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Chronic Obstructive Pulmonary Disease

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Chronic Obstructive Pulmonary Disease (COPD) is the most widespread respiratory disease worldwide. It is expected to be the 5th disability reasons in 2020. Besides medical treatment burden and hospital applications COPD also has a social and economic dimension. PR is an interdisciplinary programme for patients who have restriction in daily activities and dyspnoea sensation is high as a result of burden of the disease. The target of PR is to reach a patient’s ideal functional capacity, improve dyspnoea, improve social isolation and quality of life. Besides medical therapy pulmonary rehabilitation (PR) is also recommended for CODP patients.

PR is designed as patient tailored programmes depending on each patient’s deprivation, including exercise practices, psychological and social support and if necessary nutritional support. PR is adviced for chronic respiratory diseases including COPD, interstitial lung disease, bronchiectasis, kyphoscoliosis ignoring age.[5,6] The behavioral changes gained by PR are important to keep the benefits of PR as the benefits and the gains of obtained by (PR) programme may decline over time. In this study we aimed to investigate whether the gains after PR were continued in the first month.

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Patients and methods: This retrospective cohort study was administrated in the PR unit of a tertiary training hospital for chest diseases and thoracic surgery between May 2014 and December 2015. The study was in compliance with the Helsinki Declaration and authorized by the ethics committee.(protocol code;046,17/05/2018). The patient’s written consent was obtained.

COPD diagnosis was established in accordance with the Global Initiative Chronic Obstructive Pulmonary Disease (GOLD) assessment scheme. All COPD patients were older than 40 years old, they had smoking history. In spirometry COPD patients had forced expiratory volume in the first minute (FEV 1) of <80% of the predicted value and a ratio of FEV 1 to forced vital capacity (FEV1/FVC) of ≤ 0.7.[7] Cardiological evaluation was applied to all of the patients before PR . Inclusion criteria for PR: COPD patients who completed the eight-week PR programme and had 1. month PR control data

Exclusion criteria for PR: Patients wih unstable cardiac diseases, cognitive disorders, neurological or orthopaedic disorders, patients with chronic respiratory disease other than COPD, patients who did not complete PR programme, short-term PR programme prior to thoracic surgery, candidates for lung transplantation, patients who could not achieve walking test and patients whose 1.moth control data were missing.

Exercise capacity was evaluated with a field test. The incremental shuttle walking test (ISWT) which is used to measure the sub-maximal exercise capability was performed to all patients prior and at the end of PR programme.

ISWT was achieved in accordance with the European Respiratory Society(ERS)/American Thoracic Society (ATS) guidelines. [8,9] The test was performed in a corridor, patients were guided to walk between two cones ( the space between the two cones was 10 m) in guidance with voice signals that increased with one minute periods. The test was finished if the patient described dyspnoea that inhibit to continue the walking test or when the patient missed to walk between the two cones within the allowed time. During the walking test heart rate and oxygen saturation were also monitored by two pulse oximeters.

Pulmonary function test (PFTs) was performed with ZAN 300 before and after PR. [11,12] Body mass index (BMI) was calculated with a bioelectrical impedance analyser (Tanita Body Composition Analyser, Model TBF-300).

Modified Medical Research Council (mMRC) was used to evaluate dyspnoea.[13] COPD Assessment Test (CAT) was also applied to all patients.[14] Quality of life was assessed by St.George’s Respiratory Questionnaire (SGRQ) that has total scores range from 0 (no impairment) to 100 (maximum impairment).[5,16] Anxiety and depression was evaluated by the Hospital Anxiety and Depression Questionnaire (HADS) score. This questionary, has 14 items, total scores range between 0 and 21 for either anxiety or depression.

The PR programme was 2 days/week which was delivered by three physiotherapists for outpatients. The PR sessions included cycling and treadmill training for 30 minutes, breathing exercises and upper and lower limb strengthening exercises of the extremities.[5,6] Patients received supplementary O2 if SpO2 decreased under 90% and patients who were already receiving long-term oxygen therapy (LTOT) at home also received O2 during the sessions. Besides the exercise training PR programme also involved energy conservation methods and bronchial clearance techniques. Inhaler medication techniques were controlled for all patients and their relatives/care givers were informed by disease-related educational sessions.

After 8 week PR programme a written home-exercise programme diary with exercise figures were given to all patients and they were invited for PR control programme at the end of the 1 month. Each patient had PR file that included patients demographics, clinical and anthropometric data, PFTs, ISWT, SGRQ and HADS that were registered prior and after PR.

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