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Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease.

Maekura R, Hiraga T, Miki K, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Mori M - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172-0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296-0.933]; P=0.0291; log-rank test, P=0.0232].At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively).Survival of patients with life-threatening pathophysiological conditions also greatly improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan.

ABSTRACT

Take-home summary: Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD.

Purpose: We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities.

Patients and methods: The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan-Meier analyses.

Results: In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172-0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296-0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved.

Conclusion: The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.

No MeSH data available.


Related in: MedlinePlus

Study designs of (A) the retrospective control study and (B) the prospective observational study.Note: *Indicates the number of patients included in the survival analyses.Abbreviations: COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MRC, Medical Research Council; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.
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f1-copd-10-1787: Study designs of (A) the retrospective control study and (B) the prospective observational study.Note: *Indicates the number of patients included in the survival analyses.Abbreviations: COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MRC, Medical Research Council; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.

Mentions: Figure 1 shows the study design. We first conducted a retrospective control study to test the safety and feasibility of the PPR-OT program in 107 patients with COPD. This was followed by a prospective observational study to determine the efficacy of the clinical PPR-OT program, initiated prior to the commencement of home oxygen therapy (HOT), for the long-term survival of patients with advanced COPD over a 5-year period. The primary outcome parameter was improvement in the survival time. The secondary outcome parameter was improvement in adverse effects related to survival in the three life-threatening exercise-induced conditions.


Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease.

Maekura R, Hiraga T, Miki K, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Mori M - Int J Chron Obstruct Pulmon Dis (2015)

Study designs of (A) the retrospective control study and (B) the prospective observational study.Note: *Indicates the number of patients included in the survival analyses.Abbreviations: COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MRC, Medical Research Council; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562755&req=5

f1-copd-10-1787: Study designs of (A) the retrospective control study and (B) the prospective observational study.Note: *Indicates the number of patients included in the survival analyses.Abbreviations: COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MRC, Medical Research Council; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.
Mentions: Figure 1 shows the study design. We first conducted a retrospective control study to test the safety and feasibility of the PPR-OT program in 107 patients with COPD. This was followed by a prospective observational study to determine the efficacy of the clinical PPR-OT program, initiated prior to the commencement of home oxygen therapy (HOT), for the long-term survival of patients with advanced COPD over a 5-year period. The primary outcome parameter was improvement in the survival time. The secondary outcome parameter was improvement in adverse effects related to survival in the three life-threatening exercise-induced conditions.

Bottom Line: In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172-0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296-0.933]; P=0.0291; log-rank test, P=0.0232].At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively).Survival of patients with life-threatening pathophysiological conditions also greatly improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan.

ABSTRACT

Take-home summary: Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD.

Purpose: We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities.

Patients and methods: The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan-Meier analyses.

Results: In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172-0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296-0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved.

Conclusion: The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.

No MeSH data available.


Related in: MedlinePlus