Spirometrik İleri Evre Usot Kullanan Koah Tanılı Olgularda Pulmoner Rehabilitasyon Etkinliği

Abstract

Introduction: Pulmonary rehabilitation (PR) has also been shown to be an effective approach in COPD pateients using long-term oxygen therapy (LTOT). In this study, it was aimed to investigate the factors that might determine the effectiveness of PR program in patients with advanced COPD using LTOT with chronic hypoxemic respiratory failure. Method: The datas of patients with spirometric stage 3-4 COPD who completed a comprehensive multidipliner PR program, were investigated retrospectively. Patients with systolic pulmonary artery pressure ≤ 36 mmHg according to echocardiographic evaluation and 19 patients with LTOT (Group I) and 21 patients without exertional desaturation and resting hypoxemia (Group II), were included to the study. The subjects were divided into two groups according to the using LTOT. The values of MRC score, the S. George quality of life questionnaire (SGRQ), incremental shuttle walking test (ISWT) and endurance shuttle walking test (ESWT), body mass and fat-free mass index (BMI, FFMI) performing before and after PR were recorded. The relationship between baseline values before PR and the gainings of PR program was examined. Results: Mean value of age was 61±5 year with mean value of FEV1 predicted 32 ±8%. MRC, SGRQ scores and ISWT distances were improved after PR in both groups and the improvements were smiliar between groups. In group I, baseline FEV1 predicted % was not found to be correlated with improvements in exercise capacity and quality of life. In this group the improvements in sensation of dyspnea was found to be less in those with a higher baseline MRC score [ΔMRC with MRC (p = 0.015, r = -0.550)]. In the group II, there was a significant correlation between baseline FEV1 predicted% and ΔSGRQ total score (p=0,014, r=0,526), between MRC and ΔMRC (p =0.008, r=-0.565), ΔSGRQ activity and total score (respectively p=0,010, r=0,551 /p=0,017, r=0,516), ΔISWT (p=0,006, r=-0,574). Conclusion: Multidisciplinary, comprehensive, outpatients supervised PR program was found to be an effective approach in advanced stage COPD with LTOT as smilar as patients without LTOT and improvements in exercise capacity and quality of life were not shown to be influenced by level of loss in pulmonary function and furthermore in patients who were more dyspneic, the improvements in sensation of dyspnea were found to be less.

Keywords

• COPD
• dyspnea
• LTOT
• exercise capacity
• quality of life
• PR

Spirometrik İleri Evre Usot Kullanan Koah Tanılı Olgularda Pulmoner Rehabilitasyon Etkinliği

Abstract

Giriș:Pulmoner rehabilitasyonun (PR) uzun süreli oksijen tedavisi (USOT) kullanan KOAH tanılı olgularda da etkin bir yaklașım olduğu gösterilmiștir. Bu çalıșmada kronik hipoksemik solunum yetmezliği tanısıyla USOT kullanan ileri evre KOAH’lı olgularda PR program etkinliğinde belirleyici olabilecek faktörlerin araștırılması amaçlanmıștır. Metod: Multidipliner, kapsamlı, ayaktan PR programını tamamlayan GOLD spirometrik evre 3-4 KOAH tanılı olguların verileri retrospektif olarak incelenmiștir. Transtorasik ekokardiyografide sistolik pulmoner arter basıncı (SPAP) ≤ 36 mmHg olan, USOT kullanan 19 olgu (Grup I) istirahat ve egzersiz hipoksemisi olmayan USOT kullanmayan 21 olgu (GrupII) çalıșmaya dahil edilmiștir. Olguların PR programı önce ve sonrası Medical research council (MRC) dispne skalası, S. George respiratory questionary (SGRQ), artan hızda mekik yürüme testi (AHMYT) ve endurans mekik yürüme testi (EMYT), vücut kitle ve yağsız vücut kitle indeksi (VKİ, YVKİ) değerleri kaydedilmiștir. PR öncesi bașlangıç değerlendirme verileri ile PR programı sonrası kazanımlar arasındaki ilișki incelenmiștir. Bulgular: Olguların yaș ortalaması 61±5 yıl ve FEV1 ortalaması beklenenin %32 ±8’di. Her iki grupta PR sonrası MRC, SGRQ toplam ve alt skorları, AHMYT sonuçlarında istatistiksel anlamlı değișim izlenmiș olup her iki grupta da kazanımların benzer düzeylerde olduğu görülmüștür. Grup I’de PR sonrası kazanımlar solunum fonksiyonları, yașam kalitesi, egzersiz kapasitesi bașlangıç düzeyleri ile anlamlı korelasyon bulunmazken bașlangıç dispne algısı yüksek olanlarda dispne algısındaki iyileșmenin daha az olduğu görülmüștür [MRC ile ΔMRC (p =0.015, r=-0.550)]. Grup II’de bașlangıç ortalama FEV1 %’si ile ΔSGRQ toplam skor arasında (p=0,014, r=0,526) , MRC ile ΔMRC (p =0.008, r=-0.565), ΔSGRQ aktive ve toplam skoru (sırasıyla p=0,010, r=0,551 /p=0,017, r=0,516), ΔAHMYT (p=0,006, r=-0,574) arasında anlamlı korelasyon bulunmuștur. Sonuç: USOT kullanan ileri evre KOAH tanılı olgularda multidisipliner, kapsamlı, ayaktan direkt gözetimli PR programlarının USOT kullanmayan olgularla benzer șekilde etkin bir yaklașımdır. Ayrıca, kazanımların solunum fonksiyonlarındaki kayıp düzeyi, egzersiz kapasitesi ve yașam kalitesi düzeylerinden etkilenmediği görülürken bașlangıç değerlendirmesinde dispne algısı yüksek olanlarda dispne algısındaki iyileșmenin daha az olduğu görülmüștür

Keywords

• KOAH
• dispne
• USOT
• egzersiz kapasitesi
• yașam kalitesi
• pulmoner rehabilitasyon

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