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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

Effectiveness of the PPR-OT program against the three life-threatening conditions in 85 patients with COPD undergoing HOT.Notes: The Kaplan–Meier curves for time to death (ie, all-cause mortality) are shown, based on distributions of the three life-threatening pathophysiological conditions: (A) PaO2 slope, (B), and (C)  after CPET in 85 patients with COPD in the PPR-OT group for 7-year survival, and in comparison with the reference group (no PPR-OT) with each life-threatening pathophysiological condition in previous reports for 5-year survival. Identification of three exercise-induced mortality risk factors in patients with COPD, Yoshimura K, Maekura R, Hiraga T, et al, COPD. 11(6), Copyright © 2014, Informa Healthcare USA, Inc.11 This analysis was conducted to compare the survival rates of patients with (ie, Group A) and without (ie, Group B) each life-threatening pathophysiological condition in the PPR-OT group and compare the survival rates between Group A and Reference group with these conditions but no PPR-OT in a previous study.11 (A) Group A1 (partial arterial pressure of oxygen [PaO2] slope ≤−55 mmHg L−1min−1): the 5-year survival is 86.2%. Reference group (PaO2 slope ≤−55 mmHg L−1min−1): the 5-year survival is 52.2%. Group B1 (PaO2 slope ≥−55 mmHg L−1min−1). (B) Group A2: the 5-year survival is 84.5%. Reference group : the 5-year survival is 50.0%. Group B2. (C) Group A3: the 5-year survival is 81.3%. Reference group : the 5-year survival is 58.3%. Group B .Abbreviations:, the difference in  between values at rest and peak exercise; , the decrease in ; COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; HOT, home oxygen therapy; NE, norepinephrine; PaO2, partial arterial pressure of oxygen; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; , oxygen uptake.
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f5-copd-10-1787: Effectiveness of the PPR-OT program against the three life-threatening conditions in 85 patients with COPD undergoing HOT.Notes: The Kaplan–Meier curves for time to death (ie, all-cause mortality) are shown, based on distributions of the three life-threatening pathophysiological conditions: (A) PaO2 slope, (B), and (C) after CPET in 85 patients with COPD in the PPR-OT group for 7-year survival, and in comparison with the reference group (no PPR-OT) with each life-threatening pathophysiological condition in previous reports for 5-year survival. Identification of three exercise-induced mortality risk factors in patients with COPD, Yoshimura K, Maekura R, Hiraga T, et al, COPD. 11(6), Copyright © 2014, Informa Healthcare USA, Inc.11 This analysis was conducted to compare the survival rates of patients with (ie, Group A) and without (ie, Group B) each life-threatening pathophysiological condition in the PPR-OT group and compare the survival rates between Group A and Reference group with these conditions but no PPR-OT in a previous study.11 (A) Group A1 (partial arterial pressure of oxygen [PaO2] slope ≤−55 mmHg L−1min−1): the 5-year survival is 86.2%. Reference group (PaO2 slope ≤−55 mmHg L−1min−1): the 5-year survival is 52.2%. Group B1 (PaO2 slope ≥−55 mmHg L−1min−1). (B) Group A2: the 5-year survival is 84.5%. Reference group : the 5-year survival is 50.0%. Group B2. (C) Group A3: the 5-year survival is 81.3%. Reference group : the 5-year survival is 58.3%. Group B .Abbreviations:, the difference in between values at rest and peak exercise; , the decrease in ; COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; HOT, home oxygen therapy; NE, norepinephrine; PaO2, partial arterial pressure of oxygen; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; , oxygen uptake.

Mentions: A Kaplan–Meier analysis was conducted to compare the survival rate between the patients with (Group A) and without (Group B) each life-threatening pathophysiological condition in the PPR-OT group. In addition, the comparison of the 5-year survival rate between patients in Group A and patients with the previously described conditions in a previous study (ie, Reference group without PPR-OT) was conducted for the reference data.11 Differences in the indicators of poor prognosis (ie, relevant values for PaO2 slope, , and ) were not identified between Groups A and B (Figure 5). The 5-year survival rates of patients with each of the life-threatening pathophysiological conditions described previously (PaO2 slope ≤−55 mmHg L−1min−1: 86.2%; : 84.5%; and : 81.3%) were much higher than those of the Reference group in the previous report (52.2%, 50%, and 58.3%, respectively11). These findings indicate that the adverse effects of the three life-threatening conditions on the prognosis of patients with advanced COPD were decreased by the PPR-OT intervention.


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)

Effectiveness of the PPR-OT program against the three life-threatening conditions in 85 patients with COPD undergoing HOT.Notes: The Kaplan–Meier curves for time to death (ie, all-cause mortality) are shown, based on distributions of the three life-threatening pathophysiological conditions: (A) PaO2 slope, (B), and (C)  after CPET in 85 patients with COPD in the PPR-OT group for 7-year survival, and in comparison with the reference group (no PPR-OT) with each life-threatening pathophysiological condition in previous reports for 5-year survival. Identification of three exercise-induced mortality risk factors in patients with COPD, Yoshimura K, Maekura R, Hiraga T, et al, COPD. 11(6), Copyright © 2014, Informa Healthcare USA, Inc.11 This analysis was conducted to compare the survival rates of patients with (ie, Group A) and without (ie, Group B) each life-threatening pathophysiological condition in the PPR-OT group and compare the survival rates between Group A and Reference group with these conditions but no PPR-OT in a previous study.11 (A) Group A1 (partial arterial pressure of oxygen [PaO2] slope ≤−55 mmHg L−1min−1): the 5-year survival is 86.2%. Reference group (PaO2 slope ≤−55 mmHg L−1min−1): the 5-year survival is 52.2%. Group B1 (PaO2 slope ≥−55 mmHg L−1min−1). (B) Group A2: the 5-year survival is 84.5%. Reference group : the 5-year survival is 50.0%. Group B2. (C) Group A3: the 5-year survival is 81.3%. Reference group : the 5-year survival is 58.3%. Group B .Abbreviations:, the difference in  between values at rest and peak exercise; , the decrease in ; COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; HOT, home oxygen therapy; NE, norepinephrine; PaO2, partial arterial pressure of oxygen; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; , oxygen uptake.
© Copyright Policy
Related In: Results  -  Collection

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

f5-copd-10-1787: Effectiveness of the PPR-OT program against the three life-threatening conditions in 85 patients with COPD undergoing HOT.Notes: The Kaplan–Meier curves for time to death (ie, all-cause mortality) are shown, based on distributions of the three life-threatening pathophysiological conditions: (A) PaO2 slope, (B), and (C) after CPET in 85 patients with COPD in the PPR-OT group for 7-year survival, and in comparison with the reference group (no PPR-OT) with each life-threatening pathophysiological condition in previous reports for 5-year survival. Identification of three exercise-induced mortality risk factors in patients with COPD, Yoshimura K, Maekura R, Hiraga T, et al, COPD. 11(6), Copyright © 2014, Informa Healthcare USA, Inc.11 This analysis was conducted to compare the survival rates of patients with (ie, Group A) and without (ie, Group B) each life-threatening pathophysiological condition in the PPR-OT group and compare the survival rates between Group A and Reference group with these conditions but no PPR-OT in a previous study.11 (A) Group A1 (partial arterial pressure of oxygen [PaO2] slope ≤−55 mmHg L−1min−1): the 5-year survival is 86.2%. Reference group (PaO2 slope ≤−55 mmHg L−1min−1): the 5-year survival is 52.2%. Group B1 (PaO2 slope ≥−55 mmHg L−1min−1). (B) Group A2: the 5-year survival is 84.5%. Reference group : the 5-year survival is 50.0%. Group B2. (C) Group A3: the 5-year survival is 81.3%. Reference group : the 5-year survival is 58.3%. Group B .Abbreviations:, the difference in between values at rest and peak exercise; , the decrease in ; COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; HOT, home oxygen therapy; NE, norepinephrine; PaO2, partial arterial pressure of oxygen; PPR-OT, personalized patient-specific pulmonary rehabilitation-occupational therapy; , oxygen uptake.
Mentions: A Kaplan–Meier analysis was conducted to compare the survival rate between the patients with (Group A) and without (Group B) each life-threatening pathophysiological condition in the PPR-OT group. In addition, the comparison of the 5-year survival rate between patients in Group A and patients with the previously described conditions in a previous study (ie, Reference group without PPR-OT) was conducted for the reference data.11 Differences in the indicators of poor prognosis (ie, relevant values for PaO2 slope, , and ) were not identified between Groups A and B (Figure 5). The 5-year survival rates of patients with each of the life-threatening pathophysiological conditions described previously (PaO2 slope ≤−55 mmHg L−1min−1: 86.2%; : 84.5%; and : 81.3%) were much higher than those of the Reference group in the previous report (52.2%, 50%, and 58.3%, respectively11). These findings indicate that the adverse effects of the three life-threatening conditions on the prognosis of patients with advanced COPD were decreased by the PPR-OT intervention.

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