Cooper, Christopher B.; (1991) Methods of rehabilitation in chronic obstructive pulmonary disease. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Selected aspects of pulmonary rehabilitation (PR) were examined in subjects with chronic obstructive pulmonary disease (COPD) seeking objective evidence of improvements in exercise tolerance, respiratory muscle function, symptoms and survival prospects. Each group of subjects had moderately severe airflow obstruction and every effort was made to select subjects without reversibility of airflow obstruction so as to dissociate any physiological changes accompanying bronchodilatation from those genuinely due to improvement in other modalities. Two supervised methods of physical training were compared over eight weeks. General physical training, consisting of timed walking and stair climbing, increased the six-minute walking distance by 7% in seven subjects. Respiratory muscle training consisting of targeted inspiratory resistance breathing, increased walking distance by 5% in nine subjects. A significant reduction in breathlessness was observed which appeared to be specific for walking assessment after general physical training. Acute and chronic administration of aminophyl1ine, giving mean plasma theophylline levels within the accepted therapeutic range, improved airflow obstruction despite the selection of subjects. Acute administration increased walking distance by 6% and produced evidence of increased respiratory drive. Chronic administration increased maximum exercise ventilation by 11% and maximum oxygen uptake by 10%. None of these studies produced evidence of change in respiratory muscle strength. Long-term oxygen therapy (LTOT) improved survival prospects in 72 subjects with hypoxic cor pulmonale. Pulmonary haemodynamics were stable in 45 subjects after 12 months of LTOT. The benefit was apparent soon after commencement of LTOT and the survival curves were similar for males and females. Survival was closely related to the degree of airflow obstruction but not to arterial blood gas tensions or pulmonary haemodynamics. Death rate accelerated after about ten years indicating that the benefit was temporary. In general, the changes which v/ere observed with different aspects of PR were modest reflecting wide individual variations in response. Future endeavours need to identify specific clinical or pathophysiological features which are associated with potential improvements. This approach will lead to the rational selection of subjects for particular forms of treatment and the appropriate use of resources.

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