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Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease

TAKE-HOME SUMMARY: Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD. PURPOSE: We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: h...

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Autores principales: Maekura, Ryoji, Hiraga, Toru, Miki, Keisuke, Kitada, Seigo, Miki, Mari, Yoshimura, Kenji, Yamamoto, Hiroshi, Kawabe, Toshiko, Mori, Masahide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562755/
https://www.ncbi.nlm.nih.gov/pubmed/26366071
http://dx.doi.org/10.2147/COPD.S86455
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author Maekura, Ryoji
Hiraga, Toru
Miki, Keisuke
Kitada, Seigo
Miki, Mari
Yoshimura, Kenji
Yamamoto, Hiroshi
Kawabe, Toshiko
Mori, Masahide
author_facet Maekura, Ryoji
Hiraga, Toru
Miki, Keisuke
Kitada, Seigo
Miki, Mari
Yoshimura, Kenji
Yamamoto, Hiroshi
Kawabe, Toshiko
Mori, Masahide
author_sort Maekura, Ryoji
collection PubMed
description TAKE-HOME SUMMARY: Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD. PURPOSE: We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities. PATIENTS AND METHODS: The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan–Meier analyses. RESULTS: In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172–0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296–0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved. CONCLUSION: The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.
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spelling pubmed-45627552015-09-11 Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease Maekura, Ryoji Hiraga, Toru Miki, Keisuke Kitada, Seigo Miki, Mari Yoshimura, Kenji Yamamoto, Hiroshi Kawabe, Toshiko Mori, Masahide Int J Chron Obstruct Pulmon Dis Original Research TAKE-HOME SUMMARY: Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD. PURPOSE: We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities. PATIENTS AND METHODS: The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan–Meier analyses. RESULTS: In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172–0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296–0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved. CONCLUSION: The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions. Dove Medical Press 2015-09-03 /pmc/articles/PMC4562755/ /pubmed/26366071 http://dx.doi.org/10.2147/COPD.S86455 Text en © 2015 Maekura et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Maekura, Ryoji
Hiraga, Toru
Miki, Keisuke
Kitada, Seigo
Miki, Mari
Yoshimura, Kenji
Yamamoto, Hiroshi
Kawabe, Toshiko
Mori, Masahide
Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
title Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
title_full Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
title_fullStr Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
title_full_unstemmed Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
title_short Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
title_sort personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562755/
https://www.ncbi.nlm.nih.gov/pubmed/26366071
http://dx.doi.org/10.2147/COPD.S86455
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