Effect of pulmonary rehabilitation on adult cystic fibrosis patient: a case report

Yıl 2019, Cilt: 6 Sayı: 3, 220 - 225, 10.01.2020

Gamze Yalçınkaya , Aylin Özgen Alpaydın , Sevgi Özalevli

Öz

Cystic fibrosis
is an autosomal recessive and fatal disease that affect the respiratory
functions and daily living activities of patients. Fifty percent of the cystic
fibrosis population consists of adult patients aged 18 years and older. The
most common problems are decreased pulmonary function and exercise capacity in
adult cystic fibrosis. In addition, many different comorbidities can be seen
such as diabetes, osteoporosis and pain due to systematic influence. Pulmonary
rehabilitation is known to increase mucus clearance and exercise tolerance in
adult cystic fibrosis patients, however the studies that investigating the
effectiveness of pulmonary rehabilitation are limited in this population.  Therefore, pulmonary rehabilitation program
of an adult patient with cystic fibrosis was performed in our study. The
patient was included in an 8-week supervised pulmonary rehabilitation program
with two sessions per week. The patient's severity of dyspnea perception,
pulmonary function test, cardiopulmonary exercise test, static stabilization of
the trunk muscles, quadriceps muscle strength, grip strength and health-related
quality of life were assessed before and after the pulmonary rehabilitation
program. Breathing exercises, bronchial hygiene techniques, aerobic training
and home program were applied to our patient within the scope of pulmonary
rehabilitation program. The patient's severity of dyspnea perception was
decreased while 6-minute walking distance, cardiopulmonary exercise test
parameters and respiratory function test results increased at the end of the
8-week supervised pulmonary rehabilitation program. The patient’s grip strength
and static trunk endurance increased while the quadriceps muscle strength did
not change. In addition, it was determined that the patient’s quality of life
increased according to the Saint George Respiratory Questionnaire.

Anahtar Kelimeler

Cystic fibrosis, Pulmonary Rehabiltation, Exercise

Pulmoner rehabilitasyonun erişkin kistik fibrozisli hasta üzerindeki etkisi: bir olgu sunumu

Öz

Kistik fibrozis otozomal resesif geçişli,
hastaların solunum fonksiyonları ve günlük yaşam aktivitelerini etkileyen
ölümcül bir hastalıktır. Kistik fibrozisli popülasyonun %50’si 18 yaş ve üzeri
erişkin hastalardan oluşmaktadır. Erişkin kistik fibroziste en yaygın görülen
problemler solunum fonksiyonları ve egzersiz kapasitesinin azalmasıdır. Ek
olarak, sistematik etkilenimden dolayı diyabet, osteoporoz ve ağrı gibi birçok
farklı problem de görülebilmektedir. Erişkin kistik fibrozisli hastalarda
pulmoner rehabilitasyonun mukus klirensini ve egzersiz toleransını artırdığı
bilinmektedir ancak bu popülasyonda pulmoner rehabilitasyonun etkinliğini
araştıran yayınlar sınırlı sayıdadır. Bu nedenle, çalışmamızda kistik
fibrozisli erişkin bir hastanın pulmoner rehabilitasyon programı
gerçekleştirildi. Hasta, haftada iki seans olacak şekilde 8 haftalık hastaya
özgü planlanmış bir pulmoner rehabilitasyon programına dahil edildi.
Programının öncesinde ve sonrasında hastanın dispne seviyesi, solunum fonksiyon
testi, kardiyopulmoner egzersiz testi, gövde kaslarının statik stabilizasyonu,
quadriceps kas kuvveti, kavrama kuvveti ve sağlıkla ilişkili yaşam kalitesi
değerlendirildi. Pulmoner rehabilitasyon programı kapsamında hastamıza solunum
egzersizleri, bronşiyal hijyen teknikleri, aerobik eğitim ve ev programı
uygulandı. 8 haftalık pulmoner rehabilitasyon programı sonunda hastanın 6
dakika yürüme mesafesi, kardiyopulmoner egzersiz testi parametreleri ve solunum
fonksiyon test sonuçları artarken, algılanan dispne şiddeti azaldı. Hastanın
quadriceps kas kuvvetinde tedavi başlangıcına göre değişim görülmezken, kavrama
kuvveti ve statik gövde enduransı arttı. Ek olarak, Saint George Solunum
Anketi’ne göre hastanın yaşam kalitesinin arttığı belirlendi. 

Anahtar Kelimeler

Kistik fibrozis, pulmoner rehabilitasyon, egzersiz

Kaynakça

• 1. Kerem E, Cohen-Cymberknoh M. Disparities in cystic fibrosis care and outcome: socioeconomic status and beyond. Chest. 2016;149:298-300.
• 2. Le CG, Vandervelde L, Poncin W, et al. Impact of physical exercise in cystic fibrosis patients: A systematic review. Rev Mal Respir. 2016;33:573-582.
• 3. Beaudoin N, Bouvet GF, Coriati A, et al. Combined exercise training improves glycemic control in adult with cystic fibrosis. Med Sci Sports Exerc. 2017;49:231-237.
• 4. Dwyer TJ, Zainuldin R, Daviskas E, et al. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17:14.
• 5. Lima TRL, Guimaraes FS, Sá Ferreira A, et al. Correlation between posture, balance control, and peripheral muscle function in adults with cystic fibrosis. Physiother Theory Pract. 2014;30:79-84.
• 6. Wilson RC, Jones PW. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci, 1989;76:277-282.
• 7. Deones VL, Wiley SC, Worrell T. Assessment of quadriceps muscle performance by a hand-held dynamometer and an isokinetic dynamometer. J Orthop Sports Phys Ther, 1994;20:296-301.
• 8. Hamilton A, Balnave R, Adams R. Grip strength testing reliability. J Hand Ther. 1994;7:163-170.
• 9. Moreau CE, Green BN, Johnson CD, et al. Isometric back extension endurance tests: a review of the literature. J Manipulative Physiol Ther. 2001; 24:110-122.
• 10. Culver BH, Graham BL, Coates AL, et al. Recommendations for a standardized pulmonary function report. An official American Thoracic Society technical statement. Am J Respir Crit Care Med. 2017;196:1463-1472.
• 11. American Thoracic Society, American Collage of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167:211.
• 12. Polatlı M, Yorgancıoğlu A, Aydemir Ö, et al. Validity and reliability of Turkish version of St. George's respiratory questionnaire. Tuberkuloz ve toraks. 2013;61:81-87.
• 13. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. American journal of respiratory and critical care medicine. Am J Respir Crit Care Med. 1998;158:1384-1387.
• 14. Smyth AR, Bell SC, Bojcin S, et al. European cystic fibrosis society standards of care: best practice guidelines. J Cyst Fibros. 2014;13:23-42.
• 15. Rovedder PME, Flores J, Ziegler B, et al. Exercise programme in patients with cystic fibrosis: a randomized controlled trial. Respir med. 2014;108:1134-1140.
• 16. Kriemler S, Kieser S, Junge S, et al. Effect of supervised training on FEV1 in cystic fibrosis: a randomised controlled trial. J Cyst Fibros. 2013;12:714-720.
• 17. Gruber W, Orenstein DM, Braumann KM, et al. Interval exercise training in cystic fibrosis-effects on exercise capacity in severely affected adults. J Cyst Fibros. 2014;13:86-91.
• 18. McIlwaine MP, Son NML, Richmond ML. Physiotherapy and cystic fibrosis: what is the evidence base? Curr Opin Pulm Med. 2014;20:613-617.
• 19. Reichman G, De Boe V, Braeckman J, et al. Urinary incontinence in patients with cystic fibrosis. Scand J Urol. 2016;50:128-131.
• 20. Sapsford R, Hodges P, Richardson C, et al. Co‐activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31-42.
• 21. Orenstein DM, Higgins LW. Update on the role of exercise in cystic fibrosis. Curr Opin Pulm Med. 2005;11:519-523.