| Author: | Choi, Ching Man |
| Title: | Incorporation of non-invasive ventilation (NIV) in early physical training program for patients recovering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) |
| Advisors: | Ng, Gabriel (RS) Pang, Marco (RS) Ngai, Shirley (RS) |
| Degree: | DHSc |
| Year: | 2020 |
| Subject: | Lungs -- Diseases, Obstructive Respiratory organs -- Diseases Physical therapy Artificial respiration Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | i, iii, iv, iv, 70 pages : color illustrations |
| Language: | English |
| Abstract: | BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common irreversible lung disease with chronic lung airflow obstruction interfering breathing. COPD is associated with significant morbidity and incurs heavy utilization of health care resources. Prompt management of both acute exacerbations of COPD (AECOPD) and stable COPD is important to improve a patient's exercise capacity, functional activity level and quality of life, reducing the number of hospital admissions and mortality rate. Limitations in exercise capacity and reduced activity level of patients were attributed to dyspnoea, reduced ventilatory capacity and peripheral muscle dysfunction. For patients with AECOPD, there is typically an increase in symptom severity from the baseline status (worsening cough, shortness of breath, sputum production, fatigue) rather than the onset of new symptoms. These quantitative changes in symptoms have a profound effect on patient's physical activity levels. These symptoms will affect their willingness in doing exercise and may delay physical rehabilitation, causing further deconditioning and impairment of exercise performance and functional capacity of these patients. Previous literatures showed that the incorporation of non-invasive ventilation (NIV) in exercise could increase exercise endurance, unload respiratory muscle, reduce dyspnoea, improve pattern of breathing and gaseous exchange for people with stable COPD. Given the benefit of NIV during exercise in patients with stable COPD conditions, it prompts the question whether NIV during exercise can yield similar outcomes for patients recovering from AECOPD. Patients with stable COPD often have a significant increase in partial pressure of carbon dioxide (PaCO2) from rest to peak exercise, which is associated with a significant drop in arterial oxygen tension (PaO2). This may potentially cause carbon dioxide retention leading to respiratory failure in these patients with stable COPD. However, it is not known how the mechanism of blood gases changes is during gentle or moderate exercise for patients with COPD, especially during AECOPD with or without NIV support. If the changes during exercise in patients with AECOPD with NIV support are demonstrated e.g. PaCO2 is washed out or lowered during exercise with NIV support, it may have a potential role in management for these patients. OBJECTIVE: The main objective of this study was to determine both immediate and cumulative effects of the incorporation of NIV in an early physical training program for patients recovering from AECOPD. METHOD: This study was conducted in a local regional hospital. Patients with diagnosis of AECOPD and being prescribed with NIV therapy fulfilled the inclusion criteria and not the exclusion criteria were recruited. Eligible participants were randomly assigned into control or NIV group and then performed a 3-minute step training with fixed pace. Transcutaneous partial pressure of carbon dioxide (PtCO2), oxygen saturation (SpO2), rate of perceived dyspnoea (RPD), exercise duration and recovery duration of each training session were recorded and those of the first and the last session were analyzed to investigate the immediate effects of NIV during exercise while NIV weaning days and hospital length of stay (LOS) were recorded and analyzed to investigate cumulative effects of NIV during exercise. All the training was performed twice a day until participants were weaned off from NIV. RESULTS : Fifty-six (7 women and 49 men) participants were recruited and all of them completed the early physical training (treatment days: control group: 5.05±2.25 days; NIV group 2.71±2.19 days). Concerning the immediate effects of incorporating NIV during exercise, the present study demonstrated that in NIV group, in the first training session, dyspnoea in RPD significantly decreased by 1.11 (p=0.02) and recovery duration significantly decreased by 33.86 secs (p=0.03). There were no significant differences in change of PtCO2, SpO2 and exercise duration between the groups in the first session of training. In the last training session, there were no significant differences in all the outcome measures between the two groups. However, in NIV group, improving trends in change of RPD (-0.98), recovery duration (-18.04 secs) and exercise duration (+18.21 secs) were observed. For the cumulative effect of incorporating NIV during exercise, there were no significant differences between the two groups in both the NIV weaning days and LOS. However, improving trends were observed in NIV group (-2.79 days in NIV weaning days; -0.96 day in LOS). CONCLUSION : Incorporation of NIV during an early physical training for patients with AECOPD showed a significantly lowered level of post exertional dyspnoea and a shorter recovery time in the first training session but not apparent in the last session. Our data suggest the potential early incorporation of NIV during exercise to enhance recovery from AECOPD. |
| Rights: | All rights reserved |
| Access: | restricted access |
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| File | Description | Size | Format | |
|---|---|---|---|---|
| 5065.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 2.5 MB | Adobe PDF | View/Open |
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