Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease

Puhan, Milo A.; Scharplatz, Madlaina; Troosters, Thierry; Walters, E. Haydn; Steurer, Johann

doi:10.1590/s1516-31802009000500016

Cited by 30 publications

(43 citation statements)

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“…Explanation for this finding could be that exacerbations and hospital admissions cause deterioration of functional and nutritional status. 10 Furthermore, in the present study, decline of functional and nutritional status was part of the selection criteria for indication of post-acute PR. The effect of the exacerbation and hospital admission on functional and nutritional status was probably dominant in comparison with the effect of pain.…”

Section: Interpretation Of Findings and Relation To Literaturementioning

confidence: 90%

“…Acute exacerbations in COPD (AECOPD) play a key role. They represent a major burden for individual patients, 10 are the most frequent reason for hospital admissions and deaths among patients with COPD 11 and negatively influence HRQoL and functional capacity, 10,11 often leading to rehospitalizations, further decline of health status and high mortality rates. 12,13 The prevalence of pain and its relationship with other symptoms, functional capacity and HRQoL in unstable disease is however unknown, as data on pain during AECOPD are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Post-acute pulmonary rehabilitation (PR) is an effective and safe intervention to counteract the adverse effects of hospital admission for AECOPD on symptom burden and physical functioning. 10 From this viewpoint, post-acute PR could be an effective nonpharmacological intervention to reduce pain in unstable COPD, as it might counteract the painrelated vicious circles in COPD. 14 Also, as pain management is preferably undertaken using multi-domain strategies (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

et al. 2018

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Pain is a significant problem in stable chronic obstructive pulmonary disease (COPD) and is associated with other symptoms, worse health status and lower functional status. Not much is known about pain in unstable disease. The primary aim of the present study is to investigate prevalence, characteristics and relationships of pain in patients with COPD hospitalized for an acute exacerbation (AECOPD) and indicated for post-acute pulmonary rehabilitation (PR). This cross-sectional observational study included 149 patients (mean age 70.8 (±7.9) years, 49% male, mean forced expiratory volume in one second as percentage of predicted value 35.3 (±12.6)). Pain was assessed using the brief pain inventory. Functional status and health status were measured using the six-minute walking test (6MWT), the Barthel index (BI) and the clinical COPD questionnaire (CCQ), respectively. Pain was prevalent in 39.6% of all patients. Symptom burden was high, especially in patients with pain. Although we found no difference in objective measurements of functional status (6MWT, BI), patients with pain had clinically relevant lower health status (CCQ), attributed to the functional domain. Pain in patients hospitalized for AECOPD and indicated for post-acute PR is a relevant problem and needs more attention. Incorporation of standard pain assessment during exacerbations and post-acute PR is recommended.

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Section: Interpretation Of Findings and Relation To Literaturementioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

et al. 2018

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“…3,4 The number of individuals able to complete programmes is further diminished (9%) in those who have recently suffered an acute exacerbation (defined as an increase in symptoms and often resulting in an admission to hospital). 5,6 While sociodemographic data and clinical variables appear to explain some variance in completion rates, psychological variables have shown more promise. Heightened experiences of depression have led to increased drop-out rates in those whose diseasesymptoms remained stable.…”

Section: Introductionmentioning

confidence: 99%

The meaning of the name of ‘pulmonary rehabilitation’ and its influence on engagement with individuals with chronic lung disease

Oxley

Harrison

Rose³

et al. 2019

Chron Respir Dis

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Pulmonary rehabilitation (PR) is recommended for all individuals living with a lung condition and chronic breathlessness. This article considers how adopting an interdisciplinary, medical humanities approach to the term ‘pulmonary rehabilitation’ might unpack some of the misconceptions, misrepresentations or negative connotations surrounding it, which have been largely overlooked in explanations of the low uptake of this programme. Taking key insights from Wellcome Trust-funded Life of Breath project, including ethnographic research in community fitness groups in North East England and the ‘Breath Lab’ special interest group, this article outlines how the whole-body approach of PR is not easily understood by those with lung conditions; how experience can inform breath perception through the pacing of everyday life; and how stigma can impact rehabilitation. This article highlights the value of medical humanities in working through communicative challenges evident in the translation of PR between patient and clinical contexts and sets out two arts-based approaches (Singing for Lung Health and dance movement) as potential options that could be included in the PR referral. Finally, the article outlines the need for collaborative research exploring the communication and meaning of healthcare strategies and experiences at the interface of the arts, humanities and medical practice.

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“…The main benefits of comprehensive PR programs for patients with COPD include a decrease in symptoms (dyspnoea and fatigue), improvements in exercise tolerance and health-related quality of life, 2 –4 a reduction in health-care utilization and potentially an effect on exacerbation rate and survival. 5 –7 Over the last decade, compelling evidence is also rising on the indication of PR for other respiratory domains, including cystic fibrosis, interstitial lung diseases, pulmonary hypertension, lung cancer and lung transplantation. 8 –12 Furthermore, several authors have demonstrated a favourable cost-benefit ratio for PR in different health-care systems.…”

Section: Introductionmentioning

confidence: 99%

How resources determine pulmonary rehabilitation programs: A survey among Belgian chest physicians

et al. 2018

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Despite overwhelming evidence of its benefits, a widespread implementation of pulmonary rehabilitation (PR) is lacking and the landscape of multidisciplinary programs remains very scattered. The objective of this study is to assess how PR is organized in specialized care centres in Belgium and to identify which barriers may exist according to respiratory physicians. A telephone and online survey was developed by a Belgian expert panel and distributed among all active Belgian chest physicians (n ¼ 492). Data were obtained from 200 respondents (40%). Seventy-five percentage of the chest physicians had direct access to an ambulatory rehabilitation program in their hospital. Most of these programs are organized bi or triweekly for an average period of 3-6 months. Programs focus strongly on chronic obstructive pulmonary disease patients from secondary care, have a multidisciplinary approach and provide exercise capacity and quality of life measures as main outcomes. Yet large differences were observed in process and outcome indicators between the programs of centres with standard funding and those of specialized centres with a larger allocated budget. We conclude that multidisciplinary PR programs are available in the majority of Belgian hospitals. Differences in funding determine the quality of the team, the diversity of the interventions and the monitoring of outcomes. More resources for rehabilitation will directly improve the utilization and quality of this essential treatment option in respiratory diseases.

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Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease

Cited by 30 publications

References 0 publications

Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

The meaning of the name of ‘pulmonary rehabilitation’ and its influence on engagement with individuals with chronic lung disease

How resources determine pulmonary rehabilitation programs: A survey among Belgian chest physicians

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