Limits...
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

Determination of a safe range using partial pressure of arterial oxygen (PaO2), NE, and the Borg scale during CPET.Notes: We measured hypoxemia (PaO2 <60 mmHg), the NE threshold, and breathlessness onset for each individual during exercise. The NE threshold was determined by using a log-log transformation of the NE–oxygen uptake relationship. The criteria for the safe range were 1) PaO2 >60 mmHg and 2) lower than the NE threshold and/or Borg scale score of <2. These variables were used together to determine the safe range as indicated by oxygen uptake (mL/min), which was determined from each patient’s SpO2 (%) reading and pulse rate (beats/min) using a watch-type pulse oximeter, in addition to the Borg scale. The yellow triangles indicates PaO2; the pink squares indicates norepinephrine (NE); the dark blue diamond is the Borg scale. The dotted line indicates oxygen uptake at the point of NT.Abbreviations: CPET, cardiopulmonary exercise testing; NE, norepinephrine; NT, norepinephrine threshold; PaO2, partial pressure of arterial oxygen.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4562755&req=5

f2-copd-10-1787: Determination of a safe range using partial pressure of arterial oxygen (PaO2), NE, and the Borg scale during CPET.Notes: We measured hypoxemia (PaO2 <60 mmHg), the NE threshold, and breathlessness onset for each individual during exercise. The NE threshold was determined by using a log-log transformation of the NE–oxygen uptake relationship. The criteria for the safe range were 1) PaO2 >60 mmHg and 2) lower than the NE threshold and/or Borg scale score of <2. These variables were used together to determine the safe range as indicated by oxygen uptake (mL/min), which was determined from each patient’s SpO2 (%) reading and pulse rate (beats/min) using a watch-type pulse oximeter, in addition to the Borg scale. The yellow triangles indicates PaO2; the pink squares indicates norepinephrine (NE); the dark blue diamond is the Borg scale. The dotted line indicates oxygen uptake at the point of NT.Abbreviations: CPET, cardiopulmonary exercise testing; NE, norepinephrine; NT, norepinephrine threshold; PaO2, partial pressure of arterial oxygen.

Mentions: The aim of the PPR-OT program is for patients with advanced COPD to be able to safely live at home for a longer time without feeling breathlessness with their remaining cardiopulmonary capacity, which has been improved to the greatest extent possible by medication and PPR, including exercise training. As pathophysiological responses to exercise vary widely among patients with COPD,10 we determined the safe range of activity for each patient, based on their CPET parameters. The criteria for a safe range were 1) PaO2 >60 mmHg and 2) Borg scale score of <2 and/or lower than the norepinephrine (NE) threshold as there is a strong linear positive correlation between the NE threshold and the onset of dyspnea during incremental exercise.10 The safe range was identified by oxygen uptake (mL/min), which was determined according to each patient’s pulse oximeter O2 saturation (SpO2) (%) reading and pulse rate (beats/min) using a watch-type pulse oximeter, in addition to the Borg scale (Figures 2, S1). We designed this pulse oximeter in collaboration with Minolta Co Ltd (Hachioji City, Tokyo, Japan).


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)

Determination of a safe range using partial pressure of arterial oxygen (PaO2), NE, and the Borg scale during CPET.Notes: We measured hypoxemia (PaO2 <60 mmHg), the NE threshold, and breathlessness onset for each individual during exercise. The NE threshold was determined by using a log-log transformation of the NE–oxygen uptake relationship. The criteria for the safe range were 1) PaO2 >60 mmHg and 2) lower than the NE threshold and/or Borg scale score of <2. These variables were used together to determine the safe range as indicated by oxygen uptake (mL/min), which was determined from each patient’s SpO2 (%) reading and pulse rate (beats/min) using a watch-type pulse oximeter, in addition to the Borg scale. The yellow triangles indicates PaO2; the pink squares indicates norepinephrine (NE); the dark blue diamond is the Borg scale. The dotted line indicates oxygen uptake at the point of NT.Abbreviations: CPET, cardiopulmonary exercise testing; NE, norepinephrine; NT, norepinephrine threshold; PaO2, partial pressure of arterial oxygen.
© Copyright Policy
Related In: Results  -  Collection

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

f2-copd-10-1787: Determination of a safe range using partial pressure of arterial oxygen (PaO2), NE, and the Borg scale during CPET.Notes: We measured hypoxemia (PaO2 <60 mmHg), the NE threshold, and breathlessness onset for each individual during exercise. The NE threshold was determined by using a log-log transformation of the NE–oxygen uptake relationship. The criteria for the safe range were 1) PaO2 >60 mmHg and 2) lower than the NE threshold and/or Borg scale score of <2. These variables were used together to determine the safe range as indicated by oxygen uptake (mL/min), which was determined from each patient’s SpO2 (%) reading and pulse rate (beats/min) using a watch-type pulse oximeter, in addition to the Borg scale. The yellow triangles indicates PaO2; the pink squares indicates norepinephrine (NE); the dark blue diamond is the Borg scale. The dotted line indicates oxygen uptake at the point of NT.Abbreviations: CPET, cardiopulmonary exercise testing; NE, norepinephrine; NT, norepinephrine threshold; PaO2, partial pressure of arterial oxygen.
Mentions: The aim of the PPR-OT program is for patients with advanced COPD to be able to safely live at home for a longer time without feeling breathlessness with their remaining cardiopulmonary capacity, which has been improved to the greatest extent possible by medication and PPR, including exercise training. As pathophysiological responses to exercise vary widely among patients with COPD,10 we determined the safe range of activity for each patient, based on their CPET parameters. The criteria for a safe range were 1) PaO2 >60 mmHg and 2) Borg scale score of <2 and/or lower than the norepinephrine (NE) threshold as there is a strong linear positive correlation between the NE threshold and the onset of dyspnea during incremental exercise.10 The safe range was identified by oxygen uptake (mL/min), which was determined according to each patient’s pulse oximeter O2 saturation (SpO2) (%) reading and pulse rate (beats/min) using a watch-type pulse oximeter, in addition to the Borg scale (Figures 2, S1). We designed this pulse oximeter in collaboration with Minolta Co Ltd (Hachioji City, Tokyo, Japan).

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