Pulmonary Rehabilitation Improves Exercise Capacity in Subjects with Kyphoscoliosis and Severe Respiratory Impairment

Abstract

BACKGROUND: Patients with kyphoscoliosis and severe respiratory impairment frequently experience reduction in exercise tolerance, limitation in daily life activities, and deterioration in health-related quality of life (HRQOL). Noninvasive ventilation (NIV) as an add-on treatment to long-term oxygen therapy (LTOT) was shown to improve symptoms and HRQOL in these patients. Pulmonary rehabilitation can increase exercise capacity and HRQOL in patients with COPD, but its role in patients with restrictive thoracic disease, such as kyphoscoliosis, is uncertain. The aim of this study was to analyze the effects of combining pulmonary rehabilitation with LTOT and NIV treatments on arterial blood gases and the 6-min walk test (6MWT) in a homogeneous group of subjects with kyphoscoliosis. METHODS: Twenty-three subjects with kyphoscoliosis and respiratory failure who were being treated with both LTOT and NIV and who had been referred to a pulmonary rehabilitation program were retrospectively analyzed. Eighteen subjects were included, and there was no control group. Pulmonary rehabilitation involved educational and physical training sessions and was carried out daily for 4 -6 weeks. Exercise intensity was personalized based on individual tolerance, physiologic parameters, or physiotherapist judgment. RESULTS: Upon completion of pulmonary rehabilitation, a significant improvement in 6-min walk distance was observed (P ‫؍‬ .04). The dyspnea score at the end of the 6MWT improved as well, although the improvement did not reach statistical significance (P ‫؍‬ .06). These changes were not confirmed at a 12-month follow-up visit. No significant effects of pulmonary rehabilitation on arterial blood gases were observed. CONCLUSIONS: A combined intervention including a tailored pulmonary rehabilitation program together with LTOT and NIV seems to be of short-term benefit in subjects with kyphoscoliosis and severe respiratory impairment.

Management of respiratory symptoms in paediatric palliative care

“…Psychosocial support alongside other nonpharmacological interventions such as exercise training and breathing control can be beneficial in managing dyspnoea in adults with cancer and COPD [46][47][48] and self-hypnosis has been shown to be beneficial in children [49,50]. Studies of acupuncture in dyspnoeic adults with COPD and cancer have had mixed results [46].…”

Kyphoscoliosis—What Can We Do for Respiration besides NIV?

“…In contrast, Fuschillo et al [14] have found that the combination of pulmonary rehabilitation with non-invasive ventilation and long-term oxygen therapy improved peripheral muscle strength, HRQL and endurance only for a short period of time after the rehabilitation programme. They have reported that rehabilitation after a one-year follow-up did not prevent the test results decreasing.…”

Intensive care and non-invasive mechanical ventilation in kyphoscoliosis: are new perspectives still needed?

“…This effect improves outcome and quality of life in long term application [1]. Kyphoscoliosis is a common cause of pulmonary restrictive lung disease [2]. The benefits of short- and long-term intermittent nocturnal therapy have been previously reported as improvement in lung vital capacity, muscle strength, daytime oxygenation, exercise capacity, and pulmonary hypertension [2,3].…”

“…Kyphoscoliosis is a common cause of pulmonary restrictive lung disease [2]. The benefits of short- and long-term intermittent nocturnal therapy have been previously reported as improvement in lung vital capacity, muscle strength, daytime oxygenation, exercise capacity, and pulmonary hypertension [2,3]. In severe stages kyphoscoliosis demonstrates impaired ventilatory mechanics and NIV appears to be the treatment of choice [3].…”

“…Secondly, long-term O 2 therapy may contribute to pCO 2 level, significant reduction in pulmonary artery pressure (PAP) and sleep quality [2,6]. These factors were not evaluated in this study.…”