Pınar ERGÜN, Dicle KAYMAZ, Nurcan EGESEL, Filiz TAŞDEMİR, İpek CANDEMİR

Spirometrik İleri Evre Usot Kullanan Koah Tanılı Olgularda Pulmoner Rehabilitasyon Etkinliği

Giriș: Pulmoner rehabilitasyonun (PR) uzun süreli oksijen tedavisi (USOT) kullanan KOAH tanılı olgularda da etkin bir yaklașım olduğu gösterilmiștir. Bu çalıșmada kronik hipoksemik solunum yetmezliği tanısıyla USOT kullanan ileri evre KOAH’lı olgularda PR program etkinliğinde belirleyici olabilecek faktörlerin araștırılması amaçlanmıștır.Metod: Multidipliner, kapsamlı, ayaktan PR programını tamamlayan GOLD spirometrik evre 3-4 KOAH tanılı olguların verileri retrospektif olarak incelenmiștir. Transtorasik ekokardiyografide sistolik pulmoner arter ba-sıncı (SPAP) ≤ 36 mmHg olan, USOT kullanan 19 olgu (Grup I) istirahat ve egzersiz hipoksemisi olmayan USOT kullanmayan 21 olgu (GrupII) çalıșmaya dahil edilmiștir. Olguların PR programı önce ve sonrası Medical rese-arch council (MRC) dispne skalası, S. George respiratory questionary (SGRQ), artan hızda mekik yürüme testi (AHMYT) ve endurans mekik yürüme testi (EMYT), vücut kitle ve yağsız vücut kitle indeksi (VKİ, YVKİ) değerleri kaydedilmiștir. PR öncesi bașlangıç değerlendirme verileri ile PR programı sonrası kazanımlar arasındaki ilișki incelenmiștir.Bulgular: Olguların yaș ortalaması 61±5 yıl ve FEV1 ortalaması beklenenin %32 ±8’di. Her iki grupta PR sonrası MRC, SGRQ toplam ve alt skorları, AHMYT sonuçlarında istatistiksel anlamlı değișim izlenmiș olup her iki grupta da kazanımların benzer düzeylerde olduğu görülmüștür. Grup I’de PR sonrası kazanımlar solunum fonksiyonları, yașam kalitesi, egzersiz kapasitesi bașlangıç düzeyleri ile anlamlı korelasyon bulunmazken baș-langıç dispne algısı yüksek olanlarda dispne algısındaki iyileșmenin daha az olduğu görülmüștür [MRC ileMRC (p =0.015, r=-0.550)]. Grup II’de bașlangıç ortalama FEV1 %’si ile SGRQ toplam skor arasında (p=0,014, r=0,526) , MRC ile MRC (p =0.008, r=-0.565), SGRQ aktive ve toplam skoru (sırasıyla p=0,010, r=0,551 /p=0,017, r=0,516), AHMYT (p=0,006, r=-0,574) arasında anlamlı korelasyon bulunmuștur.Sonuç: USOT kullanan ileri evre KOAH tanılı olgularda multidisipliner, kapsamlı, ayaktan direkt gözetimli PR programlarının USOT kullanmayan olgularla benzer șekilde etkin bir yaklașımdır. Ayrıca, kazanımların solu-num fonksiyonlarındaki kayıp düzeyi, egzersiz kapasitesi ve yașam kalitesi düzeylerinden etkilenmediği görü-lürken bașlangıç değ erlendirmesinde dispne algısı yüksek olanlarda dispne algısındaki iyileșmenin daha az olduğu görülmüștür.

The Effıcacy of Pulmonary Rehabılıtatıon in Patıents Copd Usıng Long-Term Oxygen Therapy

Introduction: Pulmonary rehabilitation (PR) has also been shown to be an effective approach in COPD pateients using long-term oxygen therapy (LTOT). In this study, it was aimed to investigate the factors that might determine the effectiveness of PR program in patients with advanced COPD using LTOT with chronic hypoxemic respiratory failure. Method: The datas of patients with spirometric stage 3-4 COPD who completed a comprehensive multidipliner PR program, were investigated retrospectively. Patients with systolic pulmonary artery pressure ≤ 36 mmHg according to echocardiographic evaluation and 19 patients with LTOT (Group I) and 21 patients without exertional desaturation and resting hypoxemia (Group II), were included to the study. The subjects were divided into two groups according to the using LTOT. The values of MRC score, the S. George quality of life questionnaire (SGRQ), incremental shuttle walking test (ISWT) and endurance shuttle walking test (ESWT), body mass and fat-free mass index (BMI, FFMI) performing before and after PR were recorded. The relationship between baseline values before PR and the gainings of PR program was examined. Results: Mean value of age was 61±5 year with mean value of FEV1 predicted 32 ±8%. MRC, SGRQ scores and ISWT distances were improved after PR in both groups and the improvements were smiliar between groups. In group I, baseline FEV1 predicted % was not found to be correlated with improvements in exercise capacity and quality of life. In this group the improvements in sensation of dyspnea was found to be less in those with a higher baseline MRC score [ MRC with MRC (p = 0.015, r = -0.550)]. In the group II, there was a significant correlation between baseline FEV1 predicted% and SGRQ total score (p=0,014, r=0,526), between MRC and MRC (p =0.008, r=-0.565), SGRQ activity and total score (respectively p=0,010, r=0,551 /p=0,017, r=0,516), ISWT (p=0,006, r=-0,574).

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39. Greulich T, Koczulla AR, Nell C, et al. Ef-fect of a Three-Week Inpatient Rehabilita-tion Program on 544 Consecutive Patients with Very Severe COPD: A Retrospective Analysis. Respiration. 2015;90:287-92.
38. Vagaggini B, Costa F, Antonelli S, et al. Clinical predictors of the efficacy of a pul-monary rehabilitation programme in pati-ents with COPD. Respir Med 2009; 103:1224–1230.
37. Zanini A, Chetta A, Gumiero F, et al. Six-minute walking distance improvement af-ter pulmonary rehabilitation is associated with baseline lung function in complex COPD patients: a retrospective study. Bi-omed Res Int 2013;13:48-62.
36. Garrod R, Marshall J, Barley E, et al. Pre-dictors of success and failure in pulmo-nary rehabilitation. Eur Respir J 2006; 27: 788– 794.
35. Alfarroba S, Rodrigues F, Papoila AL, et al. Pulmonary Rehabilitation in COPD According to Global Initiative for Chronic Obstructive Lung Disease Categories. Respir Care. 2016;61:1331-40.
34. Schroff P, Hitchcock J, Schumann C, et al. Pulmonary Rehabilitation Improves Out-comes in Chronic Obstructive Pulmonary Disease Independent of Disease Burden. Ann Am Thorac Soc. 2017;14:26-32.
33. Jacome C, Marques A. Pulmonary rehabi-litation for mild COPD: a systematic re-view. Respiratory care 2014; 59: 588-594
32. Jacome C, Marques A. Impact of pulmo-nary rehabilitation in subjects with mild COPD. Respiratory care 2014; 59: 1577-1582.
31. Evans RA, Singh SJ, Collier R, et al. Pul-monary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respiratory medicine 2009; 103: 1070-1075.
30. Vagaggini B, Costa F, Antonelli S, et al. Clinical predictors of the efficacy of a pul-monary rehabilitation programme in pati-ents with COPD. Respir Med 2009;103:1224–1230.
29. Sahin H, Varol Y, Naz I, et al. Effective-ness of pulmonary rehabilitation in COPD patients receiving long-term oxygen the-rapy..Clin Respir J. 2017. doi: 10.1111/crj.12680.
28. Greulich T, Koczulla AR, Nell C, et al. Ef-fect of a Three-Week Inpatient Rehabilita-tion Program on 544 Consecutive Patients with Very Severe COPD: A Retrospective Analysis. Respiration. 2015;90:287-92
27. Vagaggini B, Costa F, Antonelli S, et al. Clinical predictors of the efficacy of a pul-monary rehabilitation programme in pati-ents with COPD. Respir Med. 2009;103:1224-30.
26. Ergan B, Nava S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations. COPD. 2017;14:351-366.
25. Ameer F, Carson KV, Usmani ZA, et al. Ambulatory oxygen for people with chro-nic obstructive pulmonary disease who are not hypoxaemic at rest. Cochrane Data-base Syst Rev 2014; 6:CD000238.
24. Jolly EC, Di Boscio V, Aguirre L, et al. Ef-fects of supplemental oxygen during acti-vity in patients with advanced COPD wit-hout severe resting hypoxemia. Chest 2001; 120:437–443.
23. Kim V, Benditt JO, Wise RA, et al. A.Oxy-gen therapy in chronic obstructive pulmo-nary disease.Proc Am ThoracSoc. 2008; 5:513-8.
22. Saglam M, Vardar-Yagli, Savci S, et al. Functional capacity, physical activity, and quality of life in hypoxemic patients with chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis. 2015; 26;10:423-8.
21. Romer LM, Haverkamp HC, Amann M, et al. Effect of acute severe hypoxia on pe-ripheral fatigue and endurance capacity in healthy humans. Am J Physiol Regul In-tegr Comp Physiol. 2007; 292(1):598-606.
20. Ortega Ruiz F, Diaz Lobato S, Galdiz Iturri JB, et al.Continuous home oxygen therapy. Arch Bronconeumol 2014; 50:185–200.
19. Kocabas A, Atıs S, Çöplü L, ve ark. Kro-nik obstrüktif akciger hastalıgı (KOAH) koruma, tanı ve tedavi raporu 2014. Tur-kish Thoracic Journal 2014; 2:68– 71.
18. Bettoncelli G, Blasi F, Brusasco V, et al. The clinical and integrated management of COPD. An official document of AIMAR (Inter disciplinary Association of Research in Lung Disease), AIPO (Italian Associa-tion of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medi-cine). Multidiscip Respir Med 2014; 9:1-25.
17. Qaseem A, Wilt TJ, Weinberger SE, Ha-nania NA, et al. Diagnosis and manage-ment of stable chronic obstructive pulmo-nary disease: a clinical practice guideline update from American College of Physici-ans, American Collage of Chest Physici-ans, American Thoracic Society, and Eu-ropean Respiratory Society. Ann Intern Med 2011; 155:179–191.
16. Hardinge M, Annandale J, Bourne S, et al. British Thoracic Society guidelines for home oxygen use in adults. Thorax 2015; 70:1–43.
15. McDonald ML, Cho MH, Sorheim IC, et al. Common genetic variants associated with resting oxygena- tion in chronic obst-ructive pulmonary disease. Am J Respir Cell Mol Biol 2014; 51:678–687.
14. Boutou AK, Shrikrishna D, Tanner RJ, et al. Lung function indices for predicting mortality in COPD. Eur Respir J 2013; 42:616–625.
13. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/Euro-pean Respiratory Society statement: key concepts and advances in pulmonary reha-bilitation. Am J Respir Crit Care Med 2013; 188: 13-64.
12. Harris CS, Bishop JM, Clark JH, et al. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complica-ting chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet. 1981;1:681–686.
11. Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmo-nary disease. Am Rev Respir Dis. 1986;133:14–20.
10. Garcia-Aymerich J, Monso E, Marrades RM, et al. Risk factors for hospitalization for a chronic obstructive pulmonary dise-ase exacerbation. EFRAM study. Am J Respir Crit Care Med. 2001;164:1002– 1007.
9. Vanier T, Dulfano J, Wu C, et al. Emphy-sema, hypoxia and the polycythemic res-ponse. N Engl J Med. 1963;269:169–178.
8. Kim HC, Mofarrahi M, Hussain SN. Ske-letal muscle dysfunction in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2008;3:637–658.
7. Chaouat A, Naeije R, Weitzenblum E. Pul-monary hypertension in COPD. Eur Res-pir J. 2008;32:1371–1385.
6. Antonucci R, Berton E, Huertas A, et al. Exercise physiology in COPD. Monaldi Arch Chest Dis. 2003;59:134–139.
5. Andrianopoulos V, Celli BR, Franssen FM, et al. Determinants of exercise- indu-ced oxygen desaturation including pulmo-nary emphysema in COPD: Results from the ECLIPSE study. Respir Med 2016; 119:87– 95.
4. Stoller JK, Aboussouan LS, Kanner RE, et al. LOTT Research Group. Characteristics of alpha-1 antitrypsin- deficient individu-als in the long-term oxygen treatment trial and comparison with other subjects with chronic obstructive pulmonary disease. Ann Am Thorac Soc 2015; 12:1796– 1804.
3. Vold ML, Aasebo U, Hjalmarsen A, et al. Predictors of oxygen saturation 95% in a cross-sectional population based survey. Respir Med 2012; 106:1551–1558.
2. Wells JM, Estepar RSJ, McDonald MN, et al. Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study. BMC Pulm Med 2016; 16:169.
1. Global Strategy for the Diagnosis, Mana-gement and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from: http://goldcopd.org