Are there differences in the characteristics of individuals with COPD who exacerbate or not during a pulmonary rehabilitation program?
DOI:
https://doi.org/10.33448/rsd-v11i12.34290Keywords:
Chronic obstructive pulmonary disease; Physical exercise; Symptom flare up.Abstract
Objectives:To identify the characteristics of individuals with Chronic Obstructive Pulmonary Disease (COPD) that exacerbate or not during a exercise training (ET) program, and check if any these groups are less likely to the benefits of ET. Methods:Individuals with COPD were evaluated for lung function, respiratory muscle strength, body composition, 6-minute walk test (6MWT), peripheral muscle strength, quality of life, functional status, dyspnea sensation in daily life (Medical Research Council [MRC] scale), anxiety and depression. All individuals performed a high-intensity exercise training (ET) program with aerobic exercises and strength training (three times/week, 12 weeks). For analysis, the individuals were separated into two groups (Group that Exacerbated [GE] and Group that did Not Exacerbate [GNE], and compared as to their characteristics. Results: 44 individuals completed the ET (26 in the GNE [FEV1 46±16%predicted] and 18 in the GE [FEV1 42±18 %predicted]). In pre-training, GE individuals were younger, more anxious and with worse forced vital capacity than GNE. After the ET, only the GE showed significant improvement in dyspnea (pre vs post-training: MRC 4 [3–4] vs 3 [2–4]; P=0.03) and only the GNE in the 6MWT (478 [424-519] vs 516 [467–558]; P<0.0001). Both groups showed improvement significant in the peripheral muscle strength. Finally, considering the comparison of the change post-pre ET, the GNE had a more marked improvement in quality of life and 6MWT. Conclusion: Individuals who exacerbate during an ET are less likely to benefit from ET, and training strategies tailored t are necessary.
References
Alahmari, A. D., Kowlessar, B. S., Patel, A. R., Mackay, A. J., Allinson, J. P., Wedzicha, J. A., & Donaldson, G. C. (2016). Physical activity and exercise capacity in patients with moderate COPD exacerbations. Eur Respir J, 48(2), 340–349. https://doi.org/10.1183/13993003.01105-2015
Bernard, S., LeBlanc, P., Whittom, F., Carrier, G., Jobin, J., Belleau, R., & Maltais, F. (1998). Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 158(2), 629–634.
Bohn Júnior, I., Costa, C., Souza, R. M., Santos, Á., & Teixeira, P. (2020). Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype. J Bras Pneumol, 46(6), e20190309. https://doi.org/10.36416/1806-3756/e20190309
Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia, C., Jr, & Pereira, W. A. (1995). Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Rev Saúde Publica, 29(5), 355–363. https://doi.org/10.1590/s0034-89101995000500004
Britto, R. R., Probst, V. S., de Andrade, A. F., Samora, G. A., Hernandes, N. A., Marinho, P. E., Karsten, M., Pitta, F., & Parreira, V. F. (2013). Reference equations for the six-minute walk distance based on a Brazilian multicenter study. Braz J Phys Ther, 17(6), 556–563. https://doi.org/10.1590/S1413-35552012005000122
Carpes, M. F., Mayer, A. F., Simon, K. M., Jardim, J. R. & Garrod, R. (2008). The Brazilian Portuguese version of the London Chest Activity of Daily Living scale for use in patients with chronic obstructive pulmonary disease. J Bras Pneumol, 34, 143-51. https://doi.org/10.1590/S1806-37132008000300004
Carr, S. J., Goldstein, R. S., & Brooks, D. (2007). Acute exacerbations of COPD in subjects completing pulmonary rehabilitation. Chest, 132(1), 127–134. https://doi.org/10.1378/chest.07-0269
Consenso Brasileiro sobre Doença Pulmonar Obstrutiva Crônica II – DPOC. (2004). J Bras. Pneumol, 30(Supl 5), S1-42.
Decramer, M., Lacquet, L. M., Fagard, R., & Rogiers, P. (1994). Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am J Respir Crit Care Med, 150(1), 11–16. https://doi.org/10.1164/ajrccm.150.1.8025735
Donaldson, G. C., Wilkinson, T. M., Hurst, J. R., Perera, W. R., & Wedzicha, J. A. (2005). Exacerbations and time spent outdoors in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 171(5), 446–452. https://doi.org/10.1164/rccm.200408-1054OC
Dourado, V. Z., Tanni, S. E., Vale, S. A., Faganello, M. M., Sanchez, F. F., & Godoy, I. (2006). Systemic manifestations in chronic obstructive pulmonary disease. J Bras Pneumol, 32(2), 161–171. https://doi.org/10.1590/s1806-37132006000200012
Garcha, D. S., Thurston, S. J., Patel, A. R., Mackay, A. J., Goldring, J. J., Donaldson, G. C., McHugh, T. D. & Wedzicha, J. A. (2012). Changes in prevalence and load of airway bacteria using quantitative PCR in stable and exacerbated COPD. Thorax, 67, 1075-1080.
Garcia-Rio, F., Rojo, B., Casitas, R., Lores, V., Madero, R., Romero, D., Galera, R., & Villasante, C. (2012). Prognostic value of the objective measurement of daily physical activity in patients with COPD. Chest, 142(2), 338–346. https://doi.org/10.1378/chest.11-2014
Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2022). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. http://www.goldcopd.org/.
Halpin, D., Decramer, M., Celli, B. R., Mueller, A., Metzdorf, N., & Tashkin, D. P. (2017). Effect of a single exacerbation on decline in lung function in COPD. Respir Med, 128, 85–91. https://doi.org/10.1016/j.rmed.2017.04.013
Hernandes, N. A., Teixeira, D., Probst, V. S., Brunetto, A. F., Ramos, E. M., & Pitta, F. (2009). Profile of the level of physical activity in the daily lives of patients with COPD in Brazil. J Bras Pneumol, 35(10), 949–956. https://doi.org/10.1590/s1806-37132009001000002
Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., McCormack, M. C., Carlin, B. W., Sciurba, F. C., Pitta, F., Wanger, J., MacIntyre, N., Kaminsky, D. A., Culver, B. H., Revill, S. M., Hernandes, N. A., Andrianopoulos, V., Camillo, C. A., Mitchell, K. E., Lee, A. L., Hill, C. J., & Singh, S. J. (2014). An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J, 44(6), 1428–1446. https://doi.org/10.1183/09031936.00150314
Hopkinson, N. S., Tennant, R. C., Dayer, M. J., Swallow, E. B., Hansel, T. T., Moxham, J., & Polkey, M. I. (2007). A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary disease. RespirRes, 8(1), 25. https://doi.org/10.1186/1465-9921-8-25
Jones, S. E., Barker, R. E., Nolan, C. M., Patel, S., Maddocks, M., & Man, W. (2018). Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease. J Thor Dis, 10(Suppl 12), S1390–S1399. https://doi.org/10.21037/jtd.2018.03.18
Kessler, R., Faller, M., Fourgaut, G., Mennecier, B., & Weitzenblum, E. (1999). Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 159(1), 158–164. https://doi.org/10.1164/ajrccm.159.1.9803117
Kovelis, D., Segretti, N. O., Probst, V. S., Lareau, S. C., Brunetto, A. F., & Pitta, F. (2008). Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease. J Bras Pneumol, 34(12), 1008–1018. https://doi.org/10.1590/s1806-37132008001200005
Kyle, U. G., Pichard, C., Rochat, T., Slosman, D. O., Fitting, J. W., & Thiebaud, D. (1998). New bioelectrical impedance formula for patients with respiratory insufficiency: comparison to dual-energy X-ray absorptiometry. Eur Respir J, 12(4), 960–966. https://doi.org/10.1183/09031936.98.12040960
Li, J., Sun, S., Tang, R., Qiu, H., Huang, Q., Mason, T. G., & Tian, L. (2016). Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis. Intern J COPD, 11, 3079–3091. https://doi.org/10.2147/COPD.S122282
Marino, D. M., Marrara, K. T., Arcuri, J. F., Candolo, C., Jamami, M., & Di Lorenzo, V. A. (2014). Determination of exacerbation predictors in patients with COPD in physical therapy - a longitudinal study. Braz J Phys Ther, 18(2), 127–136. https://doi.org/10.1590/s1413-35552012005000146
Mesquita, R., Donária, L., Genz, I. C., Pitta, F., & Probst, V. S. (2013). Respiratory muscle strength during and after hospitalization for COPD exacerbation. Respir care, 58(12), 2142–2149. https://doi.org/10.4187/respcare.02393
Miller, M. R., Crapo, R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Enright, P., van der Grinten, C. P., Gustafsson, P., Jensen, R., Johnson, D. C., MacIntyre, N., McKay, R., Navajas, D., Pedersen, O. F., Pellegrino, R., Viegi, G., Wanger, J., & ATS/ERS Task Force (2005). General considerations for lung function testing. Eur Respir J, 26(1), 153–161. https://doi.org/10.1183/09031936.05.00034505
Moreira, G. L., Pitta, F., Ramos, D., Nascimento, C. S., Barzon, D., Kovelis, D., Colange, A. L., Brunetto, A. F., & Ramos, E. M. (2009). Portuguese-language version of the Chronic Respiratory Questionnaire: a validity and reproducibility study. J Bras Pneumol, 35(8), 737–744. https://doi.org/10.1590/s1806-37132009000800004
Neder, J. A., Andreoni, S., Lerario, M. C., & Nery, L. E. (1999). Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res, 32(6), 719–727. https://doi.org/10.1590/s0100-879x1999000600007
Pereira, C. A., Sato, T., & Rodrigues, S. C. (2007). New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol, 33(4), 397–406. https://doi.org/10.1590/s1806-37132007000400008
Pitta, F., Breyer, M. K., Hernandes, N. A., Teixeira, D., Sant'Anna, T. J., Fontana, A. D., Probst, V. S., Brunetto, A. F., Spruit, M. A., Wouters, E. F., Burghuber, O. C. & Hartl, S. (2009). Comparison of daily physical activity between COPD patients from Central Europe and South America. Respir Med, 103, 421-6. https://doi.org/10.1016/j.rmed.2008.09.019
Pitta, F., Probst, V. S., Kovelis, D., Segretti, N. O., Mt Leoni, A., Garrod, R., & Brunetto, A. F. (2008). Validation of the Portuguese version of the London Chest Activity of Daily Living Scale (LCADL) in chronic obstructive pulmonary disease patients. Rev Port Pneumol, 14(1), 27–47.
Pitta, F., Troosters, T., Probst, V. S., Langer, D., Decramer, M., & Gosselink, R. (2008). Are patients with COPD more active after pulmonary rehabilitation?. Chest, 134(2), 273–280. https://doi.org/10.1378/chest.07-2655
Pitta, F., Troosters, T., Spruit, M. A., Probst, V. S., Decramer, M., & Gosselink, R. (2005). Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 171(9), 972–977. https://doi.org/10.1164/rccm.200407-855OC
Seemungal, T., Harper-Owen, R., Bhowmik, A., Moric, I., Sanderson, G., Message, S., Maccallum, P., Meade, T. W., Jeffries, D. J., Johnston, S. L., & Wedzicha, J. A. (2001). Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 164(9), 1618–1623. https://doi.org/10.1164/ajrccm.164.9.2105011
Seemungal, T. A., Donaldson, G. C., Paul, E. A., Bestall, J. C., Jeffries, D. J., & Wedzicha, J. A. (1998). Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med (5 Pt 1), 1418–1422. https://doi.org/10.1164/ajrccm.157.5.9709032
Soler-Cataluña, J. J., Martínez-García, M. A., Román Sánchez, P., Salcedo, E., Navarro, M., & Ochando, R. (2005). Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax, 60(11), 925–931. https://doi.org/10.1136/thx.2005.040527
Spitzer, K. A., Stefan, M. S., Priya, A., Pack, Q. R., Pekow, P. S., Lagu, T., Pinto-Plata, V. M., ZuWallack, R. L., & Lindenauer, P. K. (2019). Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries. Annals Am Thorac Soc, 16(1), 99–106. https://doi.org/10.1513/AnnalsATS.201805-332OC
Spruit, M. A., Gosselink, R., Troosters, T., De Paepe, K., & Decramer, M. (2002). Resistance versus endurance training in patients with COPD and peripheral muscle weakness. Eur Respir J, 19(6), 1072–1078. https://doi.org/10.1183/09031936.02.00287102
Spruit, M. A., Gosselink, R., Troosters, T., Kasran, A., Gayan-Ramirez, G., Bogaerts, P., Bouillon, R., & Decramer, M. (2003). Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax, 58(9), 752–756. https://doi.org/10.1136/thorax.58.9.752
Spruit, M. A., Singh, S. J., Garvey, C., et al. (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 188(8), e13–e64. https://doi.org/10.1164/rccm.201309-1634ST
Swallow, E. B., Reyes, D., Hopkinson, N. S., Man, W. D., Porcher, R., Cetti, E. J., Moore, A. J., Moxham, J., & Polkey, M. I. (2007). Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax, 62(2), 115–120. https://doi.org/10.1136/thx.2006.062026
Troosters, T., Demeyer, H., Hornikx, M., Camillo, C. A., & Janssens, W. (2014). Pulmonary rehabilitation. Clin Chest Med, 35(1), 241–249. https://doi.org/10.1016/j.ccm.2013.10.006
Williams, J. E., Singh, S. J., Sewell, L., Guyatt, G. H., & Morgan, M. D. (2001). Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR). Thorax, 56(12), 954–959. https://doi.org/10.1136/thorax.56.12.954
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psych Scand, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Mariana Rosalem Vicentin; Igor Lopes Brito; Nidia Aparecida Hernandes; Fabio Pitta
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
