Factors Affecting Exercise Capacity of Emphysema Phenotype of Chronic Obstructive Pulmonary Disease

Yıl 2020, Cilt: 2 Sayı: 2, 60 - 66, 20.06.2020

Esra Pehlivan , Esra Yazar , Arif Balcı Demet Turan Erdoğan Çetinkaya

Öz

Objective: The aim of our study is to determine the effect of exercise factors and exercise programs on the clinical status of patients with Chronic Obstructive Pulmonary Disease (COPD) in the emphysema phenotype.

Materials and Methods: Patients diagnosed with emphysema and included in the exercise program were included in the study. Aerobic and resistive exercise program was applied to the patients for 2 months. The exercise capacity of the patients was assessed with a 6-minute walking test distance (6MWM), dyspnea perception was modified with a modified Medical Research Concile (mMRC) dyspnea score, and symptom severity was assessed by the COPD assessment questionnaire (CAT). In addition, Force Expiratory Volumes in one seconds (FEV1), Force Vital Capacities (FVC), and body mass indices (BMI) were recorded. Relationship between changes in clinical status and walking distance obtained from walking test and other clinical features were made at the end of the program.

Results: A total of 66 patients were included in the study. The average age was 64 and 91% were male. A statistically significant difference was obtained in 6MWD (p = .000), mMRC (p = .000) and CAT values (p = .000). Initial 6MWD was correlated with body mass index(r=.355), mMRC (r = .553), FEV1% (r = .323) and FVC% (r = .277). At the end of the program, there was a relationship between the development in 6MWD and changes in mMRC (r = .279) and FEV1% (r = .262).

Conclusions: This study showed that exercise capacity is associated with body composition, pulmonary functions and symptoms in emphysema patients, and exercise programs have positive effects on exercise capacity, dyspnea and disease symptoms.

Anahtar Kelimeler

emphysema, dyspnea, exercise, pulmonary rehabilitation, volume reduction

Kronik Obstruktif Akciğer Hastalığının Amfizem Fenotipinde Egzersiz Kapasitesini Etkileyen Faktörler

Öz

Amaç: Çalışmamızın amacı Kronik Obstruktif Akciğer Hastalığının (KOAH) amfizem fenotipindeki olgularında egzersiz kapasitesini etkileyen faktörlerin ve egzersiz programlarının hastaların klinik durumları üzerine etkisinin belirlenmesidir.

Gereç ve Yöntemler: Amfizem tanısı almış olup egzersiz programına alınan hastalar çalışmaya dahil edildi. Hastalara 2 ay süresince aerobik ve rezistif egzersiz programı uygulandı. Hastaların egzersiz kapasitesi 6 dakikalık yürüme testi mesafesi (6DYM) ile, dispne algısı modifiye Medical Research Concile (mMRC) dispne skoru ile, ve semptom şiddetleri KOAH değerlendirme anketi ile (CAT) değerlendirildi. Ayrıca 1. saniyedeki Force Ekspiratuar Volümleri (FEV1), Force Vital Kapasiteleri (FVC) ve beden kitle indeksleri (BKİ)’de kaydedildi. Program sonu klinik durumdaki değişimler ve yürüyüş testinden elde edilen yürüme mesafesi ile diğer klinik özellikler arasında ilişki analizi yapıldı.

Bulgular: Çalışmaya toplam 66 hasta dahil edildi. Yaş ortalaması 64, %91’i erkekti. Program sonu değerlendirmede 6DYM’de (p=.000), mMRC’de (p=.000) ve CAT değerlerinde (p=.000) istatistiksel olarak anlamlı fark elde edildi. Başlangıç 6DYM ile BKİ (r=.355), mMRC (r=.553), FEV1% (r=.323) ve FVC% (r=.277) ile korelasyon saptandı. Program sonu 6DYM’de meydana gelen gelişim ile mMRC (r=.279) ve FEV1% (r=.262)’de meydana gelen değişimler arasında ilişki bulundu.

Sonuç: Bu çalışma, amfizem hastalarında egzersiz kapasitesinin vücut kompozisyonu, solunum fonksiyonları ve semptomlarla ilişkili olduğunu, egzersiz programlarının egzersiz kapasitesi, dispne ve hastalık semptomları üzerine olumlu etkileri olduğunu göstermiştir.

Anahtar Kelimeler

amfizem, dispne, egzersiz, pulmoner rehabilitasyon, volüm küçültme

Kaynakça

• 1. Thurlbeck WM, Muller NL. Emphysema: definition, imaging, and quantification. AJR American journal of roentgenology. 1994;163(5):1017-25.
• 2. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. American journal of respiratory and critical care medicine. 1995;152(5 Pt 2):S77-121.
• 3. Smith BM, Jensen D, Brosseau M, Benedetti A, Coxson HO, Bourbeau J. Impact of pulmonary emphysema on exercise capacity and its physiological determinants in chronic obstructive pulmonary disease. Scientific reports. 2018;8(1):15745.
• 4. Pehlivan E, Balci A, Kilic L, Kadakal F. Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2018;16(4):455-60.
• 5. Pehlivan E. What is the Clinical Parameter Affecting the Quality of Life in Lung Transplant Candidates. . Biomed J Sci & Tech Res. 2018;12(2).
• 6. Pehlivan E, Mutluay F, Balci A, Kilic L. The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial. Clinical rehabilitation. 2018;32(10):1328-39.
• 7. Pehlivan E, Niksarlioglu EY, Balci A, Kilic L. The Effect of Pulmonary Rehabilitation on the Physical Activity Level and General Clinical Status of Patients with Bronchiectasis. Turkish thoracic journal. 2019;20(1):30-5.
• 8. Pehlivan E, Turna A, Gurses A, Gurses HN. The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 2011;17(5):461-8.
• 9. Pehlivan EB, A.; Kılıç, L. . The effect of pulmonary rehabilitation on dyspnea and factors related to dyspnea in lung transplantation candidates. The European Research Journal. 2020.
• 10. Pehlivan E, KalafaT, S., Balcı, A., Kılıç, L. . Akciger Nakil Adaylarında Egzersiz Kapasitesinin Periferik Kas Kuvveti Ve Solunum Fonksiyonları Ile Iliskisi. Mustafa Kemal Üniversitesi Tıp Dergisi. 2019.
• 11. Laboratories ATSCoPSfCPF. ATS statement: guidelines for the six-minute walk test. American journal of respiratory and critical care medicine. 2002;166(1):111-7.
• 12. Rebordosa C, Plana E, Aguado J, Thomas S, Garcia-Gil E, Perez-Gutthann S, et al. GOLD assessment of COPD severity in the Clinical Practice Research Datalink (CPRD). Pharmacoepidemiology and drug safety. 2019;28(2):126-33.
• 13. Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: a systematic review. The European respiratory journal. 2014;44(4):873-84.
• 14. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. The European respiratory journal. 2005;26(1):153-61.
• 15. Ramaswamy A, Puchalski J. Bronchoscopic lung volume reduction: recent updates. Journal of thoracic disease. 2018;10(4):2519-27.
• 16. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. American journal of respiratory and critical care medicine. 2013;188(8):e13-64.
• 17. Rochester CL. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. 2015;192(11):1373-86.
• 18. Maestri R, Bruschi C, Fracchia C, Pinna GD, Fanfulla F, Ambrosino N. Physiological and clinical characteristics of patients with COPD admitted to an inpatient pulmonary rehabilitation program: A real-life study. Pulmonology. 2018.
• 19. Pehlivan E, Balci A, Kilic L, Kadakal F. Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2017.
• 20. Ozalevli S, Karaali HK, Ilgin D, Ucan ES. Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Multidisciplinary respiratory medicine. 2010;5(1):31-7.
• 21. Herth FJF, Slebos DJ, Criner GJ, Shah PL. Endoscopic Lung Volume Reduction: An Expert Panel Recommendation - Update 2017. Respiration; international review of thoracic diseases. 2017;94(4):380-8.
• 22. Tomioka H, Mamesaya N, Yamashita S, Kida Y, Kaneko M, Sakai H. Combined pulmonary fibrosis and emphysema: effect of pulmonary rehabilitation in comparison with chronic obstructive pulmonary disease. BMJ open respiratory research. 2016;3(1):e000099.
• 23. Ries AL, Make BJ, Lee SM, Krasna MJ, Bartels M, Crouch R, et al. The effects of pulmonary rehabilitation in the national emphysema treatment trial. Chest. 2005;128(6):3799-809.
• 24. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. The Cochrane database of systematic reviews. 2015(2):CD003793.
• 25. Onodera A, Yazaki K. [Effects of a short-term pulmonary rehabilitation program on patients with chronic respiratory failure due to pulmonary emphysema]. Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society. 1998;36(8):679-83.
• 26. Cameron-Tucker HL, Wood-Baker R, Joseph L, Walters JA, Schuz N, Walters EH. A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD. International journal of chronic obstructive pulmonary disease. 2016;11:1991-2000.
• 27. Smith BM, Jensen D, Brosseau M, Benedetti A, Coxson HO. Impact of pulmonary emphysema on exercise capacity and its physiological determinants in chronic obstructive pulmonary disease. 2018;8(1):15745.
• 28. Jones JH, Zelt JT, Hirai DM, Diniz CV, Zaza A, O'Donnell DE, et al. Emphysema on Thoracic CT and Exercise Ventilatory Inefficiency in Mild-to-Moderate COPD. Copd. 2017;14(2):210-8.
• 29. Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function: the normative aging study. Chest. 1997;111(4):891-8.
• 30. Han TS, Tijhuis MA, Lean ME, Seidell JC. Quality of life in relation to overweight and body fat distribution. American journal of public health. 1998;88(12):1814-20.
• 31. Hulens M, Vansant G, Claessens AL, Lysens R, Muls E. Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scandinavian journal of medicine & science in sports. 2003;13(2):98-105.
• 32. Pehlivan EB, A.; Yazar, E.; Niksarlioglu, EY.; Kiliç, L. . The effect of body mass index on pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease. Eurasian Journal of Pulmonology. 2018;20:150-6.