The effect of pulmonary rehabilitation on dyspnea and factors related to dyspnea in lung transplantation candidates

Abstract

Objectives: Lung transplantation is the last treatment option when conservative treatment is not effective in individuals with terminal stage lung disease. Dyspnea is the primary symptom affecting quality of life in these patients. In our study, the effects of Pulmonary Rehabilitation (PR) on dyspnea and factors related with dyspnea were investigated in lung transplant candidates.

Methods: Patients who were in the lung transplant waiting list and completed the 3-month PR program were included in the study. Study result measurements: 6-minute walk test distance (6MWD), lung functions (FEV1, FVC), respiratory muscle strength (MIP, MEP), quadriceps femoris muscle strength as measured by digital dynanometer, hand grip force measured by hand dinanometer (HG) and modified Modified Medical Research Council (mMRC) dyspnea scale.

Results: A total of 47 patients were included in the study. After PR, 6MWD (p < 0.0001), MIP (p < 0.0001), MEP (p < 0.0001), HG (p < 0.0001) and mMRC (p < 0.0001) improvements were detected. There was no statistically significant relationship between the decrease in mMRC and the amount of change occurring in other outcome measurements (p > 0.05).

Conclusions: According to the results of our study, PR has a positive effect on exercise capacity, peripheral and respiratory muscle strength and dyspnea in lung transplant candidates. But there was no relationship between these positive developments and dyspnea. There is a need for studies investigating the effects of different clinical features on rehabilitation outcomes. 

Keywords

• lung transplantation
• dyspnea
• exercise
• muscle strength
• rehabilitation

References

1. 1. Mathur S, Reid WD, Levy RD. Exercise limitation in recipients of lung transplants. Phys Ther 2004;84:1178-87.
2. 2. Mathur S, Levy RD, Reid WD. Skeletal muscle strength and endurance in recipients of lung transplants. Cardiopulm Phys Ther J 2008;19:84-93.
3. 3. Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, et al. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745-55.
4. 4. Taylor JL, Smith PJ, Babyak MA, Barbour KA, Hoffman BM, Sebring DL, et al. Coping and quality of life in patients awaiting lung transplantation. J Psychosom Res 2008;65:71-9.
5. 5. Picard C, Boisseau M, De Miranda S, Hamid A, Grenet D, Parquin F, et al. [The management of lung transplantation candidates. A case series]. Rev Mal Respir 2015;32:1-7. [Article in French]
6. 6. Munari AB, Gulart AA, Dos Santos K, Venancio RS, Karloh M, Mayer AF. Modified Medical Research Council Dyspnea Scale in GOLD Classification better reflects physical activities of daily living. Respir Care 2018;63:77-85.
7. 7. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J 2005;26:153-61.
8. 8. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. Am J Respir Crit Care Med 2003;167:1287.

9. 9. Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46.
10. 10. American Thoracic Society/European Respiratory S. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002;166:518-624.
11. 11. Wen AS, Woo MS, Keens TG. How many maneuvers are required to measure maximal inspiratory pressure accurately. Chest 1997;111:802-7.
12. 12. Burki NK, Lee L-Y. Mechanisms of dyspnea. Chest 2010;138:1196-201.
13. 13. Buchanan GF, Richerson GB. Role of chemoreceptors in mediating dyspnea. Respir Physiol Neurobiol 2009;167:9-19.
14. 14. Faisal A, Alghamdi BJ, Ciavaglia CE, Elbehairy AF, Webb KA, Ora J, et al. Common mechanisms of dyspnea in chronic interstitial and obstructive lung disorders. Am J Respir Crit Care Med 2016;193:299-309.
15. 15. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med 1999;159:321-40.
16. 16. Evans RA, Singh SJ, Collier R, Williams JE, Morgan MD. Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respir Med 2009;103:1070-5.
17. 17. Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J 2006;27:788-94.
18. 18. Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R, et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax 2013;68 Suppl 2:ii1-30.
19. 19. Wickerson L, Rozenberg D, Janaudis-Ferreira T, Deliva R, Lo V, Beauchamp G, et al. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J Transplant 2016;6:517-31.
20. 20. Kenn K, Gloeckl R, Soennichsen A, Sczepanski B, Winterkamp S, Boensch M, et al. Predictors of success for pulmonary rehabilitation in patients awaiting lung transplantation. Transplantation 2015;99:1072-7.
21. 21. Mathur S, Hornblower E, Levy RD. Exercise training before and after lung transplantation. Phys Sportsmed 2009;37:78-87.
22. 22. Pehlivan E, Mutluay F, Balci A, Kilic L. The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial. Clin Rehabil 2018;32:1328-39.
23. 23. Pehlivan E, Balci A, Kilic L, Kadakal F. Preoperative pulmonary rehabilitation for lung transplant: effects on pulmonary function, exercise capacity, and quality of life; first results in Turkey. Exp Clin Transplant 2018;16:455-60.
24. 24. Vainshelboim B, Oliveira J, Fox BD, Soreck Y, Fruchter O, Kramer MR. Long-term effects of a 12-week exercise training program on clinical outcomes in idiopathic pulmonary fibrosis. Lung 2015;193:345-54.