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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

Effect of the personalized pulmonary rehabilitation program that included occupational therapy (PPR-OT) on the 5- to 7-year survival of patients with COPD undergoing HOT in the prospective observational study.Notes: (A) all-cause mortality and (B) respiratory-related mortality after prescription of HOT. In the PPR-OT group, the 5-year survival was (A) 81.2% and (B) 90.6%; the 7-year survival was (A) 71.8% and (B) 83.5%. In the control group, the 5-year survival was (A) 66.0% and (B) 72.3%; the 7-year survival was (A) 53.2% and (B) 66.0%.Abbreviations: COPD, chronic obstructive pulmonary disease; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.
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f4-copd-10-1787: Effect of the personalized pulmonary rehabilitation program that included occupational therapy (PPR-OT) on the 5- to 7-year survival of patients with COPD undergoing HOT in the prospective observational study.Notes: (A) all-cause mortality and (B) respiratory-related mortality after prescription of HOT. In the PPR-OT group, the 5-year survival was (A) 81.2% and (B) 90.6%; the 7-year survival was (A) 71.8% and (B) 83.5%. In the control group, the 5-year survival was (A) 66.0% and (B) 72.3%; the 7-year survival was (A) 53.2% and (B) 66.0%.Abbreviations: COPD, chronic obstructive pulmonary disease; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.

Mentions: Univariate analyses indicated that patients who participated in the PPR-OT program had a significantly better prognosis (Table 6). In addition, the PPR-OT program significantly improved the survival of these patients, independent of medication with anticholinergics or β2 agonists and the admission rate for exacerbation of COPD. Table 6 also shows the results of the univariate analyses for the other management protocols associated with mortality due to any cause. The use of anticholinergics and β2 agonists significantly reduced mortality. Kaplan–Meier analysis of survival showed that inclusion in the PPR-OT group significantly improved all-cause mortality and respiratory-related mortality during the follow-up period relative to the control group (Figure 4). These findings enabled us to confirm that implementation of the PPR-OT program prior to HOT improved the survival of patients with COPD undergoing HOT.


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)

Effect of the personalized pulmonary rehabilitation program that included occupational therapy (PPR-OT) on the 5- to 7-year survival of patients with COPD undergoing HOT in the prospective observational study.Notes: (A) all-cause mortality and (B) respiratory-related mortality after prescription of HOT. In the PPR-OT group, the 5-year survival was (A) 81.2% and (B) 90.6%; the 7-year survival was (A) 71.8% and (B) 83.5%. In the control group, the 5-year survival was (A) 66.0% and (B) 72.3%; the 7-year survival was (A) 53.2% and (B) 66.0%.Abbreviations: COPD, chronic obstructive pulmonary disease; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.
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Related In: Results  -  Collection

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

f4-copd-10-1787: Effect of the personalized pulmonary rehabilitation program that included occupational therapy (PPR-OT) on the 5- to 7-year survival of patients with COPD undergoing HOT in the prospective observational study.Notes: (A) all-cause mortality and (B) respiratory-related mortality after prescription of HOT. In the PPR-OT group, the 5-year survival was (A) 81.2% and (B) 90.6%; the 7-year survival was (A) 71.8% and (B) 83.5%. In the control group, the 5-year survival was (A) 66.0% and (B) 72.3%; the 7-year survival was (A) 53.2% and (B) 66.0%.Abbreviations: COPD, chronic obstructive pulmonary disease; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; HOT, home oxygen therapy.
Mentions: Univariate analyses indicated that patients who participated in the PPR-OT program had a significantly better prognosis (Table 6). In addition, the PPR-OT program significantly improved the survival of these patients, independent of medication with anticholinergics or β2 agonists and the admission rate for exacerbation of COPD. Table 6 also shows the results of the univariate analyses for the other management protocols associated with mortality due to any cause. The use of anticholinergics and β2 agonists significantly reduced mortality. Kaplan–Meier analysis of survival showed that inclusion in the PPR-OT group significantly improved all-cause mortality and respiratory-related mortality during the follow-up period relative to the control group (Figure 4). These findings enabled us to confirm that implementation of the PPR-OT program prior to HOT improved the survival of patients with COPD undergoing HOT.

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