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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

Kaplan–Meier curves of time to death (all-cause mortality) using (A) the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, (B) body mass index, and (C) peak  distribution after cardiopulmonary exercise testing (CPET) in 85 patients with chronic obstructive pulmonary disease (COPD) in the personalized patient-specific pulmonary rehabilitation-occupational therapy (PPR-OT) group and comparison with the Reference group (no PPR-OT) in previous report.11Notes: The survival of patients with GOLD 4 is compared to that of patients in GOLD 3 and Reference (GOLD 4) groups. The 5-year survival of patients with GOLD 4 is 84.4%. The 5-year survival of the Reference group (GOLD 4) is 64.3%, (B) The survival of patients with a body mass index (BMI) <18 was compared to that of patients with a BMI ≥18 and Reference (ie, BMI <18) patients. The 5-year survival of patients with a BMI <18 is 81.5%; the 5-year survival of the Reference group (ie, BMI <18) is 60.7%. (C) The survival of patients with peak  is compared to that of patients with peak  and Reference patients (ie, peak ). The 5-year survival of patients with peak  is 83.4%. The 5-year survival of the Reference group patients (ie, peak ) is 45.8%.
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f6-copd-10-1787: Kaplan–Meier curves of time to death (all-cause mortality) using (A) the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, (B) body mass index, and (C) peak distribution after cardiopulmonary exercise testing (CPET) in 85 patients with chronic obstructive pulmonary disease (COPD) in the personalized patient-specific pulmonary rehabilitation-occupational therapy (PPR-OT) group and comparison with the Reference group (no PPR-OT) in previous report.11Notes: The survival of patients with GOLD 4 is compared to that of patients in GOLD 3 and Reference (GOLD 4) groups. The 5-year survival of patients with GOLD 4 is 84.4%. The 5-year survival of the Reference group (GOLD 4) is 64.3%, (B) The survival of patients with a body mass index (BMI) <18 was compared to that of patients with a BMI ≥18 and Reference (ie, BMI <18) patients. The 5-year survival of patients with a BMI <18 is 81.5%; the 5-year survival of the Reference group (ie, BMI <18) is 60.7%. (C) The survival of patients with peak is compared to that of patients with peak and Reference patients (ie, peak ). The 5-year survival of patients with peak is 83.4%. The 5-year survival of the Reference group patients (ie, peak ) is 45.8%.

Mentions: When the other prognostic predictors were evaluated in the PPR-OT group, BMI and peak oxygen uptake were identified as significant predictors of mortality in the 7-year survival analysis (Figure 6). However, in the 5-year survival analysis, BMI (risk ratio =0.895, range: 0.714–1.105; P=0.3065) and low exercise capacity (risk ratio =0.999, range: 0.996–1.001; P=0.409), in addition to airflow limitation (risk ratio =0.961, range: 0.897–1.020; P=0.2045), were not significantly associated with the mortality of patients with advanced COPD. The survival rates of patients with COPD with very severe predictors of mortality were surprisingly higher (5-year survival was 81.5% with BMI <18, 83.4% with peak , and 84.4% with GOLD Stage 4 disease) than the rates reported in previous studies.8,9,11,20,21,29,30 These results also confirm that the survival of patients with advanced COPD who undergo the PPR-OT program is excellent.


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)

Kaplan–Meier curves of time to death (all-cause mortality) using (A) the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, (B) body mass index, and (C) peak  distribution after cardiopulmonary exercise testing (CPET) in 85 patients with chronic obstructive pulmonary disease (COPD) in the personalized patient-specific pulmonary rehabilitation-occupational therapy (PPR-OT) group and comparison with the Reference group (no PPR-OT) in previous report.11Notes: The survival of patients with GOLD 4 is compared to that of patients in GOLD 3 and Reference (GOLD 4) groups. The 5-year survival of patients with GOLD 4 is 84.4%. The 5-year survival of the Reference group (GOLD 4) is 64.3%, (B) The survival of patients with a body mass index (BMI) <18 was compared to that of patients with a BMI ≥18 and Reference (ie, BMI <18) patients. The 5-year survival of patients with a BMI <18 is 81.5%; the 5-year survival of the Reference group (ie, BMI <18) is 60.7%. (C) The survival of patients with peak  is compared to that of patients with peak  and Reference patients (ie, peak ). The 5-year survival of patients with peak  is 83.4%. The 5-year survival of the Reference group patients (ie, peak ) is 45.8%.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4562755&req=5

f6-copd-10-1787: Kaplan–Meier curves of time to death (all-cause mortality) using (A) the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, (B) body mass index, and (C) peak distribution after cardiopulmonary exercise testing (CPET) in 85 patients with chronic obstructive pulmonary disease (COPD) in the personalized patient-specific pulmonary rehabilitation-occupational therapy (PPR-OT) group and comparison with the Reference group (no PPR-OT) in previous report.11Notes: The survival of patients with GOLD 4 is compared to that of patients in GOLD 3 and Reference (GOLD 4) groups. The 5-year survival of patients with GOLD 4 is 84.4%. The 5-year survival of the Reference group (GOLD 4) is 64.3%, (B) The survival of patients with a body mass index (BMI) <18 was compared to that of patients with a BMI ≥18 and Reference (ie, BMI <18) patients. The 5-year survival of patients with a BMI <18 is 81.5%; the 5-year survival of the Reference group (ie, BMI <18) is 60.7%. (C) The survival of patients with peak is compared to that of patients with peak and Reference patients (ie, peak ). The 5-year survival of patients with peak is 83.4%. The 5-year survival of the Reference group patients (ie, peak ) is 45.8%.
Mentions: When the other prognostic predictors were evaluated in the PPR-OT group, BMI and peak oxygen uptake were identified as significant predictors of mortality in the 7-year survival analysis (Figure 6). However, in the 5-year survival analysis, BMI (risk ratio =0.895, range: 0.714–1.105; P=0.3065) and low exercise capacity (risk ratio =0.999, range: 0.996–1.001; P=0.409), in addition to airflow limitation (risk ratio =0.961, range: 0.897–1.020; P=0.2045), were not significantly associated with the mortality of patients with advanced COPD. The survival rates of patients with COPD with very severe predictors of mortality were surprisingly higher (5-year survival was 81.5% with BMI <18, 83.4% with peak , and 84.4% with GOLD Stage 4 disease) than the rates reported in previous studies.8,9,11,20,21,29,30 These results also confirm that the survival of patients with advanced COPD who undergo the PPR-OT program is excellent.

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