Effects of exercise-based home pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: An overview of systematic review

Zheng, Jiang; Zhang, Zhi; Han, Ruijuan; Zhang, Hongxia; Deng, Jie; Chai, Meimei

doi:10.1371/journal.pone.0277632

Cited by 6 publications

(4 citation statements)

References 43 publications

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“…1 Others have previously reported the benefits of nonpharmacological management, such as smoking intervention, pulmonary rehabilitation, breathing exercises and education programmes in reducing symptoms and mortality, as well as improving lung function and health-related quality of life in patients with COPD. 29 – 36 In this study, COPD education was provided to almost all patients, but optimal self-management behaviour was evident in a much smaller proportion. Moreover, COPD knowledge was poor.…”

Section: Discussionmentioning

confidence: 82%

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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Background: Underdiagnosis and undertreatment pose major barriers to optimal management of chronic obstructive pulmonary disease (COPD) in China. Objective: The REAL trial was performed to generate reliable information on real-world COPD management, outcomes and risk factors among Chinese patients. Here, we present study outcomes related to COPD management. Design: It is a 52-week, prospective, observational, multicentre study. Methods: Outpatients (aged ⩾40 years) enrolled from 50 secondary and tertiary hospitals across six geographic regions of China were followed up for 12 months, with two onsite visits and by telephone every 3 months following baseline. Results: Between June 2017 and January 2019, 5013 patients were enrolled and 4978 included in the analysis. Mean [standard deviation (SD)] age was 66.2 (8.9) years, the majority of patients were male (79.5%) and mean (SD) time since COPD diagnosis was 3.8 (6.2) years. The most common treatments at each study visit were inhaled corticosteroids/long-acting beta-agonists (ICSs/LABAs; 28.3–36.0%), long-acting muscarinic antagonists (LAMAs; 13.0–16.2%) and ICS/LABA + LAMA (17.5–18.7%), but up to 15.8% of patients at each visit received neither ICS nor long-acting bronchodilators. The use of ICS/LABA, LAMA and ICS/LABA + LAMA differed across regions and hospital tiers; up to fivefold, more patients received neither ICS nor long-acting bronchodilators in secondary (17.3–25.4%) versus tertiary hospitals (5.0–5.3%). Overall, rates of nonpharmacological management were low. Direct treatment costs increased with disease severity, but the proportion of direct treatment costs incurred due to maintenance treatment decreased with disease severity. Conclusion: ICS/LABA, LAMA and ICS/LABA + LAMA were the most frequently prescribed maintenance treatments for patients with stable COPD in China, although their use differed between region and hospital tier. There is a clear need for improved COPD management across China, particularly in secondary hospitals. Registration: The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362; https://clinicaltrials.gov/ct2/show/NCT03131362 ). Plain language summary Treatment patterns in patients with COPD in China Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and irreversible airflow limitation. In China, many patients with this disease do not receive a diagnosis or appropriate treatment. Objective: This study aimed to generate reliable information on the treatment patterns among patients with COPD in China to help inform future management strategies. Study design and methods: Patients (aged ⩾40 years) were enrolled from 50 hospitals across 6 regions of China and physicians collected data over the course of 1 year during routine outpatient visits. Results: The majority of patients were receiving long-acting inhaled treatments, which are recommended to prevent worsening of the disease. Up to 16% of patients in this study, however, did not receive any of these recommended treatments. The proportion of patients who received long-acting inhaled treatments differed across regions and hospital tiers; there were about five times more patients in secondary hospitals (about 25%) who did not receive these treatments compared with those in tertiary hospitals (about 5%). Guidelines recommend that pharmacological treatment should be complemented by nondrug treatment, but this was only received by a minority of patients in this study. Patients with higher disease severity incurred greater direct treatment costs compared with those with milder disease. Maintenance treatment costs made up a smaller proportion of overall direct costs for patients with higher disease severity (60–76%) compared with patients with milder disease (81–94%). Conclusion: Long-acting inhaled treatments were the most frequently prescribed maintenance treatments among patients with COPD in China, but their use differed between region and hospital tier. There is a clear need to improve disease management across China, especially in secondary hospitals.

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Section: Discussionmentioning

confidence: 82%

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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“…In recent years, understanding of the pathogenetic mechanisms involved in COPD has greatly increased [ 130 ]. Indeed, the awareness of the wide range of inflammatory patterns that can be observed in this disabling condition led to the identification of more personalized rehabilitation and pharmacological approaches [ 131 , 132 , 133 , 134 , 135 ], with a potential role for biologically targeted therapies. The inflammatory pattern in COPD is extremely variegated.…”

Section: Eosinophils and Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

Eosinophilic Airway Diseases: From Pathophysiological Mechanisms to Clinical Practice

Mormile

Fuschillo

et al. 2023

IJMS

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Eosinophils play a key role in airway inflammation in many diseases, such as allergic and non-allergic asthma, chronic rhinosinusitis with nasal polyps, and chronic obstructive pulmonary disease. In these chronic disabling conditions, eosinophils contribute to tissue damage, repair, remodeling, and disease persistence through the production a variety of mediators. With the introduction of biological drugs for the treatment of these respiratory diseases, the classification of patients based on clinical characteristics (phenotype) and pathobiological mechanisms (endotype) has become mandatory. This need is particularly evident in severe asthma, where, despite the great scientific efforts to understand the immunological pathways underlying clinical phenotypes, the identification of specific biomarkers defining endotypes or predicting pharmacological response remains unsatisfied. In addition, a significant heterogeneity also exists among patients with other airway diseases. In this review, we describe some of the immunological differences in eosinophilic airway inflammation associated with severe asthma and other airway diseases and how these factors might influence the clinical presentation, with the aim of clarifying when eosinophils play a key pathogenic role and, therefore, represent the preferred therapeutic target.

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“…While CR has been shown to improve aerobic fitness and musculoskeletal strength, there has been minimal research exploring the impact of CR on resting spirometry and on ventilatory function during exercise (6). Previous studies demonstrate exercise training leads to improvements in lung volumes and flows in healthy children and adults as well as individuals with chronic lung diseases such as emphysema and asthma (7)(8)(9). Inhalation training has also been shown to increase dynamic lung volumes and slow deconditioning in peak VO 2 in patients with tetralogy of Fallot or a Fontan circulation (10,11).…”

Section: Introductionmentioning

confidence: 99%

Pulmonary responses following cardiac rehabilitation and the relationship with functional outcomes in children and young adults with heart disease

Kershner,

Hardie,

Chin

et al. 2024

Front. Surg.

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IntroductionPatients with congenital heart disease (CHD) often have pulmonary abnormalities and exercise intolerance following cardiac surgery. Cardiac rehabilitation (CR) improves exercise capacity in patients with CHD, but minimal study has been performed to see if resting and dynamic pulmonary performance improves following CR in those with prior cardiac surgery.MethodsThis was a retrospective cohort study of all patients who completed ≥12 weeks of CR from 2018 through 2022. Demographic, cardiopulmonary exercise test (CPET), spirometry, 6-minute walk, functional strength measures, and outcomes data were collected. Data are presented as median[IQR]. A Student's t-test was used for comparisons between groups and serial measurements were measured with a paired t-test. A p < 0.05 was considered significant.ResultsThere were a total of 37 patients [age 16.7 (14.2–20.1) years; 46% male] included. Patients with prior surgery (n = 26) were more likely to have abnormal spirometry data than those without heart disease (n = 11) (forced vital capacity [FVC] 76.7 [69.1–84.3]% vs. 96.4 [88.1–104.7]%, p = 0.002), but neither group experienced a significant change in spirometry. On CPET, peak oxygen consumption increased but there was no change in other pulmonary measures during exercise. Percent predicted FVC correlated with hand grip strength (r = 0.57, p = 0.0003) and percent predicted oxygen consumption (r = 0.43, p = 0.009). The number of prior sternotomies showed negative associations with both percent predicted FVC (r = −0.43, p = 0.04) and FEV1 (r = −0.47, p = 0.02).DiscussionYouth and young adults with a prior history of cardiac surgery have resting and dynamic pulmonary abnormalities that do not improve following CR. Multiple sternotomies are associated with worse pulmonary function.

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Effects of exercise-based home pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: An overview of systematic review

Cited by 6 publications

References 43 publications

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Eosinophilic Airway Diseases: From Pathophysiological Mechanisms to Clinical Practice

Pulmonary responses following cardiac rehabilitation and the relationship with functional outcomes in children and young adults with heart disease

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