Garrod Rachel, Lasserson Toby
School of Physiotherapy, St. George's, University of London, Faculty of Health and Social Care Sciences, Cranmer Terrace, London SW17 0RE, UK.
Respir Med. 2007 Dec;101(12):2429-36. doi: 10.1016/j.rmed.2007.06.007. Epub 2007 Sep 17.
Four Cochrane respiratory reviews of relevance to physiotherapeutic practice are discussed in this overview. Physiotherapists aim to improve ventilation for people with respiratory disease, and approach this using a variety of techniques. As such, the reviews chosen for discussion consider a wide range of interventions commonly used by physiotherapists: breathing exercises, bronchopulmonary hygiene techniques and physical training for peripheral and respiratory muscles. The reviews show that breathing exercises may have beneficial effects on health-related quality of life in asthma, and that inspiratory muscle training (IMT) may improve inspiratory muscle strength. However, the clinical relevance of increased respiratory muscle strength per se is unknown, and the longer-term effects of breathing exercises on morbidity have not been considered. One review clearly shows that bronchopulmonary hygiene techniques in chronic obstructive pulmonary disease (COPD) and bronchiectasis increase sputum production. Frequent exacerbation is associated with increased sputum and high bacterial load, suggesting that there may be important therapeutic benefit of improved sputum clearance. Future studies evaluating the long-term effects of bronchopulmonary hygiene techniques on morbidity are recommended. In the third review, the importance of pulmonary rehabilitation in the management of COPD is once again reinforced. Physiotherapists are crucial to the delivery of exercise training programmes, and it is likely that the effects of pulmonary rehabilitation extend to other important outcomes, such as hospital admission and re-admission. On the basis of the evidence provided by these Cochrane reviews, this overview highlights important practice points of relevance to physiotherapy, and recommendations for future studies.
本综述讨论了四项与物理治疗实践相关的Cochrane呼吸领域综述。物理治疗师旨在改善呼吸系统疾病患者的通气功能，并采用多种技术来实现这一目标。因此，本次讨论所选的综述考虑了物理治疗师常用的广泛干预措施：呼吸锻炼、支气管肺卫生技术以及外周和呼吸肌的体能训练。综述表明，呼吸锻炼可能对哮喘患者的健康相关生活质量产生有益影响，吸气肌训练（IMT）可能会提高吸气肌力量。然而，呼吸肌力量增强本身的临床相关性尚不清楚，且尚未考虑呼吸锻炼对发病率的长期影响。一项综述明确显示，慢性阻塞性肺疾病（COPD）和支气管扩张症中的支气管肺卫生技术会增加痰液生成。频繁发作与痰液增多和高细菌载量相关，这表明改善痰液清除可能具有重要的治疗益处。建议未来开展研究评估支气管肺卫生技术对发病率的长期影响。在第三项综述中，再次强调了肺康复在COPD管理中的重要性。物理治疗师对于实施运动训练计划至关重要，肺康复的效果可能会扩展到其他重要结局，如住院和再次入院。基于这些Cochrane综述提供的证据，本综述突出了与物理治疗相关的重要实践要点以及对未来研究的建议。
