Pulmonary rehabilitation and physical interventions

Effect of home noninvasive positive pressure ventilation combined with pulmonary rehabilitation on dyspnea severity and quality of life in patients with severe stable chronic obstructive pulmonary disease combined with chronic type II respiratory failure: a randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that significantly affects patients' quality of life. Non-invasive positive pressure ventilation (NPPV) and pulmonary rehabilitation have both shown promise in improving symptoms and lung function in COPD patients. However, the combined effects of home-based pulmonary rehabilitation and NPPV on moderate to severe COPD patients remain unclear.

OBJECTIVE

This study aimed to evaluate the efficacy of home pulmonary rehabilitation combined with non-invasive positive pressure ventilation (CPRNG group) compared to conventional treatment (CTG group) in patients with moderate to severe COPD.

METHODS

A total of 269 patients with moderate to severe COPD were enrolled, with 137 patients in the CTG group and 132 in the CPRNG group. The primary outcome measures included the COPD assessment test (CAT) score, modified medical research council scale (mMRC) score, forced expiratory volume in one second (FEV₁) percentage, 6-min walk test, and arterial oxygen pressure (PaO₂). Secondary outcomes included various dimensions of quality of life (impact, symptoms, and activity) measured through patient-reported outcomes.

RESULTS

Baseline comparisons between groups showed no significant differences in sociodemographic characteristics, disease duration, or symptoms. The CPRNG group showed significant improvements compared to the CTG group in the CAT score (p = 0.028), mMRC score (p = 0.015), FEV1% (p = 0.008), 6-min walk test (p = 0.001), and PaO₂ (p < 0.001). Additionally, improvements in impact, symptoms, activity, and overall scores were significantly better in the CPRNG group (p < 0.05).

CONCLUSIONS

Home pulmonary rehabilitation combined with non-invasive positive pressure ventilation significantly improves multiple dimensions of quality of life, particularly in controlling symptoms and enhancing daily activities in COPD patients. This combined therapy proves to be an effective treatment strategy, offering notable benefits in lung function, exercise capacity, and overall quality of life in COPD patients.

TRIAL REGISTRATION

The clinical trial was registered retrospectively on the Chinese Clinical Trial Registry (ChiCTR, www.chictr.org.cn ID: ChiCTR2500096605) on 2025-01-26, as required by The Fourth Hospital of Institutional (Changsha Fourth Hospital, Hunan Province, China) Review Board guidelines. Ethics approval date: January 2023 to December 2025.

Marine-Derived Bioactive Compounds: A Promising Strategy for Ameliorating Skeletal Muscle Dysfunction in COPD

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by skeletal muscle dysfunction, a critical and severe extrapulmonary complication. This dysfunction contributes to reduced exercise capacity, increased frequency of acute exacerbations, and elevated mortality, serving as an independent risk factor for poor prognosis in COPD patients. Owing to the unique physicochemical conditions of the marine environment, marine-derived bioactive compounds exhibit potent anti-inflammatory and antioxidant properties, demonstrating therapeutic potential for ameliorating COPD skeletal muscle dysfunction. This review summarizes marine-derived bioactive compounds with promising efficacy against skeletal muscle dysfunction in COPD, including polysaccharides, lipids, polyphenols, peptides, and carotenoids. The discussed compounds have shown bioactivities in promoting skeletal muscle health and suppressing muscle atrophy, thereby providing potential strategies for the prevention and treatment of COPD skeletal muscle dysfunction. These findings may expand the therapeutic strategies for managing COPD skeletal muscle dysfunction.

Feasibility of postoperative home-based pulmonary function training for lung cancer patients: a real-world study

BACKGROUND

Pulmonary surgery can significantly impact patients' respiratory function and reduce their quality of life. Previous studies have shown that perioperative breathing exercises (BE) can facilitate the recovery of lung function and improve patients' quality of life after surgery. However, due to the lack of supervision and awareness, patients often struggle to adhere to the prescribed exercise regimen. This study statistics and analyzes the effect of postoperative respiratory function training on postoperative recovery of patients undergoing pneumonectomy in a realistic environment, in order to provide a basis for optimizing postoperative rehabilitation strategies.

METHODS

Patients undergoing surgical treatment for pulmonary nodules received standardized education upon admission, including guidance on performing breathing exercises. Preoperative pulmonary function tests (PFT) and arterial oxygen saturation measurements were conducted, and patients were instructed to return for follow-up pulmonary function and arterial oxygen saturation assessments at 1 month, 3 months, and 6 months post-surgery. In addition, patients were asked to complete online questionnaires at these time points. Oxygen saturation levels were also re-assessed before discharge, and patients were encouraged to complete a discharge questionnaire. Weekly phone calls were made to remind patients to continue their breathing exercises. The study analyzed 12 potential factors that might affect the outcomes, including preoperative nebulization use, surgical method, and patient age. The primary outcome measures were the effects of postoperative breathing exercises on FEV1, FVC, DLCO, and SPO2 at 1 month (T1), 3 months (T2), and 6 months (T3) post-surgery. Secondary outcomes included LCQ cough assessment, FACT-L quality of life assessment, evaluations of pain and appetite, SAS anxiety level, SDS depression level, AIS sleep quality, and the modified MRAC assessment of dyspnea symptoms.

RESULTS

The study initially enrolled 296 patients (T0), including 233 patients who underwent sublobar resection (SRP) and 63 patients who underwent lobectomy (LBP). Between T0 and T1, 203 patients remained in the SRP group and 47 in the LBP group. Between T0 and T2, 36 patients remained in the SRP group and 9 in the LBP group. By T3, the SRP group had 14 patients, and the LBP group had 5 patients remaining. Due to incomplete data, SPO2 measurements were excluded from the analysis. Additionally, the SRP group at T3 and the LBP group at T2 and T3 were not included in the analysis.In the SRP group, at T1, the BE group showed significantly better recovery in FEV1 and FVC compared to the control group. By T2, the BE group had a significantly improved sleep quality compared to the control group (P < 0.05). In the LBP group, at T1, the BE group demonstrated a significant advantage in alleviating anxiety symptoms compared to the control group (P < 0.05). No significant differences were observed in other outcomes.

Associations between postoperative pulmonary interventions based on enhanced recovery programs and outcomes in patients with lung cancer: A retrospective propensity score matching study

PURPOSE

The purpose of the study was to assess the impact of postoperative pulmonary interventions based on enhanced recovery programs (PPIE) on patients undergoing lung cancer surgery using a retrospective propensity score matching (PSM).

METHODS

The non-PPIE group only received the enhanced recovery programs, while the PPIE group received additional postoperative pulmonary interventions, including the active cycle of breathing techniques, oscillatory positive expiratory pressure therapy, incentive spirometry training, and early mobilization, conducted by nurses.

RESULTS

656 patients with lung cancer were identified from January 2020 to December 2022. PSM resulted in 253 patients in each group. The PPIE group showed significant improvements in the presence of postoperative pulmonary complications within the first 30-day (4.7% vs. 11.9%, OR 0.37, 95% CI 0.19-0.74, p = 0.004) and in-hospital postoperative pulmonary complications (3.2% vs. 11.1%, OR 0.26, 95% CI 0.12-0.59, p = 0.001). PPIE was associated with an estimated median reduction in the postoperative hospital length of stay by 1 day (P < 0.001). Moreover, the duration of chest tube indwelling didn't significantly differ between groups (p = 0.394).

CONCLUSION

PPIE is beneficial to the outcomes of patients after lung cancer surgery, except for the duration of postoperative chest tube indwelling. Postoperative pulmonary interventions could be integrated into the ERPs to enhance rehabilitation. Moreover, nurses play a role in facilitating the recovery of patients who have undergone lung cancer surgery.

Effects of whole-body vibration exercise on functional capacity, muscle strength, and quality of life in individuals with severe chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

Whole body vibration (WBV) exercise is a therapy used for individuals with low tolerance to conventional exercises, such as patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the impact of WBV exercise on the functional capacity, muscle strength, and health-related quality of life (HRQoL) in severe COPD patients.

METHODS

Studies published until March 2024 were reviewed, encompassing randomized clinical trials (RCTs) without temporal or linguistic constraints, comparing WBV exercise with other interventions. The PubMed/MEDLINE, Scopus, Cochrane Airways Trials Register, and CINAHL databases were queried. The Revised Cochrane risk-of-bias tool for randomized trials 2.0A was employed for quality assessment.

RESULTS

Among 351 screened studies, 7 met the criteria, totaling 356 participants (WBV group, n = 182; control group, n = 174). Meta-analysis revealed a significant mean difference of 41.36 m [95%CI (13.28-69.44); p = .004] in the 6-minute walk test distance favoring the WBV group for functional capacity. Lower limb muscle strength improved in 57.14% of included studies. HRQoL meta-analysis demonstrated a 1.13-point difference [95%CI -1.24-3.51; p = .35] favoring WBV, although group differences were not significant. A mean difference of 2.31 points favored the control group in health condition [95%CI (-1.32-5.94); p = .021].

CONCLUSION

WBV exercise is recognized as a promising therapeutic modality for severe COPD patients, notably enhancing functional capacity. Although heterogeneous study protocols weaken the evidence for clinically relevant outcomes, improvements in lower limb muscle strength and HRQoL were also observed, differences between groups were not significant.

Impact of Leisure-Time Physical Activity and Sedentary Behavior on Mortality in Patients With Chronic Obstructive Pulmonary Disease

OBJECTIVE

This study sought to examine the association between inactive time, leisure-time physical activity and mortality in individuals diagnosed with chronic obstructive pulmonary disease.

DESIGN

This study utilized a nationally representative sample of patients with chronic obstructive pulmonary disease from National Health and Nutrition Examination Survey ( n = 1817; weighted population, 23,698,840). Mortality was tracked from the date of interview and examination. Leisure-time physical activity and sedentary time were assessed using a Global Physical Activity Questionnaire.

RESULTS

The study found that only 28% of patients with chronic obstructive pulmonary disease achieved sufficient leisure-time physical activity (leisure-time physical activity ≥150 mins/wk), while 58% reported no physical activity and 47% sat for over 6 hrs per day. Over a 9-yr follow-up period, 501 deaths occurred, with 101 due to heart diseases. Adequate leisure-time physical activity levels were associated with a decreased risk of mortality from any cause. Moreover, patients who engaged in sufficient leisure-time physical activity and reduced sitting time had a lower risk of mortality from any cause compared to those who did not engage in sufficient leisure-time physical activity.

CONCLUSIONS

Participating in an adequate amount of leisure-time physical activity was linked to a reduced risk of death from any cause in patients with chronic obstructive pulmonary disease. However, irrespective of the extent of the leisure-time physical activity, there was no significant correlation between sedentary behavior and the risk of mortality.

Effect of traditional Chinese exercise on pulmonary function in middle-aged and older patients with stable chronic obstructive pulmonary disease: A randomized controlled trial

BACKGROUND

Traditional Chinese exercise (TCE) has been shown effective for chronic obstructive pulmonary disease (COPD). However, there are no studies investigating the effect of traditional Chinese exercise (TCE) programme on COPD. The aim of this study was to evaluate the effectiveness of specific TCE programme on the pulmonary function in patients with COPD.

METHODS

76 patients with COPD was randomly assigned to receive either TCE group or control group in a 1:1 ratio. The primary outcome was changes in forced vital capacity (FVC) from baseline to 12 weeks. Secondary outcomes included forced expiratory volume in the first second (FEV1), tidal volume (VT), inspiratory capacity (IC), expiratory reserve volume (ERV), FEV1/FVC, peak expiratory flow (PEF), the 6-min walking test (6MWT), the COPD Assessment Test (CAT), the Short Form 36-item Health Survey (SF-36), modified medical research council scale (mMRC).

RESULTS

After 12 weeks, the TCE group demonstrated a significantly greater improvement of FVC (-12.67; 95 % CI, -18.21 to -7.15; P < 0.001) and FEV1 (-9.70; 95 % CI, -13.73 to -5.68; P < 0.001). But there was no statistically significant difference between groups in FEV1/FVC, PEF, VT, IC or ERV. Besides, patients in the TCE group also reported a statistically significant within-group difference at week 12 in CAT, mMRC and 6MWT. As for eight dimensions of SF-36, patients in TCE group had higher scores in SF-36 (P < 0.05 for 8 dimensions).

CONCLUSION

Our results demonstrate that the traditional Chinese exercise can serve as an effective therapeutic tool for middle-aged and older patients with COPD.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry, ChiCTR2300069283, https://www.chictr.org.cn/showproj.html?proj=192116.

Impact of Fluticasone Propionate and Salmeterol Combined with Pulmonary Rehabilitation on Pulmonary Function, Exercise Tolerance, and Quality of Life in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease

Aims/Background Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent respiratory problems. COPD has become a major public health concern worldwide as the population ages. Therefore, we investigated the impact of fluticasone propionate and salmeterol inhalation combined with pulmonary rehabilitation on pulmonary function, exercise tolerance, and quality of life in elderly patients with stable COPD. Methods This retrospective study included 102 elderly patients with stable COPD who were treated between January 2021 and October 2023. Based on previous treatment regimens, patients were divided into a fluticasone propionate and salmeterol inhalation combined with a pulmonary rehabilitation group (n = 58) and a pulmonary rehabilitation alone group (n = 44). We collected baseline data upon admission and other relevant data after 3 months of follow-up. Furthermore, we evaluated pulmonary function [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF)], inflammatory markers [interleukin-8 (IL-8), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), tumour necrosis factor-β (TNF-β)], exercise tolerance [6-minute walk test (6MWT)], and quality of life [COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ)] between the two experimental groups. Additionally, the recurrence rate and adverse events during the 3-month follow-up were examined. Results Compared to baseline, FEV1, FVC, PEF, and 6MWT levels were significantly improved in both groups at the 3-month follow-up, with the combined treatment group performing better than the pulmonary rehabilitation alone group (p < 0.05). CAT and SGRQ scores decreased significantly, with the combined treatment group scoring lower than the pulmonary rehabilitation alone group (p < 0.05). Inflammatory markers, such as IL-8, IL-6, TNF-α, and TNF-β were significantly reduced in the combined treatment group and were lower than in the pulmonary rehabilitation alone group (p < 0.05). The recurrence rate in the combined treatment group was significantly lower than in the pulmonary rehabilitation alone group (p = 0.018), with no significant difference in the incidence of adverse events between the two groups (p > 0.05). Conclusion Fluticasone propionate and salmeterol inhalation combined with pulmonary rehabilitation can reduce recurrence rates, and improve pulmonary function, inflammatory status, and exercise tolerance, thereby significantly enhancing the quality of life for elderly patients with stable COPD.

Efficacy of remote respiratory rehabilitation in stable chronic obstructive pulmonary disease and factors affecting acute exacerbation

OBJECTIVES

To evaluate the effects of remote respiratory rehabilitation on patients with stable chronic obstructive pulmonary disease (COPD) and identify factors influencing acute exacerbation.

METHODS

This retrospective study included 60 stable COPD patients who visited the First Affiliated Hospital of Gannan Medical University between June 2020 and December 2021. Among them, 27 patients in the control group received routine health guidance, while 33 patients in the research group received WeChat app-based remote respiratory rehabilitation. The study comparatively analyzed pulmonary function (PF; forced vital capacity percentage [FVC%], forced expiratory volume in 1 second percentage [FEV1%], and FEV1/FVC), blood oxygen saturation (SaO2), dyspnea index (Borg Dyspnea Scale), 6-minute walking distance (6MWD), number of hospitalizations, frequency of acute exacerbations, and health-related quality of life (measured using the Chronic Respiratory Disease Questionnaire [CRQ]). Additionally, univariate and multivariate analyses were conducted to identify factors contributing to acute exacerbation in stable COPD patients.

RESULTS

Significant improvement in FVC%, FEV1%, FEV1/FVC, SaO2, 6MWD, and various CRQ scores were observed in the research group after treatment with higher values than the control group (all P<0.05). The Borg Dyspnea Scale scores were significantly lower in the research group than those of the control group (P<0.05). The research group had significantly fewer hospitalizations and acute exacerbations compared to the control group (P<0.05). Univariate analysis indicated that body mass index (BMI; P=0.042), smoking history (P=0.011), chronic respiratory failure (P=0.010), diabetes (P=0.024), hypertension (P=0.008), and treatment modality (P=0.006) were significantly associated with acute exacerbations in stable COPD patients. Multivariate analysis identified that hypertension (P=0.032) and treatment methods (P=0.022) were risk factors for acute exacerbation in stable COPD patients.

CONCLUSIONS

Remote respiratory rehabilitation significantly benefits stable COPD patients by improving respiratory function, exercise endurance, and quality of life. Moreover, hypertension and conventional health guidance interventions are closely associated with an increased risk of acute exacerbation in stable COPD patients.

Effectiveness of high-intensity interval training in rehabilitation nursing for mild-to-moderate stable COPD patients: a randomized controlled clinical trial

OBJECTIVE

The current study was conducted to explore the clinical impact of high-intensity interval training (HIIT) in rehabilitation nursing on improving cardiopulmonary function and exercise capacity in COPD patients.

METHODS

A total of thirty-one COPD patients underwent HIIT, while an equal number underwent moderate-intensity continuous training (MICT) were included in this randomized controlled clinical study. The randomization method used was stratified block randomization, stratified by center. During the 6 months follow-up period, the clinical data, including cardiopulmonary exercise testing (CPET) results, cardiopulmonary function index, quality of life, and follow-up outcomes, were collected before and after the interventions. The therapeutic effects of the two groups were compared.

RESULTS

After the intervention, the HIIT group exhibited significantly higher peak power, exercise test duration, anaerobic threshold, peak oxygen uptake, peak ventilation, FEV1/FVC ratio, FEV1% of expected value, LVEF (%), and SF-36 scores compared to the MICT group (P < 0.05). Moreover, LVEDD was significantly lower in the HIIT group compared to the MICT group (P < 0.05). At the 6-month follow-up, the incidence of COPD acute exacerbation in the HIIT group was significantly lower than in the MICT group (P < 0.05).

CONCLUSION

Implementation of HIIT in rehabilitation nursing effectively improved cardiopulmonary function and exercise capacity in COPD patients during clinical treatment, highlighting its promising application potential.

TRIAL REGISTRATION

This study was previously registered at Chinese Clinical Trial Registry (Date 11/05/2022 Number ChiCTR2200059764).

Interactions of physical activity and lung function on cognitive health in older adults: Joint association and mediation analysis

BACKGROUND

Maintaining cognitive health in old adults has become a significant public health challenge, with lung function and physical activity (PA) as essential modifiable factors. However, the joint and mediation effects of these two factors with cognition remain unclear.

OBJECTIVES

This study assesses the joint association and mediation effects of lung function and PA with cognition.

DESIGN, SETTING, AND PARTICIPANTS

We utilized cross-sectional data from the 2011-2012 U.S. National Health and Nutrition Examination Survey, including adults aged 60-79 assessed for lung function, PA, and cognition.

MAIN OUTCOMES AND MEASURES

Lung function included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and FEV1/FVC. PA was assessed using the Global Physical Activity Questionnaire, covering occupational PA (OPA), transportation-related PA (TPA), and leisure-time PA (LTPA). Cognition was evaluated using the Digit Symbol Substitution Test, Animal Fluency Test, Delayed Recall Test and Immediate Recall Test. Weighted multiple linear regression models were used to analyze the separate and joint associations of lung function and PA with cognition, while also exploring potential mediation effects between these factors.

RESULTS

A total of 927 participants, representing 35,525,782 U.S. residents, were included, with a weighted median age of 65 (IQR, 63 -71) years, and 53.6 % were female. The results showed a significant positive association between lung function and cognitive function, with FEV1, FVC, and PEF all positively correlated, while the FEV1/FVC showed no notable link. Further analysis revealed the best cognitive performance observed in participants with active LTPA and the highest quartile of lung function, indicating a joint association of LTPA and lung function with cognition. Mediation analysis indicated that lung function mediated 24.1 % (95 %CI: 6.3 % - 47.0 %, P = 0.03) of the relationship between LTPA and cognition, while cognition mediated 10.2 % (95 %CI: 0.5 % - 27.0 %, P = 0.04) of the relationship between LTPA and lung function.

CONCLUSION

Lung function and cognition may have a bidirectional relationship. The combination of active LTPA and better lung function was strongly associated with higher cognition, highlighting the need to strengthen exercise focused on lung function to maintain cognitive health in older adults.

Fully remote versus hybrid supervision of pulmonary telerehabilitation in COVID-19: a randomized clinical trial

BACKGROUND

The restrictions imposed by the COVID-19 pandemic have impeded the traditional rehabilitation process, prompting the widespread adoption of remote programs for the recovery of survivors.

AIM

The aim of this study was to evaluate and compare the effectiveness of a pulmonary telerehabilitation program (PTRP) in the exclusively remote modality versus the hybrid modality (remote and face-to-face) in patients with persistent respiratory dysfunction following hospitalization for COVID-19 pneumonia, and to compare the functional capacity of patients who participated in a PTRP with those who did not.

DESIGN

A randomised, interventional, prospective clinical trial was conducted. In parallel, an observational cohort study was conducted.

SETTING

Outpatient rehabilitation clinic and home-based rehabilitation program.

POPULATION

Thirty patients post-COVID-19 were randomised into two groups: G1 (fully remote supervision of PTRP) or G2 (hybrid supervision of PTRP). Thirty-seven post-COVID-19 patients were followed up without participating in PTRP (non-intervention group - NIG).

METHODS

Patients with persistent respiratory dysfunction and reduced functional capacity, as measured by the Six Minute Walk Test (6MWT), after hospitalization for COVID-19 pneumonia, were considered eligible for a PTRP. To assess the efficacy of the PTRP, the primary outcome (I) was distance walked on the 6MWT (6MWD) and the secondary outcome (II) was quality of life as assessed by the SF-36 questionnaire.

RESULTS

Both G1 and G2 demonstrated similar improvement in 6MWD, P<0.001 and quality of life (P<0.05). The IG showed higher 6MWD than the NIG (P<0.001). The increase in 6MWD for the IG was 140.5 m, while for the NIG it was 16.8 m (P=0.002).

CONCLUSIONS

The PTRP was found to be a feasible and highly effective intervention for restoring functional capacity and improving quality of life, regardless of the type of supervision. Furthermore, this functional gain was maintained over the long term. In patients with pulmonary dysfunction, participation in the PTRP improved functional capacity compared with those who were simply advised to resume physical activity during recovery.

CLINICAL REHABILITATION IMPACT

Telerehabilitation has been demonstrated to be a viable and efficacious alternative to traditional in-person programs in low-income contexts.

Effect of Precise Pulmonary Rehabilitation Nursing Intervention Combined With Simultaneous Inhalation Therapy and Noninvasive Ventilation for Chronic Obstructive Pulmonary Disease Patients With Chronic Hypercapnic Respiratory Failure

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive heterogeneous pulmonary disorder with an increasing high prevalence, particularly in the older. The objective of this study is to assess the effect of noninvasive ventilation combined with simultaneous nebulization during precise pulmonary rehabilitation nursing intervention in COPD patients with chronic hypercapnic respiratory failure, compared to pulmonary rehabilitation nursing alone.

METHODS

In total, 240 elderly COPD patients with chronic hypercapnic respiratory failure were randomized controlled into either a precise pulmonary rehabilitation nursing model group (control group) or noninvasive ventilation coupled with simultaneous nebulization during pulmonary rehabilitation nursing (intervention group). For our evaluation, we considered general information, pulmonary function, exercise endurance, mental health, blood gas, inflammation, COPD severity, life quality, and overall efficacy of subjects before and on the 5-, 30-, 90-day intervention.

RESULTS

The total effective rates were 95% and 77.5% in the intervention and control group, respectively. In detail, the intervention group showed statistically significant improvements in lung function, exercise endurance, psychological health, blood gas inflammation, overall severity, and quality of life outcomes, especially on the 90-day intervention (p < 0.001).

CONCLUSIONS

The complex COPD patients with chronic hypercapnic respiratory failure may confer more gains from precise pulmonary rehabilitation nursing intervention combined with simultaneous inhalation therapy and noninvasive ventilation.

Pulmonary rehabilitation under supervision of health-professional at institute versus conventional exercise-based pulmonary rehabilitation at home in COPD patients: A longitudinal cohort study

OBJECTIVES

To evaluate the efficacy and safety of pulmonary rehabilitation under the supervision of health professionals at the institute versus conventional exercise-based pulmonary rehabilitation at home in Chronic Obstructive Pulmonary Disease (COPD) patients.

METHODS

Patients of COPD received pulmonary rehabilitation under the supervision of a professional at the institute (PI cohort, n = 115) or self-driven traditional Chinese methods-based pulmonary rehabilitation at home (CE cohort, n = 127) or did not receive any type of pulmonary rehabilitation (ME cohort, n = 155). All patients received inhaled pharmacological treatment for COPD.

RESULTS

Before commencing inhaled pharmacological treatment with or without pulmonary rehabilitation (BT) COPD patients had 5 (5-4) / patient BODE (body-mass index, airflow obstruction, dyspnea, and exercise capacity) index score and 12 (13-12) / patient exacerbations (in 6-months) reported. After 6 months of inhaled pharmacological treatment for COPD with or without pulmonary rehabilitation (AT), a six-minute walking test was improved and the BODE index score and exacerbations during 6 months were decreased for patients of the PI cohort as compared to BT conditions and compared to those of the CE and ME cohorts in AT conditions (p < 0.05 for all). Patients of PI, CE, and ME cohorts had the risk of under treatment for <0.01 BODE index score, <1.32 BODE index score, and <3.14 BODE index score, respectively.

CONCLUSIONS

Chinese patients with COPD have worse clinical conditions. After 6 months of inhaled pharmacological treatment for COPD with pulmonary rehabilitations at institutes improves the conditions of COPD patients.

Optimal vocal therapy for respiratory muscle activation in patients with COPD: effects of loudness, pitch, and vowels

Background

Vocal therapy, such as singing training, is an increasingly popular pulmonary rehabilitation program that has improved respiratory muscle status in patients with chronic obstructive pulmonary disease (COPD). However, variations in singing treatment protocols have led to inconsistent clinical outcomes.

Objective

This study aims to explore the content of vocalization training for patients with COPD by observing differences in respiratory muscle activation across different vocalization tasks.

Methods

All participants underwent measurement of surface electromyography (sEMG) activity from the sternocleidomastoid (SCM), parasternal intercostal muscle (PARA), seventh intercostal muscle (7thIC), and rectus abdominis (RA) during the production of the vowels/a/,/i/, and/u/at varying pitches (comfortable, +6 semitones) and loudness (-10 dB, +10 dB) levels. The Visual Analog Scale (VAS) was used to evaluate the condition of patients concerning vocalization, while the Borg-CR10 breathlessness scale was utilized to gauge the level of dyspnea following the task. Repeated-measure (RM) ANOVA was utilized to analyze the EMG data of respiratory muscles and the Borg scale across different tasks.

Results

Forty-one patients completed the experiment. Neural respiratory drive (NRD) in the SCM muscle did not significantly increase at high loudness levels (VAS 7-8) compared with that at low loudness levels (F (2, 120) = 1.548, P = 0.276). However, NRD in the PARA muscle (F (2, 120) = 55.27, P< 0.001), the 7thIC muscle (F (2, 120) = 59.08, P < 0.001), and the RA muscle (F (2, 120) = 39.56, P < 0.001) were significantly higher at high loudness compared with that at low loudness (VAS 2-3). Intercostal and abdominal muscle activation states were negatively correlated with maximal expiratory pressure (r = -0.671, P < 0.001) and inspiratory pressure (r = -0.571, P < 0.001) in the same loudness.

Conclusion

In contrast to pitch or vowel, vocal loudness emerges as a critical factor for vocalization training in patients with COPD. Higher pitch and loudness produced more dyspnea than lower pitch and loudness. In addition, maximal expiratory/inspiratory pressure was negatively correlated with respiratory muscle NRD in the same loudness vocalization task.

Unraveling the Role of Oxygen Pulse Variability in Endurance Exercise Training in Individuals with COPD: A Novel Approach to Response of Oxygen Pulse and Quality of Life in Pulmonary Rehabilitation

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation, airflow limitation, reduced health-related quality of life (HRQL), and exercise intolerance. Pulmonary rehabilitation (PR) is essential for COPD management, but outcomes may be influenced by individual physiological factors. Cardiopulmonary exercise testing (CPET) measures oxygen pulse (O2P), an indicator of stroke volume, yet the impact of baseline O2P on PR effectiveness remains unclear.

METHODS

This retrospective study included 97 participants with COPD who had received PR, of whom 48 were classified as Group 1 (normal O2P) and 49 as Group 2 (low O2P). PR involved 12 weeks of hospital-based endurance training on a bike, performed twice a week. Participants were assessed before and after PR using spirometry, respiratory muscle strength measurements, CPET, and HRQL evaluation with the St. George's Respiratory Questionnaire (SGRQ).

RESULTS

PR significantly improved exercise capacity (peak work rate and oxygen consumption), dyspnea score, and all domains of the SGRQ, maximum expiratory pressure, ventilatory equivalent, respiratory rate, and mean blood pressure at rest in both groups (p < 0.05). However, improvements in O2P, maximal inspiratory pressure, and tidal volume at rest were observed only in Group 2 but not in Group 1.

CONCLUSION

PR improves exercise capacity, HRQL and specific respiratory function in participants with COPD, regardless of baseline O2P levels. Individuals with lower baseline O2P experience more benefits from PR, including a significant increase in O2P.

Optimal intensity and type of lower limb aerobic training for patients with chronic obstructive pulmonary disease: a systematic review and network meta-analysis of RCTs

BACKGROUND

Lower limb aerobic exercise is the core component of pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) patients. The optimal intensity and type (e.g., interval or continuous) of exercise training remains to be determined.

OBJECTIVES

We aimed to evaluate the optimal intensities and types of lower limb aerobic exercise in patients with COPD.

DESIGN

Systematic review and network meta-analysis of randomized controlled trials.

DATA SOURCES AND METHODS

The PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant data. The interventions were classified according to their intensity and type as high-intensity interval training (HIIT), high-intensity continuous training (HICT), moderate-intensity continuous training (MICT), and low-intensity continuous training (LICT). We assessed exercise capacity using peak work rate (Wpeak) and the 6-min walking test (6-MWT). Lung function was evaluated by measuring peak minute ventilation (VE) and the percentage of predicted FEV1 (FEV1pred%). Dyspnea was assessed using the Modified Medical Research Council (mMRC) scale. Quality of life was measured with the Chronic Respiratory Questionnaire (CRQ).

RESULTS

Fifteen studies were identified (979 subjects). HIIT showed the greatest improvement in Wpeak, 6-MWT, VE, and mMRC compared to usual care (MD 18.48 (95% CI 12.35, 24.60), 67.73 (34.89, 100.57), 6.26 (2.81, 9.72), and -0.53 (-0.89, -0.17), respectively) and showed the improvement in CRQ (MD 10.80 (95% CI 1.65, 19.95)). MICT showed improvement in Wpeak and 6-MWT (MD 18.28 (95% CI 11.20, 25.22), 61.92 (28.34, 95.51)) similar to HICT (MD 16.08 (95% CI 8.19, 23.84), 64.64 (28.70, 100.57)) and showed the highest improvement in CRQ compared to usual care (MD 10.83 (95% CI 1.68, 19.98)). LICT significantly improved Wpeak compared to usual care (MD 13.47 (95% CI 4.77, 22.13)). The quality of evidence for outcomes varied from very low to moderate.

CONCLUSION

HIIT and MICT might be optimal training approaches for patients with COPD. LICT exhibited limited clinical efficacy. While HICT was as effective as MICT, it caused more dyspnea.

TRIAL REGISTRATION

This systematic review and network meta-analysis was prospectively registered with PROSPERO (No. CRD 42024520134).

Current perspectives on the rehabilitation of COPD patients with comorbidities

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by a variety of comorbidities, complicating management and rehabilitation efforts. Understanding this interplay is crucial for optimizing patient outcomes.

AREAS COVERED

This review, based on the MEDLINE, Embase and Cochrane Library databases, summarizes the main research on the rehabilitation of patients with COPD, with an emphasis on relevant comorbidities, such as cardiovascular diseases, pulmonary hypertension, lung cancer, metabolic, musculoskeletal, and gastrointestinal disorders. anxiety/depression and cognitive disorders. The study highlights the importance of pre-participation assessments, ongoing monitoring and personalized rehabilitation programs. A review includes a comprehensive literature search to assess the scientific evidence on these interventions and their impact.

EXPERT OPINION

The integration of cardiorespiratory rehabilitation program is essential for improving physical capacity and quality of life in COPD patients with comorbidities. While existing studies highlight positive outcomes, challenges such as interdisciplinary collaboration and access to rehabilitation services remain. Future strategies must prioritize personalized and integrated approaches programs combining pharmacological optimization and a close monitoring during cardiopulmonary rehabilitation to significantly reduce hospital readmissions and mortality, even in patients with complex multimorbidities. Continued research is necessary to refine rehabilitation protocols and better understand the complexities of managing COPD alongside cardiac conditions.

Acute exacerbation of COPD: Physiotherapy practice and factors that influence management

Background

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of morbidity and mortality in South Africa. Physiotherapy practice and factors that influence management of patients with AECOPD are unknown.

Objectives

To explore physiotherapy practice in the management of patients with AECOPD in South African private healthcare settings and to identify and describe factors that influence physiotherapy patient management.

Method

The study adopted a qualitative descriptive design using semi-structured interviews. Purposive and snowball sampling was used to identify physiotherapists working in private healthcare in three South African provinces. Individual interviews were conducted face-to-face or via telephone and transcribed verbatim. Content analysis was done using an inductive approach.

Results

Participants (n = 9) working in private hospitals reported that their management is based on patient-specific needs assessment. Treatment interventions included various respiratory physiotherapy techniques and exercise rehabilitation strategies. Patient education on self-management of disease symptoms featured prominently. Enablers of physiotherapy management included supportive workplace relations, conducive work environment, physiotherapists' competence, familial support and patient cooperation. Barriers identified included limited communication, nurses' attitudes, work environment, disease burden, mental health challenges and limited professional development opportunities.

Conclusion

Physiotherapists provide individual needs-based care to patients with AECOPD. Various enablers and barriers to physiotherapy patient management have been identified.

Clinical implications

Advocacy for physiotherapy, better communication between multidisciplinary team members and recognition of the need for psychological support are important factors to address to enhance the care provided to patients with AECOPD.

Effectiveness of high-intensity inspiratory muscle training, and resistance and aerobic exercise for cardiovascular health in chronic obstructive pulmonary disease (HIRAC-COPD): a randomized controlled trial protocol

BACKGROUND

Cardiovascular diseases are among the most common and clinically significant comorbidities of chronic obstructive pulmonary disease (COPD). Exercise has been shown to reduce the risk of cardiovascular diseases, and high-intensity inspiratory muscle training (H-IMT) has emerged as a promising intervention for improving arterial stiffness in individuals with COPD. Yet, there is limited evidence from randomized controlled trials (RCTs) regarding the impact of H-IMT alone or in combination with exercise on reducing arterial stiffness in COPD. We designed a three-arm RCT to evaluate the effectiveness of H-IMT, both alone and in combination with exercise, in reducing brachial-ankle pulse wave velocity (baPWV) in individuals with stable COPD within a community setting.

METHODS

This is a three-arm, parallel-group, assessor-blinded, randomized controlled trial with an eight-week intervention period and a 24-week follow-up. The trial will recruit a total of at least 162 participants with stable COPD. All participants will undergo arterial stiffness assessment using an atherosclerosis detector. Eligible participants will then be randomized into either a control group or one of two intervention groups: an H-IMT group combined with aerobic and resistance trainin, or an H-IMT group alone. The primary outcome is the baPWV at eight weeks. Secondary outcomes include baPWV at 4, 16, and 32 weeks, along with self-reported lifestyle factors, sleep quality, mental health outcomes, self-efficacy, implicit health attitudes, quality of life, and clinical outcomes at 4, 8, 16, and 32 weeks. The main analysis will follow the intention-to-treat principle, with the difference in outcome between groups analyzed using multi-level regression at eight weeks.

DISCUSSION

This study will provide evidence on the effects of H-IMT and combined exercise interventions for individuals with COPD in a community setting, offering insights into the use of integrated approaches to enhance cardiovascular health among community-dwelling residents.

TRIAL REGISTRATION NUMBER

ChiCTR2400085483. Date of registration: June 7, 2024. https://www.chictr.org.cn/index.aspx .

A Narrative Review of Impact of Incentive Spirometer Respiratory Training in Long COVID

Long COVID refers to symptoms that appear 3 months after initial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of Coronavirus disease 2019 (COVID-19), and last for at least 2 months, not attributable to other diagnoses. This health issue significantly burdens patients' quality of life, the economy, and society. Improving the af-termath of COVID-19 is a crucial global health issue in the post-pandemic era. According to current results, it is evident that developing a simple, low-cost respiratory training method that can be easily used at home by themselves with long Coronavirus disease 2019 symptoms (long COVID) is an important and urgent issue. The incentive spirometer is widely used in physical, speech, and respiratory therapy, as well as in preventing postoperative pulmonary infections and improving sputum clearance. However, to date, the role of incentive spirometer respiratory training in long COVID symptoms is still limited. In this literature review is presented to explore the effectiveness of incentive spirometer respiratory training in alleviating symptoms among individuals recovering from long COVID. We also compile non-invasive assessment methods, with the aim to enable individuals to undergo training and assessments conveniently at home or in the community. In this review, a literature review approach was utilized to explore the effectiveness of incentive spirometer intervention in alleviating long-term COVID symptoms. This study is to synthesize the findings of articles published during January 2019 and December 2023 retrieved from PubMed/CINAHL/MEDLINE/ Google Scholar without re-strictions on study type. We ultimately identified seven articles and have summarized similar past studies. This review could contribute to improving symptoms related to long COVID by incentive spirometer respiratory training and serve as practical reference material for clinical medical staff and provide insights for healthcare policymakers in de-veloping guidelines for future research directions, clinical guidance, and educational strategies in the context of nursing care.

Impact and effect of preoperative short-term preoperative pulmonary-related training on patients with gastric cancer: a randomized controlled single center trial

PURPOSE

This study aimed is to evaluate the impact of pre- and postoperative pulmonary-related training, including respiratory and aerobic training, on postoperative pulmonary complications (PPCs) after radical resection of gastric cancer (GC).

METHODS

We conducted a randomized controlled trial of 121 participants who received a systematic, comprehensive, high-intensity pulmonary exercise regimen for 5 days preoperatively and at least 5 days postoperatively. The control group received standard preoperative care. We analyzed the occurrence of PPCs in both groups as the primary outcome RESULTS: A total of 43 of 121 participants (35.5%) were diagnosed as having PPCs, and the incidence of PPCs was markedly lower in the training group than in the control group (26.2% [16 of 61] vs 45.0% [27 of 60]; P = .031). Moreover, the duration of the postoperative hospital stay was shorter in the training group (8.69 ± 1.92 days) than the control group (9.57 ± 2.16 days; P = .020) and reduced hospitalization costs, amounting to €9605.1 ± €2556.26 in the training group and €10,594.6 ± €2560.7 in the control group (P = .035).

CONCLUSION

Our study established that a perioperative pulmonary-related training notably diminishes the incidence of PPCs, curtails the duration of hospitalization, and mitigates hospitalization expenses for patients undergoing GC surgery.

Tuberous sclerosis-associated pulmonary lymphangioleiomyomatosis: The role of pulmonary rehabilitation - A case report

Lymphangioleiomyomatosis (LAM) is a rare lung disease that primarily affects women. A patient with a medical history of Tuberous Sclerosis-Associated Lymphangioleiomyomatosis (TSC-LAM), a prior thyroidectomy for thyroid cancer, chronic hypertension, and a previous pulmonary thromboembolism was admitted to the hospital. Following the stabilization of her clinical condition, diaphragmatic exercises and incentive spirometers were implemented. This intervention significantly enhanced her respiratory status, prevented the need for invasive mechanical ventilation, and expediting pulmonary functional recovery. While further studies are needed, pulmonary rehabilitation has the potential to influence the clinical course of TSC-LAM patients in the ICU by improving respiratory capacity and reducing hospitalization time.

Regenerative rehabilitation: a novel multidisciplinary field to maximize patient outcomes

Regenerative rehabilitation is a novel and rapidly developing multidisciplinary field that converges regenerative medicine and rehabilitation science, aiming to maximize the functions of disabled patients and their independence. While regenerative medicine provides state-of-the-art technologies that shed light on difficult-to-treated diseases, regenerative rehabilitation offers rehabilitation interventions to improve the positive effects of regenerative medicine. However, regenerative scientists and rehabilitation professionals focus on their aspects without enough exposure to advances in each other's field. This disconnect has impeded the development of this field. Therefore, this review first introduces cutting-edge technologies such as stem cell technology, tissue engineering, biomaterial science, gene editing, and computer sciences that promote the progress pace of regenerative medicine, followed by a summary of preclinical studies and examples of clinical investigations that integrate rehabilitative methodologies into regenerative medicine. Then, challenges in this field are discussed, and possible solutions are provided for future directions. We aim to provide a platform for regenerative and rehabilitative professionals and clinicians in other areas to better understand the progress of regenerative rehabilitation, thus contributing to the clinical translation and management of innovative and reliable therapies.

Effectiveness of pulmonary rehabilitation on exercise capacity in adult patients with lung transplantation: a systematic review and single-arm meta-analysis

Background

Lung transplantation (LTx) is a well-established option for patients in the end-stage of lung disease that is not responsive to other treatments. Although the survival rate after LTx has seen a significant increase, exercise tolerance is still limited and poses a big obstacle to recovery after LTx. Pulmonary rehabilitation (PR) is a comprehensive intervention that has many benefits for patients with chronic respiratory disease. However, the effectiveness of PR on adult patients with LTx is inconclusive. We performed this meta-analysis to assess the efficacy of PR in adult LTx recipients.

Methods

Eligible randomized controlled trials (RCTs) and quasi-experimental studies published until March 25, 2024 were searched in MEDLINE, Embase, Web of Science and CINAHL. Additionally, reference lists and published systematic reviews were scanned by manual searching. Studies selection, data extraction, and risk of bias assessment were conducted independently. Stata software (version 17.0) was utilized.

Results

There were 21 studies (9 RCTs and 12 quasi-experimental studies) were identified. Pooled analysis showed that PR positive effect in improving 6-minute walking distance (6MWD) [standard mean difference (SMD) =1.28, 95% confidence interval (CI): 1.05-1.50, P<0.001], maximum oxygen consumption (VO2max) (SMD =0.42, 95% CI: 0.15-0.68, P=0.002), handgrip force (HGF) (SMD =0.49, 95% CI: 0.26-0.73, P<0.001), and quadriceps force (QF) (SMD =0.63, 95% CI: 0.45-0.82, P<0.001). There was no significant publication bias in those outcomes mentioned above.

Conclusions

PR shows evidence for being an effective adjunctive strategy for improving exercise capacity after LTx, but multi-center trials on larger populations are required to confirm its clinical benefits in the real-world setting.

Assessing the efficacy of a graded pulmonary rehabilitation protocol in mechanically ventilated patients following brainstem hemorrhage

BACKGROUND

The objective of this study is to assess the impact of an early-graded pulmonary rehabilitation training program on patients undergoing mechanical ventilation due to brainstem hemorrhage.

METHODS

Eighty patients receiving mechanical ventilation due to brainstem hemorrhage at our hospital's neurosurgery department between August 2022 and October 2023 were enrolled as participants. A sampling table was generated based on the order of admission, and 80 random sequences were generated using SPSS software. These sequences were then sorted in ascending order, with the first half designated as the control group and the second half as the intervention group, each comprising 40 cases. The control group received standard nursing care for mechanical ventilation in brainstem hemorrhage cases, while the intervention group underwent early-graded pulmonary rehabilitation training in addition to standard care. This intervention was conducted in collaboration with a multidisciplinary respiratory critical care rehabilitation team. The study compared respiratory function indices, ventilator weaning success rates, ventilator-associated pneumonia incidence, mechanical ventilation duration, and patient discharge duration between the 2 groups.

RESULTS

The comparison between patients in the observation group and the control group regarding peak expiratory flow and maximum inspiratory pressure on days 1, 3, 5, and 7 revealed statistically significant differences (P < .05). Additionally, there was a statistically significant interaction between the main effect of intervention and the main effect of time (P < .05). The success rate of ventilator withdrawal was notably higher in the observation group (62.5%) compared to the control group (32.5%), with a statistically significant difference (P < .05). Moreover, the incidence rate of ventilator-associated pneumonia was significantly lower in the observation group (2.5%) compared to the control group (17.5%) (P < .05). Furthermore, both the duration of mechanical ventilation and hospitalization were significantly shorter in the observation group compared to the control group (P < .05).

CONCLUSION

Early-graded pulmonary rehabilitation training demonstrates effectiveness in enhancing respiratory function, augmenting the ventilator withdrawal success rate, and reducing both the duration of mechanical ventilation and hospitalization in mechanically ventilated patients with brainstem hemorrhage. These findings suggest the potential value of promoting the application of this intervention in clinical practice.

Insufficient Pulmonary Rehabilitation Uptake After Severe Exacerbation of COPD: A Multicentre Study in the South West Region of France

Purpose

Pulmonary rehabilitation (PR) is a type of multidisciplinary care strongly recommended after severe exacerbation of chronic obstructive pulmonary disease (COPD). Recently, a national French study reported a very low rate of PR uptake (8.6%); however, important clinical data were missing. Here, we aimed to identify the main factors associated with insufficient PR uptake after hospitalisation for COPD exacerbation.

Patients and Methods

This multicentre retrospective study included patients hospitalised with COPD exacerbation between 1 January 2017 and 31 December 2018, as identified by both coding and a detailed review of medical records. PR was defined as inpatient care in a specialised centre or unit within 90 days of discharge. Multivariate logistic regression was used to identify associations between PR uptake and patient characteristics, such as comorbidities, non-invasive ventilation (NIV), inhaled treatment, and forced expiratory volume in 1 second (FEV1).

Results

Among the 325 patients admitted for severe COPD exacerbation, 92 (28.3%) underwent PR within 90 days of discharge. In univariate analysis, relative to those who underwent PR, patients without PR had significantly more comorbidities, were less often treated with triple bronchodilator therapy or NIV, and had a higher FEV1. In multivariate analysis, variables independently associated with the lack of PR uptake were the presence of comorbidities (adjusted odds ratio (aOR) = 1.28 [1.10-1.53], p = 0.003) and a higher FEV1 (aOR = 1.04 [1.02-1.06], p < 0.001). There was no significant correlation between PR uptake and departmental PR centre capacity (notably, some departments had no PR facilities).

Conclusion

These data highlight the lack of PR in the early stages of COPD. Collaboration among all healthcare providers involved in patient management is crucial for improved PR uptake.

A Magnetic Field-Based Wearable Respiration Sensor for Real-Time Monitoring During Pulmonary Rehabilitation

OBJECTIVE

This work explores Hall effect sensing paired with a permanent magnet, in the context of pulmonary rehabilitation exercise training.

METHODS

Experimental evaluation was performed considering as reference the gold-standard of respiratory monitoring, an airflow transducer, and performance was compared to another wearable device with analogous usability - a piezoelectric sensor. A total of 16 healthy participants performed 15 activities, representative of pulmonary rehabilitation exercises, simultaneously using all devices. Evaluation was performed based on detection of flow reversal events and key respiratory parameters.

RESULTS

Overall, the proposed sensor outperformed the piezoelectric sensor with a mean ratio, precision, and recall of 0.97, 0.97, and 0.95, respectively, against 0.98, 0.90, and 0.88. Evaluation regarding the respiratory parameters indicates an adequate accuracy when it comes to breath cycle, inspiration, and expiration times, with mean relative errors around 4% for breath cycle and 8% for inspiration/expiration times, despite some variability. Bland-Altman analysis indicates no systematic biases.

CONCLUSION

Characterization of the proposed sensor shows adequate monitoring capabilities for exercises that do not rely heavily on torso mobility, but may present a limitation when it comes to activities such as side stretches.

SIGNIFICANCE

This work provides a comprehensive characterization of a magnetic field-based respiration sensor, including a discussion on its robustness to different algorithm thresholds. It proves the viability of the sensor in a range of exercises, expanding the applicability of Hall effect sensors as a feasible wearable approach to real-time respiratory monitoring.

Prevalence and prognostic importance of exercise limitation and physical inactivity in COPD

Exercise limitation and physical inactivity are separate, but related constructs. Both are commonly present in individuals with COPD, contribute to disease burden over and above the respiratory impairments, and are independently predictive of adverse outcomes. Because of this, clinicians should consider assessing these variables in their patients with COPD. Field tests of exercise performance such as the 6-min walk test and the incremental and endurance shuttle walk tests require limited additional resources, and results correlate with negative outcomes. Laboratory measures of exercise performance using a treadmill or cycle ergometer assess exercise capacity, provide prognostic information and have the advantage of explaining physiological mechanisms (and their interactions) underpinning exercise limitation. Limitations in exercise capacity (i.e. "cannot do") and physical inactivity (i.e. "do not do") are both associated with mortality; exercise limitation appears to be the more important driver of this outcome.

Applying behavioral change theories to optimize pulmonary rehabilitation in COPD patients: A review

This review meticulously evaluates the integration of behavioral change theories into pulmonary rehabilitation programs for chronic obstructive pulmonary disease (COPD) management, addressing the critical need for enhanced patient compliance and improved therapeutic outcomes. With COPD posing significant global health challenges, characterized by high morbidity and mortality rates, the manuscript underscores the potential of Self-Determination Theory, Social Cognitive Theory, the Transtheoretical Model, the Health Belief Model, and the Theory of Planned Behavior to foster meaningful health behavior changes among patients. Through a comprehensive literature analysis, it reveals how each model contributes to understanding patient behaviors in pulmonary rehabilitation contexts, advocating for their systematic application to craft more effective, patient-centered interventions. Despite the proven efficacy of these theories in various health domains, their current underutilization in pulmonary rehabilitation underscores a gap between theoretical knowledge and clinical practice. The review calls for an interdisciplinary approach that bridges this gap, highlighting the urgency of developing actionable, theory-based behavioral intervention plans. By doing so, it aims to advance COPD management strategies, ultimately improving the quality of life for individuals living with this debilitating disease.

Immune Dysregulation in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a disease whose incidence increase with age and is characterised by chronic inflammation and significant immune dysregulation. Inhalation of toxic substances cause oxidative stress in the lung tissue as well as airway inflammation, under the recruitment of chemokines, immune cells gathered and are activated to play a defensive role. However, persistent inflammation damages the immune system and leads to immune dysregulation, which is mainly manifested in the reduction of the body's immune response to antigens, and immune cells function are impaired, further destroy the respiratory defensive system, leading to recurrent lower respiratory infections and progressive exacerbation of the disease, thus immune dysregulation play an important role in the pathogenesis of COPD. This review summarizes the changes of innate and adaptive immune-related cells during the pathogenesis of COPD, aiming to control COPD airway inflammation and improve lung tissue remodelling by regulating immune dysregulation, for further reducing the risk of COPD progression and opening new avenues of therapeutic intervention in COPD.

NLRP3 inflammasome and pyroptosis in cardiovascular diseases and exercise intervention

NOD-like receptor protein 3 (NLRP3) inflammasome is an intracellular sensing protein complex that possesses NACHT, leucine-rich repeat, and pyrin domain, playing a crucial role in innate immunity. Activation of the NLRP3 inflammasome leads to the production of pro-inflammatory cellular contents, such as interleukin (IL)-1β and IL-18, and induction of inflammatory cell death known as pyroptosis, thereby amplifying or sustaining inflammation. While a balanced inflammatory response is beneficial for resolving damage and promoting tissue healing, excessive activation of the NLRP3 inflammasome and pyroptosis can have harmful effects. The involvement of the NLRP3 inflammasome has been observed in various cardiovascular diseases (CVD). Indeed, the NLRP3 inflammasome and its associated pyroptosis are closely linked to key cardiovascular risk factors including hyperlipidemia, diabetes, hypertension, obesity, and hyperhomocysteinemia. Exercise compared with medicine is a highly effective measure for both preventing and treating CVD. Interestingly, emerging evidence suggests that exercise improves CVD and inhibits the activity of NLRP3 inflammasome and pyroptosis. In this review, the activation mechanisms of the NLRP3 inflammasome and its pathogenic role in CVD are critically discussed. Importantly, the purpose is to emphasize the crucial role of exercise in managing CVD by suppressing NLRP3 inflammasome activity and proposes it as the foundation for developing novel treatment strategies.

Heterogeneities and impact profiles of early chronic obstructive pulmonary disease status: findings from the China Pulmonary Health Study

Background

The prevalence, epidemiological and clinical heterogeneities, and impact profiles of individuals with preserved ratio impaired spirometry (PRISm), pre-COPD, young COPD, and mild COPD in general Chinese population were not known yet.

Methods

Data were obtained from the China Pulmonary Health study (2012-2015), a nationally representative cross-sectional survey that recruited 50,991 adults aged 20 years or older. Definitions of the four early disease status were consistent with the latest publications and the Global Initiative for Chronic Obstructive Lung Disease criteria.

Findings

The age-standardised prevalences of PRISm, pre-COPD, young COPD, and mild COPD were 5.5% (95% confidence interval, 4.3-6.9), 7.2% (5.9-8.8), 1.1% (0.7-1.8), and 3.1% (2.5-3.8), respectively. In summary, mild COPD was under more direct or established impact factor exposures, such as older age, male gender, lower education level, lower family income, biomass use, air pollution, and more accumulative cigarette exposures; young COPD and pre-COPD experienced more personal and parents' events in earlier lives, such as history of bronchitis or pneumonia in childhood, frequent chronic cough in childhood, parental history of respiratory diseases, passive smoke exposure in childhood, and mother exposed to passive smoke while pregnant; pre-COPD coexisted with heavier symptoms and comorbidities burdens; young COPD exhibited worse airway obstruction; and most of the four early disease status harbored small airway dysfunction. Overall, older age, male gender, lower education level, living in the urban area, occupational exposure, frequent chronic cough in childhood, more accumulated cigarette exposure, comorbid with cardiovascular disease and gastroesophageal reflux disease were all associated with increased presence of the four early COPD status; different impact profiles were additionally observed with distinct entities. Over the four categories, less than 10% had ever taken pulmonary function test; less than 1% reported a previously diagnosed COPD; and no more than 13% had received pharmaceutical treatment.

Interpretation

Significant heterogeneities in prevalence, epidemiological and clinical features, and impact profiles were noted under varied defining criteria of early COPD; a unified and validated definition for an early disease stage is warranted. Closer attention, better management, and further research need to be administrated to these population.

Funding

Chinese Academy of Medical Sciences Institute of Respiratory Medicine Grant for Young Scholars (No. 2023-ZF-9); China International Medical Foundation (No. Z-2017-24-2301); Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No. 2021-I2M-1-049); National High Level Hospital Clinical Research Funding (No. 2022-NHLHCRF-LX-01); Major Program of National Natural Science Foundation of China (No. 82090011).

Association between the Static and Dynamic Lung Function and CT-Derived Thoracic Skeletal Muscle Measurements-A Retrospective Analysis of a 12-Month Observational Follow-Up Pilot Study

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) with low skeletal muscle mass and severe airway obstruction have higher mortality risks. However, the relationship between dynamic/static lung function (LF) and thoracic skeletal muscle measurements (SMM) remains unclear. This study explored patient characteristics (weight, BMI, exacerbations, dynamic/static LF, sex differences in LF and SMM, and the link between LF and SMM changes.

METHODS

A retrospective analysis of a 12-month prospective follow-up study patients with stable COPD undergoing standardized treatment, covering mild to severe stages, was conducted. The baseline and follow-up assessments included computed tomography and body plethysmography.

RESULTS

This study included 35 patients (17 females and 18 males). This study revealed that females had more stable LF but tended to have greater declines in SMM areas and indices than males (-5.4% vs. -1.9%, respectively), despite the fact that females were younger and had higher LF and less exacerbation than males. A multivariate linear regression showed a negative association between the inspiratory capacity/total lung capacity ratio (IC/TLC) and muscle fat area.

CONCLUSIONS

The findings suggest distinct LF and BC progression patterns between male and female patients with COPD. A low IC/TLC ratio may predict increased muscle fat. Further studies are necessary to understand these relationships better.

Using Remote Technology to Engage Patients with Interstitial Lung Diseases in a Home Exercise Program: A Pilot Study

INTRODUCTION

The access and compliance of patients with interstitial lung diseases (ILDs) to exercise programs (EPs) remain challenges.

OBJECTIVES

We assessed the dropout rate, intervention completion, compliance with data acquisition and submission, safety, and satisfaction of a home EP delivered via video conference (EPVC group) or self-directed (EPSD group) to patients with ILD. Pre- and post-intervention changes in patient outcomes (dyspnea, fatigue, exercise capacity, lung function, and quality of life) were secondarily explored.

MATERIAL AND METHODS

Groups performed an eight-week virtual EP three times/week. Video conferences were led by a registered respiratory therapist, whereas self-directed exercises were completed following a pre-recorded video. Participants submitted spirometry, heart rate, and SpO2 results weekly to the research team.

RESULTS

Fourteen patients with ILD were equally assigned to the EPVC and EPSD groups, but three from the EPSD group dropped out after the initial assessment (dropout rate of 42.8% in the EPSD group). Eleven patients (mean age of 67 ± 12 years) completed 96.5% of sessions. Compliance with data acquisition and submission was optimal (≥97.6% in both groups), and no adverse events were reported. Changes in overall fatigue severity were significantly different between groups (p = 0.014, Cohen's r = 0.64).

CONCLUSIONS

The results suggest that a structured virtual EP delivered via video conference or pre-recorded video can be feasible, safe, and acceptable for patients with ILD.

Physical Activity, Depression and Quality of Life in COPD - Results from the CLARA II Study

Background

Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease.

Methods

We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain.

Results

After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV1%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8-10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C - total score and all subscores).

Conclusions

In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.