Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease

• Published in: International journal of chronic obstructive pulmonary disease Vol. 10; no. Issue 1; pp. 1787 - 1800
• Main Authors: Maekura, Ryoji, Hiraga, Toru, Miki, Keisuke, Kitada, Seigo, Miki, Mari, Yoshimura, Kenji, Yamamoto, Hiroshi, Kawabe, Toshiko, Mori, Masahide
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2015; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Acidosis; Activities of Daily Living; Aged; Care and treatment; Chronic obstructive pulmonary disease; Diagnosis; Dyspnea; Exercise Test; Feasibility Studies; Female; Fitness training programs; Forced Expiratory Volume; Hospitalization; Hospitals; Humans; Kaplan-Meier Estimate; Lung - physiopathology; Lung diseases, Obstructive; Male; Medical prognosis; Medical records; Medical research; Middle Aged; Occupational Therapy; Original Research; Oxygen Inhalation Therapy; Oxygen therapy; Patient Selection; Patients; Predictive Value of Tests; Program Evaluation; Proportional Hazards Models; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Pulse oximetry; Rehabilitation; Respiratory Therapy - methods; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Tuberculosis; Vital Capacity; Japan; pulmonary rehabilitation; cardiopulmonary exercise testing; prognosis; occupational therapy; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S86455

Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD. We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities. The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan-Meier analyses. In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172-0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296-0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved. The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.