Advertisement

Pulmonary Rehabilitation: Targeting the Systemic Manifestations of COPD

  • Linda Nici
  • Richard ZuWallack
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

Optimal clinical management of chronic obstructive pulmonary disease (COPD) requires a comprehensive, integrated approach encompassing both pharmacologic and nonpharmacologic interventions. Pulmonary rehabilitation is an interdisciplinary, patient-centered approach to patient care that complements pharmacological therapy. It has emerged as a standard component of treatment of COPD, and as such, has a prominent place in all its current guidelines.

Keywords

Pulmonary rehabilitation COPD Systemic manifestations Pharmacologic intervention Non-pharmacologic intervention Pharmacological therapy Guidelines Self-management education 

References

  1. 1.
    American Thoracic Society and European Respiratory Society. Standards for the diagnosis and management of patients with COPD 2004; http://www.thoracic.org.
  2. 2.
    Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation. Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131: 4S–42S.PubMedCrossRefGoogle Scholar
  3. 3.
    Nici L, Donner C, ZuWallack R, Wouters E, et al. The ATS/ERS statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–414.PubMedCrossRefGoogle Scholar
  4. 4.
    Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality – a systematic review. Respir Res. 2005;6:54.PubMedCrossRefGoogle Scholar
  5. 5.
    Nici L, Lareau S, ZuWallack R. Pulmonary Rehabilitation in the treatment of COPD. Am Fam Phys. 2010;82(6):655–60.Google Scholar
  6. 6.
    Mador MJ, Bozkanat E. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. Respir Res. 2001;2(4):216–24.PubMedCrossRefGoogle Scholar
  7. 7.
    Bernard S et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;158(2):629–34.PubMedGoogle Scholar
  8. 8.
    Vermeeren MA et al. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100(8):1349–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Schols A. Nutritional modulation as part of the integrated management of chronic obstructive pulmonary disease. Proc Nutr Soc. 2003;62(4):783–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Jorgensen NR et al. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease-A cross sectional study. Respir Med. 2007;101(1):177–85.PubMedCrossRefGoogle Scholar
  11. 11.
    Guell R et al. Impact of pulmonary rehabilitation on psychosocial morbidity in patients with severe COPD. Chest. 2006;129(4):899–904.PubMedCrossRefGoogle Scholar
  12. 12.
    Light RW et al. Prevalence of depression and anxiety in patients with COPD. Relationship to functional capacity. Chest. 1985;87(1):35–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Maltais F et al. Oxidative enzyme activities of the vastus lateralis muscle and the functional status in patients with COPD. Thorax. 2000;55(10):848–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Maltais F et al. Altered expression of myosin heavy chain in the vastus lateralis muscle in patients with COPD. Eur Respir J. 1999;13(4):850–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Berger HJ et al. Memorial Award Paper. Comparison of exercise right ventricular performance in chronic obstructive pulmonary disease and coronary artery disease: noninvasive assessment by quantitative radionuclide angiocardiography. Invest Radiol. 1979;14(5):342–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Schols AM et al. Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax. 1996;51(8):819–24.PubMedCrossRefGoogle Scholar
  17. 17.
    Spruit MA et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003;58(9):752–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Decramer M et al. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am J Respir Crit Care Med. 1994;150(1):11–6.PubMedGoogle Scholar
  19. 19.
    Rahman I, Skwarska E, MacNee W. Attenuation of oxidant/antioxidant imbalance during treatment of exacerbations of chronic obstructive pulmonary disease. Thorax. 1997;52(6): 565–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Kayahan B et al. Psychological outcomes of an outpatient pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease. Respir Med. 2006;100(6):1050–7.PubMedCrossRefGoogle Scholar
  21. 21.
    American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for pulmonary rehabilitation programs. 3rd ed. Chicago, IL: American Association of Cardiovascular & Pulmonary Rehabilitation; 2004.Google Scholar
  22. 22.
    Human Kinetics, American Thoracic Society/American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167:211–77.CrossRefGoogle Scholar
  23. 23.
    Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–12.PubMedCrossRefGoogle Scholar
  24. 24.
    American Thoracic Society, European Respiratory Society. ATS/ERS statement on skeletal muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:S1–S40.Google Scholar
  25. 25.
    Bernard S, Leblanc P, Whittom F, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;158(2):629–34.PubMedGoogle Scholar
  26. 26.
    Engelen MP, Schols AM, Does JD, et al. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 2000;71(3):733–8.PubMedGoogle Scholar
  27. 27.
    Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med. 1996;153:976–80.PubMedGoogle Scholar
  28. 28.
    Sala E, Roca J, Marrades RM, Alonso J, Gonzalez de Suso JM, Moreno A, et al. Effects of endurance training on skeletal muscle bioenergetics in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:1726–34.PubMedGoogle Scholar
  29. 29.
    American college of sports medicine. Position stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22:265–74.Google Scholar
  30. 30.
    Maltais F, LeBlanc P, Jobin J, et al. Intensity of training and physiologic adaptation in patient with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155:555–61.PubMedGoogle Scholar
  31. 31.
    Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991;143:9–18.PubMedGoogle Scholar
  32. 32.
    Normandin EA, McCusker C, Connors ML, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121: 1085–91.PubMedCrossRefGoogle Scholar
  33. 33.
    Puente-Maestu L, Sanz ML, Sanz P, de Ona JM Ruiz, Rodriguez-Hermosa JL, Whipp BJ. Effects of two types of training on pulmonary and cardiac responses to moderate exercise in patients with COPD. Eur Respir J. 2000;15:1026–32.PubMedCrossRefGoogle Scholar
  34. 34.
    Bernard S, Whittom F, LeBlanc P, Jobin J, Belleau R, Berube C, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:896–901.PubMedGoogle Scholar
  35. 35.
    O’Donnell DE, McGuire M, Samis L, Webb KA. The impact of exercise reconditioning on breathlessness in severe chronic airflow limitation. Am J Respir Crit Care Med. 1995;152: 2005–13.PubMedGoogle Scholar
  36. 36.
    Emery CF, Leatherman NE, Burker EJ, MacIntyre NR. Psychological outcomes of a pulmonary rehabilitation program. Chest. 1991;100:613–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Emery CF, Schein RL, Hauck ER, MacIntyre NR. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychol. 1998;17:232–40.PubMedCrossRefGoogle Scholar
  38. 38.
    Green RH, Singh SJ, Williams J, Morgan MD. A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax. 2001;56:143–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Rossi G, Florini F, Romagnoli M, Bellatone T, Lucic S, Lugli D, et al. Length and clinical effectiveness of pulmonary rehabilitation in outpatients with chronic airway obstruction. Chest. 2005;127:105–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002;3:CD003793.PubMedGoogle Scholar
  41. 41.
    Ringbaek TJ, Broendum E, Hemmingsen L, Lybeck K, Nielsen D, Andersen C, et al. Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient! Respir Med. 2000;94:150–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Puente-Maestu L, Sanz ML, Sanz P, Cubillo JM, Mayol J, Casaburi R. Comparison of effects of supervised versus self-monitored training programs in patients with chronic obstructive pulmonary disease. Eur Respir J. 2000;15:517–25.PubMedCrossRefGoogle Scholar
  43. 43.
    Casaburi R, Kukafka D, Cooper CB, Witek TJ, Kesten S. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005;127:809–17.PubMedCrossRefGoogle Scholar
  44. 44.
    Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20:12–9.PubMedCrossRefGoogle Scholar
  45. 45.
    O’Donnell DE, D’Arisigny C, Webb KA. Effects of hperoxia on ventilatory limitation during exercise in advanced chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:892–8.PubMedGoogle Scholar
  46. 46.
    Coppoolse R, Schols AMWJ, Baarends EM, et al. Interval versus continuous training in patients with severe COPD: a randomized clinical trial. Eur Respir J. 1999;14:258–63.PubMedCrossRefGoogle Scholar
  47. 47.
    Somfay A, Porszasz J, Lee SM, et al. Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients. Eur Respir J. 2001;18:77–84.PubMedCrossRefGoogle Scholar
  48. 48.
    Emtner M, Porszasz J, Burns M, et al. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med. 2003;168:1034–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Ries AL, Moser KM, Bullock PJ, Limber TM, Myers R, Sassi-Dambron DE, et al., editors. Shortness of breath: a guide to better living and breathing. St. Louis, MO: Mosby; 1996.Google Scholar
  50. 50.
    Ries AL. Pulmonary rehabilitation. In: Tierney DF, editor. Current pulmonology. St. Louis, MO: Mosby; 1994. p. 441–67.Google Scholar
  51. 51.
    Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127:1097–102.Google Scholar
  52. 52.
    Gilmartin ME. Patient and family education. Clin Chest Med. 1986;7:619–27.PubMedGoogle Scholar
  53. 53.
    Neish CM, Hopp JW. The role of education in pulmonary rehabilitation. J Cardiopulm Rehabil. 1988;11:439–41.CrossRefGoogle Scholar
  54. 54.
    Bourbeau J, Julien M, Maltais F, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003;163(5):585–91.PubMedCrossRefGoogle Scholar
  55. 55.
    Heffner JE, Fahy B, Barbieri C. Advance directive education during pulmonary rehabilitation. Chest. 1996;109(2):373–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Heffner JE, Fahy B, Hilling L, Barbieri C. Outcomes of advance directive education of pulmonary rehabilitation patients. Am J Resp Crit Care Med. 1997;155(3):1055–9.PubMedGoogle Scholar
  57. 57.
    Agle DP, Baum GL. Psychosocial aspects of chronic obstructive pulmonary disease. Med Clin North Am. 1977;61:749–58.PubMedGoogle Scholar
  58. 58.
    McSweeny AJ, Grant I, Heaton RK, Adams KM, Timms RM. Life quality of patients with chronic obstructive pulmonary disease. Arch Intern Med. 1982;142:473–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Kaplan RM, Ries AL, Prewitt LM, Eakin E. Self-efficacy expectations predict survival for patients with chronic obstructive pulmonary disease. Health Psychol. 1994;13:366–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Mauer J et al. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008;134:43S–56S.CrossRefGoogle Scholar
  61. 61.
    Kozora E, Tran ZV, Make B. Neurobehavioral improvement after brief rehabilitation in patients with chronic obstructive pulmonary disease. J Cardiopulm rehabil. 2002;22:426–30.PubMedCrossRefGoogle Scholar
  62. 62.
    Engelen MPKJ, Schols AMWJ, Baken WC, Wesseling GJ, Wouters EF. Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in outpatients with COPD. Eur Respir J. 1994;7:1793–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Schols AMWJ, Soeters PB, Dingemans AMC, Mostert R, Frantzen PJ, Wouters EF. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis. 1993;147:1151–6.PubMedGoogle Scholar
  64. 64.
    Schols AMWJ, Fredrix EW, Soeters PB, Westerterp KR, Wouters EFM. Resting energy expenditure in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 1991;5:983–7.Google Scholar
  65. 65.
    Engelen MPKJ, Schols AMWJ, Heidendal GAK, Wouters EFM. Dual-energy X-ray absorptiometry in the clinical evaluation of body composition and bone mineral density in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 1998;68:1298–303.PubMedGoogle Scholar
  66. 66.
    Mostert R, Goris A, Weling-Scheepers C, Wouters EF, Schols AM. Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease. Respir Med. 2000;94(9):859–67.PubMedCrossRefGoogle Scholar
  67. 67.
    Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(6 Pt 1): 1791–7.PubMedGoogle Scholar
  68. 68.
    Wilson DO, Rogers RM, Wright EC, Anthonisen NR. Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. Am Rev Respir Dis. 1989;139(6):1435–8.PubMedGoogle Scholar
  69. 69.
    Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(6):1856–61.PubMedGoogle Scholar
  70. 70.
    Steiner MC, Barton RL, Singh SJ, Morgan MD. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial. Thorax. 2003;58(9):745–51.PubMedCrossRefGoogle Scholar
  71. 71.
    Efthimiou J, Fleming J, Gomes C, Spiro SG. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1988;137(5):1075–82.PubMedGoogle Scholar
  72. 72.
    Franssen FM, Broekhuizen R, Janssen PP, Wouters EF, Schols AM. Effects of whole-body exercise training on body composition and functional capacity in normal-weight patients with COPD. Chest. 2004;125(6):2021–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Bernard S, Whittom F, Leblanc P, Jobin J, Belleau R, Berube C, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159(3):896–901.PubMedGoogle Scholar
  74. 74.
    Schols AM, Soeters PB, Mostert R, Pluymers RJ, Wouters EF. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med. 1995;152:1268–74.PubMedGoogle Scholar
  75. 75.
    Casaburi R, Bhasin S, Cosentino L, Porszasz J, Somfay A, Lewis MI, et al. Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(8):870–8.PubMedCrossRefGoogle Scholar
  76. 76.
    The Nocturnal Oxygen Therapy Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease. Ann Intern Med. 1980;93:391–8.Google Scholar
  77. 77.
    Medical Research Council Working Party. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet. 1981;8222: 681–6.Google Scholar
  78. 78.
    O’Donnell DE, D’Arisigny C, Webb KA. Effects of hyperoxia on ventilatory limitation during exercise in advanced chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:892–89.PubMedGoogle Scholar
  79. 79.
    Somfay A, Porszasz J, Lee SM, Casaburi R. Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxemic COPD patients. Eur Respir J. 2001;18:77–84.PubMedCrossRefGoogle Scholar
  80. 80.
    Emtner M, Porszasz J, Burns M, Somfay A, Casaburi R. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med. 2003;168:1034–42.PubMedCrossRefGoogle Scholar
  81. 81.
    Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 2007;29:1224–38.PubMedCrossRefGoogle Scholar
  82. 82.
    Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double-blind, placebo-controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ. 2000;320:1297–303.PubMedCrossRefGoogle Scholar
  83. 83.
    Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, et al. UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359:1543–54.PubMedCrossRefGoogle Scholar
  84. 84.
    Garcia-Aymerich J, Hernandez C, Alonso A, Casas A, Rodriguez-Roisin R, Anto JM, et al. Effects of an integrated care intervention on risk factors of COPD readmission. Respir Med. 2007;101(7):1462–9.PubMedCrossRefGoogle Scholar
  85. 85.
    Casas A, Troosters T, Garcia-Aymerich J, Roca J, Hernandez C, Alonso A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28: 123–30.PubMedCrossRefGoogle Scholar
  86. 86.
    Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2009;1:005305.Google Scholar
  87. 87.
    Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1995;122:823–32.PubMedGoogle Scholar
  88. 88.
    Brooks D, Krip B, Mangovski-Alzamora S, Goldstein RS. The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. Eur Respir J. 2002;20:20–9.PubMedCrossRefGoogle Scholar
  89. 89.
    Troosters T, Gosselink R, Decramer M. Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med. 2000;109(3):207–12.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.The Warren Alpert Medical School of Brown UniversityProvidenceUSA
  2. 2.Providence Veterans Affairs Medical CenterProvidenceUSA
  3. 3.University of Connecticut School of MedicineHartfordUSA
  4. 4.St. Francis Hospital and Medical CenterHartfordUSA

Personalised recommendations