Long-Term Efficacy of Pulmonary Rehabilitation in Patients with Occupational Respiratory Diseases

Abstract

Background: Pulmonary rehabilitation is a well-recognized treatment option in chronic obstructive lung disease improving exercise performance, respiratory symptoms and quality of life. In occupational respiratory diseases, which can be rather cost-intensive due to the compensation needs, very little information is available. Objectives: This study aims at the evaluation of the usefulness of pulmonary rehabilitation in patients with occupational respiratory diseases, partly involving complex alterations of lung function and of the sustainability of effects. Methods: We studied 263 patients with occupational respiratory diseases (asthma, silicosis, asbestosis, chronic obstructive pulmonary disease) using a 4-week inpatient rehabilitation program and follow-up examinations 3 and 12 months later. The outcomes evaluated were lung function, 6-min walking distance (6MWD), maximum exercise capacity (Wmax), skeletal muscle strength, respiratory symptoms, exacerbations and associated medical consultations, quality of life (SF-36, SGRQ), anxiety/depression (HADS) and Medical Research Council and Baseline and Transition Dyspnea Index scores. Results: Compared to baseline, there were significant (p < 0.05) improvements in 6MWD, Wmax and muscle strength immediately after rehabilitation, and these were maintained over 12 months (p < 0.05). Effects were less pronounced in asbestosis. Overall, a significant reduction in the rate of exacerbations by 35%, antibiotic therapy by 27% and use of health care services by 17% occurred within 12 months after rehabilitation. No changes were seen in the questionnaire outcomes. Conclusions: Pulmonary rehabilitation is effective even in the complex settings of occupational respiratory diseases, providing sustained improvement of functional capacity and reducing health care utilization.

Quality of Life in Children with Non-Cystic-Fibrosis Bronchiectasis

“…Studies have shown that HRQOL has been adversely affected in adults with non-CF BE [9,12,13,14,15,16]. The SGRQ is the only scale that measures disease-specific QOL in adult patients which has been used in a few studies in non-CF BE [9,12,13,14]. Although the SGRQ and the SF-36 have been used for children (6-12 years) previously, they were not actually validated [17,18].…”

“…Disease-specific HRQOL instruments are much preferred to general instruments since they are designed to assess symptoms and areas of functioning that are most important for a specific disease [11]. SGRQ and SF-36 are adult scales and have both been used for patients with non-CF BE [12,13,14,15,16]. Although they have not been validated in children, a few studies have used them for children between the ages of 6 and 12 years [17,18].…”

Bedeutung von Depression und Angst im Krankheitsmanagement von pneumologischen Berufskrankheiten

“…Die Ergebnisse einer Längsschnitt-studie an 2 deutschen berufsgenossenschaftlichen Kliniken bestätigen, dass eine stationäre Rehabilitation für berufsbedingte Lungen-und Atemwegspatienten zu einer Verbesserung der körperlichen Leistungsfähigkeit, gemessen an der maximalen Belastbarkeit mittels Spiroergometrie (W max ), der 6-Minuten-Gehstrecke und der Muskelkraft, direkt im Anschluss sowie bis 12 Monate nach Beendigung der Rehabilitation führt [42]. Zusätzlich reduziert sich die Anzahl der Exazerbationen, der antibiotischen Therapien bei akuten Atemwegsinfekten sowie der Arztbesuche signifikant.…”

“…Die pneumologische Rehabilitation kann zu einer Verbesserung psychischer Symptome führen [39]. Jedoch zeigen sich keine Veränderungen der Depression oder Angst über die Zeit [42]. [24].…”

Is an Individual Prediction of Maximal Work Rate by 6-Minute Walk Distance and Further Measurements Reliable in Male Patients with Different Lung Diseases?

“…Based on these considerations, we reanalyzed the baseline data from a large study on the efficacy of rehabilitation [9]. We aimed to quantify the correlations of W max with other measures and to assess the maximal reliability of individual prediction by including a broad range of predictors.…”