The Clinical Applying Study Of Pulmonary Rehabilitation Toward Expiratory Airflow Limitation Of COPD

1. Objective:To observe the clinical effects on dyspnea,activity of daily living,quality of life,exercise tolerance,respiratory muscle function and pulmonary function in acute and severe patients with COPD by pulmonary rehabilitation toward expiratory airflow limitation of COPD,so that a new method of pulmonary rehabilitation could be found for acute and severe patients with COPD.2. Methods:The acute and severe patients with COPD by GOLD(2006)were chosen to study objects in our clinical trial.All enrolled patients were divided into three groups by randomized controlled trial.They were pulmonary rehabilitation toward expiratory airflow limitation of COPD group(group A),pursed lips breathing group(group B) and no pulmonary rehabilitation group(group C) respectively.The patients in group A were administered pulmonary rehabilitation toward expiratory airflow limitation of COPD three times a day,once 15 minutes,for 8 weeks.The patients in group B were administered pulmonary rehabilitation with pursed lips breathing three times a day,once 15 minutes,for 8 weeks.The patients in group C were administered no pulmonary rehabilitation.Every group had 20 individuals.The patients in group A and group B before and after pulmonary rehabilitation,and the patients in group C before and after 8 weeks,were measured 6MWD,MRC,ADL,QOL,MEP,MIP,pulmonary function respectively.3. Results:3.1 A total of 3,5 and 5 patients dropped out this study in group A,in group B and in group C respectively,and the differentia wasn't significant(p>0.05).3.2 The influence of pulmonary rehabilitation to dyspnea:3.2.1 the comparison before and after pulmonary rehabilitation:①The patients' MRC grade in group A after pulmonary rehabilitation(1.94±1.19)was very lower than that of patients before pulmonary rehabilitation(3.40±0.88)(P<0.01).②The patients'MRC grade in group B after pulmonary rehabilitation(2.40±1.12)was very lower than that of patients before pulmonary rehabilitation(3.50±0.89)(P<0.01).③The differentia of patients'MRC grade in group C before and after 8 weeks(3.40±0.82,3.40±0.91)wasn't significant(P>0.05).3.2.2 the comparison of different pulmonary rehabilitation:①The differentia of patients'MRC grade dispersion in group A before and after pulmonary rehabilitation (1.35±0.61)and in group B before and after pulmonary rehabilitation(1.00±0.53) wasn't significant(P>0.05).②The differentia of patients'MRC grade dispersion in group A before and after pulmonary rehabilitation(1.35±0.61)and in group C before and after 8 weeks(0.13±0.35)was very significant(P<0.01).③The differentia of patients'MRC grade dispersion in group B before and after pulmonary rehabilitation(1.00±0.53)and in group C before and after 8 weeks(0.13±0.35)was very significant(P<0.01).3.3 The influence of pulmonary rehabilitation to ADL:3.3.1 the comparison before and after pulmonary rehabilitation:①The patients'ADL grade in group A after pulmonary rehabilitation(5.41±0.62)was very higher than that of patients before pulmonary rehabilitation(4.25±0.85)(P<0.01).②The patients'ADL grade in group B after pulmonary rehabilitation(4.73±0.88)was higher than that of patients before pulmonary rehabilitation(4.00±0.97)(P<0.05).③The differentia of patients'ADL grade in group C before and after 8 weeks(4.05±0.89,4.07±0.70)wasn't significant(P>0.05).3.3.2 the comparison of different pulmonary rehabilitation:①The differentia of patients'ADL grade dispersion in group A before and after pulmonary rehabilitation (1.18±0.95)and in group B before and after pulmonary rehabilitation(0.40±1.18) was significant(P<0.05).②The differentia of patients'ADL grade dispersion in group A before and after pulmonary rehabilitation(1.18±0.95)and in group C before and after 8 weeks(0.06±0.88)was very significant(P<0.01).③The differentia of patients'ADL grade dispersion in group B before and after pulmonary rehabilitation (0.40±1.18)and in group C before and after 8 weeks(0.06±0.88)wasn't significant(P>0.05).3.4 The influence of pulmonary rehabilitation to QOL:3.4.1 the comparison before and after pulmonary rehabilitation:①The differentia of body status(52.1±26.3,78.2±29.5),short of breath(49.4±18.3,32.6±14.9),unease(41.2±19.4,23.7±18.6)was very significant (P<0.01),and the differentia of society activity(48.9±20.6,64.2±24.2),house-hold job(51.5±28.4,72.2±21.5)was significant(P<0.05),and the differentia of mood(54.8±21.2,69.7±23.8),head ache(15.7±11.7,10.9±10.8),appetite(57.5±29.7,60.1±25.7)wasn't significant(P>0.05)in group A before and after pulmonary rehabilitation respectively.②The differentia of short of breath(51.3±23.7,30.5±19.6)was very significan(tP<0.01),and the differentia of body statu(s54.1±24.7,73.2±23.8),society activity(47.1±25.8,65.4±23.7),house-hold job(52.3±28.2,71.1±22.5)was significant(P<0.05),and the differentia of mood(55.6±25.8,65.4±26.3),head ache(14.2±11.8,12.5±11.9),appetite(56.5±23.6,59.4±23.7),unease(43.8±17.5,32.9±15.1)wasn't significant(P>0.05)in group B before and after pulmonary rehabilitation respectively.③The differentia of body status(53.7±20.9,51.3±25.2),mood(52.3±23.5,52.1±22.4),short of breath(53.5±24.6,50.7±20.5),society activity(51.2±26.8,45.9±23.4),house-hold job(52.7±26.4,53.1±26.9),head ache(15.1±16.2,15.8±13.4),appetite(54.7±26.4,57.1±25.5),unease(43.4±18.1,41.2±19.7)wasn't significant(P>0.05)in group C before and after 8 weeks respectively.3.4.2 the comparison of different pulmonary rehabilitation:①The differentia of body status dispersion(27.9±22.3,24.5±21.7),mood dispersion(21.5±19.6,12.3±21.6),short of breath dispersion(21.6±15.8,24.7±21.9),society activity dispersion ( 20.5±19.3 , 21.6±21.9 ), house-hold job dispersion ( 21.8±24.6 ,17.9±18.7),head ache dispersion(6.23±12.4,2.58±10.6),appetite dispersion(4.86±23.8,3.85±21.8),unease dispersion(17.2±15.4,12.5±16.3)wasn't significant in group A before and after pulmonary rehabilitation and in group B before and after pulmonary rehabilitation respectively(P>0.05).②The differentia of body status dispersion(27.9±22.3,3.96±19.8),short of breath dispersion(21.6±15.8,2.33±21.8)was very significant(P<0.01),and the differentia of mood dispersion(21.5±19.6,1.24±18.5),society activity dispersion(20.5±19.3,4.26±23.5),house-hold job dispersion(21.8±24.6,2.72±24.8),unease dispersion(17.2±15.4,2.36±16.5)was significant(P<0.05),and the differentia of head ache dispersion(6.23±12.4,1.32±13.7),appetite dispersion(4.86±23.8,4.93±19.1)wasn't significan(tP>0.05)in group A before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively.③The differentia of short of breath dispersion(24.7±21.9,2.33±21.8)was very significant(P<0.01),and the differentia of body status dispersion(24.5±21.7,3.96±19.8),society activity dispersion(21.6±21.9,4.26±23.5)was significant(P<0.05),and the differentia of mood dispersion(12.3±21.6,1.24±18.5),house-hold job dispersion(17.9±18.7,2.72±24.8),head ache dispersion(2.58±10.6,1.32±13.7),appetite dispersion(3.85±21.8,4.93±19.1),unease dispersion(12.5±16.3,2.36±16.5)wasn't significant (P>0.05) in group B before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively.3.5 The influence of pulmonary rehabilitation to exercise tolerance:3.5.1 the comparison before and after pulmonary rehabilitation:①The patients'6MWD in group A after pulmonary rehabilitation(321.1±21.6 m)was very higher than that of patients before pulmonary rehabilitation(236.9±18.1 m)(P<0.01).②The patients'6MWD in group B after pulmonary rehabilitation(283.0±20.2 m)was very higher than that of patients before pulmonary rehabilitation(239.7±19.7 m)(P<0.01).③The differentia of patients'6MWD(234.6±21.7 m,232.9±15.5 m)in group C before and after 8 weeks wasn't significant(P>0.05).3.5.2 the comparison of different pulmonary rehabilitation:①The differentia of patients'6MWD dispersion in group A before and after pulmonary rehabilitation(83.71±27.1 m)and in group B before and after pulmonary rehabilitation(44.40±27.8 m)was very significant(P<0.01).②The differentia of patients' 6MWD dispersion in group A before and after pulmonary rehabilitation(83.71±27.1 m)and in group C before and after 8 weeks(0.066±15.9 m)was very significant(P<0.01).③The differentia of patients'6MWD dispersion in group B before and after pulmonary rehabilitation(44.40±27.8 m)and in group C before and after 8 weeks(0.066±15.9 m)was very significant(P<0.01).3.6 The influence of pulmonary rehabilitation to respiratory muscle function:3.6.1 the comparison before and after pulmonary rehabilitation:①The patients'MEP(11.04±0.65Kpa)and MIP(9.04±0.36 Kpa)in group A after pulmonary rehabilitation were very higher than those of MEP(9.26±0.28 Kpa)and MIP(7.72±0.53 Kpa)in group A before pulmonary rehabilitation respectively(P<0.01).②The patients'MEP(10.43±0.55 Kpa)and MIP(8.15±0.23 Kpa)in group B after pulmonary rehabilitation were very higher than those of MEP(9.15±0.33 Kpa)and MIP(7.59±0.66)in group B before pulmonary rehabilitation respectively(P<0.01).③The differentia of patients'MEP(9.12±0.29 Kpa,9.01±0.47 Kpa),MIP(7.64±0.59 Kpa,7.54±0.39 Kpa)in group C before and after 8 weeks wasn't significant respectively(P>0.05).3.6.2 the comparison of different pulmonary rehabilitation:①The differentia of patients'MEP dispersion(1.75±0.74 Kpa,1.13±0.42 Kpa)and MIP dispersion(1.36±0.62 Kpa,0.51±0.42 Kpa)in group A before and after pulmonary rehabilitation and in group B before and after pulmonary rehabilitation was very significant respectively(P<0.01).②The differentia of patients'MEP dispersion(1.75±0.74 Kpa,0.09±0.26 Kpa)and MIP dispersion(1.36±0.62 Kpa,0.10±0.35 Kpa)in group A before and after pulmonary rehabilitation and in group C before and after 8 weeks was very significant respectively(P<0.01).③The differentia of patients'MEP dispersion(1.13±0.42 Kpa,0.09±0.26Kpa)and MIP dispersion(0.51±0.42 Kpa,0.10±0.35 Kpa)in group B before and after pulmonary rehabilitation and in group C before and after 8 weeks was very significant respectively(P<0.01).3.7 The influence of pulmonary rehabilitation to pulmonary function(pre-inhaled bronchodilators): 3.7.1 the comparison before and after pulmonary rehabilitation:①The patients'MVV(24.9±3.7 L/m)in group A after pulmonary rehabilitation was very higher than that of MVV(18.7±2.6 L/m)in group A before pulmonary rehabilitation respectively(P<0.01),and the differentia of FEV1(0.72±0.11 L,0.78±0.10 L),FEV1(pred%)(33.5±6.2,37.8±7.4),FVC(1.48±0.17 L,1.52±0.18 L),FVC(pred%)(56.7±5.5,59.1±6.5),PEF(1.09±0.15 L/s,1.17±0.16 L/s)wasn't significant in group A before and after pulmonary rehabilitation respectively(P>0.05).②The patients'MVV(23.5±4.1 L/m)in group B after pulmonary rehabilitation was very higher than that of MVV(17.3±2.8 L/m)in group B before pulmonary rehabilitation(P<0.01),and the differentia of patients'FEV1(0.70±0.10 L,0.73±0.11 L),FEV1(pred%)(33.8±6.6,35.2±7.1),FVC(1.45±0.15 L,1.56±0.15 L),FVC(pred%)(54.3±5.5,56.3±6.4),PEF(1.10±0.16 L/s,1.16±0.19 L/s)wasn't significant in group B before and after pulmonary rehabilitation respectively(P>0.05).③The differentia of patients'FEV1(0.71±0.13 L,0.72±0.08 L),FEV1(pred%)(32.4±6.7,32.7±6.9),FVC(1.44±0.16 L,1.49±0.17 L),FVC(pred%)(53.2±5.8,54.9±6.2),MVV(18.5±3.2 L/m,18.9±3.7 L/m),PEF(1.07±0.17 L/s,1.08±0.16 L/s)wasn't significant in group C before and after 8 weeks respectively(P>0.05).3.7.2 the comparison of different pulmonary rehabilitation:①The differentia of FEV1 dispersion(0.07±0.12 L,0.04±0.13 L),FEV1(pred%)dispersion(4.21±6.9,2.52±7.4),FVC dispersion(0.05±0.16 L,0.08±0.17 L),FVC(pred%)dispersion(2.81±6.6,2.39±5.8),MVV dispersion(6.74±4.5 L/m,6.14±3.3 L/m),PEF dispersion(0.11±0.14 L/s,0.05±0.14 L/s)wasn't significant in group A before and after pulmonary rehabilitation and in group B before and after pulmonary rehabilitation respectively(P>0.05).②The differentia of patients'MVV dispersion(6.74±4.5 L/m,0.14±3.2 L/m)was very significant(P<0.01),and the differentia of patients'FEV1 dispersion(0.07±0.12 L,0.02±0.12 L),FEV1(pred%)dispersion(4.21±6.9,0.41±6.2),FVC dispersion(0.05±0.16 L,0.06±0.18 L),FVC(pred%)dispersion(2.81±6.6,2.61±6.3),PEF dispersion(0.11±0.14 L/s,0.03±0.18 L/s)wasn't significant in group A before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively(P>0.05).③The differentia of patients'MVV dispersion(6.14±3.3,0.14±3.2 L/m)was very significant(P<0.01),and the differentia of patients'FEV1 dispersion(0.04±0.13 L,0.02±0.12 L),FEV1(pred%)dispersion(2.52±7.4,0.41±6.2),FVC dispersion(0.08±0.17 L,0.06±0.18 L),FVC(pred%)dispersion(2.39±5.8,2.61±6.3),PEF dispersion(0.05±0.14 L/s,0.03±0.18 L/s)wasn't significant in group B before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively(P>0.05).3.8 The influence of pulmonary rehabilitation to pulmonary function(post-inhaled bronchodilators):3.8.1 the comparison before and after pulmonary rehabilitation:①The patients'MVV (26.7±4.3 L/m)in group A after pulmonary rehabilitation was very higher than that of MVV(20.2±3.5 L/m)in group A before pulmonary rehabilitation respectively(P<0.01),and the differentia of FEV1(0.73±0.18L,0.80±0.10 L),FEV1(pred%)(34.6±6.7,38.9±7.5),FVC(1.56±0.15 L,1.63±0.16 L),FVC(pred%)(57.2±5.6,59.8±6.5),PEF(1.11±0.17 L/s,1.20±0.15 L/s)wasn't significant in group A before and after pulmonary rehabilitation respectively(P>0.05).②The patients'MVV(23.9±3.8 L/m)in group B after pulmonary rehabilitation was very higher than that of MVV(19.7±4.2 L/m)in group B before pulmonary rehabilitation(P<0.01),and the differentia of patients'FEV1(0.71±0.10 L,0.74±0.11 L),FEV1(pred%)(35.4±6.8,36.9±7.3),FVC(1.53±0.13 L,1.58±0.15 L),FVC(pred%)(55.4±5.8,58.7±6.8),PEF(1.13±0.20 L/s,1.19±0.16 L/s)wasn't significant in group B before and after pulmonary rehabilitation respectively(P>0.05).③The differentia of patients'FEV1(0.72±0.13 L,0.73±0.12 L),FEV1(pred%)(34.1±6.5,34.5±6.9),FVC(1.49±0.15 L,1.54±0.14 L),FVC(pred%)(54.2±5.4,55.2±6.4),MVV(19.6±3.8 L/m,19.5±3.5 L/m),PEF(1.07±0.18 L/s,1.11±0.13 L/s)wasn't significant in group C before and after 8 weeks respectively(P>0.05).3.8.2 the comparison of different pulmonary rehabilitation:①The differentia of FEV1 dispersion(0.06±0.13 L,0.03±0.16 L),FEV1(pred%)dispersion(3.91±7.3,1.76±8.1),FVC dispersion(0.09±0.13 L,0.06±0.12 L),FVC(pred%)dispersion (2.63±6.2,2.72±4.2),MVV dispersion(6.47±5.1 L/m,5.96±4.5 L/m),PEF dispersion(0.13±0.19 L/s,0.07±0.18 L/s)wasn't significant in group A before and after pulmonary rehabilitation and in group B before and after pulmonary rehabilitation respectively(P>0.05).②The differentia of patients'MVV dispersion(6.47±5.1 L/m,0.16±4.1 L/m)was very significant(P<0.01),and the differentia of patients'FEV1 dispersion(0.06±0.13 L,0.02±0.17 L),FEV1(pred%)dispersion(3.91±7.3,0.53±5.4),FVC dispersion(0.09±0.13 L,0.05±0.16 L),FVC(pred%)dispersion(2.63±6.2,1.29±5.7),PEF dispersion(0.13±0.19 L/s,0.05±0.15 L/s)wasn't significant in group A before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively(P>0.05).③The differentia of patients'MVV dispersion(5.96±4.5 L/m,0.16±4.1 L/m)was very significant(P<0.01),and the differentia of patients'FEV1 dispersion(0.03±0.16 L,0.02±0.17 L),FEV1(pred%)dispersion(1.76±8.1,0.53±5.4),FVC dispersion(0.06±0.12 L,0.05±0.16 L),FVC(pred%)dispersion(2.72±4.2,1.29±5.7),PEF dispersion(0.07±0.18 L/s,0.05±0.15 L/s)wasn't significant in group B before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively(P>0.05).3.9 The influence of pulmonary rehabilitation to SpO2%,PaO2,PaCO2:3.9.1 the comparison before and after pulmonary rehabilitation:①The differentia of patients'PaO(283.6±2.7mmHg,91.5±2.4 mmHg)was very significan(tP<0.01),and the differentia of patients'SpO2%(93.6±1.7,94.3±1.6),PaCO(243.1±2.0 mmHg,43.4±4.3 mmHg ) wasn't significant in group A before and after pulmonary rehabilitation respectively(P>0.05).②The differentia of patients'PaO2(84.1±3.5 mmHg,90.3±4.1 mmHg)was very significant(P<0.01),and the differentia of patients'SpO2%(93.7±1.8,93.6±2.4),PaCO2(44.6±2.2 mmHg,43.6±1.9 mmHg)wasn't significant in group B before and after pulmonary rehabilitation respectively(P>0.05).③The differentia of patients'SpO2%(92.4±2.2,93.9±1.8),PaO2(84.7±3.9 mmHg,85.0±2.9 mmHg),PaCO2(44.1±2.1 mmHg,43.9±2.5 mmHg)in group C before and after 8 weeks wasn't significant respectively(P>0.05).3.9.2 the comparison of different pulmonary rehabilitation:①The differentia of patients'SpO2% dispersion(0.63±2.07,0.14±1.77),PaO2 dispersion(7.88±2.17 mmHg,6.14±4.95 mmHg),PaCO2 dispersion(0.25±2.05 mmHg,1.00±3.37 mmHg)wasn't significant in group A before and after pulmonary rehabilitation and in group B before and after pulmonary rehabilitation respectively(P>0.05).②The differentia of patients'PaO2 dispersion(7.88±2.17 mmHg,0.29±2.14 mmHg)was very significant(P<0.01).and the differentia of patients'SpO2% dispersion(0.63±2.07,1.43±2.64),PaCO2 dispersion(0.25±2.05 mmHg,0.29±3.77 mmHg)wasn't significant in group A before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively(P>0.05).③The differentia of patients'PaO2 dispersion(6.14±4.95 mmHg,0.29±2.14 mmHg)was very significan(tP<0.01).and the differentia of patients'SpO2% dispersion(0.14±1.77,1.43±2.64),PaCO2 dispersion(1.00±3.37 mmHg,0.29±3.77 mmHg)wasn't significant in group B before and after pulmonary rehabilitation and in group C before and after 8 weeks respectively(P>0.05).4. Conclusions:4.1 The pulmonary rehabilitation could ameliorate dyspnea,improve ADL,QOL,exercise tolerance,respiratory muscle function of the acute and severe patients with COPD remarkably.4.2 The pulmonary rehabilitation toward expiratory airflow limitation of COPD improved ADL,exercise tolerance,respiratory muscle function more than those of the pulmonary rehabilitation with pursed lips breathing.So the pulmonary rehabilitation toward expiratory airflow limitation of COPD could be considered as a more effective pulmonary rehabilitation method of the acute and severe patients with COPD.