Efficacy of a Respiratory Rehabilitation Exercise Training Package in Hospitalized Elderly Patients with Acute Exacerbation of COPD: a Randomized Control Trial
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Journal name: International Journal of COPD Article Designation: Original Research Year: 2015 Volume: 10 International Journal of COPD Dovepress Running head verso: Liao et al Running head recto: Respiratory rehabilitation exercise training package open access to scientific and medical research DOI: http://dx.doi.org/10.2147/COPD.S90673 Open Access Full Text Article ORIGINAL RESEARCH Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial Lin-Yu Liao1,2 Clinical trials identifier: NCT02329873 Kuei-Min Chen2 Background: Acute exacerbation (AE) of COPD is characterized by a sudden worsening of Wei-Sheng Chung3 COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation Jung-Yien Chien4 for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. 1Department of Nursing, Chest Hospital, Ministry of Health and Objective: To evaluate the effects of a respiratory rehabilitation exercise training package Welfare, Rende District, Tainan, on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly 2 For personal use only. College of Nursing, Kaohsiung patients with AECOPD. Medical University, Sanmin District, Kaohsiung, 3Department of Internal Methods: A randomized control trial was conducted. Pretest and posttest evaluations of Medicine, Taichung Hospital, Ministry 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were per- of Health and Welfare, Taichung, formed. The experimental group received respiratory rehabilitation exercise training twice a day, 4Department of Medicine, Chest Hospital, Ministry of Health and 10–30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, Welfare, Rende District, Tainan, Taiwan and sputum expectoration) were assessed at the baseline and at the end of the fourth day. Results: All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P,0.05). Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth day (all P,0.05). Conclusion: Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD. Keywords: COPD, severe early onset, exercise, older adults, respiratory diseases International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 54.70.40.11 on 29-Dec-2018 Introduction Acute exacerbation (AE) of AECOPD is characterized by a sudden worsening of COPD symptoms. Older adults with COPD have a high risk of experiencing AECOPD,1 which typically leads to a decreased lung function, an increased incidence of respiratory fail- ure, and even death.2,3 Patients with COPD who experience aggravation of symptoms, Correspondence: Kuei-Min Chen such as dyspnea, cough, and sputum production, for .48 hours are diagnosed with College of Nursing, Kaohsiung Medical AECOPD.3,4 Dyspnea, coughing, difficulties in sputum clearance, and low exercise University, 100 Shih-Chuan 1st Rd, Sanmin District, Kaohsiung 80708, tolerance are systemic symptoms in patients with AECOPD.5,6 Taiwan Pharmacological therapy and respiratory rehabilitation exercise management constitute Tel +886 7 313 6900 Email [email protected] the standard treatment for COPD.2 According to the guidelines for global COPD care, submit your manuscript | www.dovepress.com International Journal of COPD 2015:10 1703–1709 1703 Dovepress © 2015 Liao 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 http://dx.doi.org/10.2147/COPD.S90673 permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Powered by TCPDF (www.tcpdf.org) 1 / 1 Liao et al Dovepress pharmacological treatment involves antibiotics, bronchodila- were developed. The efficacy of the intervention in reducing tors, and steroids. Airway clearance devices and oxygen therapy AECOPD symptoms (such as dyspnea and cough), increas- are sometimes used in patients with acute exacerbation.7 ing exercise tolerance, and sputum expectoration in elderly In the progression of AECOPD, poor exercise tolerance could inpatients was evaluated. be caused by prolonged bed rest during hospitalization, expo- sure to high dosage of glucocorticoids,8 and negative protein Methods balance, which are due to the insufficient dietary intake and Design increased resting energy expenditure during acute exacerba- This study was a randomized controlled trial in which pur- tion.9 Although the aforementioned drugs can treat AECOPD, posive sampling was conducted to recruit patients who were they have side effects and, thus, reduce patients’ willingness to randomized to the respiratory rehabilitation exercise training move, contributing to adverse effects on physical and mental package (experimental) group or the control group, according health,10 and ultimately leading to patient readmission.11 to a coin toss. To prevent mutual interference, the patients in Clini et al indicated that rehabilitation exercises performed the experimental and control groups were assigned to wards during hospitalization effectively ameliorate AECOPD located in different areas (east and west wings) upon admis- symptoms, improve quality of life, and increase exercise sion. The experimental group received 4 days of respiratory tolerance.12 Greening et al found that rehabilitation interven- rehabilitation exercise training in addition to the usual care tion within 48 hours of hospital admission improved muscle and health education. The control group only received usual strength, field walking performance, and rapid recovery of care and health education, which included monitoring of the endurance walking after discharge.13 Previous studies have vital signs and the AECOPD symptoms, assessing the nutri- reported that respiratory rehabilitation exercise performed tional status, educating the smoking cessation, and providing within 2 weeks of disease onset (unstable period) alleviates the nasal O2 therapy. One hour before the intervention, the acute symptoms to a greater extent than does the exercise patients were assessed for dyspnea, cough, exercise tolerance, performed 6 months after disease onset (stable period).14 and sputum expectoration. The pretest results served as the For personal use only. According to an American Thoracic Society/European baseline data. Posttest measurements were completed within Respiratory Society statement, pulmonary rehabilitation is 1 hour after the final intervention session. a comprehensive intervention that includes exercise training, education, and behavioral changes.15 Rehabilitation approach Setting and participants includes 1) upper-limb exercise training for increasing The study was conducted in two pulmonary wards of the maximal exercise capacity, decreasing dyspnea, and reducing Chest Hospital, Ministry of Health and Welfare, in Southern fatigue,16,17 2) pursed lip breathing (PLB) for increasing the Taiwan. Sixty-two patients were recruited of which 31 were respiratory coordination of the diaphragm and inspiratory assigned to the respiratory rehabilitation exercise training pack- muscle strength, reducing coughing frequency, dyspnea, and age (experimental) group and 31 were assigned to the control hypoxemia symptoms, and facilitating sputum clearance,18,19 group. One experimental group participant withdrew from the 3) treadmill exercises for enhancing cardiopulmonary func- study due to discharge (Figure 1). Sample size calculation was tions and weight training for improving muscles of the legs,12 based on previous studies,23 and we estimated that a sample of 4) airway clearance (such as chest percussion and postural 60 (experimental =30, control =30) would have 80% power to drainage) for transferring the sputum into the main bronchi detect a 35% difference in the dyspnea score. International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 54.70.40.11 on 29-Dec-2018 and, consequently, increasing sputum expectoration,20,21 Inclusion criteria stipulated that the participants should and 5) smoking cessation, health education, and self-health have the following five characteristics: 1) had been diag- management.12 These measures are often provided to stable nosed with moderate exacerbation COPD (an increased patients or after discharge through individual routine nurs- need for medication and feel the need to seek additional ing care;22 however, no training program specific to acute medical assistance),4 2) were older than 65 years; 3) were in exacerbation in elderly