Determinants of successful completion of pulmonary rehabilitation in COPD
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Abstract:
Despite known benefits, a significant proportion of patients with COPD do not complete pulmonary rehabilitation (PR). Little is known regarding which factors promote successful completion of PR.We analyzed data from a prospectively maintained database of subjects with COPD who attended a PR program at the University of Alabama at Birmingham, from 1996 to 2013. Subjects were categorized as either completers or non-completers, based on successful completion of at least 8 weeks of PR. Demographics and comorbidities were recorded. Short Form 36 Health Survey, Beck Depression Inventory-II, and San Diego Shortness of Breath Questionnaire were administered to all participants at baseline and on completion of PR to assess participants' perception of their health status, severity of depression, and dyspnea with performance of activities of daily living. Univariate and multivariable analyses were performed to identify predictors of successful completion of PR.Four hundred and forty subjects were included, of whom 229 completed PR. Forty-one percent were female, and 17% were African American. Compared with non-completers, completers had greater Short Form 36 Health Survey pain score, lower forced expiratory volume in the first second, and lower Beck Depression Inventory score, and included a lower percentage of current smokers. On multivariate analysis, cigarette smoking at enrollment was associated with lower likelihood of completion of PR (adjusted odds ratio 0.38, 95% confidence interval 0.16-0.90; P=0.02).Cigarette smoking was the sole independent predictor of PR dropout, and smoking cessation may warrant greater emphasis prior to enrollment.Keywords:
Depression
Vital capacity
现在，医药社区应该很好知道长期的妨碍的肺的疾病(COPD ) 的重要性，有高病态和死亡的一个逐渐地普通的条件。在现代条款， COPD 来了意味着并发的长期的支气管炎，气喘的支气管炎和肺气肿。香烟吸烟长作为占优势的病因论的代理人被认出了。动脉的 hypoxaemia， COPD 的经常的复杂并发症，能导致肺的高血压和英国管 pulmonale。COPD 影响超过 5% 成年人口并且是其病态和死亡在几个国家正在增加的死亡的唯一的主要原因。在中国，确定是困难的多少人与 COPD 被影响。然而，最近的流行病学的调查显示那 COPD 流行在中国是 8.2% 。在男人的 COPD 流行比在女人显著地高(12.4% cf 5.1%) 。在农村区域的流行在城市的区域(8.8%cf7.8%) 比那高。有 COPD 的病人， 61.5% 是吸烟者。报告也声明 COPD 是在在中国和在城市的区域的死亡的第四个领先的原因的农村区域的死亡的主要原因，升起到在 2020 的死亡的第三个领先的原因。疾病的流行与年龄增加，最高的率在超过 70 年岁的人看。COPD 是有升起的发生和世界范围的流行的死亡的唯一的主要原因，显示它一逐渐地使人烦恼的。
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Background
There is evidence to suggest that Pulmonary Rehabilitation (PR) is beneficial for patients with chronic lung diseases other than COPD (AACP/AACVPR guidelines 2007, ILD consultation document 2013). However, there is little evidence to suggest that PR provides exercise tolerance benefits comparable to COPD patients who participate in the same PR programmes.Aim
To determine whether walking distance improvements differ significantly between ILD and COPD patients following PR.Method
Retrospective data of PR Endurance Shuttle Walk Test distances (ESWTD) pre- to post-PR were analysed and compared between 55 Interstitial Lung Disease (ILD) and 440 COPD patients from February 2005 to December 2012. Patients participated in a PR programme run by the same clinical team. Independent sample two-tailed t-tests were performed on data for pre-PR ESWTD, post-PR ESWTD and ESWTD change.Results
There were no significant differences between group ESWTD prior to PR (t = -0.049, p = 0.961), following PR (t = -0.227, p = 0.820) or change in ESWTD (t = -0.228, p = 0.820).Conclusions
These data indicate there is no significant difference between ILD and COPD patients’ walking distances. ILD patients with a reduced exercise tolerance should be included and referred to PR programmes.Cite
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Forced expiratory spirograms and peak expiratory flow were measured in 102 resident male medical students (60 nonsmokers and 42 smokers). Forced vital capacity; forced expiratory volume in 1 sec; forced expiratory volume in 1 sec expressed as a percentage of forced vital capacity; forced expiratory flows between 80 and 70 per cent, between 55 and 45 per cent, between 30 and 20 per cent, and between 15 and 5 per cent of the forced vital capacity; forced expiratory time for the last 0.5 liter of the forced vital capacity; and maximal mid-expiratory flow were determined from the forced expiratory spirogram. Peak expiratory flow, all forced expiratory flows (except the forced expiratory volume in 1 sec), and the ratio of forced expiratory volume in 1 sec to forced vital capacity were significantly lower, and forced expiratory time for the last 0.5 liter of the forced vital capacity was significantly higher in the heavy smokers (those who had smoked a lifetime total of more than 10,000 cigarettes) than the nonsmokers. The light smokers (those who smoked a lifetime total of fewer than 10,000 cigarettes) had values between those of nonsmokers and the heavy smokers. Thus, a definite dose-related response to smoking was seen. Flows at lower lung volumes showed greater percentage changes than flows at higher lung volumes. The forced expiratory flow between 30 and 20 per cent of the forced vital capacity was the most sensitive test for detecting abnormality in smokers. Among heavy smokers, 58 per cent had abnormally low forced expiratory flow between 30 and 20 per cent of the forced vital capacity, whereas only 47 per cent had abnormally low ratio of forced expiratory volume in 1 sec to forced vital capacity, and 32 percent had abnormally low maximal mid-expiratory flow. The results show that even subjects with short smoking histories may have changes in pulmonary function that probably reflect narrowing of small airways. Moreover, these changes can easily be detected by simple tests, such as evaluation of a forced expiratory spirogram.
Vital capacity
Forced-air
Two-alternative forced choice
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Several small studies suggest that pulmonary rehabilitation improves short-term functional outcomes in patients with chronic obstructive pulmonary disease (COPD). This randomized study evaluated whether a comprehensive pulmonary rehabilitation program improved long-term outcomes in 119 outpatients with stable, mild to severe COPD. The patients …
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瞄准：为了调查手术后的肺的复杂并发症(POPC ) 的各种各样的类型的发生并且评估起作用的仙子的意义，在有食道的癌症的病人的动脉的血气体在食管切除术以后与长期的妨碍的肺的疾病(COPD ) 伴随了。方法：358 个病人被划分成 POPC 组和 COPD 组。我们为食道的癌症在食管切除术以后执行了 358 个连续病人的回顾的评论与或没有 COPD 在手术后的肺的复杂并发症上估计 COPD 的可能的影响。我们在 1 s (FEV1 ) 根据预言百分比的强迫的吐气的体积分类 COPD 进四个等级并且在四个等级之中分析了复杂并发症的发生率。Perioperative 动脉的血气体在 COPD 组并且与 POPC 组相比在病人被测试与或没有肺的复杂并发症。结果：有 COPD 的病人(29/86， 33.7%) 没有 COPD，比那些有更肺的复杂并发症(36/272， 13.2%)(P 或 =80% 预言) COPD (P < 0.05 ) 。PaO (2 ) 被减少， PaCO (2 ) 在第一个手术后的星期内在 COPD 组与肺的复杂并发症在病人被增加。结论：COPD 的标准是为在经历食管切除术的食道的癌症病人的肺的复杂并发症的批评预言者。COPD 的严厉影响肺的复杂并发症的发生率，并且预言百分比的 FEV1 是为在有 COPD 的病人的肺的复杂并发症的一个好预兆的变量。动脉的血气体在指导起作用的仙子是有用的管理。
POPC
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서론: 만성폐쇄성폐질환(chronic obstructive pulmonary disease, COPD)는 최근 사망률과 유병률이 증가하는 만성적인 질환이다. 국내에서의 유병률은 간헐적으로 보고되고 있지만, 수년간에 걸친 COPD 유병률의 변화와 그리고 COPD 위험인자의 변화에 관한 연구는 없었다. 이 연구는 국민건강영양조사 자료를 이용하여 8년 간의 COPD 빈도와 위험인자의 변화에 관해 알아보고자 하였다. 방법: 2007년부터 2014년 간의 국민건강영양조사 원시자료를 이용하였으며, 이중 나이 40세 이상이면서 폐기능 검사를 시행한 총 24,500명 (남자 43.8%, 여자 56.2%)의 자료를 분석하였다. COPD의 진단은 FEV1/FVC 비가 0.7 미만인 경우로 하였다. COPD 위험인자의 분석에는 거주 지역, 소득, 교육, 흡연, BMI, vitamin D를 이용하였다. 결과: COPD 빈도는 2007년도에 18.4%로 가장 높았으며, 이후 감소하는 추세를 보여 2009년에는 11.9% 였다. 2011년도부터 다시 증가하기 시작하여 2014년도 까지 COPD 빈도는 13.5%에서 15.4 % 였다. 여자와 남자 모두 비슷한 형태를 보였다. 다항 로지스틱 회귀 분석에서 2007년도부터 2014년 전체를 대상으로 하였을 때, COPD 위험인자는 저소득, 낮은 교육, 흡연, 낮은 BMI 와 혈중 vitamin D 였으며, 거주 지역은 위험인자가 아니었다. 년도별 분석에서도 저소득, 흡연, 낮은 BMI는 COPD의 위험인자였지만, 낮은 교육은 2009년도 이후부터는 COPD의 위험인자가 아니었다. Vitamin D는 년도에 따라 다른 결과를 보였다. 결론: 낮은 교육 수준은 COPD의 위험인자가 아니었다.
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Chronic obstructive pulmonary disease(COPD) is a common disease with significant disability rate and mortality.Smoking continues to be a major cause of COPD.As a simple way to reduce exposure to COPD risk factors, smoking cessation can prevent the development of COPD effectively.This review summarizes the effects of smoking cessation in the treatment of COPD and smoking cessation drugs.
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Smoking is the main cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the only effective intervention to slow its progression. We examined whether smokers with COPD received more cessation services than smokers without COPD. Current smokers from 18 Veterans Health Administration primary care clinics completed baseline and 12 month follow-up surveys (baseline n = 1,941; 12 month n = 1,080), composed of validated questions on smoking habits, history, and attitudes; health/functional status; and sociodemographics. Both at baseline and 12 month follow-up, smokers with COPD were more likely to report that they had been advised to quit, prescribed nicotine patches, or referred to a smoking cessation program within the last year. However, the rate of quitting smoking was the same for smokers with COPD and smokers without COPD. The increase in cessation services received by smokers with COPD was noted primarily among smokers not interested in quitting. New approaches may be required, particularly to help smokers not interested in quitting.
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The benefit of pulmonary rehabilitation is well documented for patients with chronic obstructive pulmonary disease (COPD). However, such benefit has not been demonstrated for severely impaired patients with other chronic pulmonary diseases. Occasional non-COPD patients have been admitted to our 4-wk inpatient program. We compared the improvement of these non-COPD patients with that of COPD patients in the same program. Improvement is assessed by a 6-min walk test done at admission and discharge. On the admission 6-min walk test, 32 non-COPD patients had an ambulation distance of 276 ± 219 ft (SD). At completion of the program, their ambulation distance increased to 574 ± 367 ft (increase in ambulation 298 ± 290 ft, P< 0.0001). Diagnostic subgroups improved to essentially the same extent. The increase in ambulation was not statistically different between non-COPD patients and a series of 317 patients with COPD. Patients severely impaired with chronic pulmonary disease other than COPD benefit from intensive pulmonary rehabilitation, and the degree of improvement is similar to that of COPD patients.
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