KOAH hastalarında tekrarlanan pulmoner rehabilitasyon programı ilki kadar etkili midir?

Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda pulmoner rehabilitasyon (PR) programlarının etkilerinin zamanla azaldığı bilinmekle birlikte, tekrarlanan PR programlarının etkinliği çelişkilidir. Çalışmamızda; KOAH hastalarında başlangıç ve tekrar uygulanan PR programının fonksiyonel sonuçlar üzerindeki etkilerinin karşılaştırılması amaçlanmıştır. Materyal ve Metod: İkinci kez PR programını tamamlayan 32 KOAH hastası retrospektif kohort çalışmamıza dahil edildi. Hastalara en az bir yıl arayla iki kez, sekiz hafta süren PR programı uygulandı. Her iki programdan önce ve sonra mMRC Dispne Ölçeği, Altı Dakika Yürüme Testi, Hastane Anksiyete ve Depresyon Ölçeği, 36 Maddelik Kısa Form Anketi (SF-36) ve St. George’s Solunum Anketi (SGRQ) yapıldı. İlk ve tekrar programların kazanımları karşılaştırıldı. Bulgular: Her iki programın ardından hastaların altı dakika yürüme mesafesi, nefes darlığı ve yaşam kalitesi düzeldi (p< 0,05). İlk PR programında altı dakika yürüme mesafesi (p= 0,009), dispne (p= 0,003) ve SGRQ yaşam kalitesindeki (aktivite skoru için p= 0,037, toplam skor için p= 0,050) iyileşmeler anlamlı olarak daha yüksek bulundu. Sonuç: Tekrarlanan PR programlarındaki birçok kazanım ilk PR programına benzer olmasına rağmen, ilk PR programında elde edilen yürüme mesafesi, dispne algısı ve yaşam kalitesindeki iyileşmeler tekrarlanan PR programına göre daha yüksektir.

Is the repeated pulmonary rehabilitation program as effective as the first one in COPD patients?

Introduction: Although it is known that the effects of pulmonary rehabilitation (PR) programs in patients with chronic obstructive pulmonary disease (COPD) decrease over time, the results of the repeat PR programs are contradictory. Our study aimed to compare the effectiveness of the initial and the repeat PR programs on functional outcomes in COPD patients. Materials and Methods: Thirty two COPD patients who completed a second PR program were included in our retrospective cohort study. Eight-week PR program was applied to the patients twice with at least a one-year interval in between. mMRC Dyspnea Scale, Six-Minute Walk Test, Hospital Anxiety and Depression Scale, 36 Item Short Form Survey (SF-36), and St. George’s Respiratory Questionnaire (SGRQ) were performed before and after both programs. The gains from the initial and the repeated programs were compared. Results: Six-minute walk distance, dyspnea, and quality of life improved following both programs (p< 0.05). Improvements in six-minute walk distance (p= 0.009), dyspnea (p= 0.003), and SGRQ quality of life (p= 0.037 for activity score, p= 0.050 for total score) were found to be significantly higher in the initial PR program. Conclusion: Although many of the gains obtained from the repeated PR programs were similar to the initial PR program, the improvements in walk distance, perception of dyspnea, and quality of life obtained in the initial PR program were higher compared to the repeated PR program.

PDF

___

1. Global Strategy for The Diagnosis, Management, and Prevention of COPD: 2022 Report. Available from: https:// goldcopd.org/wp-content/uploads/2021/12/GOLDREPORT- 2022-v1. (Accessed date: 12 February 2022).
2. Kaplan RM, Ries AL. Quality of life as an outcome measure in pulmonary diseases. J Cardiopulm Rehabil 2005; 25(6): 321-31. https://doi.org/10.1097/00008483- 200511000-00002
3. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/ European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188(8): e13-64.
4. Corhay JL, Dang DN, Van Cauwenberge H, Louis R. Pulmonary rehabilitation and COPD: Providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis 2014; 9: 27-39. https://doi. org/10.2147/COPD.S52012
5. Ries AL. Pulmonary rehabilitation: Summary of an evidence- based guideline. Respir Care 2008; 53(9): 1203-7. 6. Jácome C, Marques A. Short-and long-term effects of pulmonary rehabilitation in patients with mild COPD: A
comparison with patients with moderate to severe COPD. J Cardiopulm Rehabil Prev 2016; 36(6): 445-53. https:// doi.org/10.1097/HCR.0000000000000219
7. Atabaki A, Fine J, Haggerty M, Marolda C, Wakefield D, Yu A, et al. Effectiveness of repeated courses of pulmonary rehabilitation on functional exercise capacity in patients with COPD. J Cardiopulm Rehabil Prev 2015; 35(4): 272- 7. https://doi.org/10.1097/HCR.0000000000000115
8. Bauldoff GS, Hoffman LA, Zullo TG, Sciurba FC. Exercise maintenance following pulmonary rehabilitation: Effect of distractive stimuli. Chest 2002; 122(3): 948-54. https:// doi.org/10.1378/chest.122.3.948
9. Hill K, Bansal V, Brooks D, Goldstein RS. Repeat pulmonary rehabilitation programs confer similar increases in functional exercise capacity to initial programs. J Cardiopulm Rehabil Prev 2008; 28(6): 410-4. https://doi. org/10.1097/HCR.0b013e31818c3c8d
10. Stav D, Raz M, Shpirer I. Three years of pulmonary rehabilitation: Inhibit the decline in airflow obstruction, improves exercise endurance time, and body-mass index, in chronic obstructive pulmonary disease. BMC Pulm Med 2009; 9: 26. https://doi.org/10.1186/1471-2466-9-26
11. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. ATS/ERS task force. Standardisation of spirometry. Eur Respir J 2005; 26(2): 319-38. https://doi. org/10.1183/09031936.05.00034805
12. Sweer L, Zwillich CW. Dyspnea in the patient with chronic obstructive pulmonary disease. Etiology and management. Clin Chest Med 1990; 11(3): 417-45. https://doi. org/10.1016/S0272-5231(21)00710-3
13. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166(1): 111-7. https://doi.org/10.1164/ ajrccm.166.1.at1102
14. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14(5): 377-81. https://doi. org/10.1249/00005768-198205000-00012
15. Polkey MI, Spruit MA, Edwards LD, Watkins ML, Pinto- Plata V, Vestbo J, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med 2013; 187(4): 382-6. https://doi. org/10.1164/rccm.201209-1596OC
16. Aydemir O, Guvenir T, Kuey L, Kultur S. Reliability and validity of the Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg 1997; 8(3): 280-7.
17. Koçyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Validity and reliability of Turkish version of Short form SF-36. Turk J Drug Therap 1999; 12: 102-6.
18. Polatlı M, Yorgancıoglu A, Aydemir O, Yılmaz Demirci N, Kırkıl G, Atıs Naycı S, et al. Validity and reliability of Turkish version of St. George’s respiratory questionnaire. Tuberc Torax 2013; 61(2): 81-7. https://doi.org/10.5578/ tt.5404
19. Foglio K, Bianchi L, Ambrosino N. Is it really useful to repeat outpatient pulmonary rehabilitation programs in patients with chronic airway obstruction? A 2-year controlled study. Chest 2001; 119(6): 1696-704. https://doi. org/10.1378/chest.119.6.1696
20. Ingram K, Canavan J, Kon S, Nolan C, Jones S, Clark A, et al. Repeat pulmonary rehabilitation programmes: Are they beneficial in COPD? ERJ 2014; 44: P610.
21. Heng H, Lee AL, Holland AE. Repeating pulmonary rehabilitation: Prevalence, predictors and outcomes. Respirology 2014; 19(7): 999-1005. https://doi. org/10.1111/resp.12365
22. Foglio K, Bianchi L, Bruletti G, Porta R, Vitacca M, Balbi B, et al. Seven-year time course of lung function, symptoms, health-related quality of life, and exercise tolerance in COPD patients undergoing pulmonary rehabilitation programs. Respir Med 2007; 101(9): 1961-70. https://doi. org/10.1016/j.rmed.2007.04.007
23. Marchetti N, Criner GJ, Albert RK. Preventing acute exacerbations and hospital admissions in COPD. Chest 2013; 143(5): 1444-54. https://doi.org/10.1378/chest.12-1801
24. Criner GJ, Bourbeau J, Diekemper RL, Ouellette DR, Goodridge D, Hernandez P, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest 2015; 147(4): 894-942. https://doi.org/10.1378/ chest.14-1676
25. Bourbeau J. Preventing hospitalization for COPD exacerbations. Semin Respir Crit Care Med 2010; 31(3): 313-20. https://doi.org/10.1055/s-0030-1254071
26. Kon SS, Canavan JL, Man WD. Pulmonary rehabilitation and acute exacerbations of COPD. Expert Rev Respir Med 2012; 6(5): 523-31. https://doi.org/10.1586/ers.12.47
27. Sahin H, Varol Y, Naz I, Aksel N, Tuksavul F, Ozsoz A. The effect of pulmonary rehabilitation on COPD exacerbation frequency per year. Clin Respir J 2018; 12(1): 165-74. https://doi.org/10.1111/crj.12507
28. Tantucci C, Modina D. Lung function decline in COPD. Int J Chron Obstruct Pulmon Dis 2012; 7: 95-9. https://doi. org/10.2147/COPD.S27480
29. Marciniuk DD, Goodridge D, Hernandez P, Rocker G, Balter M, Bailey P, et al; Canadian Thoracic Society COPD Committee Dyspnea Expert Working Group. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: A Canadian Thoracic Society clinical practice guideline. Can Respir J 2011; 18(2): 69-78. https://doi.org/10.1155/2011/745047