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Gloeckl R, Nell C, Schneeberger T, Jarosch I, Boensch M, Watz H, Wirtz H, Welte T, Kenn K, Koczulla AR. Benefits of pulmonary rehabilitation in patients with advanced lymphangioleiomyomatosis (LAM) compared with COPD - a retrospective analysis. Orphanet J Rare Dis 2020; 15:255. [PMID: 32962746 PMCID: PMC7507679 DOI: 10.1186/s13023-020-01540-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/10/2020] [Indexed: 01/29/2023] Open
Abstract
Abstract Lymphangioleiomyomatosis (LAM) is a rare and progressive cystic lung disease with limited therapeutic options. We retrospectively analyzed the effects of a comprehensive 4-week inpatient pulmonary rehabilitation (PR) program in 58 patients with advanced LAM (FEV1: 45 ± 34%predicted, 6-min walk distance (6MWD): 338 ± 167 m). Exercise performance (6MWD: + 49 ± 50 m; p < 0.001) and quality of life (SF-36 physical component: + 2.4 ± 7.8 points; p = 0.049 and mental component: + 5.2 ± 12.1 points; p < 0.001) increased significantly after PR comparable to an COPD cohort. There were no clinical parameters that predicted changes in outcomes following PR. PR seems to be an effective therapeutic option even in patients with advanced LAM. Trial registration Clinical-Trials registration number: NCT04184193; date of registration: December 3, 2019.
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Affiliation(s)
- Rainer Gloeckl
- Department of Pulmonary Rehabilitation, Philipps - University of Marburg, German Center for Lung Research (DZL), Marburg, Germany. .,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau am Koenigssee, Germany.
| | - Christoph Nell
- Department of Internal Medicine, Division of Pulmonary Diseases, Philipps University of Marburg, Marburg, Germany
| | - Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Philipps - University of Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Department of Pulmonary Rehabilitation, Philipps - University of Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau am Koenigssee, Germany
| | - Martina Boensch
- Department of Pulmonary Rehabilitation, Philipps - University of Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau am Koenigssee, Germany
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Klaus Kenn
- Department of Pulmonary Rehabilitation, Philipps - University of Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau am Koenigssee, Germany
| | - Andreas Rembert Koczulla
- Department of Pulmonary Rehabilitation, Philipps - University of Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau am Koenigssee, Germany.,Teaching Hospital, Paracelsus Medical University, Salzburg, Austria
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Taveira-DaSilva AM, Moss J. Addressing the challenges of lymphangioleiomyomatosis assessment in the clinic. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1400966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Angelo M. Taveira-DaSilva
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Bahmer T, Watz H, Develaska M, Waschki B, Rabe KF, Magnussen H, Kirsten D, Kirsten AM. Physical Activity and Fatigue in Patients with Sarcoidosis. Respiration 2017; 95:18-26. [PMID: 29131111 DOI: 10.1159/000481827] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about physical activity in daily life among patients with sarcoidosis. Fatigue is a frequent and disabling symptom that might negatively affect physical activity levels. METHODS In patients with sarcoidosis, we measured physical activity (steps per day) by accelerometry (SenseWear Armband) for 1 week. We assessed lung function (DLCO, FVC), exercise capacity (6-min walking distance [6MWD]), health-related quality of life (St George's Respiratory Questionnaire [SGRQ]), generic quality of life (12-Item Short-Form Health Survey [SF-12]), and fatigue (Multidimensional Fatigue Inventory [MFI-20]). RESULTS We investigated 57 patients with sarcoidosis (mean age 50 years, 56% male, mean DLCO 73% predicted, mean FVC 91% predicted, mean 6MWD 525 m, mean steps per day 7,490), of whom n = 14 (25%) had severe fatigue. The MFI-20 subscales "reduced activity" and "physical fatigue" were weakly associated with steps per day on a bivariate level (Spearman ρ = -0.274 and ρ = -0.277, respectively; p < 0.05), while the other subscales and the total score were not. 6MWD, SGRQ score, and SF-12 (physical health) score showed stronger associations with steps per day in bivariate analyses (Pearson r = 0.499, r = -0.386, and r = 0.467, respectively; p < 0.01), and were independent predictors of steps per day in multivariate linear regression analyses adjusting for confounders (p < 0.05). In ROC curve analyses, 6MWD, SGRQ score, and SF-12 (physical health) score properly identified sedentary patients (steps per day <5,000; AUROC 0.90, 0.81, and 0.80, respectively; p < 0.01). Fatigue was less predictive (MFI-20 subscale "general fatigue," AUROC 0.70; p = 0.03). CONCLUSION While exercise capacity and quality of life measurements were robust predictors of physical activity in patients with sarcoidosis, associations of objectively measured physical activity with fatigue were surprisingly weak. In sarcoidosis, fatigue might not preclude affected patients from being physically active, although this symptom is subjectively perceived as highly disabling.
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Affiliation(s)
- Thomas Bahmer
- Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Benjamin Waschki
- Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Klaus F Rabe
- Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Detlef Kirsten
- Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
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Torre O, Elia D, Caminati A, Harari S. New insights in lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis. Eur Respir Rev 2017; 26:26/145/170042. [PMID: 28954765 PMCID: PMC9488980 DOI: 10.1183/16000617.0042-2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) and pulmonary Langerhans cell histiocytosis (PLCH) are rare diseases that lead to progressive cystic destruction of the lungs. Despite their distinctive characteristics, these diseases share several features. Patients affected by LAM or PLCH have similar radiological cystic patterns, a similar age of onset, and the possibility of extrapulmonary involvement. In this review, the recent advances in the understanding of the molecular pathogenesis, as well as the current and most promising biomarkers and therapeutic approaches, are described. Understanding of LAM/PLCH pathogenesis has improved over the past years, leading to new therapeutic approacheshttp://ow.ly/7wjR30erSJY
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Affiliation(s)
- Olga Torre
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Davide Elia
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
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