Rehabilitation and acute exacerbations

Abstract

Recent evidence indicates that acute exacerbations of chronic obstructive pulmonary disease aggravate the extrapulmonary consequences of the disease. Skeletal muscle dysfunction, a sustained decrease in exercise tolerance, enhanced symptoms of depression and fatigue are reported. Avoidance of physical activities is likely to be a key underlying mechanism and increases the risk of new exacerbations. Pulmonary rehabilitation is an intervention targeting these systemic consequences. Exercise strategies need to be adapted to the increased feelings of dyspnoea and fatigue.This review aims to describe the systemic consequences of acute exacerbations and compiles evidence for the feasibility and effectiveness of different rehabilitation strategies to counteract these consequences during and/or immediately after the acute phase of the exacerbation. Resistance training and neuromuscular electrical stimulation have been applied safely in frail, hospitalised patients and have the potential to prevent muscle atrophy. Comprehensive pulmonary rehabilitation, including general exercise training, can be implemented immediately after the exacerbation, leading to a reduction in hospital admissions and an increase in exercise tolerance and quality of life. Self-management strategies play a crucial role in changing diseaserelated health behaviour and preventing hospital admissions.

An Official American Thoracic Society/European Respiratory Society Statement: Update on Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease

“…Keeping in mind the deleterious effects of exacerbations on limb muscles, several interventions to prevent or counteract muscle impairment have been considered (522). These interventions, mainly based on exercise training, have been used during, immediately after, or late after the exacerbation (523).…”

Zalecenia Polskiego Towarzystwa Chorób Płuc Dotyczące Rozpoznawania i Leczenia Przewlekłej Obturacyjnej Choroby Płuc

“…Istotnym elementem w zapobieganiu zaostrzeniom może być rehabilitacja oddechowa [202] oraz operacyjne zmniejszanie objętości płuc [203].…”

Impact of physiotherapy on patients with advanced lung cancer

“…59 Several investigators have shown that NMES intervention is well tolerated and effective alone or in combination with exercise, results in improvements in strength, muscle mass, exercise capacity, and sense of dyspnea during daily living activities in patients with very severe COPD, chronic heart failure, and mechanically ventilated intensive care unit patients who experience intolerable symptoms during or after active training due to the progression of their underlying disease. 12,22,60,61 It has been suggested that applying the NMES as a home-based NMES program maintains and improves quadriceps femoris muscle strength in patients with lung cancer. 62,63 Randomized-controlled trials are needed to study the efficacy and safety of NMES for severely disabled lung cancer patients.…”

“…14,75 Even though in lung cancer, cough is helped with medication, it has been stated that hydration, gentle suctioning, postural drainage, chest physiotherapy, and external oscillation applications can be useful for patients with lung cancer, underlying COPD and bronchiectasis who have poor cough reflex to maintain bronchial hygiene. 5,7,9,14,23,25,61 Unfortunately, there are no studies in this area. Since the risk of metastasis is high in patients with advanced lung cancer, it is sensible to avoid the percussive applications on the chest wall (percussion, vibration, etc.).…”