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Redalyc.COPD Patients with Severe Diffusion Defect in Carbon Monoxide Diffusing Capacity Predict a Better Outcome for Pulmonary

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Redalyc.COPD Patients with Severe Diffusion Defect in Carbon Monoxide Diffusing Capacity Predict a Better Outcome for Pulmonary Revista Portuguesa de Pneumología ISSN: 0873-2159 [email protected] Sociedade Portuguesa de Pneumologia Portugal Sahin, H.; Naz, I.; Varol, Y.; Aksel, N.; Tuksavul, F.; Ozsoz, A. COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation Revista Portuguesa de Pneumología, vol. 22, núm. 6, noviembre-diciembre, 2016, pp. 323 -330 Sociedade Portuguesa de Pneumologia Lisboa, Portugal Available in: http://www.redalyc.org/articulo.oa?id=169749132004 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Documento descargado de http://www.elsevier.pt el 15/12/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. Rev Port Pneumol. 2016;22(6):323---330 www.revportpneumol.org ORIGINAL ARTICLE COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation a b c,∗ c a c H. Sahin , I. Naz , Y. Varol , N. Aksel , F. Tuksavul , A. Ozsoz a Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonary Rehabilitation Unit, Izmir, Turkey b Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation c Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, Izmir, Turkey Received 7 November 2015; accepted 6 March 2016 Available online 25 April 2016 KEYWORDS Abstract 6-Minute walk test; Purpose: The aim of this study was to compare the effects of pulmonary rehabilitation (PR) on Pulmonary six-minute walk test (6mWT) between chronic obstructive pulmonary disease (COPD) patients rehabilitation; with moderate or severe carbon monoxide diffusion defects. We also evaluated dyspnea sen- Pulmonary function sation, pulmonary functions, blood gases analysis, quality of life parameters and psychological tests; symptoms in both groups before and after pulmonary rehabilitation. DLCO; Methods: Patients with COPD underwent a comprehensive 8-week out-patient PR program par- Quality of life; ticipated in this study. Patients grouped according to diffusion capacity as moderate or severe. Dyspnea Outcome measures were exercise capacity (6mWT), dyspnea sensation, pulmonary function tests, blood gases analysis, quality of life (QoL) and psychological symptoms. Results: A total of 68 patients enrolled in the study. Thirty-two (47%) of them had moderate l diffusion defect [T CO; 52 (47---61) mmol/kPa] and 36 (53%) of them had severe diffusion defect l [T CO; 29 (22---34) mmol/kPa]. At the end of the program, PaO2 (p = 0.001), Modified Medical Research Council dyspnea scale (p = 0.001), 6mWT (p < 0.001) and quality of life parameters l improved significantly in both groups (p < 0.05). Also the improvement in D CO (p = 0.04) value and FEV1% (p = 0.01) reached a statistically significant level in patients with severe diffusion defect. When comparing changes between groups, dyspnea reduced significantly in patients with severe diffusion defect (p = 0.04). ∗ Corresponding author. E-mail address: [email protected] (Y. Varol). http://dx.doi.org/10.1016/j.rppnen.2016.03.003 2173-5115/© 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana,˜ S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Documento descargado de http://www.elsevier.pt el 15/12/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. 324 H. Sahin et al. Conclusion: Pulmonary rehabilitation improves oxygenation, severity of dyspnea, exercise capacity and quality of life independent of level of carbon monoxide diffusion capacity in l patents with COPD. Furthermore pulmonary rehabilitation may improve D CO values in COPD patients with severe diffusion defect. © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana,˜ S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). Introduction Subject selection Chronic obstructive pulmonary disease (COPD) is defined We recruited COPD patients diagnosed according to Global by airflow limitation and is a complex pathological condi- initiative for Chronic Obstructive Lung Disease (GOLD) def- tion. COPD is associated with an important reduction in inition, stable from exacerbations (with no worsening of physical activity that contributes to the patient’s disability respiratory symptoms, no increase in the use of rescue and poor health-related quality of life. Pulmonary reha- medication, and no unscheduled visits due to COPD wors- bilitation (PR) is aimed to eliminate or at least attenuate ening) for at least 4 weeks. All patients were suffering 1,2 these difficulties. Therefore, PR has been recommended from dyspnea, reduced exercise tolerance and limitation of 3,4 as an integral part of management for patients with COPD. daily living activities. The recruitment criteria included a However, the responses to PR may vary significantly among minimum age of 40 years old, a history of 10 or more pack- individuals. Although there are many studies mentioning years of smoking, a FEV1 of less than 80% of the predicted changes of FEV1, FVC, FEV1/FVC after PR, in some studies, value after bronchodilator use and a ratio of FEV1 to FVC 12 significant changes in forced expiratory volume in one sec- of 0.7 or less after bronchodilator use. The condition of ond (FEV1), forced vital capacity (FVC) and FEV1/FVC values the patients was graded according to the stages of disease 5 --- 8 13 were not detected after PR. defined by the GOLD. The patients’ self-reported respira- l The diffusing capacity for carbon monoxide (D CO) is a tory symptoms, medications, smoking history, and coexisting common and clinically useful test that provides a quanti- medical conditions were documented at the beginning of 9 tative measure of gas transfer in the lungs. The decrease the study. Comorbid diagnoses were established using the in DlCO, one of the first signs of disease progression, can clinical history and physical examination findings during the point out the arterial O2 desaturation during exercise. For visit and were supported by a review of the available medi- l COPD patients with low D CO values pose a high risk for poor cal records. We excluded patients who were suffering from 10 survival. Although PR is known to have many effects on acute exacerbation, history of other lung diseases, (pneumo- functional outcomes of COPD patients, there is not enough coniosis, pulmonary tuberculosis, interstitial lung disease); information about the diffusion capacity in terms of PR and orthopedic, neurologic, or cardiovascular impairment 2 outcome. Also in a recent study authors suggest that diffus- that might render the subject incapable of completing the ing capacity was the strongest predictor of exercise capacity exercise training. Also subjects with lack of motivation, poor 11 in all subjects with COPD. Therefore can CO diffusion compliance (not attending the program more than 2 times) capacity be used to evaluate which patient will benefit more or having transport problems were excluded from the study. from PR program? Moreover will there be a significant change We grouped patients; those with diffusion capacity between in CO diffusion capacity after PR program in patients with 41 and 60% of predicted as moderate (group 1) and under 40% 14 COPD? of predicted as severe (group 2) diffusion defect. The aim of our study was to compare the results of PR pro- gram on exercise capacity (6mWT) between COPD patients with moderate and severe diffusion defect detected by Measurement of pulmonary parameters and l D CO. Our secondary aims were comparing the results of the questionnaires program on arterial blood gas analysis, dyspnea sensation, exercise capacity, quality of life and psychological symptoms All patients underwent cardiac and respiratory system exam- between two groups. inations and were evaluated by chest X-rays and blood gases analysis. Pulmonary functions were assessed by measur- Methods ing body plethysmography (Zan 500, Germany) and carbon monoxide diffusing capacity test (Zan 300, Germany). The We conducted a prospective cohort study to compare the DLCO maneuver begins with a full exhalation to residual vol- effectiveness of exercise training in COPD patients with ume (RV), the mouthpiece is then connected to the test moderate and severe diffusion defect. The study was gas (0.3 percent carbon monoxide [CO], 10 percent helium), approved by the local institutional review board. Patients and the subject inhales rapidly to total lung capacity. Fol- included in the study completed an informed written con- lowing a 10 s breath hold, the subject exhales quickly and sent form. completely to RV. An alveolar sample of the exhaled gas Documento descargado de http://www.elsevier.pt el 15/12/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. Severe diffusing capacity predict a better outcome for pulmonary rehabilitation 325 is then analyzed for calculation of the dilution of helium Exercise capacity before and after pulmonary rahabilitation between groups and the uptake of CO. Dyspnea was assessed by Modi- 500 fied Medical Research Council (MMRC) dyspnea scale and 3 450 modified BORG scales. Quality of life was assessed using disease specific St. George Respiratory Questionnaire and 15,16 400 SF-36 health related quality of life questionnaire. Psy- chological symptoms were assessed by Hospital Anxiety and 350 17,18 Meters Depression Questionnaires. 6-Minute walking test was 300 used which was defined by American Thoracic Society (ATS) 19 standards. All measurements were assessed at admission 250 and at the end of the PR. 200 Before PR After PR Pulmonary rehabilitation parameters Moderate Severe Fig.
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