Jan 2, 2017 - 1Department of Pulmonary Rehabilitation and Home Care, Ataturk Chest ... Methods: Patients underwent multidisciplinary PR in a hospital outpatient programme twice weekly for 8 weeks. ..... Special considerations in the.
Acta Medica Mediterranea, 2017, 33: 321
COMPREHENSIVE MULTIDISCIPLINARY PULMONARY REHABILITATION IS AN EFFECTIVE TREATMENT STRATEGY IN OLD ELDERLY PATIENTS WITH COPD
DICLE KAYMAZ¹, NURSEL TÜRKOĞLU SELÇUK², PINAR ERGÜN1, PERVIN DEMIR3, İPEK CANDEMIR¹, FILIZ TAŞDEMIR¹, FATMA ŞENGÜL¹, NURCAN EGESEL¹ 1 Department of Pulmonary Rehabilitation and Home Care, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey - ²Department of Pulmonary Medicine, Antalya Training and Research Hospital, Antalya, Turkey -3Department of Biostatistics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
ABSTRACT Introduction: We investigated the effectiveness of multidisciplinary, 8 weeks, outpatient Pulmonary rehabilitation (PR) in old elderly patients with chronic obstructive pulmonary disease (COPD). And also we aimed to compare the outcomes of multidisciplinary, 8 weeks, outpatient PR programme in young elderly and old elderly patients with COPD. Methods: Patients underwent multidisciplinary PR in a hospital outpatient programme twice weekly for 8 weeks. Dyspnea, incremental shuttle walk test (ISWT) distance, endurance time (ET) health status with SGRQ, anxiety and depression scores and body compositions were assessed before and after PR. Results: Subjects were divided in two groups: group A (young elderly) (n = 33,mean age 62.39 ± 5.66 years) and group B (old elderly) (n = 16,mean age 77.34 ± 2.52 years). ISWT distance increased significantly (P < 0.001) by a median 40 m in group A and 65 m in group B. There were significant improvements in HAD (Hospital Anxiety Depression) scores within the young and old elderly groups. Conclusions: With PR; except for the improvement in exercise capacity, old elderly patients with COPD improved dyspnea, health related quality of life, anxiety and depression as much as the young elderly ones. PR should be integrated to the treatment of symptomatic patients who is 75 years and older with decreased exercise capacity, daily activities and quality of life as an effective approach. Age should not be an exclusion criteria for comprehensive outpatient PR programmes.Out patient PR is an effective treatment strategy for old elderly patients with COPD. Keywords: chronic obstructive pulmonary disease, pulmonary rehabilitation, elderly, treatment, outcome. DOI: 10.19193/0393-6384_2017_2_048 Received June 30, 2016; Accepted January 02, 2017
Introduction Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality and a major contributor to morbidity especially in older ages and will be the world’s fifth ranking cause of disability by 2020(1,2). Thus, the management of COPD in elderly patients has become a relevant and targeted treatment strategy.
Pharmacological interventions are often unsatisfactory. PR (Pulmonary Rehabilitation) has become an established part of the management of COPD. A comprehensive PR programme for COPD patients includes: patient assessment, exercise training, education of the patient and family, nutritional advices, psychosocial counseling, and support. PR has been proved to be effective in improving functional exercise capacity and health-related quality
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of life (HRQoL) of the patients with COPD, and reducing exertional dyspnea, the use of health services and health costs(3-5). However, some patients have difficulty completing these relatively intense PR programmes, while others do not derive the expected benefit. As well as effect of PR, the optimal structure and essential components of a program has been poorly investigated in elderly patients with COPD. There is an underlying perception among most clinicians, and not only general practitioners, that PR has limited benefits for the patients aged 75 years or more(6,7). So we aimed to compare the outcomes of multidisciplinary, 8 weeks, outpatient PR programme in young elderly and old elderly patients with COPD. Materials and methods Study design The patients who were admitted to PR center of Atatürk Chest Diseases and Chest Surgery Training and Research Hospital between 2008-2009 were included. Patients on optimum COPD treatment, who were adequately motivated to exercise and were able to attend, undertake the full programme. Only the data of the patients who had completed the program was evaluated, retrospectively. All patients with COPD fulfilled the criteria proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines(8). According the spirometric classification patients were classified as stage 2-3 or 4. Patients were divided into 2 groups according to age: Group A (young elderly group, age less than 75 years) and Group B (old elderly- group, age 75 years and older). A respiratory physician assessed all patients prior to the program to ensure that the diagnosis was correct and there were no contraindications to entering the program. At baseline, spirometry was performed pre and post-bronchodilator administration (15-30 minutes after inhalation of 400 mcg salbutamol via a spacer device using Flowhandy ZAN 100 USB) (nSpire Health GmbH, Oberthulba, Germany). Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC were each recorded and expressed as percentages of predicted values(9). The criterion for confirmation of a diagnosis of COPD was a post-bronchodilator FEV1/FVC ratio of
