三种肺康复方式联合干预老年COPD患者焦虑抑郁的效果

目的 观察肺康复干预对COPD患者焦虑抑郁及呼吸困难的改善.方法 对30例COPD患者进行为期8周的肺康复干预,比较康复前后患者焦虑、抑郁及呼吸困难症状的差异.结果 经过8周的肺康复干预, Hamilton Anxiety Scale评分:14.63±5.37与10.03±2.71相比较(P<0.001),Hamilton Depression Scale评分:14.40±4.01与10.2±2.25相比较(P<0.001),基础呼吸困难指数BDI: 3.933±2.52与5.133±2.32相比较(P<0.001).结论 三种肺康复方式联合干预可有效改善COPD合并焦虑抑郁状态以及呼吸困难症状.肺康复干预对COPD康复具有重要意义.     

The 6-min walking distance: long-term follow up in patients with COPD.

The 6-min walking distance (6MWD) test is used in clinical practice and research into patients with chronic obstructive pulmonary disease (COPD). However, little is known about natural long-term change in this parameter. The 6MWD was measured at baseline and then annually for 5 yrs in 294 patients with COPD and its annual rate of decline was determined. Forced expiratory volume in one second (FEV1) was also measured and the relationship between changes in both markers was explored. At baseline, the median 6MWD was 380 m (range 160-600 m). It declined by 19% (16 m.yr(-1)) over the 5 yrs compared with baseline in patients with American Thoracic Society/European Respiratory Society stage III COPD (FEV1 30-50% predicted) and by 26% (15 m.yr(-1)) in patients with stage IV COPD (FEV1 <30% pred). Over the 5-yr follow-up, the proportion of patients with a minimal clinically significant decline of 54 m increased with the severity of the disease. It was 24% in stage II, 45% in stage III, and 63% in stage IV disease. In contrast, the rate of decline of FEV1 was greater in patients with milder airflow obstruction and lesser in patients with lower absolute FEV1 values. In conclusion, the 6-min walking distance test provides increasingly useful information as the severity of chronic obstructive pulmonary disease increases.     

One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education

Objective . To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup. Methods . Twenty-nine (61.1%) of 47 original intervention program patients and 23 (51.1%) of 45 original control patients were interviewed by telephone at 1-year followup. Patients completed the Arthritis Impact Measurement Scales physical activity, arthritis impact, pain, medication use, and general health perceptions subscales, as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms. Results . Adherence to walking was low, and there were no statistically significant differences between intervention and control patients at one year. Conclusions . The failure of intervention patients to maintain regular walking resulted in loss of functional benefits that were observed at 8 weeks in the original study. Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes.     

Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy

STUDY OBJECTIVES: To analyze the influence of a hospital-based home-care program (HCP) on the management of patients with COPD receiving long-term oxygen therapy. DESIGN AND SETTING: Randomized, controlled study in a 1,000-bed university hospital. INTERVENTION: The HCP applied to patients in the intervention group (HCP group) consisted of a monthly telephone call, home visits every 3 months, and home or hospital visits on a demand basis. Patients in the control group were given conventional medical care. MEASUREMENTS: Pulmonary function data, gas exchange, use of hospital resources (emergency department visits, admissions, and hospital stay) and the cost of medical assistance were investigated in both groups before and after 1 year of study. Quality of life was analyzed using the chronic respiratory questionnaire in the first 40 consecutive patients included in the study. Survival throughout the study was also assessed. RESULTS: One hundred twenty-two patients were enrolled in the study, and 94 patients (46 in the HCP group and 48 in the control group) completed the 1-year follow-up period: 83 patients (88%) were men, and mean (+/- SD) age was 68 +/- 8 years. During the follow-up period, there was a highly significant decrease in the mean number of emergency department visits (0.45 +/- 0.83 vs 1.58 +/- 1.96; p = 0.0001) and also a significant decrease in hospital admissions (0.5 +/- 0.86 vs 1.29 +/- 1.7; p = 0.001) and days of hospital stay (7.43 +/- 15.6 vs 18.2 +/- 24.5; p = 0.01) in the HCP group. Patients in the intervention group required a total of 221 home visits (mean per patient, 4.8 +/- 0.8) and 69 hospital visits (mean per patient, 1.5 +/- 1.07). In spite of the cost of the program, cost analysis showed a total saving of 8.1 million pesetas ($46,823) in the HCP group, mainly due to a decrease in the use of hospital resources. There was no difference in pulmonary function, gas exchange, quality of life, and survival between the two groups. CONCLUSIONS: Hospital-based home care is an effective alternative to hospital admission. It reduces the use of hospital resources and the cost of health care.     

老年慢性阻塞性肺疾病的康复治疗

1993年,美国国家健康委员会的肺疾病专业委员会和刚成立的国家医学康复研究中心20名专家及10名特邀专家共同对肺疾病的康复问题进行了全面研讨,并对美国胸科学会1982年所作的肺康复定义进行了重新界定.     

Effects of 3-week Outpatient Pulmonary Rehabilitation on Exercise Capacity, Dyspnea, and Quality of Life in COPD

The effects of intensive 3-week outpatient pulmonary rehabilitation (PR) on exercise capacity, dyspnea, and health-related quality of life (HRQL) were investigated in patients with COPD. Two hundred ten patients with COPD (mean FEV₁ = 54%pred) underwent PR consisting of exercise training, patient and psychosocial education, breathing and relaxation therapy, nutrition counseling, and smoking cessation support. Before and after PR, exercise capacity was assessed with 6-min walking tests (6MWT) and constant cycle ergometer exercise (CEE). Dyspnea was measured after 6MWTs with a Borg scale and after PR with the Transition Dyspnoea Index (TDI). HRQL was examined with the Medical Outcomes Study Short Form 36 (SF-36). Results showed improvements in the 6MWT (+39 m, p < 0.001) and CEE (+241 W × min, p < 0.001) after PR, paralleled by decreased dyspnea during the 6MWT (−0.5, p < 0.001) and during activities (TDI score = 3.6). Increases in all SF-36 subscales reflected improved HRQL after PR (p < 0.001). No gender differences were found. Patients with milder versus more severe COPD improved similarly in most outcomes. Regression analyses revealed that TDI scores were the most important predictor of improvements in HRQL. The results suggest that intensive 3-week outpatient PR is associated with improvements in exercise capacity, dyspnea, and HRQL in male and female patients with COPD irrespective of COPD severity. Reduced dyspnea during activities contributed the most to improvements in HRQL.     

Effects of a walking aid in COPD patients receiving oxygen therapy

STUDY OBJECTIVES: To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister. DESIGN: Randomized crossover trial. SETTING: Physiopathology laboratory of three rehabilitation centers. PATIENTS AND INTERVENTIONS: We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality). MEASUREMENTS AND RESULTS: The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline. CONCLUSIONS: This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.     

Safety of cardiac rehabilitation in a medically supervised, community-based program

The time to occurrence of cardiovascular complications after the beginning of an exercise rehabilitation program is variable. It is not clear whether such complications are related to the duration in the program. The aim of the present study was to assess the timing of cardiovascular events occurring during the activity and the long-term safety of a medically supervised cardiac rehabilitation program performed in the community, in a large cohort. We retrospectively evaluated 3,511 patients with a history of myocardial infarction, coronary artery bypass grafting and risk factors for coronary artery disease, participating in exercise training, for 69 months. The total number of patient-hours was 338,688 with an event rate of 1/58,902 patient-hours/year (0.02%). Non-fatal events occurred in 11 patients and fatal cardiovascular events in 2 patients; 1 was successfully resuscitated. Most of the non-fatal events (62%) occurred during the first 4 weeks from the beginning of the exercise program. One third of the patients who experienced cardiovascular events, resumed the exercise program with no further complications. Medically supervised cardiac rehabilitation program is accompanied by a very low incidence of cardiovascular events. Nevertheless, special caution should be undertaken during the first sessions of the program.     

A randomised study of the effects of supplemental exercise sessions after a 7-week chronic obstructive pulmonary disease rehabilitation program

Background: Several studies have suggested that the effects of chronic obstructive pulmonary disease (COPD) rehabilitation programs tend to attenuate with time. We aimed to investigate the effects of supplemental exercise sessions following an initial 7‐week COPD rehabilitation program with regard to exercise capacity and disease‐specific quality of life (QoL). Methods: We performed a 7‐week COPD rehabilitation program in 140 COPD patients. Patients (n = 118) who completed the initial program were randomised for additional six supervised supplemental exercise sessions or three follow‐up examinations without exercise. Both groups were followed for 12 months. Primary end‐points were QoL as measured by the St. George's Respiratory Questionnaire total score and exercise capacity as measured by the endurance shuttle walking time (ESWT). Results: A marked increase in ESWT (from 193 to 921 s) and a moderate decrease in total SGRQ score (2.5 points) was obtained during the initial 7 weeks rehabilitation program. The ESWT declined moderately and was 645 s at week 52 in both the intervention and control group. Unexpectedly, QoL increased slightly in the control group, while it decreased slightly in the intervention group. However, there were no statistically significant differences between the groups in the observed changes in QoL or ESWT at any time point. Conclusions: In conclusion, a program of six supplemental exercise sessions following the initial 7‐week COPD rehabilitation program did not have any effect on ESWT or QoL during a 1‐year follow‐up. Please cite this paper as: Linneberg A, Rasmussen M, Buch TF, Wester A, Malm L, Fannikke G and Vest S. A randomised study of the effects of supplemental exercise sessions after a 7‐week chronic obstructive pulmonary disease rehabilitation program. Clin Respir J 2012; 6: 112–119.     

The effect of a 20-week endurance training program on adipose-tissue morphology and lipolysis in men and women

In order to assess the effect of endurance training on adipose-tissue morphology and lipolysis, 22 adult subjects (11 men and 11 women) took part in a 20-week ergocycle training program, four to five days a week, 40 minutes a day, at 80% of their maximal heart rate. Before and after training, they were submitted to an adipose-tissue biopsy in the suprailiac region. Fat cell weight (FCW), and lipolytic activity were determined on isolated fat cells. For the whole sample, training significantly reduced FCW (pre: 0.40 ± 0.13 (mean ± SD) versus post: 0.36 ± 0.13 μg; P < 0.05), percentage of fat (pre: 22.0 ± 8.3 versus post: 19.7 ± 8.1%; P < 0.05), and increased adipocyte epinephrine maximal stimulated lipolysis (ESL) (pre: 1.08 ± 0.49 versus post: 1.69 ± 0.67 μmol glycerol/30 min/10⁶ cells; P < 0.001). No changes were observed in fat cell number. In women, however, training induced no changes in the fatness indicators (% fat, sum of skinfolds, FCW). The exercise program significantly lowered the adiposity of men (% fat: P < 0.001; sum of skinfolds: P < 0.01; FCW: P < 0.05). In both sexes, a significant increase in ESL was observed after training. ESL of men, however, responded better than that of women to training (ESL of women: 1.36 ± 0.67 versus ESL of men: 2.02 ± 0.50 μmol glycerol/30 min/10⁶ cells; P < 0.05), with increases over pre-training values of 46% and 66% in women and men, respectively. These results demonstrate that training can influence adipose-tissue morphology and lipolysis and suggest that there is a sex difference in the sensitivity to training.     

Effects of long-term, self-monitored exercise on the serum lipoprotein and apolipoprotein profile in middle-aged men

To study the effects of long-term, self-monitored exercise on the serum lipid profile and body composition of middle-aged non-smoking males, a controlled study was conducted in 61 sedentary, middle-class Swiss men. Thirty-nine men were randomly allocated to jog 2 h/wk for 4 months on an individually prescribed, heart rate-controlled basis, whereas 22 men served as controls. Despite varying adherence to the exercise regimen, the following 4-month net changes (effect in exercise group minus effect in control group) in lipids were seen: HDL cholesterol (C) +0.12 mmol/l (95% CI 0.02, 0.22; P = 0.028), LDL-C +0.08 mmol/l (ns), VLDL-C -0.26 mmol/l (-0.45, -0.07; P = 0.009), total triglycerides (TT) -0.21 mmol/l (ns), HDL-C/total C +0.02 (0.001, 0.05; P = 0.047). The net changes in endurance capacity and resting heart rate in favour of exercisers were significant as well, whereas no significant changes in apolipoprotein levels were seen. Exploratory analyses revealed, for example, associations of the increase in total physical activity with an increase in the HDL-C/total C ratio (r = 0.46; P less than 0.001), and of the change in estimated body fat content with an opposed change in the HDL-C/total C ratio (r = -0.40; P less than 0.001), or an inverse relationship of the change in subcutaneous fat with a change in the HDL2-C level (r = -0.39; P less than 0.001). Multivariable regression analysis suggested that much of the effect of jogging on HDL-C was apparently mediated through a decrease in body fat content. A change in the waist/hip ratio was unrelated to lipoprotein changes but was related to the change of TT level (r = 0.22; P less than 0.05). This study confirms that individually prescribed, unsupervised jogging can increase HDL-C levels and improve the serum lipoprotein profile in self-selected nonsmoking males. Although the effect is modest, it may be relevant to preventive cardiology, given the evidence for a reduction in cardiovascular risk even after apparently small decreases in risk factor levels.     

Efficacy and Safety of a 12-week Treatment with Twice-daily Aclidinium Bromide in COPD Patients (ACCORD COPD I)

Abstract

Background: This Phase III study evaluated the efficacy and safety of twice-daily aclidinium 200 μg and 400 μg versus placebo in the treatment of moderate-to-severe COPD. Methods: In this 12-week, double-blind, multicenter trial, patients were randomized (1:1:1) to inhaled twice-daily aclidinium 200 μg, aclidinium 400 μg, or placebo. Primary and secondary endpoints were changes from baseline in trough FEV1 and peak FEV1 at Week 12, respectively. Health status (St. George's Respiratory Questionnaire [SGRQ]), COPD symptoms (Transitional Dyspnea Index [TDI], night and early morning symptoms), and safety were also assessed. Results: A total of 561 patients (mean age, 64 ± 9 years) with a mean baseline FEV1 of 1.36 ± 0.54 L (47.2% of predicted value) were randomized. At Week 12, aclidinium 200 μg and 400 μg showed significant improvements from baseline in mean (95% CI) trough FEV1 compared with placebo by 86 (45, 127) mL and 124 (83,164) mL, respectively, and in peak FEV1 by 146 (101, 190) mL and 192 (148, 236) mL, respectively (p ≤ 0.0001 for all). Both aclidinium doses also provided significant improvements in SGRQ, TDI and almost all COPD symptom scores compared with placebo (p < 0.05 for all). Incidences of adverse events (AEs) were similar across treatment groups. The incidence of anticholinergic AEs was low and similar across groups (dry mouth: 0.5%–1.6%; constipation: 0%-1.1%). Conclusions: Treatment of moderate-to-severe COPD patients with twice-daily aclidinium 200 μg and 400 μg was associated with significant improvements in bronchodilation, health status, and COPD symptoms. Both doses were well tolerated and had safety profiles similar to placebo.

Trial Registration: This ACCORD I study (AClidinium in Chronic Obstructive Respiratory Disease I) was registered on clinicaltrials.gov (NCT00891462) as “Efficacy and Safety of Aclidinium Bromide for Treatment of Moderate to Severe Chronic Obstructive Pulmonary Disease (COPD)”.