Pınar Ergün

Comprehensive out-patient pulmonary rehabilitation: Treatment outcomes in early and late stages of chronic obstructive pulmonary disease.

BACKGROUND: The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) and to establish whether in early disease stage PR is as effective as in late stages of disease. METHODS: A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To eluciate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council (MRC)], body composition [body mass index (BMI), fat free mass (FFM), fat free mass index (FFMI)], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life (HRQoL) with St. George Respiratory Disease Questionnaire, psycohological status (Hospital anxiety–depression (HAD) scale) were evaluated before and after PR. RESULTS: At the end of PR in the early disease stage group, the improvement in forced vital capacity (FVC) reached a statistically significant level (P < 0.05). In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements (P < 0.001). HRQoL and exercise capacity were significantly improved for the two groups (P < 0.001). Psychological status evaluated with the HAD scale improved after PR (P < 0.001) both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages. CONCLUSIONS: These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program.

Effect of nutritional status in individuals with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation.

Chronic obstructive pulmonary disease (COPD) is considered a worldwide major public health problem. Weight loss, muscle and fat mass depletion are common nutritional problems in COPD patients and are determinant factors in pulmonary function, health status, disability and mortality. We aimed to assess the relationships between nutritional status and perception of dyspnoea, pulmonary function tests (PFT), exercise capacity and health‐related quality of life (HRQoL) using the subjective global assessment (SGA) in COPD patients who were referred for pulmonary rehabilitation programme.

Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease

Aim: The purpose of this study was to investigate whether adding neuromuscular electrical stimulation (NMES) to a comprehensive pulmonary rehabilitation (cPR) program would have additive effects on clinical-functional outcomes. Methods: Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were randomly allocated to NMES + cPR (n = 13) or Sham + cPR (n = 14) groups. Quadriceps strength, exercise capacity, symptoms, mood, activities of daily living and quality of life were evaluated pre- and post-interventions. Results: There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR (p > 0.05). In fact, the NMES + cPR group showed lower increases in incremental shuttle walk test (ISWT) distance (38.4 vs 69.2 m, respectively) and %ISWT distance (5.1 vs 9%, respectively) compared with the Sham + cPR group (p < 0.05). Conclusion: The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR.

Relation between upper‐limb muscle strength with exercise capacity, quality of life and dyspnea in patients with severe chronic obstructive pulmonary disease

In chronic obstructive pulmonary disease (COPD), skeletal muscle weakness is characterized by reduced muscle strength, reduced muscle endurance and the presence of muscle fatigue especially in lower limbs. There has been little research into the upper limb skeletal muscles.

Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support: A randomized controlled trial

The role of non‐invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6‐min walking distance (6MWD) and cycle endurance time compared with ET alone.

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study.

Objective To determine distribution of COPD assessment categories and physicians’ adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in >70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient =0.993, P<0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient =0.237, P<0.0001) were noted. Conclusion Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected.

Assessment of pulmonary rehabilitation efficacy in chronic obstructive pulmonary disease patients using the chronic obstructive pulmonary disease assessment test.

Aim: We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment test (CAT) and improvements after pulmonary rehabilitation (PR) and PR efficiency in COPD patients. Methods & results: Forty COPD patients completed PR. After PR, mean change in CAT score was found to be 13 (p < 0.001), Medical Research Council (MRC), St George’s Respiratory Questionnaire (SRGQ) and London Chest Activity Daily Living (LCADL) scores decreased, while Endurance Shuttle Walking Test (ESWT) time and Incremental Shuttle Walking Test (ISWT) distance increased significantly. Baseline CAT scores correlated with MRC, SRGQtotal, %FVC, ISWT, ESWT, LCADL. Change in CAT was significantly correlated with changes in MRC, SGRQtotal, LCADL-leisure scores, and ESWT. Conclusion: CAT score shows moderate degree correlation with some measures of outcome of PR and response to PR efficacy.

The Comparison of Clinical Variables in Two Classifications: GOLD 2017 Combined Assessment and Spirometric Stage of Chronic Obstructive Pulmonary Disease

Background There are limited number of studies that investigate clinical variables instead of chronic obstructive lung disease (COPD) management according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 classification. The aim of the study was to investigate whether there was a difference between GOLD 2017 classification and spirometric stage in clinical variables in patients with COPD. The data of 427 male patients with stable COPD were investigated retrospectively. Methods Patients were allocated into combined assessment of GOLD 2017 and spirometric stage. Age, amount of smoking, pulmonary function, modified Medical Research Council (mMRC), incremental shuttle walk test (ISWT), Hospital Anxiety-Depression Scale (HADS), St. Georges Respiratory Questionnaire (SGRQ), body mass index (BMI), and fat free mass index (FFMI) were recorded. Results Seventy-three (17%) patients were in group A, 103 (24%) constituted group B, 38 (9%) were included in group C, and 213 (50%) comprised group D according to the combined assessment of GOLD 2017. Twenty-three patients (5%) were in stage 1, 95 (22%) were in stage 2, 149 (35%) were in stage 3, and 160 (38%) were in stage 4 according to spirometric stage. According to GOLD 2017, age, amount of smoking, mMRC, BMI, FFMI, SGRQ, HADS, forced vital capacity, forced expiratory volume in 1 second (FEV1), and ISWT were significantly different between groups. Ages, amount of smoking, FFMI, BMI, HADS of group A were different from B and D. Smiliar values of FEV1 were found in A–C and B–D. A and C had smiliar ISWT. According to spirometric stage, BMI, FFMI of stage 4 were statistically different. mMRC, ISWT, and SGRQ of stages 3 and 4 were different from other stages, amongst themselves. FEV1 was correlated with mMRC, SGRQ, anxiety scores, BMI, FFMI, and ISWT. Conclusion This study showed that the GOLD ABCD classification might not represent the severity of COPD sufficiently well in terms of lung function or exercise capacity. The combination of both spirometric stage and combined assessment of GOLD 2017 is important, especially for estimating clinical variables.

Oral nutritional supplement in patients with COPD who completed PR program: six months and one year follow ups

Introduction Oral nutritional supplement (ONS), an important part of multidisciplinary pulmonary rehabilitation (PR) program, is indicated according to body composition abnormalities in the patients with chronic obtructive pulmonary disease (COPD). We evaluated efficacy of oral nutritional supplement (ONS) during 5-8 months in patients with COPD who completed PR program. Materials and Methods The data of 41 patients with stable COPD were recorded after the approval had been taken. Patients were grouped according to ONS duration. Group 1 consisted of patients who took ONS during 2 months, group 2: 5 months, group 3: 8 months. In all patients, pulmonary function tests, quality of life, exercise capacity and body composition datas were recorded before and after PR program, at 3rd, 6th month and in 20 patients 1 year follow-up visit. Result In all groups, improvements after PR in exercise capacity, dyspnea, and body composition sustained at 3 and 6 month. Quality of life was protected in group 1 during six month, in other groups it was over values before PR despite loss at 6. month. All improvements after PR were similiar between groups. In 20 patients with one year follow up, while the improvements in dyspnea and body composition were preserved, both exercise capacity and quality of life decreased, exercise capacity was lower than values before PR. Conclusions In patients with COPD, after multidisplinary PR program, the improvements in dyspnea, exercise capacity, quality of life were maintained during six months regardless of body composition and ONS duration. Furthermore, while the improvements in body composition, dyspnea, quality of life were protected, exercise capacity was found to be lower than baseline.

Assessing the knowledge in primary health care following an educational course structured in the context of gard chronic airway diseases national control program

Introduction Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program. Materials and Methods The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test. Result From 11 different cities, 1817 and 1788 primary health care physician were attended to the asthma and COPD educations, respectively. The accuracy rate of ≥ 75% was obtained from only 4 questions in pre-test asthma questionnaire. On the contrary, in 15 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 45.8%, and this rate raised to 69.6% after education course. The accuracy rate of ≥ 75% could not be obtained from any of the questions in pre-test COPD questionnaire. On the contrary, in 19 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 42.0%, and this rate raised to 71.3% after education course. Conclusions It has been shown that, in primary care settings, the level of knowledge in asthma and COPD should be enhanced and that this increase can be achieved with an education course.