KOAH Tanılı Yaşlı Bireylerde Pulmoner Rehabilitasyon

Abstract

Kronik obstrüktif akciğer hastalığı (KOAH) yüksek morbidite ve mortalite oranları olan, yaşlı popülasyonda yaygın olarak görülen ve prevalansı yaşla birlikte artan kronik respiratuar bir problemdir. Yaşlı nüfus oranının dünya genelinde artmasıyla birlikte KOAH özellikle gelişmiş ülkelerde majör bir halk sağlığı problemi olmuştur ve en yüksek mortalite nedenleri arasında yer almaktadır. Yaşa bağlı olarak akciğerlerde meydana gelen fizyolojik değişiklikler ve çevresel faktörler nedeniyle KOAH prevalansı yaşlılarda yüksektir. Pulmoner rehabilitasyon ve inhaler farmakolojik ajanlar, KOAH'lı yaşlıların bireysel tedavisinde önemli bir yere sahiptir. Pulmoner rehabilitasyon yaşlılarda fonksiyonel egzersiz kapasitesinin ve sağlıkla ilgili yaşam kalitesinin geliştirilmesinde; dispnenin, sağlık hizmetlerinin kullanımı ve sağlık maliyetlerinin azaltılmasında etkindir. Yapılan çalışmalar KOAH'lı yaşlı bireylerin, pulmoner rehabilitasyondan genç hastalar kadar fayda görmekte olduğunu, dolayısıyla yaşın pulmoner rehabilitasyon için bir dışlama kriteri olmadığını göstermektedir. Hastalığın akut alevlenme dönemlerinde bile yaşlılarda pulmoner rehabilitasyonun etkin olduğu görülmüştür. Bu derlemede KOAH tanısı olan yaşlı bireylerde pulmoner rehabilitasyonun bileşenleri olan aerobik ve dirençli egzersizler, respiratuar kas kuvvet eğitimi, diafragmatik solunum ve fiziksel aktivitenin etkinliği güncel literatür ışığında tartışılacaktır.

Keywords

• KOAH
• Yaşlı
• Pulmoner Rehabilitasyon
• Pulmoner Fizyoterapi

Pulmonary Rehabilitation in Elderly Individuals with COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory problem with high morbidity and mortality rates and common in the elderly population with increasing prevalence by aging. COPD is among the highest causes of mortality and has been a major public health problem, especially in developed countries, as the elderly population increases worldwide. The prevalence of COPD is high in the elderly due to age-related physiological changes in the lungs and environmental factors. Pulmonary rehabilitation and inhaler pharmacological agents play an important role in the individual treatment of the elderly with COPD. Pulmonary rehabilitation is effective in improving functional exercise capacity and health-related quality of life; reducing dyspnea, the use of health services and health costs in the elderly. Studies have shown that elderly individuals with COPD benefit from pulmonary rehabilitation as much as younger patients, and therefore age is not an exclusion criterion for pulmonary rehabilitation. Even in acute exacerbations, pulmonary rehabilitation is effective in the elderly. In this review; aerobic and resistant exercises, respiratory muscle strength training, diaphragmatic respiration and physical activity, the components of pulmonary rehabilitation in elderly individuals with COPD, will be discussed in the light of the current literature.

Keywords

• COPD
• elderly
• pulmonary rehabilitation

References

1. 1. Cortopassi F, Gurung P, Pinto-Plata V. Chronic Obstructive Pulmonary Disease in Elderly Patients. Clin Geriatr Med. 2017;33(4):539–52.
2. 2. Kim EJ, Yoon SJ, Kim YE, Go DS, Jung Y. Effects of aging and smoking duration on cigarette smoke-induced COPD severity. J Korean Med Sci. 2019;34:1–7.
3. 3. Crisafulli E, Morandi A, Olivini A, Malerba M, Clini EM. Rehabilitation and supportive therapy in elderly patients with chronic obstructive pulmonary disease. Eur J Intern Med [Internet]. 2014;25(4):329–35.
4. 4. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. In: Journal of global health. 2015. p. 20415.
5. 5. Kocabaş A, Atış S, Çöplü L, Erdinç E, Ergan B, Gürgün A, et al. Türk Toraks Derneği KOAH Çalışma Grubu KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI (KOAH) KORUMA, TANI ve TEDAVİ RAPORU 2014. Turkısh Thorac J. 2014;15.
6. 6. Coates J, Potal ICR, West JB, et al E. The lung: scientific foundations vol.2. 2nd ed. Philadelphia; 1997. 2193–203. p.
7. 7. Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto-Plata V, et al. Comorbidities and Risk of Mortality in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2012;186(2):155–61.
8. 8. Shweta P. Kukrety, Jai D. Parekh KLB. Chronic obstructive pulmonary disease and the hallmarks of aging. Lung India. 2018;35(4):1–2.

9. 9. Gold 2017 global strategy for the diagnosis, management and prevention of copd. 2019.
10. 10. Kocabaş A. KOAH EPİDEMİYOLOJİSİ VE RİSK FAKTÖRLERİ. TTD Toraks Cerrahisi Bülteni. 2010;1(2):105–13.
11. 11. Marcus BS, McAvay G, Gill TM, Vaz Fragoso CA. Respiratory symptoms, spirometric respiratory impairment, and respiratory disease in middle-aged and older persons. J Am Geriatr Soc. 2015;63(2):251–7.
12. 12. Vollmer WM, Gíslason P, Burney P, Enrigh PL, Gulsvik A, Kocabas A, et al. Comparison of spirometry criteria for the diagnosis of COPD: Results from the BOLD study. Eur Respir J. 2009;34(3):588–97.
13. 13. Hardie JA, Buist AS, Vollmer WM, Ellingsen I, Bakke PS, Mørkve O. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J. 2002;20(5):1117–22.
14. 14. Shirtcliffe P, Weatherall M, Marsh S, Travers J, Hansell A, Mcnaughton A, et al. COPD PREVALENCE IN A RANDOM POPULATION SURVEY : A MATTER OF DEFINITION Study subjects. Eur Respir J. 2008;30(2):232–9.
15. 15. Allen SC, Warwick-Sanders M, Baxter M. A comparison of four tests of cognition as predictors of inability to learn to use a metered dose inhaler in old age. Int J Clin Pract. 2009;63(8):1150–3.
16. 16. Taffet GE, Donohue JF, Altman PR. Considerations for managing chronic obstructive pulmonary disease in the elderly. Clin Interv Aging [Internet]. 2014;9:23–30. Available from: http://www.dovepress.com/permissions.php
17. 17. Jones SE, Maddocks M, Kon SSC, Canavan JL, Nolan CM, Clark AL, et al. Sarcopenia in copd: Prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax. 2015;70(3):213–8.
18. 18. Tatiana Munhoz da Rocha Lemos Costa, Fabio Marcelo Costa, Carolina Aguiar Moreira, Leda Maria Rabelo, César Luiz Boguszewski VZCB. Sarcopenia in COPD: relationship with COPD severity and prognosis. J Bras Pneumol [Internet]. 2015;41(5):415–21.
19. 19. Lahousse L, Ziere G, Verlinden VJA, Zillikens MC, Uitterlinden AG, Rivadeneira F, et al. Risk of Frailty in Elderly With COPD: A Population-Based Study. Journals Gerontol - Ser A Biol Sci Med Sci. 2016;71(5):689–95.
20. 20. Guan C, Niu H. Frailty assessment in older adults with chronic obstructive respiratory diseases. Clin Interv Aging. 2018;13:1513–24.
21. 21. Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S. Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: A randomized controlled study. Chest . 2004;125(6):2011–20.
22. 22. Antoaneta Dimitrova, Daniela Lubenova, Kristin Grigorova-Petrova, Ivan Maznev MN. The effectiveness of long term physical therapy in elderly patients with chronic obstructive pulmonary disease. Eur Respir J. 2016;48(PA 684).
23. 23. Liao LY, Chen KM, Chung WS, Chien JY. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: A randomized control trial. Int J COPD. 2015;10(1):1703–9.
24. 24. Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al. An official American Thoracic Society/European Respiratory Society policy statement: Enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med. 2015;192(11):1373–86.
25. 25. Sundararajan L, Balami J, Packham S. Effectiveness of outpatient pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2010;30(2):121–5.
26. 26. Yang S, He Y, Wang J, Liu M, Jiang B. Smoking cessation protects against COPD in an elderly population. Int J Clin Exp Med. 2018;11(8):8628–33.
27. 27. Singer J, Yelin EH, Katz PP, Sanchez G, Iribarren C, Eisner MD, et al. Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: Impact on exercise capacity and lower extremity function. J Cardiopulm Rehabil Prev. 2011;31(2):111–9.
28. 28. Anne-Marie Boxall, MPH Hons; Louise Barclay, RN; Allyn Sayers, Gideon A. Caplan. Managing chronic obstructive pulmonary disease in the community setting. Br J Community Nurs. 2018;23(1):6–12.
29. 29. Di Meo F, Pedone C, Lubich S, Pizzoli C, Traballesi M, Incalzi RA. Age does not hamper the response to pulmonary rehabilitation of COPD patients. Age Ageing. 2008;37(5):530–5.
30. 30. Mehani SHM. Comparative study of two different respiratory training protocols in elderly patients with chronic obstructive pulmonary disease. Clin Interv Aging. 2017;12:1705–15.
31. 31. Kawagoshi A, Kiyokawa N, Sugawara K, Takahashi H, Sakata S, Satake M, et al. Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease. Respir Med [Internet]. 2015;109(3):364–71.
32. 32. Fernandes M, Cukier A, Feltrim MIZ. Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2011;8(4):237–44.
33. 33. Cameron-Tucker HL, Wood-Baker R, Owen C, Joseph L, Walters EH. Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: A randomized controlled trial. Int J COPD. 2014;9:513–23.
34. 34. Boeselt T, Nell C, Lütteken L, Kehr K, Koepke J, Apelt S, et al. Benefits of High-Intensity Exercise Training to Patients with Chronic Obstructive Pulmonary Disease: A Controlled Study. Respiration. 2017;93(5):301–10.
35. 35. Donaire-Gonzalez D, Gimeno-Santos E, Balcells E, Rodríguez DA, Farrero E, De Batlle J, et al. Physical activity in COPD patients: Patterns and bouts. Eur Respir J. 2013;42(4):993–1002.
36. 36. Iwakura M, Okura K, Shibata K, Kawagoshi A, Sugawara K, Takahashi H, et al. Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients. Int J COPD. 2016;11(1):1505–14.
37. 37. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–45.
38. 38. Attwell L, Vassallo M. Response to pulmonary rehabilitation in older people with physical frailty, sarcopenia and chronic lung disease. Geriatr. 2017;2(1):5–11.
39. 39. Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier JS, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65(5):423–8.