SAFETY AND EFFICACY OF PULMONARY REHABILITATION IN ELDERLY FEMALES WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Ross Arena, PhD, PT, Virginia Commonwealth University/MCV Campus; Noah Greenspan; Judith Haas, Pulmonary Wellness and Rehabilitation Center
Rationale:
Pulmonary rehabilitation has consistently proven effective with respect to improving exercise capacity in patients with chronic obstructive pulmonary disease (COPD). While this body of literature is substantial, few studies have examined the effect of pulmonary rehabilitation on groups who are of advanced age (mean age > 70) and/or purely female.
Objectives:
The present study is directed toward determining the safety and efficacy of pulmonary rehabilitation in elderly women with COPD.
Methods:
Twenty-two female subjects diagnosed with COPD were enrolled in an outpatient pulmonary rehabilitation program. Mean age, FVC, FEV1, FEV1/FVC and FEF25-75 were 72.4 (+/- 9.7) years, 2.0 (+/- 0.8) liters, 1.2 (+/- 0.6) liters, 57.9 (+/- 13.2%), and 0.7 (+/- 0.4) liters/sec, respectively. Subjects underwent a progressive exercise test on a treadmill prior to and following pulmonary rehabilitation. Subjects were tracked for emergency events occurring during the rehabilitation sessions (CPR, defibrillation, etc).
Results:
The mean number of pulmonary rehabilitation sessions and total aerobic exercise time were 21.1 (+/- 4.4) and 13.3 (+/- 3.2) hours per subject. The paired t test revealed a significant improvement in peak metabolic equivalent (MET) level during the exercise test following rehabilitation (2.9 vs 4.5 METs, P < .001). Peak heart rate during the two tests was not significantly different indicating similar effort (110.2 vs 112.8, P = .30). The group completed 292 hours of aerobic exercise in 465 sessions. No events warranting emergency intervention occurred.
Conclusion:
This study demonstrates aerobic exercise training is safe and effective in elderly female patients with COPD. Analysis of this population is of particular importance given the prevalence of COPD with advanced age and recent trends suggesting a rise in the number of females being diagnosed compared to men. Future research is needed to support the findings reported in the present study and advocate pulmonary rehabilitation for all patients who would benefit.
A COMPARISON OF FEV1 PERCENT AND CHANGE IN DYSPNEA AMONG PATIENTS IN PULMONARY REHABILITATION
Kathryn E. Young, MS; Rachel Benko; Karen Jordan; Ann C. Miller; Natalie P. Outslay; Albert Rizzo; Christiana Care Health Services
Many studies have researched dyspnea change in response to pulmonary rehabilitation, however few studies have reported on factors that may affect the degree of improvement. A retrospective study was conducted on 185 patients that completed an 8-week multi-disciplinary pulmonary rehabilitation program (PR). The Chronic Respiratory Questionnaire (CRQ) was administered pre- and postprogram to determine changes in dyspnea. The difference in score classified patients into one of 4 clinically important groups-large, moderate, small, or no change as recommended by Guyatt et al at McMaster University Medical Centre. Of the 185 patients, 88 patients (48%) demonstrated large improvement in dyspnea and 32 patients (17%) showed no change in dyspnea. For the purpose of this study we compared the forced expiratory volume in 1 second (FEV1) between the two groups. A two-tailed t test analysis was performed to determine if there was a difference in their average admission FEV1. Results showed an average FEV1 of 53.7 +/- 21% for the large group and 53 +/- 21% for the no-change group. Statistically, there was no significant difference (P > .05). These results demonstrate that many patients enrolled in PR show a large improvement in dyspnea. This study further suggests that the criteria of FEV1 alone may not be a good predictor when selecting patients for PR. Further research is needed to determine predictors for success in PR. This information may be valuable for physicians, programs, and insurance companies when determining the appropriateness of candidates entering into PR.
INSPIRATORY MUSCLE TRAINING IN PATIENTS WITH CHRONIC OBSTRUCTION PULMONARY DISEASE
Mary Jane Ruf, BSN; Judah Skolnick, MD; Josephine Mei, MD; Patricia Cerrito, PhD; Carolyn Cunningham, MS, ARNP, CS; Betty Greaver, BSN; Linda Shelburne, PT
Rationale:
Controversy exists regarding the efficacy of inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD).
Objectives:
This study was performed to evaluate this modality of therapy.
Methods:
123 patients in an outpatient pulmonary rehabilitation program were evaluated. All patients suffered from COPD. Patients used the Threshold Inspiratory Muscle Trainer. Baseline starting pressures were set at 30% of the negative inspiratory force (NIF). If patients were not able to tolerate this setting, the setting was reduced by 2 cm of water pressure. Patients started at 5 to 15 minutes at least once daily, and were instructed to increase the time gradually. When the patient reached 15 minutes, they were instructed to increase the pressure by 2 cm of water pressure and reduce the time. The patients were instructed to work back up to 15 minutes. NIF was used as a measure of the inspiratory muscle function. The more negative value the NIF, the better the function. Measurements were made at entry into and exit from the program. Results were subjected to statistical analysis.
Results:
The average entry value of the NIF was -34.43 cm. The average exit value was -38.69 cm. P = .0282, which was statistically significant. Probability analysis showed there was little probability that patients would perform poorly.
Conclusions:
1. Inspiratory muscle training improves NIF in patients with COPD.
2. The patients trained without daily supervision, so compliance may have been an issue.
3. It is not certain that the degree of improvement in NIF is clinically significant.
SEX DIFFERENCES IN PREDICTORS OF 6-MINUTE WALK PERFORMANCE IN CHILDREN WITH CYSTIC FIBROSIS
Anne K. Swisher; K. Moffett; L. Baer; B. Stanton; Mountain State Cystic Fibrosis Center, West Virginia University
Rationale:
Cystic fibrosis (CF) is a common genetic disorder that leads to death in young adulthood from respiratory failure. It also affects nutritional status and exercise capacity. Young women are known to die earlier and have a more rapidly declining course of the disease than young men.
Objectives:
This study was undertaken to determine if differences existed in prepubertal boys and girls with CF that might predict the disease course.
Methods:
Subjects aged 5 to 12 (15 males, 26 females) were assessed during routine clinic visits for the following: measurements of body fat from skinfold thickness at triceps and calf sites, leg muscle strength, spirometry and 6-minute walk test.
Results:
Results of t tests indicated no differences between males and females, except for girls having higher body fat (19.7% vs 12.6%). Stepwise regression analyses indicated that 6-minute walk distance could be predicted from left ankle strength and FEV1 (% of predicted) (R2 = 0.70) for boys and by right ankle strength and percent fat in girls (R2 = 0.16).
Conclusion:
It appears that nutritional status may be more important in predicting exercise tolerance for girls than boys with CF, and that nutritional status is more important than lung function in predicting girls' exercise tolerance. The ability to predict exercise tolerance based on lung function, body fat, and leg strength is poor for prepubertal girls with CF, and other important factors need to be identified. Sex differences exist prior to puberty that may partially account for the different disease course in adulthood.
THE CALIFORNIA PULMONARY REHABILITATION COLLABORATIVE PROJECT (CPRCP)
Herbert Yue; Lela M. Prewitt; David H. Kupferberg; Andrew L. Ries; on behalf of the CPRCP Research Group University Of California, San Diego
Rationale:
Most studies evaluating the benefits of pulmonary rehabilitation are limited to small patient populations in a few selected centers.
Objective:
Evaluate the effectiveness of pulmonary rehabilitation in a collaborative study involving 10 programs in California.
Methods:
Following a common clinical program evaluation protocol, we examined changes in health-related quality of life (HRQOL), dyspnea, and healthcare utilization in patients with chronic lung disease before and up to 18 months after pulmonary rehabilitation. 542 patients were enrolled; 415 in eight centers were included in final analyses (age = 68.3 +/- 9.0 SD years). Subjects completed the RAND(SF)-36 (MCS = mental component score, PCS = physical component score), UCSD Shortness of Breath (SOBQ), and UCSD Health Care Utilization questionnaires before and immediately after rehabilitation, and 3, 6, 12, and 18 months later. Baseline measures of lung function (FEV1, FVC, FEV1/FVC) and 6-minute walk (6MW) distance were also obtained.
Results:
(mean +/- SD) for all patients indicated moderate-severe lung disease and respiratory impairment (FEV1 = 1.14 +/- 0.51 L [44% pred]; FVC = 2.40 +/- 0.83 L [70% pred]; 6MW distance = 345 +/- 125 m; PCS = 31.3 +/- 8.1; MCS = 48.2 +/- 11.3; SOBQ = 55.7 +/- 21.6). There were no significant differences among test centers in FEV1, but there were differences for FVC, FEV1/FVC, and 6MW. After rehabilitation, there were significant improvements in HRQOL (MCS = +3.6 +/- 9.6; PCS = +2.8 +/- 7.4) and dyspnea (SOBQ = -6.6 +/- 14.1) that diminished after 3 months but persisted up to 12 months after rehabilitation. Significant decreases were observed in hospital days, physician visits, urgent care visits, and healthcare telephone calls.
Conclusion:
We conclude that pulmonary rehabilitation, as practiced in a variety of clinical programs, is effective in improving quality of life, dyspnea, and exercise tolerance and reducing healthcare utilization in patients with chronic lung disease.