Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease – A quasi-experimental pilot study

Machado, Ana; Oliveira, Ana; Valente, Carla; Burtin, Chris; Marques, Alda

doi:10.1016/j.pulmoe.2019.05.004

Cited by 8 publications

(17 citation statements)

References 54 publications

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“…The studies enrolled people with a diagnosis of COPD, who were 50 years or older, presenting with FEV 1 predicted between 19.3 and 89.2%, and those who were mostly clinically stable without exacerbations during the previous 4–12 weeks, except one study that investigated participants during acute exacerbation ( 79 ).…”

Section: Resultsmentioning

confidence: 99%

“…Walking activity was established based on ISWT results ( 81 , 88 , 90 ), based on symptoms of dyspnea rating, based on 60% or more of the maximum HR ( 89 ), perceived exertion between 4 and 6 on the modified Borg scale ( 79 , 82 , 91 ), walking on the treadmill at 75% speed achieved in the 6MWT ( 82 ), or based on the symptom-limited exercise test ( 88 ). Some studies used a strategy of combining several modalities of endurance training such as walking along a corridor, in a garden, or on a treadmill; cycling; or a climbing stairs ( 79 – 81 , 86 , 88 – 90 , 92 ). These combined modalities defined exercise intensity based on the results of the symptom-limited exercise test ( 80 , 81 , 86 , 88 , 90 , 92 ) or 60–80% of the estimated maximum heart rate ( 79 ).…”

Section: Resultsmentioning

confidence: 99%

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Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review

Oliveira

Pereira

Costa

et al. 2022

Front. Rehabilit. Sci.

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This paper presents a rapid review of the literature for the components, benefits, barriers, and facilitators of pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) people in-home and community-based settings. seventy-six studies were included: 57 home-based pulmonary rehabilitation (HBPR) studies and 19 community-based pulmonary rehabilitation (CBPR) studies. The benefits of HBPR on exercise capacity and health-related quality of life were observed in one-group studies, studies comparing HBPR to usual care, and studies comparing to hospital-based pulmonary rehabilitation, although the benefits were less pronounced in the latter. HBPR reduced hospital admissions compared to usual care and was more cost-effective than hospital pulmonary rehabilitation. Most HBPRs were designed with low-density or customized equipment, are minimally supervised, and have a low intensity of training. Although the HBPR has flexibility and no travel burden, participants with severe disease, physical frailty, and complex comorbidities had barriers to complying with HBPR. The telerehabilitation program, a facilitator for HBPR, is feasible and safe. CBPR was offered in-person supervision, despite being limited to physical therapists in most studies. Benefits in exercise capacity were shown in almost all studies, but the improvement in health-related quality of life was controversial. Patients reported the benefits that facilities where they attended the CBPR including social support and the presence of an instructor. They also reported barriers, such as poor physical condition, transport difficulties, and family commitments. Despite the minimal infrastructure offered, HBPR and CBPR are feasible, safe, and provide clinical benefits to patients with COPD. Home and community settings are excellent opportunities to expand the offer of pulmonary rehabilitation programs, as long as they follow protocols that ensure quality and safety following current guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review

Oliveira

Pereira

Costa

et al. 2022

Front. Rehabilit. Sci.

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“…In Uganda, patients-participants included lung tuberculosis (TB), HIV but not COPD [24][25][26] . Results of the studies reviewed suggest most of the patients treated are suffering from respiratory diseases like COPD in Congo, India, Philippine, Nigeria, and Tunisia 20,22,23 In Tunisia, in a study on COPD patients, the intervention group underwent balance training 3 times a week for 6 months in addition to the standard PR. The control group received 6 months of the standard PR only.…”

Section: Patients Attending Prmentioning

confidence: 99%

Evidence on Pulmonary Rehabilitation and the Challenges Faced in Low- and Middle-Income Countries: A Systematic Qualitative Review

Farah

Groot

Pavlova

2021

Preprint

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Background In low-income countries (LIC) and low-middle-income countries (LMIC), the burden of chronic obstructive pulmonary disease (COPD) has increased due to the lack of prevention and the presence of barriers to enter rehabilitation programs. The aim of this systematic review is to analyze the evidence on pulmonary rehabilitation (PR) in LIC and LMIC. Methods A systematic literature review was conducted. Four electronic databases were searched for qualitative and quantitative studies that documented the presence of PR in LIC and LMIC. We report our findings following the Prisma guidelines. In addition, grey literature was also searched. Articles not in English, presenting a point of view and/or not treating an adult population (< 18 years old) were excluded from the review. Data were extracted by one reviewer and synthesized in the form of tables. Tables present individual characteristics of the PR reported within countries, including country of origin, study design, population attending, intervention (kind of program setting), frequency and duration of a program established (if available), with health outcomes. The PICO framework was used for every country with reported PR to assess population, intervention, comparison and outcomes found. This systematic review is registered on Prospero: CRD42020141655. Results In total, 47 publications were included in the review. In LIC, PR for HIV-infected patients was most frequently reported, while in LMIC, PR for COPD patients was most frequent. Duration and frequency of treatments reported were also different in LIC and LMIC. Health outcomes on cardiopulmonary function were established in all publications. Results found that the implementation of PR in LMIC is ongoing. The most important barriers to access are the lack of funds and know-how among professional healthcare givers. Conclusion Findings suggest that the literature on PR is scarce in LIC and LMIC. Structured or non-structured rehabilitation programs for patients suffering from COPD, HIV and Tuberculosis, are infrequently available. Strategic policy initiatives to diminish barriers and challenges are needed to implement more PR programs in LIC and LMIC.

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“…They account for more than 70% of all COPD-related costs [12], and AECOPD is responsible for patients' clinical deterioration. In this way, treatment goals for patients with AECOPD are to minimize the negative impacts of these events and prevent their recurrence [13]. The management of severe AECOPD is divided into pharmacological (inhaled bronchodilators, steroids, and antibiotics) and nonpharmacological treatments (oxygen therapy, high-flow nasal therapy (HFNT), non-invasive mechanical ventilation (NIMV), and pulmonary rehabilitation (PR)) [5].…”

Section: Introductionmentioning

confidence: 99%

“…PR is a comprehensive non-pharmacological treatment which has the best chance of improving COPD symptoms [14]. According to an American Thoracic Society (ATS)/ European Respiratory Society statement, PR is a cornerstone intervention for managing patients with stable COPD [13]. PR is a comprehensive intervention that includes exercise training, education, and behavioral changes [15].…”

Section: Introductionmentioning

confidence: 99%

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

et al. 2020

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Background: Chronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD. Methods: We enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software.Result: We recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group.Conclusions: HFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.

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Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease – A quasi-experimental pilot study

Cited by 8 publications

References 54 publications

Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review

Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review

Evidence on Pulmonary Rehabilitation and the Challenges Faced in Low- and Middle-Income Countries: A Systematic Qualitative Review

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

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