Paulo Viana

Pulmonary rehabilitation in patients with bronchiectasis: pulmonary function, arterial blood gases, and the 6-minute walk test.

BACKGROUND: Information regarding the effects of pulmonary rehabilitation (PR) on pulmonary function (PF), arterial blood gases (ABG), and 6-minute walk distance (6MWD) in patients with bronchiectasis is scant in the literature. METHODS: To evaluate the effects of PR on these indices in this population, a retrospective evaluation of those who attended PR from 2007 to 2010, was made. Pulmonary rehabilitation lasted a mean of 12 weeks and included cycle ergometer exercise for 30 minutes, 3 times per week, with additional upper limbs and quadriceps training. PF, ABG, and 6MWD were evaluated before and after PR to determine the potential influence of gender, exacerbations, underlying cause of bronchiectasis, severity of obstruction, and colonization with bacteria. RESULTS: Forty-one patients (48.8% males; median age, 54 years) were included; 25 had severe obstruction and 19 were colonized with bacteria. Following PR, no significant changes were detected in PF or ABG. Median 6MWD before PR was 425 m and post-PR was 450 m (P = .431). Outcomes did not show any interaction with gender, colonization, or exacerbations. However, patients with idiopathic bronchiectasis did show a significant improvement in forced vital capacity in percent of predicted and residual volume after PR (P = .016 and .048, respectively). Patients with severe obstruction showed a statistically significant decrease in percent of predicted residual volume (P = .025). CONCLUSION: There appears to be a beneficial impact of PR on PF in certain groups of patients with bronchiectasis. In addition, PR indications and protocols for patients with bronchiectasis may need to be adapted to accommodate specific patients, so that expressive exercise capacity improvement can be achieved.

Influence of critical hyperinflation in exercise capacity improvement after pulmonary rehabilitation in severely obstructed patients

Introduction: Hyperinflation is known to limit the increase in ventilation associated with exercise, and overinflated patients often have to adapt exercise training during pulmonary rehabilitation (PR). Objectives: To study the influence of critical hyperinflation (CH, defined as RV% ≥ 230% predicted value) in the improvement of exercise capacity in severely obstructed patients with chronic respiratory diseases after PR. Methods: Retrospective evaluation of records regarding demographic data, lung function tests as well as 6MWT results before and after PR. Results: 62 patients were included, mean age 61.6 yrs., 47 were male. 38 had COPD, 13 bronchiectasis, 4 asthma, 2 ACOS, 2 cystic fibrosis and3 other chronic lung diseases. PR mean duration was 11.8 wks., with upper and lower limbs strength and endurance training. At start, mean values for all patients were: 6MWD - 369.1m, FEV 1 % - 33.7%, RV% - 231.7%. 6MWD in patients with CH at the start was 361.8m and 376.0m in the others. At the end of PR, 6MWDs were respectively 376.7m and 391.9m, with no statistically significant difference between the groups ( p =0.963, independent-samples T test). Considering only COPD patients and those without exacerbation during PR, CH did not influence the results in exercise capacity after PR as well ( p values respectively 0.658 and 0.621), as did not the definition of lower cut offs of RV% for CH. Conclusion: In this group of severely obstructed patients with chronic lung diseases, the presence of critical hyperinflation did not influence exercise capacity change after PR.