肺康复对稳定期慢性阻塞性肺疾病的疗效分析

目的探讨肺康复锻炼对稳定期慢性阻塞性肺疾病患者的临床疗效及意义。方法 300例稳定期慢阻肺患者,采用前瞻性随机对照法分为两组:康复组(n=149)给予门诊慢阻肺健康宣教,包括饮食干预,戒烟教育,用药指导;肺康复锻炼(呼吸运动训练联合步行运动训练)。对照组(n=151)仅给予门诊慢阻肺健康宣教。比较6个月后两组患者的血气分析、肺功能、6MWD(6分钟步行距离)及慢阻肺急性加重期住院的次数等。结果 6个月后共234例完成试验,康复组(n=121)较对照组(n=113)的6MWD,血气分析等指标有明显改善,具有统计学意义(P0.05),而两组间肺功能FEV_1/FVC、FEV_1%和慢阻肺急性加重期住院的次数无统计差异(P0.05)。结论肺康复锻炼(呼吸运动训练联合步行运动训练)能有效提高PaO_2及降低PaCO_2,提高6MWD,适度改善运动耐力,是一种简便易行的康复锻炼方法,值得临床应用及推广。     

Effect of upper extremity exercise in people with COPD

Background

Exercise for people with COPD has focused on leg training, such as walking and cycling. The role and effectiveness of arm training has not been investigated in detail. This review was undertaken to examine the literature for the effectiveness of upper extremity exercise on arm exercise capacity and arm strength in people with COPD.

Methods

Trials relating to arm endurance and strength training in COPD were located by searching electronic databases and screening the reference lists of pertinent articles. Where possible, effect sizes and 95% CI were determined and meta-analysis used.

Results

The search strategy yielded 24 articles. Unsupported arm training improved arm endurance capacity (standard mean difference [SMD] =1.25; 95% CI=0.16 to 2.66) and was the optimal mode of arm endurance training. Combined unsupported and supported arm training was also found to have a large positive effect on peak arm exercise capacity (SMD=1.27; 95% CI=0.59 to 1.94). In addition arm strength training produced moderate improvements in arm strength (SMD=0.46; 95% CI=0.10 to 0.81).

Conclusion

This review suggests that in the short term, arm endurance training improves arm exercise capacity and arm strength training improves arm strength. Further research is required, in people with COPD, to investigate the long-term effects of arm training.     

Creatine supplementation for patients with COPD receiving pulmonary rehabilitation: A systematic review and meta‐analysis

Background and objective: Creatine improves muscle strength in exercising healthy individuals, and in patients with neuromuscular disease and heart failure. The aim of this study was to assess whether creatine supplementation improves pulmonary rehabilitation (PR) outcomes in patients with COPD. Methods: A systematic review and meta‐analysis was performed of randomized controlled trials published between January 1966 and February 2009 that evaluated the effect of creatine compared with placebo on exercise capacity, muscle strength and health‐related quality of life (HR‐QoL) in patients undergoing PR for COPD. The pooled estimates were expressed as mean differences (MD) or standardized mean differences (SMD). Results: Four randomized controlled trials that included 151 patients were identified. There was no effect of creatine supplementation on exercise capacity (SMD ?0.01, 95% CI: ?0.42 to 0.22, n = 151). Creatine supplementation did not improve lower extremity muscle strength (SMD 0.03, 95% CI: ?0.55 to 0.61, n = 140) or upper limb muscular strength (SMD 0.02, 95% CI: ?0.33 to 0.38, n = 128) compared with placebo. Two studies (n = 48) assessed quality of life using the St. George's Respiratory Disease Questionnaire. There were no differences in HR‐QoL according to domain or total scores. Overall, creatine appeared to be safe and was well tolerated. Quality assessment of the studies showed important limitations. Conclusions: Creatine supplementation does not improve exercise capacity, muscle strength or HR‐QoL in patients with COPD receiving PR. However, important limitations were identified in the quality of the available evidence, suggesting that further research is required in this area.     

Improvement in self-reported exercise participation with the combination of tiotropium and rehabilitative exercise training in COPD patients

Background

Improvements in ventilatory mechanics with tiotropium increases exercise tolerance during pulmonary rehabilitation. We wondered whether tiotropium also increased physical activities outside of pulmonary rehabilitation.

Methods

COPD patients participating in 8 weeks of pulmonary rehabilitation were studied in a randomized, double-blind, placebo-controlled trial of tiotropium 18 μg daily (tiotropium = 47, placebo = 44). Study drug was administered for 5 weeks prior to, 8 weeks during, and 12 weeks following pulmonary rehabilitation. Patients completed a questionnaire documenting participation in pre-defined activities outside of pulmonary rehabilitation during the 2 weeks prior to each visit. Patients who submitted an activity questionnaire at week 4 and on at least one subsequent visit were included in the analysis. For each patient, the number of sessions was multiplied with the duration of each activity and then summed to give overall activity duration.

Results

Patients (n = 46) had mean age of 67 years, mean baseline FEV₁ of 0.84 L (33% predicted). Mean (SE) increase in duration of activities (minutes during 2 weeks prior to each visit) from week 4 (prior to PR) to week 13 (end of PR) was 145 (84) minutes with tiotropium and 66 (96) minutes with placebo. The increase from week 4 to week 25 (end of follow-up) was 262 (96) and 60 (93) minutes for the respective groups. Increases in activity duration from week 4 to weeks 17, 21, and 25 were statistically significant with tiotropium. No statistical differences over time were observed within the placebo-treated group and differences between groups were not significant.

Conclusions

Tiotropium appears to amplify the effectiveness of pulmonary rehabilitation as seen by increases in patient self-reported participation in physical activities.     

Osteoporosis in COPD patients: Risk factors and pulmonary rehabilitation

ObjectivesTo present a review on the pathogenesis, risk factor and treatment of chronic obstructive pulmonary disease complicated with osteoporosis and provide new ideas for the diagnosis and treatment.Data sourceA systematic search is carried out using keywords as chronic obstructive pulmonary disease, osteoporosis, risk factors, and pulmonary rehabilitation.ResultsPatients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis and a high risk of fracture. The mechanisms of osteoporosis in COPD patients are associated with general risk factors, such as smoking, reduced physical activity, low weight, and disease‐specific risk factors, such as systemic inflammatory, Vitamin D deficiency, use of glucocorticoid, anemia, hypoxemia, and hypercapnia. The treatment of osteoporosis in COPD emphasizes comprehensive intervention, which mainly include basic treatment and anti‐osteoporosis drugs. Noticeably, pulmonary rehabilitation program is an important part of treatment.ConclusionsThis work summarizes the pathogenesis, risk factor, prevention, and treatment of chronic obstructive pulmonary disease complicated with osteoporosis, and the latest progress of studies on chronic obstructive pulmonary disease and osteoporosis is discussed.     

慢性阻塞性肺疾病合并抑郁症患者心肺运动试验研究

目的观察稳定期慢性阻塞性肺疾病(简称慢阻肺)合并抑郁症患者心肺运动试验(CPET)各参数变化,研究抑郁症对慢性阻塞性肺疾病的影响。方法入选了稳定期慢阻肺患者85例,根据Zung抑郁自评量表(SDS)分成抑郁组和对照组,并分别进行CPET。结果 (1)合并抑郁症患者共26例,占慢阻肺总人数30.6%。(2)与非抑郁组相比,抑郁组具有相似水平的肺功能损害,但表现出更加明显的呼吸困难(P0.05)。(3)共4例患者未能完成试验,完成试验的患者结果显示抑郁组在峰值摄氧量(VO2peak)、无氧阈占预估峰值摄氧量百分比(AT%pred)低于非抑郁组、而二氧化碳通气当量斜率(VE/VCO2 slope)高于非抑郁组,差异有统计学意义(P0.05)。结论超过30%的稳定期慢阻肺患者合并存在抑郁症,且其对患者通气功能和运动能力产生负面影响。     

Rehabilitation effects of land and water-based aerobic exercise on lung function,dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background:We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review''s purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs.Methods:Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000–December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331).Results:Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61–465.75).Conclusion:Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.     

慢性阻塞性肺疾病肺康复相关进展与运动心肺功能的应用

慢性阻塞性肺疾病患者,特别是老年患者.运动耐力下降是其主要症状之一,不但严重影响了患者的生活质量,同时带来了沉重的社会家庭经济负担,随着人口老龄化的加深,这一问题愈显突出.很多国外研究已证明肺康复是改善慢性阻塞性肺疾病患者运动耐力的有效手段,且具有良好成本效益.同时越来越多的研究已将运动心肺功能作为其评估技术,并将其广泛运用到日常的诊疗活动中.目前国内对这方面的研究和应用还相对较少.本文将着重就肺康复及这一运动耐力评估方法作一综述.     

深吸气量与稳定期慢性阻塞性肺病患者运动耐力的相关性研究

目的探讨深吸气量（IC）与稳定期慢性阻塞性肺病患者（COPD）运动耐力的相关性。方法对人选的30例稳定期COPD患者,每日吸入噻托溴胺粉雾剂18ug,连续观察12周。于第1、43、85天检查呼吸困难的评分,6分钟行走距离（6MWD）,一秒钟用力呼气量（FEV1）,用力肺活量（FVC）,深吸气量（IC）等指标,比较用药前后各变量变化的统计学意义及肺功能各变量与6MWD的相关性。结果用药后FEV1和FEV1／FVC均有所改善,其中FEV1的改善要好于FEV1／FVC改善,但与用药前比较,均无显著差异（P〉0．05）;用药后6周、12周IC较用药前比较有显著增加（t=4．596、5．405,P均〈0．01）,6MWD用药后6周、12周较用药前有显著提高（t=4．628、6．207,P均〈0．01）;用药后6周、12周呼吸困难评分的下降较用药前比较有显著差异（z=4．433、4．026,P均〈0．001）;回归分析显示IC的变化与6MWD的变化均有较好的相关性（r=0．900、0．873,P均〈0．01）。结论本研究的结果提示比较其他肺功能指标,伦的改变与呼吸困难和运动耐力的改变有更好地相关性,IC的测定有助于COPD患者治疗效果及生活质量的预测。     

Pulmonary rehabilitation improves exercise capacity and quality of life in underweight patients with chronic obstructive pulmonary disease

Background and objective: An estimated 20–40% of COPD patients are underweight. We sought to confirm the physiological and psychosocial benefits of pulmonary rehabilitation programmes (PRP) in underweight compared with non‐underweight patients with COPD. Methods: Twenty‐two underweight COPD patients with BMI <20 kg/m², and 22 non‐underweight COPD patients, who were matched for FEV₁ and age, were studied. All patients had moderate‐to‐very severe COPD. All patients participated in 12‐week, hospital‐based outpatient PRP consisting of two sessions per week. Baseline and post‐PRP status were evaluated by spirometry, cardiopulmonary exercise testing, ventilatory muscle strength and the St. George's Respiratory Questionnaire (SGRQ). Results: At baseline, the age distribution and airflow obstruction were similar in underweight and non‐underweight patients with COPD. Baseline exercise capacity, inspiratory muscle strength and SGRQ total and symptoms scores were significantly lower in the underweight patients (all P < 0.05). After the PRP, there was significant weight gain in the underweight COPD patients (mean increase 0.8 kg, P = 0.01). There were also significant improvements in peak oxygen uptake, peak workload and the SGRQ total, symptoms, activity and impact scores in both underweight and non‐underweight patients with COPD (all P < 0.05). Conclusions: Underweight patients with COPD have impaired exercise capacity and health‐related quality of life (HRQL). Exercise training with supplemental oxygen may result in significant weight gains and improvements in exercise capacity and HRQL. Exercise training is indicated for underweight patients with COPD.     

Efficacy and safety of nitrate supplementation on exercise tolerance in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background:Exercise intolerance was prevalent in people with chronic obstructive pulmonary disease (COPD) and had a detrimental effect on the quality of life. We aimed to evaluate the efficacy and safety of nitrate supplementation in exercise tolerance of people with COPD.Methods:We searched medical databases including Cochrane Library, EMBASE, and PubMed from inception to October 2020 for randomized control trials in treating COPD with nitrate supplementation.Results:Nine trials were identified. Compared with placebo, nitrate supplementation has no significant effect on the following variables: exercise endurance time (standard mean difference [SMD]: 0.06; 95% confidence interval [CI]: –0.39 to 0.52; P = .79), exercise capacity (SMD: 0.30; 95% CI: –0.21 to 0.80; P = .25), oxygen consumption (SMD: –0.04; 95% CI: –0.33 to 0.25; P = .80), resting systolic blood pressure (MD: –2.84; 95% CI: –8.46 to 2.78; P = .32), systolic blood pressure after exercise (MD: –4.66; 95% CI –15.66 to 6.34; P = .41), resting diastolic blood pressure (MD: 0.89; 95% CI: –4.41 to 6.19; P = .74), diastolic blood pressure after exercise (MD: –0.21; 95% CI: –5.51 to 5.10; P = .94), heart rate (MD: –2.52; 95% CI: –7.76 to 2.73; P = .35), and arterial oxygen saturation (MD: –0.44; 95% CI: –2.38 to 1.49; P = .65). No severe adverse effects from nitrate supplementation were reported in the included trails.Conclusion:Current evidence suggests that nitrate supplementation may be safe but ineffective for improving exercise tolerance in people with COPD.     

慢性阻塞性肺疾病肺康复相关进展与运动心肺功能的应用

慢性阻塞性肺疾病患者,特别是老年患者.运动耐力下降是其主要症状之一,不但严重影响了患者的生活质量,同时带来了沉重的社会家庭经济负担,随着人口老龄化的加深,这一问题愈显突出.很多国外研究已证明肺康复是改善慢性阻塞性肺疾病患者运动耐力的有效手段,且具有良好成本效益.同时越来越多的研究已将运动心肺功能作为其评估技术,并将其广泛运用到日常的诊疗活动中.目前国内对这方面的研究和应用还相对较少.本文将着重就肺康复及这一运动耐力评估方法作一综述.