Effectiveness of Pulmonary Rehabilitation in a Patient with Idiopathic Pulmonary Fibrosis: A Case Study (original) (raw)
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The Role of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis
Interstitial Lung Diseases [Working Title], 2019
Idiopathic pulmonary fibrosis (IPF) is known as one of the most severe lung conditions and the worst form of interstitial lung disease (ILD). There is a continuing concern about clinical research to identify new therapies that influence the quality of life in patients diagnosed with this chronic progressive pulmonary disease, with an average survival of 3-5 years. Although in recent years great progress has been made to slow down the functional decline of the disease with new antifibrotic therapies, it has failed to alter the prognosis and survival of IPF patients. Clinical trials and recent ATS/ERS guidelines have brought at least moderate and low levels of evidence for increased effort tolerance, decreased symptoms, and improved quality of life following participation in lung rehabilitation programs for ILD patients and in particular those with IPF. Pulmonary rehabilitation has been shown to be a standard of care for COPD patients, but their personalized application to patients with IPF has had positive short-term results, becoming a safe alternative to non-pharmacological treatment. The chapter includes the general objectives of rehabilitation programs, their type and structure, ways of complex assessment of patients before and after a training exercise, types of exercises, and short-and long-term results.
Pulmonary Rehabilitation in Interstitial Lung Disease
CHEST Journal, 2009
Background and Objective: Although pulmonary rehabilitation (PR) is effective for patients with COPD, its efficacy in patients with idiopathic pulmonary fibrosis (IPF) is unknown. The purpose of this study was to evaluate the effects of PR on IPF. Methods: Thirty patients diagnosed with IPF, according to the ATS/ERS consensus statement, were randomly assigned to a PR or a control group. PR consisted of a 10 week program of exercise training integrated with peripheral muscle training and educational training. Pulmonary function, arterial blood gas analysis, 6 minute walk distance, dyspnea ratings and health related quality of life (using the St. George's Respiratory Questionnaire) were evaluated at baseline and the end of the PR program. Results: Assessment of efficacy was carried out on 13 patients in the PR group and 15 patients in the control group. Measures of pulmonary function, arterial blood gas analysis, and dyspnea ratings were similar between the groups. An improvement in 6 minute walk distance (mean difference 46.3 m [95% CI: 8.3-84.4], P Ͻ 0.05) and total health related quality of life (-6.1 [95% CI: Ϫ11.7 to-0.5], P Ͻ 0.05) were noted in the PR group. Conclusions: Pulmonary rehabilitation improves both exercise capacity and health-related quality of life in patients with IPF.
Iranian Rehabilitation Journal
Objectives: Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ventilation capacity, dyspnea, and finally reduced exercise intolerance. All of these have a significant negative impact on functional capacity and quality of life. In this study, we aim to evaluate the effects of pulmonary rehabilitation (PR) in IPF and assess the predictors of success. Methods: Data from 17 IPF patients who completed the program from the total of 27 patients who applied to PR were used in our study. We evaluated their pulmonary function tests, exercise capacity, peripheral-respiratory muscle strength, body composition, quality of life, and psychological states before and after PR. Results: Following the PR program, improvements over the minimal clinically important differences were observed in almost all parameters compared to the baseline; however, statistically significant improvements were only observed in the medical research council (P=0.020), the St. Ge...
Balneo Research Journal, 2020
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fatal lung disease with a median survival rate of 2-4 years after diagnosis, occurring primarily in older adults. The diagnosis is suggested by histology or radiologic evidence of a usual interstitial pneumonia (UIP) pattern and exclusion of known cases of pulmonary fibrosis. There are some comorbidities associated with IPF such as pulmonary hypertension, emphysema, chronic obstructive pulmonary disease (COPD), asthma, lung cancer, cardiovascular disorders, gastroesophageal reflux disease (GERD), sleep disorders and psychiatric disturbances. The management of IPF focuses on the amelioration of symptoms, preserving lung function, improving health status, minimizing the adverse effects of therapy and improving survival. Pulmonary rehabilitation is suggested for IPF patients when adequate medical therapy controls poorly the disease progression and mental, physical or social consequences of the illness persist during daily l...
Iranian Rehabilitation Journal, 2022
Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ventilation capacity, dyspnea, and finally reduced exercise intolerance. All of these have a significant negative impact on functional capacity and quality of life. In this study, we aim to evaluate the effects of pulmonary rehabilitation (PR) in IPF and assess the predictors of success. Methods: Data from 17 IPF patients who completed the program from the total of 27 patients who applied to PR were used in our study. We evaluated their pulmonary function tests, exercise capacity, peripheral-respiratory muscle strength, body composition, quality of life, and psychological states before and after PR. Results: Following the PR program, improvements over the minimal clinically important differences were observed in almost all parameters compared to the baseline; however, statistically significant improvements were only observed in the medical research council (P=0.020), the St. George respiratory questionnaire (P=0.002), the maximal inspiratory pressure (P=0.024), the anxiety score (P=0.001), the depression score (P=0.002), and the right quadriceps muscle strength (P=0.046). There was only a statistically significant negative correlation between the initial forced vital capacity and the forced expiratory volume in one-second value with the increase in patients' maximal inspiratory pressure values after PR. Discussion: After a multidisciplinary, comprehensive PR program, dyspnea sensation, exercise capacity, endurance time, quality of life, respiratory and peripheral muscle strengths, and psychological status were improved regardless of age, gender, antifibrotic treatment, and comorbidities. Therefore, patients should be referred to PR units before the deterioration in the quality of life in the early stages of the disease.
Value of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis
Egyptian Journal of Chest Diseases and Tuberculosis, 2014
Background: Idiopathic pulmonary fibrosis (IPF) is a chronic lung condition of uncertain etiology that causes progressive shortness of breath, cough, reduced exercise tolerance and quality of life. This may, at least in part, be due to daily physical inactivity. Therefore symptomatic patients with lung fibrosis may be good candidates for comprehensive pulmonary rehabilitation (PR) programs. Aim of work: To evaluate the role of PR program in improving the functional status and dyspnea scale in patients with IPF. Patients and methods: Thirty patients had IPF, according to the recent consensus statement, were subjected to PR program that mainly consisted of three sessions per week for 8 week duration. The program basically consisted of upper and lower extremity exercises, breathing exercise, and chest physical therapy. Psychological support and patient education rounded out the program. Spirometery, diffusion capacity of the lung for carbon monoxide [DLco], arterial blood gas analysis, 6-minute walking distance (6MWD), dyspnea rating with the Modified Borg Scale (MBS) and health-related quality of life (HRQL) score using the St. George's Respiratory Questionnaire (SGRQ) score were evaluated at baseline, after 4 weeks and at the end of the eighth week of the program. Results: There were significant improvement in dyspnea score (P = 0.001), 6MWD (P = 0.001), % predicted of forced vital capacity (FVC% predicted) (P = 0.001) and HRQL (P = 0.001). However, arterial blood gas values and DLco showed no significant improvement at the end of the program. Conclusions: PR improves dyspnea score, exercise capacity and HRQL in patients with IPF.
Respiration; international review of thoracic diseases, 2014
Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating, interstitial lung disease, with few therapeutic options. IPF is characterized by pulmonary restriction, dyspnea, hypoxemia, exercise intolerance and poor quality of life (QOL). We aimed to examine the effect of exercise training (ET) on clinical outcomes in IPF patients. A randomized controlled study included thirty-two IPF patients (aged 68 ± 8 years) who were allocated either to the ET group (n = 15), participating in a 12-week, twice-weekly 60-min supervised ET-based pulmonary rehabilitation program, or to a control group (n = 17) continuing with regular medical treatment alone. Cardiopulmonary exercise test, 6-min walking distance (6MWD) test, 30-second chair-stand test, pulmonary function tests, dyspnea and QOL were assessed at baseline and at the end of the 12-week intervention. Significant differences were observed between the ET and the control groups in raw mean deltas (Δ = post- - pre-intervention): Δ6MWD, 81 m...
2017
Reviewer 1, Nathan Sandbo We thank the reviewer for the precise and thorough reviewing process of our work. While we have appreciated all of his comments, we still believe that our manuscript could help clinicians in reinforcing the knowledge on the effects of pulmonary rehabilitation when delivered to ILD patients. Major comments Comments to the Author In this manuscript by Tonelli and colleagues, the authors undertook a prospective cohort study to examine the efficacy of pulmonary rehabilitation in patients with interstitial lung disease and seek to determine how specific ILD diagnoses and severity of disease is associated with response to this therapy. This was a multicenter (two centers) study, however, the cohort size was relatively small (41 patients). Most patients had IPF (63%). The authors' primary findings were that in the majority of patients with ILD participation in pulmonary rehab was associated with a positive response in 6MW distance. Secondly, they found that a low baseline 6MW distance was associated with greater improvement in 6MWD by the end of pulmonary rehabilitation. The authors did not identify any association of greater or lesser treatment response with specific ILD entities. Overall, the authors rightly identified some of the questions that remain in the field vis-à-vis patient selection for participation in pulmonary rehabilitation; namely does illness severity or specific ILD diagnosis impact response to this therapy. However, it appears that their study was underpowered to answer these questions. It is unclear if the authors performed power calculations to try to estimate how many patients need to be included to see a difference in the stated endpoints.
Respiratory Medicine
Background: The inclusion of Pulmonary Rehabilitation as part of the management of Interstitial Lung Disease, although being highly recommended in most recent guidelines, still has limited studies exploring the outcomes from such an intervention. The present study aims to contribute to the available literature by investigating the effects of a high intensity, 12 week PR programme on functional and quality of life measures in patients with a diagnosis of Interstitial Lung Disease. Method: ology: This paper reports outcomes of an observational, prospective, quasi experimental type of study. A total of 120 participants were recruited: 60 patients formed part of the active group, and another 60 patients were enrolled in an inactive group. Each participant was classified according to the modified Medical Research Council dyspnoea scale and placed in one of 5 categories (0-4) according to self-perceived breathlessness during daily activities. The following outcomes were measured: Lung function tests including plethysmography and diffusion capacity of carbon monoxide (D L CO), functional tests (6-min walking distance test, Dyspnoea Borg Scale) and health status measures (St George's Respiratory Questionnaire and Hospital Anxiety and Depression Score). Results: A 12-week PR programme for patients with Interstitial Lung Disease, led to significant improvements in the active group of patients in the 6 min walking distance test, the modified Borg Scale, mMRC scores and in the health status measures. Lung function measures did not show any significant improvement following this intervention. Conclusion: This 12week Pulmonary Rehabilitation programme resulted in improvements in functional aspects for patients with Interstitial Lung Disease. Further studies are recommended as Pulmonary Rehabilitation for Interstitial Lung Disease may have an impact at both an individual level and at global organisational/financial levels.