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Miyazaki A, Miki K, Maekura R, Tsujino K, Hashimoto H, Miki M, Yanagi H, Koba T, Nii T, Matsuki T, Kida H. Increased Oxygen Extraction by Pulmonary Rehabilitation Improves Exercise Tolerance and Ventilatory Efficiency in Advanced Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11040963. [PMID: 35207235 PMCID: PMC8878603 DOI: 10.3390/jcm11040963] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background: In cardiopulmonary exercise testing (CPET), oxygen uptake (V’O2) is calculated using the product of minute ventilation (V’E) and the difference between inspiratory and expiratory O2 concentrations (ΔFO2). However, little is known about the response of ΔFO2 to pulmonary rehabilitation (PR). The aim of the present study was (1) to investigate whether PR increases peak V’O2, based on whether ΔFO2 or V’E at peak exercise increase after PR, and (2) to investigate whether an improvement in ΔFO2 correlates with an improvement in ventilatory efficiency. Methods: A total of 38 patients with severe and very severe COPD, whose PR responses were evaluated by CPET, were retrospectively analyzed. Results: After PR, peak V’O2 was increased in 14 patients. The difference in ΔFO2 at peak exercise following PR correlated with the difference in peak V’O2 (r = 0.4884, p = 0.0019), the difference in V’E/V’CO2-nadir (r = −0.7057, p < 0.0001), and the difference in V’E–V’CO2 slope (r = −0.4578, p = 0.0039), but it did not correlate with the difference in peak V’E. Conclusions: The increased O2 extraction following PR correlated with improved exercise tolerance and ventilatory efficiency. In advanced COPD patients, a new strategy for improving O2 extraction ability might be effective in those in whom ventilatory ability can be only minimally increased.
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Affiliation(s)
- Akito Miyazaki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
- Correspondence: ; Tel.: +81-6-6853-2001
| | - Ryoji Maekura
- Graduate School of Health Care Sciences, Jikei Institute, Osaka 532-0003, Japan;
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Hisako Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Mari Miki
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto 772-8503, Japan;
| | - Hiromi Yanagi
- Department of Clinical Examination, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan;
| | - Taro Koba
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Takuro Nii
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
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Grbovic V, Markovic N, Bogojevic P, Nikolic J, Milosevic J, Simovic S, Cekerevac I, Jurišić-Škevin A, Zdravkovic N, Mijailovic S, Zdravkovic N. The effects of respiratory exercises on partial pressures of gases and anxiety in the acute phase of COVID-19 infection. Physiother Theory Pract 2021; 38:2736-2744. [PMID: 34698591 DOI: 10.1080/09593985.2021.1996497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Respiratory exercise in post-COVID-19 significantly improves pulmonary function, exercise capacity and quality of life. Our study aimed to investigate the effect of respiratory exercise on partial pressures of oxygen, carbon dioxide and oxygen saturation in arterial blood and anxiety assessed by the GAD-7 scale in the acute phase of COVID-19 infection. METHODS The study was conducted at the Clinical Center, Kragujevac, from June to July 2020. The study was a prospective clinical trial and included 62 patients with the acute-phase of COVID-19 infection (61.3% males, mean age 60.82 ± 11.72). The duration of the comprehensive pulmonary rehabilitation program was 14 days ± 2.28 days. Oxygen saturation and heart rate were determined by using the pulse oximeter, oxygen flow, and arterial blood gas analysis values by using the gas analyzer. The anxiety assessment was measured using the Generalized Anxiety Disorder (GAD-7). RESULTS The values of oxygen saturation significantly differed before and after the respiratory exercise sessions (95.77 vs 98.02, respectively; p < .001). After the respiratory exercise program, significantly lower values of the GAD-7 scale were observed compared to the values before the respiratory exercise program (p = .049). A significant negative correlation was observed between oxygen saturation after respiratory exercise and age and presence of chronic obstructive pulmonary disease (ρ = -0.329; p = .013; ρ = -0.334; p = .009, respectively). GAD-7 score after respiratory exercise negatively correlated with chronic obstructive pulmonary disease and malignancy (ρ = -0.285; p = .025; ρ = -0.350; p = .005, respectively). CONCLUSION The respiratory exercise program significantly improves oxygen saturation and anxiety levels in COVID-19 patients.
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Affiliation(s)
- Vesna Grbovic
- Department of Physical Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Natasa Markovic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Predrag Bogojevic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jovana Nikolic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jelena Milosevic
- Department of Physical Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Ivan Cekerevac
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Clinic for Pulmology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandra Jurišić-Škevin
- Department of Physical Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Nebojša Zdravkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sara Mijailovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Natasa Zdravkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Gastroenterohepatology, Clinic for Internal Medicine, Clinical Center Kragujevac, Kragujevac, Serbia
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MUNTEANU C, DOGARU G, ROTARIU M, ONOSE G. Therapeutic gases used in balneotherapy and rehabilitation medicine - scientific relevance in the last ten years (2011 – 2020) - Synthetic literature review. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT:
Background. The medical relevance of therapeutic gases can range from use in burns and stroke victims to hypoxia therapy in children. However, medical gases such as oxygen, hydrogen, helium and xenon have recently come under increased exploration for their potential therapeutic use on various brain disease states, including traumatic brain injuries, hypoxia-ischemia and, cerebral hemorrhages.
Objective. This synthetic review aims to rigorously select related articles and identify within their content the main possible uses of therapeutic gases and physiological mechanisms. The objective of this article is to present the various therapeutic mechanisms that have been proposed in the current literature and the medical relevance of various therapeutic gases used in balneotherapy or medical rehabilitation.
Methods. To elaborate our synthesis review, we have searched for relevant open access articles in 6 international databases: Cochrane, Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science, published from January 2011 until December 2020. The contextually quested keywords combinations/ syntaxes used specified on this page. The eligible articles were analyzed in detail regarding pathologies addressed by therapeutic gases. All articles with any design (reviews, randomized controlled trials, non-randomized controlled trials, case-control studies, cross-sectional studies), if eligible according to the above-mentioned selection methodology, containing in the title or abstract the above-mentioned combinations, were included in the analysis. Articles were excluded in the second phase if they did not reach the relevance criterion.
Results. Our search identified, first, 225 articles. After eliminating the duplicates, remained 180 articles. In the second phase, we applied a relevance criterion. Although our team - including the authors of this paper – have quite long and consistent expertise in achieving systematic literature reviews, the marked heterogeneity of both the item composing the subject we have approached and inherently the wase of presentations in the respective quite vast and diverse domain of medical gases, prevented us to fulfil, at least regarding this initial work, a systematic literature review. Instead, we succeeded to make a hopefully interesting and valuable narrative synthetic-related literature review. At the end of the second phase, 63 articles passed the relevance criterion and were included in this synthetic review.
Conclusions. Therapeutic gases are not fully understood and used adequately for sanogenic or medical purposes. More research is needed to fully understand the mechanisms and importance of therapeutic gases. The link between balneotherapy and medical rehabilitation regarding the usage of therapeutical gases emphasises the unity for this medical speciality.
Keywords: "Therapeutic gas"/ "Oxygen therapy"/ "Carbon dioxide"/ "CO2 therapy"/ "Carbon monoxide"/ "Mofette"/ "Hydrogen Sulfide"/ "H2S"/ "Helium"/ "Xenon"/ "Ozone therapy"/ "Radon"/ "Hydrogen therapy"/ "Nitric oxide"/ "Heliox" AND "Rehabilitation".
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Affiliation(s)
- Constantin MUNTEANU
- 1 University of Medicine and Pharmacy “Grigore T. Popa, 16 University Street, Iasi, Romania
| | - Gabriela DOGARU
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hațieganu”, Cluj-Napoca, Romania 6. Clinical Rehabilitation Hospital Cluj-Napoca, Romania
| | - Mariana ROTARIU
- 1 University of Medicine and Pharmacy “Grigore T. Popa, 16 University Street, Iasi, Romania
| | - Gelu ONOSE
- 1.The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
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Motor Pathophysiology Related to Dyspnea in COPD Evaluated by Cardiopulmonary Exercise Testing. Diagnostics (Basel) 2021; 11:diagnostics11020364. [PMID: 33670051 PMCID: PMC7926713 DOI: 10.3390/diagnostics11020364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD), exertional dyspnea, which increases with the disease’s progression, reduces exercise tolerance and limits physical activity, leading to a worsening prognosis. It is necessary to understand the diverse mechanisms of dyspnea and take appropriate measures to reduce exertional dyspnea, as COPD is a systemic disease with various comorbidities. A treatment focusing on the motor pathophysiology related to dyspnea may lead to improvements such as reducing dynamic lung hyperinflation, respiratory and metabolic acidosis, and eventually exertional dyspnea. However, without cardiopulmonary exercise testing (CPET), it may be difficult to understand the pathophysiological conditions during exercise. CPET facilitates understanding of the gas exchange and transport associated with respiration-circulation and even crosstalk with muscles, which is sometimes challenging, and provides information on COPD treatment strategies. For respiratory medicine department staff, CPET can play a significant role when treating patients with diseases that cause exertional dyspnea. This article outlines the advantages of using CPET to evaluate exertional dyspnea in patients with COPD.
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Miki K, Kitada S, Miki M, Hui SP, Shrestha R, Yoshimura K, Tsujino K, Kagawa H, Oshitani Y, Kida H, Maekura R, Kangawa K. A phase II, open-label clinical trial on the combination therapy with medium-chain triglycerides and ghrelin in patients with chronic obstructive pulmonary disease. J Physiol Sci 2019; 69:969-979. [PMID: 31595463 PMCID: PMC10716959 DOI: 10.1007/s12576-019-00716-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
The aim of this study was to investigate the effect of activated ghrelin with dietary octanoic acids or medium-chain triglyceride (MCT) administration to underweight patient with chronic obstructive pulmonary disease (COPD). Eleven severe and very severe COPD patients received a 5-day treatment with edible MCT. Sequentially, 10 patients received a 3-week combination treatment with MCT and intravenous acyl ghrelin. Five-day MCT treatment increased endogenous acyl ghrelin (p = 0.0049), but the total ghrelin level was unchanged. MCT-ghrelin combination treatment improved the peak oxygen uptake (p = 0.0120) during whole treatment course. This effect was attributed to the resultant improvements in cardiac function by O2 pulse, and to the difference between inspired and expired oxygen concentration rather than minute ventilation. Addition of dietary MCT to ghrelin treatment improved the aerobic capacity of underweight COPD patients, likely by mechanisms of increased O2 delivery through improvements in primary cardiocirculatory and muscular crosstalk.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Shu-Ping Hui
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi-5, Sapporo, Japan
| | - Rojeet Shrestha
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi-5, Sapporo, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
- Graduate School of Health Care Sciences, Jikei Institute, Miyahara 1-2-8, Yodogawa-ku, Osaka, Japan
| | - Kenji Kangawa
- National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibeshinmachi, Suita, Japan
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He GX, Li N, Ren L, Shen HH, Liao N, Wen JJ, Xu YM, Wang J, Li QY. Benefits of different intensities of pulmonary rehabilitation for patients with moderate-to-severe COPD according to the GOLD stage: a prospective, multicenter, single-blinded, randomized, controlled trial. Int J Chron Obstruct Pulmon Dis 2019; 14:2291-2304. [PMID: 31631999 PMCID: PMC6790109 DOI: 10.2147/copd.s214836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose Pulmonary rehabilitation (PR) is essential to manage patients with COPD. The aim of this study was to investigate the appropriate intensity of PR exercise training for patients with moderate-to-severe COPD. Patients and methods A prospective multicenter randomized controlled trial was conducted from January 2014 to October 2018. The subjects were randomly assigned to three groups with different intensities of PR, according to their maximum oxygen uptake percentage determined by cardiopulmonary exercise testing. After 20 weeks of exercise training, the effects of low-, moderate-, and high-intensity exercise interventions on patients were compared to determine the most appropriate PR prescription. Results For patients with moderate COPD, all the measured parameters were significantly improved in the moderate- and high-intensity PR groups (P<0.01), while there was no significant difference in the frequency of acute exacerbations and the mMRC questionnaire after 20 weeks of PR exercise in the low-intensity PR group. For patients with severe COPD, all variables were also improved in the high-intensity PR group (P<0.05), while the mean differences of pre- and post-PR were lower than those in patients with moderate COPD. Moreover, the Hamilton Anxiety Scale and body mass index showed no significant difference in low-intensity PR group (P>0.05). Conclusion High-intensity PR exercise is helpful for patients with moderate to severe COPD. Moderate COPD patients need to receive intensive PR training; the improvement degrees from PR intervention were higher than those of the severe COPD patients. For patients with severe COPD, high-intensity PR exercise may be more beneficial if patients can tolerate it.
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Affiliation(s)
- Guo Xia He
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.,Department of Respiratory Rehabilitation, The Fourth Rehabilitation Hospital of Shanghai (Shanghai Jingan Geriatric Hospital), Shanghai 200042, People's Republic of China
| | - Ning Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Lei Ren
- Department of Respiratory Rehabilitation, The Fourth Rehabilitation Hospital of Shanghai (Shanghai Jingan Geriatric Hospital), Shanghai 200042, People's Republic of China.,Department of Respiratory Medicine, The Second Affiliated Hospital of Suzhou University, Jiangsu 215004, People's Republic of China
| | - Hong Hua Shen
- Department of Respiratory Rehabilitation, The Fourth Rehabilitation Hospital of Shanghai (Shanghai Jingan Geriatric Hospital), Shanghai 200042, People's Republic of China
| | - Ning Liao
- West-Nanjing Road Community Health-care Center of Shanghai, Shanghai 200040, People's Republic of China
| | - Jian Jun Wen
- Caojiadu Community Health Service of Shanghai, Shanghai 200042, People's Republic of China
| | - Yi Min Xu
- Department of Respiratory Rehabilitation, The Fourth Rehabilitation Hospital of Shanghai (Shanghai Jingan Geriatric Hospital), Shanghai 200042, People's Republic of China
| | - Jing Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Suzhou University, Jiangsu 215004, People's Republic of China
| | - Qing Yun Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
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