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BackgroundStandardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD.MethodsA total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units.ResultsThere was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks.ConclusionsThe standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.Trial registration numberISRCTN81189044.

Purpose This study evaluated the efficacy of ninjin’yoeito for alleviating postoperative symptoms after lung cancer surgery. Methods Overall, 140 patients who underwent lobectomy were randomized into a conventional treatment group and a ninjin’yoeito group. The primary endpoint was change in the Cancer Fatigue Scale (CFS) score from baseline and the secondary endpoints were the Cancer Dyspnea Scale (CDS) scores, the Kihon Checklist, and respiratory function. Results The mean change in the CFS score 8 weeks postoperatively was − 5.56 in the ninjin’yoeito group and − 5.53 in the conventional treatment group ( P  = 0.425), but this outcome did not meet the primary endpoint. Changes in the mean CDS scores 8 weeks postoperatively were − 5.60 and − 3.38 in the ninjin’yoeito and conventional groups, respectively, with a difference of − 1.95 ( P  = 0.049). The changes in the mean vital capacity 8 weeks postoperatively were − 340.5 mL in the ninjin’yoeito group and − 473.5 mL in the conventional treatment group, with a difference of + 135.1 mL ( P  = 0.041). The ninjin’yoeito group had a significantly lower proportion of patients with malnutrition 16 weeks postoperatively than the conventional treatment group ( P  = 0.040). Conclusion The results of this study show that ninjin’yoeito is effective for alleviating respiratory symptoms and improving malnutrition after lung cancer surgery.

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating, interstitial lung disease, with few therapeutic options. IPF is characterized by pulmonary restriction, dyspnea, hypoxemia, exercise intolerance and poor quality of life (QOL). Objectives: We aimed to examine the effect of exercise training (ET) on clinical outcomes in IPF patients. Methods: A randomized controlled study included thirty-two IPF patients (aged 68 ± 8 years) who were allocated either to the ET group (n = 15), participating in a 12-week, twice-weekly 60-min supervised ET-based pulmonary rehabilitation program, or to a control group (n = 17) continuing with regular medical treatment alone. Cardiopulmonary exercise test, 6-min walking distance (6MWD) test, 30-second chair-stand test, pulmonary function tests, dyspnea and QOL were assessed at baseline and at the end of the 12-week intervention. Results: Significant differences were observed between the ET and the control groups in raw mean deltas (Δ = post- - pre-intervention): Δ6MWD, 81 m, p < 0.001; ΔV O 2 peak, 2.6 ml/kg/min, p = 0.002; Δwork rate, 22 W, p < 0.001; Δanaerobic threshold, 3.1 ml/kg/min, p < 0.001, and ΔFVC % predicted, 6%, p = 0.038. Dyspnea, QOL and 30-second chair-stand were also improved significantly following the program. Conclusions: ET improves exercise tolerance, functional capacity, pulmonary function, dyspnea and QOL in patients with IPF, suggesting a short-term treatment efficacy for clinical improvement, and should be considered the standard care for IPF.

Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the world, and it continues to increase in developing countries. The World Health Organization expects COPD to be the third most common cause of death in the world by 2020. Effective and continuous postdischarge care can help patients to maintain good health. The use of electronic health records (EHRs) as an element of community health care is new technology in China. The aim of this study was to develop and evaluate a Web-based coaching program using EHRs for physical function and health-related quality of life for patients with COPD in China. A randomized controlled trial was conducted from 2008 to 2015 at two hospitals. The control group received routine care and the intervention group received routine care with the addition of the Web-based coaching program using EHRs. These were used to manage patients' demographic and clinical variables, publish relevant information, and have communication between patients and health care providers. Participants were not blinded to group assignment. The effects of the intervention were evaluated by lung function, including percent of forced expiratory volume in 1 second (FEV1%), percent of forced vital capacity (FVC%), peak expiratory flow (PEF), maximum midexpiratory flow; St George's Respiratory Questionnaire (SGRQ); Modified Medical Research Council Dyspnea Scale (MMRC); and 6-Minute Walk Test (6MWT). Data were collected before the program, and at 1, 3, 6, and 12 months after the program. Of the 130 participants, 120 (92.3%) completed the 12-month follow-up program. There were statistically significant differences in lung function (FEV1%: F1,4=5.47, P=.002; FVC%: F1,4=3.06, P=.02; PEF: F1,4=12.49, P<.001), the total score of SGRQ (F1,4=23.30, P<.001), symptoms of SGRQ (F1,4=12.38, P<.001), the activity of SGRQ (F1,4=8.35, P<.001), the impact of SGRQ (F1,4=12.26, P<.001), MMRC (F1,4=47.94, P<.001), and 6MWT (F1,4=35.54, P<.001) between the two groups with the variation of time tendency. The Web-based coaching program using EHRs in China appears to be useful for patients with COPD when they are discharged from hospital into the community. It promotes the sharing of patients' medical information by hospital and community nurses, and achieves dynamic management and follow-up analysis for patients' disease. In addition, this program can postpone the decreasing rate of lung function, improve quality of life, decrease dyspnea, and increase physical capacity.

To evaluate the impact of dyspnea and chronic self-care management outcomes of an Education-Based Intervention Program (EBIP) compared to routine care. Methods: The population of the study consisted of self-care management scale of 61 patients diagnosed with chronic obstructive pulmonary disease (COPD) stage 2 and within one month after discharge. A total of 51 conforming patients were divided into experimental and control groups for a single-blind randomized trial. Data were collected using an introductory information form, the baseline dyspnea index (BDI), pulmonary function test (PFT), the self-care management process in chronic illness (SCMP-G) scale and body mass index (BMI). There were no addition interventions to the control group. The intervention group underwent a 3-month EBIP intervention that included education, house visits and follow-ups through phone calls between March 2019 and June 2019. The data were analyzed using Kolmogorov-Smirnov and Shapiro-Wilk tests, χ2, Mann Whitney U and Wilcoxon signed-rank tests. p less than 0.05 was statistically significant. Results: The study was completed with a total of 40 COPD patients. The effect of the EBIP training program on BDI, PFT, and SCMP-G scores in the intervention group was statistically proven (p less than 0.05). However, the differences between the groups in the BDI sub-dimension of functional impairment and PFT were not statistically significant (p greater than 0.05).  Conclusion: Providing patients with illness-related education through EBIP provided a partial improvement in dyspnea and a significant improvement in chronic care management among COPD patients.

Low body weight in COPD patients is associated with worsening dyspnea, reduced leg strength, and poor prognosis. Classical rehabilitation strategies are then limited by reduced exercise tolerance. Thus, we proposed to evaluate whether electrostimulation (ES) was a beneficial technique in the rehabilitation programs for severely deconditioned COPD patients after an acute exacerbation. Randomized, controlled study. Pulmonary rehabilitation center. Seventeen patients with severe COPD (mean [ ± SD] FEV1, 30 ± 3% predicted) and low body mass index (BMI) [18 ± 2.5 kg/m2]. Patients were randomly assigned either to usual rehabilitation (UR) alone or to a UR-plus-ES program for 4 weeks. Quadriceps muscle strength, total muscle mass (MM), exercise capacity, and health-related quality of life were measured before and after rehabilitation. The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction (MVC) compared to UR alone (97 ± 71 vs 36 ± 34 contractions, respectively; p = 0.03) and resulted in a more significant improvement in dyspnea when performing daily tasks (decrease in the dyspnea domain score of the 28-item Maugeri Foundation Respiratory Failure questionnaire, −1.7 ± 1.0 vs −0.2 ± 1.2 points, respectively; p = 0.05). There was also a significant increase in walking distance (63 ± 40 m; p = 0.01) and BMI (0.6 ± 0.5 kg/m2; p = 0.02) after training in the ES + UR group. A significant relationship was found between changes in MVC and changes in MM after training in the ES + UR group (r = 0.94; p = 0.03). The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI. In this population, ES has been revealed as a useful procedure, complementing the usual pulmonary rehabilitation.

Objectives Pulmonary rehabilitation (PR) provides benefit for patients with chronic obstructive pulmonary disease (COPD) in terms of quality of life (QoL) and exercise capacity; however, the effects diminish over time. Our aim was to evaluate a maintenance programme for patients who had completed PR. Setting Primary and secondary care PR programmes in Norfolk. Participants 148 patients with COPD who had completed at least 60% of a standard PR programme were randomised and data are available for 110 patients. Patients had greater than 20 pack year smoking history and less than 80% predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection. Interventions Patients were randomised to receive a maintenance programme or standard care. The maintenance programme consisted of 2 h (1 h individually tailored exercise training and 1 h education programme) every 3 months for 1 year. Primary and secondary outcome measures The Chronic Respiratory Questionnaire (CRQ) (primary outcome), endurance shuttle walk test (ESWT), EuroQol (EQ5D), hospital anxiety and depression score (HADS), body mass index (BMI), body fat, activity levels (overall score and activity diary) and exacerbations were assessed before and after 12 months. Results There was no statistically significant difference between the groups for the change in CRQ dyspnoea score (primary end point) at 12 months which amounted to 0.19 (−0.26 to 0.64) units or other domains of the CRQ. There was no difference in the ESWT duration (−10.06 (−191.16 to 171.03) seconds), BMI, body fat, EQ5D, MET-minutes, activity rating, HADS, exacerbations or admissions. Conclusions A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months. We do not recommend that our maintenance programme is adopted. Other methods of sustaining the benefits of PR are required. Trial registration number NCT00925171.

Purpose Improving dyspnea and exercise performance are goals of COPD therapy. We tested the hypothesis that air current applied to the face would lessen dyspnea and improve exercise performance in moderate-severe COPD patients. Methods We recruited 10 COPD patients (5 men, age 62 ± 6 years, FEV 1 0.93 ± 0.11 L (34 ± 3 % predicted), TLC 107 ± 6 %, RV 172 ± 18 %) naïve to the study hypothesis. Each patient was randomized in a crossover fashion to lower extremity ergometry at constant submaximal workload with a 12-diameter fan directed at the patients face or exposed leg. Each patients' studies were separated by at least 1 week. Inspiratory capacity and Borg dyspnea score were measured every 2 min and at maximal exercise. Results Total exercise time was longer when the fan was directed to the face (14.3 ± 12 vs. 9.4 ± 7.6 min, face vs. leg, respectively, p  = 0.03). Inspiratory capacity tended to be greater with the fan directed to the face (1.4 (0.6–3.25) vs. 1.26 (0.56–2.89) L, p  = 0.06). There was a reduction in dynamic hyperinflation, as reflected by higher IRV area in the fan on face group (553 ± 562 a.u. vs. 328 ± 319 a.u., p  = 0.047). There was a significant improvement in the Borg dyspnea score at maximal exercise (5.0 (0–10) vs. 6.5 (0–10), p  = 0.03), despite exercising for 34 % longer with the fan directed to the face. Conclusions Air current applied to the face improves exercise performance in COPD. Possible mechanisms include an alteration in breathing pattern that diminishes development of dynamic hyperinflation or to a change in perception of breathlessness.

Chronic obstructive pulmonary disease (COPD) is often complicated by depression and exemplifies the challenge in managing chronic illnesses that require active patient participation in care. In a clinical trial (NCT00151372), we compared a novel personalised intervention for depression and COPD (PID-C) targeting treatment adherence with treatment as usual (TAU). In 138 patients with major depression and severe COPD, PID-C led to a higher remission rate and a greater reduction in depressive symptoms and in dyspnoea-related disability than TAU over 28 weeks and 6 months after the last session. If replicated, PID-C may serve as a care model for patients with both depression and medical illnesses with a deteriorating course.

Aim: We assessed the long-term benefits of inspiratory muscle training (IMT) on inspiratory muscle strength, exercise capacity, the perception of dyspnea, quality of life, primary care use, and hospitalizations in patients with significant COPD. Patients: Forty-two consecutive COPD patients with FEV1< 50% of predicted were randomized into a group that received IMT for 1 year, and a control group that received training with a very low load. Results: There was a statistically significant increase in inspiratory muscle strength (at the end of the third month of training) as assessed by maximal inspiratory pressure (from 71 ± 4.9 to 90 ± 5.1 cm H2O [± SEM], p < 0.005) and 6-min walk distance (at the end of the third month of training; from 256 ± 41 to 312 ± 54 m; p < 0.005), a decrease in the mean Borg score during breathing against resistance (at the end of the ninth month of training), improvement in the health-related quality-of-life scores (at the end of the sixth month of training) in the training group but not in the control group. At the end of the training year, these changes were maintained; in addition, a decrease in primary health-care use and hospitalization days was observed. Conclusions: Our study shows that during IMT in patients with significant COPD, there is an increase in exercise capacity, improvement in quality of life, and decrease in dyspnea. Our study also provides evidence that long-term IMT can decrease the use of health services and hospitalization days.