study focuses on pulmonary rehabilitation strategies

Chronic obstructive pulmonary disease (COPD) is the third-leading reason for morbidity and mortality worldwide. In 2019, over 328 million people were diagnosed with COPD.

Pulmonary rehabilitation (PR) through regular exercise is a successful intervention for COPD patients.

Typically, the exercise prescription provided to COPD patients exceeds their exercising capability. Hence, there may be a necessity to ascertain a scientific respiratory rehabilitation/exercise prescription system that may profit them.

A recent study posted to the Research Square preprint* server focused on different perspectives of respiratory care professionals to higher understand the necessities for long-term PR for COPD patients.

Study: Understanding Long-term Requirements in Pulmonary Rehabilitation for COPD: Insights from Interviews with Respiratory Care Professionals. Image Credit: Andrew Angelov/Shutterstock.com

*Necessary notice: Research Square publishes preliminary scientific reports that will not be peer-reviewed and, subsequently, shouldn’t be thought to be conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

Physical activity is strongly connected with lung function. Lower physical activity levels result in poor quality of life and enhance the risks of premature death.

Since COPD is a clinically complex disease, scientists haven’t been capable of develop general guidelines for all patients.

Every COPD patient is different concerning medical needs and coverings. Subsequently, based on the patient’s requirement, physicians must recommend suitable exercise levels and intensity to profit them.

PR comprises diagnosis, training, and evaluation of COPD. As stated above, it is a low-cost and high-impact intervention that effectively lowers the progression of COPD. At present, nearly all of exercise prescriptions available in the marketplace are only suitable for patients who’re stable and in healthy condition.

Although regular exercise is really helpful for COPD patients, their exercise capability is significantly compromised as a consequence of physical discomfort or respiratory difficulties (e.g., chronic cough and dyspnea). 

In regards to the Study

A qualitative research design was employed on this study, which is predicated on semi-structured interviews regarding PR. Here, clinical professionals were interviewed with open-ended questions to know their perspectives regarding long-term PR for COPD patients. 

Twenty-four respiratory care professionals (RCPs), including fourteen females and ten males, between the ages of 35 and 65, were recruited.

Ten worked at Chang Gung Medical Foundation, a significant metropolitan hospital providing inpatient and outpatient rehabilitation services.

One other ten interviewees had private practices in rural areas, and 4 RCPs worked in regional local hospitals. The clinical experiences of the interviewees could help develop proper interventions for COPD patients.

Before the interview, each interviewee received a questionnaire outline. Each interview lasted 60 to 90 minutes, was recorded using a voice recorder, and was transcribed later. Other reviewers validated these transcriptions.

Study Findings

RCPs recruited on this study had over seventeen years of experience in chest medicine, respiratory therapy, and/or pulmonary/cardiac rehabilitation.

These interviews indicated the importance of utilizing technologies to deal with the needs of discharged COPD patients. These technologies may also help monitor patients usually and help establish proper care and home-based respiratory management.

Notably, this study revealed that clinical practitioners know individual differences in exercise prescriptions. The importance of an optimized exercise prescription formulated using high-tech assistance was identified by RCPs.

They further indicated the shortage of adherence to the prescribed exercise without physician support. Subsequently, it is vital to know the long-term behavior in physical activity and the motivation behind exercise adherence for optimal designing of exercise programs.

Severe issues, equivalent to lack of vital equipment, unpredictable environmental conditions, and different living conditions, limit distant monitoring and management of COPD patients. For example, oxygen-producing machines can only be deployed in hospitals as they’re extremely expensive and heavy and require RCPs to regulate the oxygen volume.

One in every of the fundamental challenges RCPs highlighted regarding using this machine for COPD patients is that not all hospitals are equipped with such facilities. As well as, not all medical units can afford cardiopulmonary exercise test (CPET) equipment, making it difficult for physicians to evaluate patients.

In comparison with individual exercise, combining exercises to enhance muscle strength and inspiratory muscle endurance was helpful for COPD patients. There’s a necessity for a more collaborative and specialized care system where patients will be triaged and referred per the recommendations of medical professionals.

The stationary bicycle is taken into account the most effective and safest option for a COPD patient discharged from the hospital. The sensors present in a stationary bike can indicate physical activity levels and vital signs. COPD patients may use an oximeter combined with the 6MWT to evaluate recovery.

Conclusions

The present study has many limitations, including the shortage of consideration of the difference within the experience level of the RCPs interviewed on this study. This might generate a difference in perspectives.

The working environment and length of service can positively influence their perspectives. RCPs working in urban and rural settings observed a notable difference of views.

Despite the constraints, this study really helpful that supervised and monitored exercise training at any COPD stage is incredibly helpful for each at-home patients and people recently discharged from hospitals.

Nonetheless, proper exercise prescription is important for effective results. The progress of the patients should be usually monitored using available technologies. This study underscored the importance of patient-centered and optimized healthcare services for COPD patients.

*Necessary notice: Research Square publishes preliminary scientific reports that will not be peer-reviewed and, subsequently, shouldn’t be thought to be conclusive, guide clinical practice/health-related behavior, or treated as established information.