added 3 times a week up to nine 1-hour sessions. Six-min walk (6MWD) with evaluation of BORG dyspnea (D) and leg fatigue (F) scores at end of effort, breathlessness sensation (B) by means of the MRC scale as well as the number of functions lost in the Basic Activity of Daily Living (BADL) categories were assessed as outcomes before (T0) and after (T1) rehabilitation. RESULTS: 6MWD (from 165 +/- 63 to 233 +/- 66 and from 187 +/- 52 to 234 +/- 65 m in the OT+PR and PR groups, respectively), D (from 4.9 +/- 2.1 to 3.2 +/- 1.6 and from 5.3 +/- 2.1 to 3.4 +/- 2.1), F (from 6.1 +/- 0.5 to 4.5 +/- 1.7 and from 5.9 +/- 0.8 to 4.3 +/- 0.8) and B (from 4.3 +/- 0.9 to 3.0 +/- 0.9 and from 4.2 +/- 1.0 to 3.2 +/- 0.8) had similarly improved (p < 0.01) in both groups at T1. The percentage distribution of patients across the BADL categories significantly changed (p = 0.004) in OT+PR (from 17 to 61%, from 70 to 34% and from 23 to 5% in categories A, B and C, respectively) but not in the PR group. CONCLUSIONS: The addition of OT to comprehensive PR is able to specifically improve the outcome of severely disabled COPD inpatients.