Is there any treatment other than drugs to alleviate dyspnea in COPD patients? (original) (raw)
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Strategies to improve breathlessness and exercise tolerance in chronic obstructive pulmonary disease
Respiratory Medicine: COPD Update, 2006
Breathlessness often limits patients with chronic obstructive pulmonary disease (COPD) in their activities. Many of the therapeutic interventions currently available relieve dyspnoea by addressing a combination of different mechanisms, namely (i) reduction of ventilatory demand, (ii) reduction of ventilatory impedance and (iii) improvement in ventilatory muscle function.
Benefits of pulmonary rehabilitation in patients with COPD and normal exercise capacity
2013
BACKGROUND: Pulmonary rehabilitation (PR) is beneficial for patients with COPD, with improvement in exercise capacity and health-related quality of life. Despite these overall benefits, the responses to PR vary significantly among different individuals. It is not clear if PR is beneficial for patients with COPD and normal exercise capacity. We aimed to investigate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity. METHODS: Twenty-six subjects with COPD and normal exercise capacity were studied. All subjects participated in 12-week, 2 sessions per week, hospital-based, outpatient PR. Baseline and post-PR status were evaluated by spirometry, the St George's Respiratory Questionnaire, cardiopulmonary exercise test, respiratory muscle strength, and dyspnea scores. RESULTS: The mean FEV 1 in the subjects was 1.29 ؎ 0.47 L/min, 64.8 ؎ 23.0% of predicted. After PR there was significant improvement in maximal oxygen uptake and work rate. Improvements in St George's Respiratory Questionnaire scores of total, symptoms, activity, and impact were accompanied by improvements of exercise capacity, respiratory muscle strength, maximum oxygen pulse, and exertional dyspnea scores (all P < .05). There were no significant changes in pulmonary function test results (FEV 1 , FVC, and FEV 1 /FVC), minute ventilation, breathing frequency, or tidal volume at rest or exercise after PR. CONCLUSIONS: Exercise training can result in significant improvement in health-related quality of life, exercise capacity, respiratory muscle strength, and exertional dyspnea in subjects with COPD and normal exercise capacity. Exercise training is still indicated for patients with normal exercise capacity.
Respiratory Medicine, 2003
In this review we shall consider the commonest techniques to reduce dyspnea that are being applied to patients with chronic obstructive pulmonary disease (COPD) subjected to a pulmonary rehabilitation program (PRP). Pursed lip breathing (PLB) and diaphragmatic breathing (DB) are breathing retraining strategies employed by COPD patientsin order to relieve and control dyspnea.However, the effectiveness of PLB in reducing dyspnoea is controversial. Moreover,DB may be associated with asynchronous and paradoxical breathing movements, reflecting a decrease in the efficiency of the diaphragm. Exercise training (EXT) is a mandatory component of PRP. EXT has been shown to improve exercise performances and peripheral muscle strength.Recent studies have focused on the effect of EXTon breathlessness.However, concerns persist as to whether the decreased sensation of dyspnea for a given exercise stimulus is principally due to psychological benefits of rehabilitation or to improved physiological ability to perform exercise.The effect of EXTon breathlessness may be reinforced by inhaling oxygen. However, two studies have recently shown that breathing supplemental oxygen during training has either a marginal effect or no advantage over training.In a comprehensive PRP, strengthtraining (ST) and arm endurance training (AET) could have a role in decreasing peripheral muscle weakness and metabolic and ventilatory requirements for AET. The role of unloading the respiratory muscles during EXT has to be clarified.
Impact of Pulmonary Rehabilitation on the Major Dimensions of Dyspnea in COPD
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2013
The evaluation of dyspnea and its responsiveness to therapy in COPD should consider the multidimensional nature of this symptom in each of its sensoryperceptual (intensity, quality), affective and impact domains. To gain new insights into mechanisms of dyspnea relief following pulmonary rehabilitation (PR), we examined effects on the major domains of dyspnea and their interaction with physiological training effects. This randomized, controlled study was conducted in 48 subjects with COPD. Subjects received either 8-weeks of PR or usual care (CTRL). Pre-and post-intervention assessments included: sensory-perceptual (i.e., exertional dyspnea intensity, dyspnea descriptors at end-exercise), affective (i.e., intensity of breathing-related anxiety during exercise, COPD self-effi cacy, walking self-effi cacy) and impact (i.e., activity-related dyspnea measured by the Baseline/Transition Dyspnea Index, Chronic Respiratory Questionnaire dyspnea component, St. George's Respiratory Disease Questionnaire activity component) domains of dyspnea; functional performance (i.e., 6-minute walk, endurance shuttle walk); pulmonary function; and physiological measurements during constant work rate cycle exercise at 75% of the peak incremental work rate. Forty-one subjects completed the study: PR (n = 17) and CTRL (n = 24) groups were well matched for age, sex, body size and pulmonary function. There were no signifi cant between-group differences in pre-to post-intervention changes in pulmonary function or physiological parameters during exercise. After PR versus CTRL, signifi cant improvements were found in the affective and impact domains but not in the sensory-perceptual domain of dyspnea. In conclusion, clinically meaningful improvements in the affective and impact domains of dyspnea occurred in response to PR in the absence of consistent physiological training effects. COPD, 10:1
Egyptian Journal of Chest Diseases and Tuberculosis, 2017
Background: Pulmonary rehabilitation (PR) using exercise training has been useful to increase the exercise capacity and life quality in patients with chronic obstructive pulmonary disease (COPD). However, airflow limitation which characterizes COPD usually worsens during exercise due to the lack of flow reserve and dyspnea hinders exercise maintenance. Non-invasive ventilation (NIV) has been a beneficial therapeutic tool for COPD patients to ameliorate their dyspnea and intensify their exercise. Thus, using NIV during exercise training program might have a synergistic effect in managing patients with COPD by increasing their physical activity, exercise intensity and capacity and their quality of life. Objective: To study the effect of using NIV during PR by exercise training on dyspnea, exercise tolerance and quality of life as compared to effect of exercise alone in patients of COPD. Subjects and methods: The present study was conducted on 24 stable male patients with COPD who were ex-smokers. Patients were divided into 2 groups; group 1 (Exercise gp) included 12 patients who had undergone exercise training only and group 2 (EX/CPAP gp) which included also 12 patients who had undergone exercise in addition to NIV using continuous positive airway pressure (CPAP). Baseline and after 1 month assessment of patients' pulmonary functions, arterial blood gases, dyspnea scale assessed with the Modified Medical Research Council (MRC), 6 minute walking test (6MWT), BODE index and COPD Assessment Test (CAT) score was done. Results: Group 2 (Ex/CPAP gp) showed a statistically significant improvement in 6MWD, BODE index, SaO 2 , PaCO 2 , Pimax, mMRC, and CAT score (p < .05). Group 1 (exercise group) showed a statistically significant improvement in 6MWD, Pimax, BODE index, mMRC and CAT score (p < .05). As regards comparison of group 1 to group 2, the % of improvement in 6MWD and BODE index was significantly more in group 2 than group 1 (p = .010 and <.001, respectively). No significant differences were found between both groups as regards blood gases, mMRC and CAT score. Conclusion: Adding non-invasive ventilation to an exercise rehabilitation program in patients with stable COPD has shown to augment improvement in exercise performance.
CHEST Journal, 2007
Background: Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity of exercise being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from reaching higher levels of intensity. Study objective: This study was to determine whether inspiratory pressure support (IPS) applied during sub maximal exercise could enable individuals with severe but stable COPD to increase their exercise tolerance. Participants: Twelve subjects with severe stable COPD (mean (SD): age = 63(8.2) years; FEV 1 = 0.89(0.42) L (34)% predicted; FEV 1 /FVC = 0.31(0.07) only nine subjects completed the study. Intervention: Each subject completed ten sessions of cycling at 25%-50% of their maximum power without NIVS and another ten sessions using NIVS. Measurements and results: Dyspnea was measured using Borg scale. Subjects reached high levels of dyspnea 4.7 (1.81) during the sessions without NIVS vs low levels of dyspnea during the sessions using NIVS 1.3 (0.6). Exercise time during the sessions without NIVS and with NIVS was 19.37 (3.4) and 33.75 (9.5) min, respectively. Maximal workload during the sessions without NIVS and with NIVS was 27 (3.7) and 50 (10.5) watt, respectively. Conclusion: We conclude that IPS delivered by nasal mask can improve exercise tolerance and dyspnea in stable severe COPD patients and hence this mode of ventilatory support may be useful in respiratory rehabilitation programs.
Exercise Training in Chronic Obstructive Pulmonary Disease
Clinics in Chest Medicine, 2000
Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high-and lowintensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower-and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.
Short-Term Effects of Normocapnic Hyperpnea and Exercise Training in Copd Patients
American Journal of Physical Medicine & Rehabilitation, 2018
The aim of the study was to evaluate the short-term physiologic effects of respiratory muscle training with normocapnic hyperpnea added to standard exercise training on respiratory muscle endurance/strength and exercise tolerance in patients with chronic obstructive pulmonary disease. Design: The study used a randomized controlled trial. Patients referred for rehabilitation were randomly assigned to 20 sessions (twice daily 5 d/wk) of either normocapnic hyperpnea (group 1, n = 12) or sham maneuvers (group 2, n = 10) in addition to individualized cycle training and abdominal, upper, and lower limb muscle exercise. At baseline and end of study, patients underwent evaluation of respiratory muscle endurance, maximum voluntary ventilation, maximal inspiratory, and expiratory pressures, and 6-min walking distance. Results: After training, a significant improvement was found only for group 1 in respiratory muscle endurance time (by 654 [481] secs versus 149 [216] secs for group 2, P = 0.0108) and maximal inspiratory (group 1: from 81.2 [21.9] cmH 2 O to 107.6 [23.0] cmH 2 O, P = 0.018 versus group 2: from 75.4 [13.8] cmH 2 O to 81.3 [18.9] cmH 2 O, P = 0.139). The difference between groups for 6-min walking distance, maximum voluntary ventilation, and expiratory pressures was not significant. Conclusions: Short-term normocapnic hyperpnea training added to standard exercise, compared with exercise training alone, improves respiratory muscle endurance and strength but not exercise tolerance in patients with chronic obstructive pulmonary disease.
Exercise Training Improves Exertional Dyspnea in Patients With COPDa
Chest, 2003
Background: To our knowledge, no data have been reported on the effects of exercise training (EXT) on central respiratory motor output or neuromuscular coupling (NMC) of the ventilatory pump, and their potential association with exertional dyspnea. Accurate assessment of these important clinical outcomes is integral to effective management of breathlessness of patients with COPD. Material and methods: Twenty consecutive patients with stable moderate-to-severe COPD were tested at 6-week intervals at baseline, after a nonintervention control period (pre-EXT), and after EXT. Patients entered an outpatient pulmonary rehabilitation program involving regular exercise on a bicycle. Incremental symptom-limited exercise testing (1-min increments of 10 W) was performed on an electronically braked cycle ergometer. Oxygen uptake (V O 2), carbon dioxide output (V CO 2), minute ventilation (V E), time, and volume components of the respiratory cycle and, in six patients, esophageal pressure swings (Pessw), both as actual values and as percentage of maximal (most negative in sign) esophageal pressure during sniff maneuver (Pessn), were measured continuously over the runs. Exertional dyspnea and leg effort were evaluated by administering a Borg scale. Results: Measurements at baseline and pre-EXT were similar. Significant increase in exercise capacity was found in response to EXT: (1) peak work rate (WR), V O 2 , V CO 2 , V E, tidal volume (VT), and heart rate increased, while peak exertional dyspnea and leg effort did not significantly change; (2) exertional dyspnea/V O 2 and exertional dyspnea/V CO 2 decreased while V E/V O 2 and V E/V CO 2 remained unchanged. The slope of both exertional dyspnea and leg effort relative to V E fell significantly after EXT; (3) at standardized WR, V E, and V CO 2 , exertional dyspnea and leg effort decreased while inspiratory capacity (IC) increased. Decrease in V E was accomplished primarily by decrease in respiratory rate (RR) and increase in both inspiratory time (TI) and expiratory time; VT slightly increased, while inspiratory drive (VT/TI) and duty cycle (TI/total time of the respiratory cycle) remained unchanged. The decrease in Pessw and the increase in VT were associated with lower exertional dyspnea after EXT; (4) at standardized V E, VT, RR, and IC, Pessw and Pessw(%Pessn)/VT remained unchanged while exertional dyspnea and leg effort decreased with EXT. Conclusion: In conclusion, increases in NMC, aerobic capacity, and tolerance to dyspnogenic stimuli and possibly breathing retraining are likely to contribute to the relief of both exertional dyspnea and leg effort after EXT.