Patients with chronic obstructive pulmonary disease (COPD) or those with paralytic restrictive pulmonary syndromes caused by progressive neuromuscular disease, kyphoscoliosis or traumatic quadriplegia may require frequent hospitalization because of respiratory impairment and have increased morbidity and mortality. Pulmonary rehabilitation has been shown to decrease the frequency of hospitalization, ameliorate symptoms, increase exercise tolerance, and in one study, prolong life for individuals with COPD. It is now recognized that principles of pulmonary rehabilitation can also be used to avoid hospitalization, intubation, tracheostomy and bronchoscopy while enhancing quality of life, decreasing cost, and greatly prolonging life for individuals with paralytic restrictive syndromes and global alveolar hypoventilation as well.
Female ; Human ; Lung Diseases/*rehabilitation ; Lung Diseases, Obstructive/rehabilitation ; Male ; Neuromuscular Diseases/complications ; Respiration, Artificial ; Respiratory Insufficiency/etiology/rehabilitation

BACKGROUND: The aim of this study was to determine the effectiveness of self-efficacy promoting pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). METHODS: thirty six patients, with clinically stable COPD were randomly assigned: 18 to a rehabilitation group and another 18 as a control group, The subjects participated in a the self-efficacy promoting pulmonary rehabilitation program for 8 weeks. This program consisted of education, breathing retraining, exercise training, relaxation and counseling. The control group received education only. The outcome variables were self-efficacy, dyspnea, exercise endurance, pulmonary function, and quality of life. Dyspnea was measured using the modified Borg scale. Exercise endurance was measured by the six minute walking distance. The quality of life was measured by the quality of life index for pulmonary disease patients. RESULTS: In the rehabilitation group after performing the self-efficacy promoting pulmonary rehabilitation program, the self-efficacy score, exercise endurance, and quality of life score were higher than the control group (p=0.007, p=0.038, and p=0.039, respectively). and the exertional dyspnea score was significantly lower than controls(p=0.045). However, the dyspnea score and FEV1 were similar after performing the self-efficacy promoting pulmonary rehabilitation program. CONCLUSION: The self-efficacy promoting pulmonary rehabilitation program is effective to in improve self-efficacy, exertional dyspnea, exercise endurance and quality of life in patients with COPD.
Counseling ; Dyspnea ; Education ; Humans ; Lung Diseases ; Outpatients* ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation* ; Relaxation ; Respiration ; Walking

PURPOSE: This study was designed to investigate the effects of a pulmonary rehabilitation program for patients with COPD. METHOD: 37 subjects, who had a FEV1/FVC below 70%, participated. 18 were assigned to the experimental group and 19 to the control group. The program consisted of individualized education program and exercise program for 6weeks, 3times a week. Data was collected through questionnaire surveys of general characteristics, anxiety and depression, blood tests for lactic acid and cardiopulmonary exercise tests, and also using bicycle ergometer, for exercise capacity. As for data analyses, paired and unpaired t-test and x2-test were adopted using an SPSS program. RESULT: The result revealed that the increase in VT, peak O2, Emax, HRmax and Wmax, at the maximal exercise, were significantly high in the experimental group. However, the anxiety and depression scores were not significantly high in the experimental group. CONCLUSION: The pulmonary rehabilitation program was effective in increasing cardiopulmonary endurance in patients with COPD. Accordingly, we should seriously consider an individualized pulmonary rehabilitation program as a nursing intervention.
Anxiety ; Depression ; Education ; Exercise Test ; Hematologic Tests ; Humans ; Lactic Acid ; Lung Diseases ; Methods ; Nursing ; Pulmonary Disease, Chronic Obstructive* ; Rehabilitation* ; Statistics as Topic

PURPOSE: The purpose of this study was to review systematically the effects of home based pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients using qualitative synthesis. METHODS: Studies designed randomized controlled trials were identified to extract data and to assess the quality of studies in 8 domestic and 3 foreign search engines, and hand search reference reviews. RESULTS: A total of 9 studies met the inclusion criteria. Overall, the methodological quality of the studies ranged from average to poor. Home based pulmonary rehabilitation consisted of exercise, education, and psychosocial interventions. Several exercises such as aerobic, strength, respiratory muscle training, and flexibility were used in home based pulmonary rehabilitation for COPD patients. Upper muscle exercise and walking were the most frequently used exercises. The most common topics for education were ‘knowledge of the illness’ and ‘drug management’. Walking distance test (WDT) and quality of life (QoL) were the most frequently measured as the dependent variables to evaluate rehabilitation outcomes, followed by pulmonary function test (PFT) and dyspnea. WDT was the most effective outcome, followed by dyspnea, QoL and PFT. CONCLUSION: This study informed about the details of scientific and effective home based rehabilitation programs in COPD patients for future researchers and clinicians. These findings can help expand the recognition and accessibility of home based rehabilitation in COPD patients.
Breathing Exercises ; Dyspnea ; Education ; Exercise ; Hand ; Humans ; Lung Diseases ; Pliability ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation* ; Respiratory Function Tests ; Search Engine ; Walking

Sarcopenia is frequently associated with chronic diseases such as chronic obstructive pulmonary disease (COPD) and cancer. COPD, which is characterized by an irreversible airflow limitation, exacerbates respiratory distress as the disease progresses. The prevalence of sarcopenia in stable COPD was reported to be 15% to 25% in previous foreign studies and 25% in a Korean study. As the amount of activity decreases, muscle mass decreases and eventually oxygen cannot be used effectively, resulting in a vicious cycle of deterioration of exercise capacity. Deconditioning due to decreased activity is a major cause of limb muscle dysfunction in patients with COPD. In these patients, the factors that decrease muscle strength and endurance include chronic inflammation, oxidative stress, inactivity, hypoxemia, hormone abnormality, deficits of nutrients such as protein and vitamin D, and the use of systemic corticosteroid. Therefore, treatment and management should either inhibit this process or should be directed toward supplementing the deficiency, such as with exercise, nutritional support, and medications and supplements. The relationship between sarcopenia and COPD is increasingly being reported, with some overlap in clinical features and treatments. We are fascinated to be able to diagnose 2 diseases through similar physical performance tests and to improve both diseases using the same treatment such as exercise. Therefore, this review summarizes the clinical relevance and integrative management of the 2 diseases.
Anoxia ; Chronic Disease ; Exercise Therapy ; Extremities ; Humans ; Inflammation ; Lung Diseases ; Muscle Strength ; Nutritional Support ; Oxidative Stress ; Oxygen ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Rehabilitation ; Sarcopenia ; Vitamin D

Chronic obstructive pulmonary disease(COPD) is a major cause of chronic morbidity and mortality. To improve management and prevention through a concerted worldwide effort, the NIH and the WHO created the Global Initiative for Obstructive Pulmonary Disease (GOLD) and published management guideline. The guideline consists of 4 components; assessment and monitoring, avoidance of risk factors; management of stable COPD and management of exacerbation. Spirometry is essential for the diagnosis and for monitoring disease progression. Smoking cessation can reduce symptoms and prevent progression of disease. Bronchodilator therapy is the mainstay of COPD treatment. beta2-agonists, anticholinergics, and theophylline are available bronchodilators and can be used individually or in combination. Inhaled corticosteroids can also improve symptom and can be combined with bronchodilators. Inhaled corticosteroids, in addition, might reduce exacerbation frequency and severity. Non-pharmacotherapies such as rehabilitation programs and long term oxygen therapy can improve the quality of life and the survival in many patients. Stepwise increment of treatment according to the severity is recommended for stable COPD. The mainstay of treatment for acute exacerbation involves increasing bronchodilator therapy, systemic use of corticosteroids, and antibiotic therapy. In those with respiratory failure, non-invasive ventilation has been shown to reduce intubation rates, shorten lengths of hospitalization, and improve mortality.
Adrenal Cortex Hormones ; Bronchodilator Agents ; Cholinergic Antagonists ; Diagnosis ; Disease Progression ; Hospitalization ; Humans ; Intubation ; Lung Diseases, Obstructive ; Mortality ; Noninvasive Ventilation ; Oxygen ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation ; Respiratory Insufficiency ; Risk Factors ; Smoking Cessation ; Spirometry ; Theophylline

Pulmonary rehabilitation has been known to improve dyspnea and exercise tolerance in patients with chronic lung disease, although it does not improve pulmonary function. The mechanism of this improvement is not clearly explained till now ; however some authors suggested that the improvement in the skeletal muscle metabolism after the rehabilitation could be a possible mechanism. The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation which causes early activation of anaerobic glycolysis and excess lactate production with exercise. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the improvement in the exercise tolerance after the rehabilitation, noninvasive 31P magnetic resonance spectroscopy(MRS) of the forearm flexor muscle was performed before and after the exercise training in nine patients with chronic lung disease who have undertaken intensive pulmonary rehabilitation for 6 weeks. 31P MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntary contraction(MVC) force of the muscle was measured before the isometric exercise, and then 30% of MVC force was constantly loaded to each patient during the isometric exercise. After the exercise training, exercise endurance of upper and lower extremities and 6 minute walking distance were significantly increased(p<0.05). There were no differences of baseline intracellular pH (pHi) and inorganic phosphate/phosphocreatine(Pi/PCr). After rehabilitation pHi at the exercise and the exhaustion state showed a significant increase(6.91+/-0.1 to 6.99+/-0.1 and 6.76+/-0.2 to 6.84+/-0.2 respectively, p<0.05). Pi/PCr at the exercise and the recovery rate of pHi and Pi/PCr did not show significant differences. These results suggest that the delayed intracellular acidosis of skeletal muscle may contribute to the improvement of exercise endurance after pulmonary rehabililtation.
Acidosis ; Dyspnea ; Exercise ; Exercise Tolerance ; Forearm ; Glycolysis ; Humans ; Hydrogen-Ion Concentration ; Isometric Contraction ; Lactic Acid ; Lower Extremity ; Lung Diseases ; Magnetic Resonance Spectroscopy* ; Metabolism* ; Muscle, Skeletal* ; Muscles ; Oxidative Phosphorylation ; Pulmonary Disease, Chronic Obstructive ; Rehabilitation* ; Walking