Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Ziemssenstrasse 1, Munich, Germany.
Respiration. 2012;84(5):396-405. doi: 10.1159/000337271. Epub 2012 May 31.
Pulmonary rehabilitation is a well-recognized treatment option in chronic obstructive lung disease improving exercise performance, respiratory symptoms and quality of life. In occupational respiratory diseases, which can be rather cost-intensive due to the compensation needs, very little information is available.
This study aims at the evaluation of the usefulness of pulmonary rehabilitation in patients with occupational respiratory diseases, partly involving complex alterations of lung function and of the sustainability of effects.
We studied 263 patients with occupational respiratory diseases (asthma, silicosis, asbestosis, chronic obstructive pulmonary disease) using a 4-week inpatient rehabilitation program and follow-up examinations 3 and 12 months later. The outcomes evaluated were lung function, 6-min walking distance (6MWD), maximum exercise capacity (Wmax), skeletal muscle strength, respiratory symptoms, exacerbations and associated medical consultations, quality of life (SF-36, SGRQ), anxiety/depression (HADS) and Medical Research Council and Baseline and Transition Dyspnea Index scores.
Compared to baseline, there were significant (p < 0.05) improvements in 6MWD, Wmax and muscle strength immediately after rehabilitation, and these were maintained over 12 months (p < 0.05). Effects were less pronounced in asbestosis. Overall, a significant reduction in the rate of exacerbations by 35%, antibiotic therapy by 27% and use of health care services by 17% occurred within 12 months after rehabilitation. No changes were seen in the questionnaire outcomes.
Pulmonary rehabilitation is effective even in the complex settings of occupational respiratory diseases, providing sustained improvement of functional capacity and reducing health care utilization.
肺康复是慢性阻塞性肺疾病的一种公认的治疗选择，可改善运动表现、呼吸症状和生活质量。在职业性呼吸系统疾病中，由于赔偿需求，费用相当高，但关于肺康复的信息却很少。
本研究旨在评估肺康复在职业性呼吸系统疾病患者中的作用，部分涉及到肺功能和效果持续性的复杂改变。
我们使用为期 4 周的住院康复计划对 263 例职业性呼吸系统疾病（哮喘、矽肺、石棉肺、慢性阻塞性肺疾病）患者进行了研究，并在 3 个月和 12 个月后进行了随访检查。评估的结果包括肺功能、6 分钟步行距离（6MWD）、最大运动能力（Wmax）、骨骼肌力量、呼吸症状、恶化和相关医疗咨询、生活质量（SF-36、SGRQ）、焦虑/抑郁（HADS）以及医学研究理事会和基础及过渡期呼吸困难指数评分。
与基线相比，康复后即刻 6MWD、Wmax 和肌肉力量均有显著改善（p<0.05），并在 12 个月时保持（p<0.05）。在石棉肺中，效果不那么明显。总体而言，在康复后 12 个月内，恶化率降低了 35%，抗生素治疗降低了 27%，医疗保健服务使用降低了 17%。问卷结果没有变化。
肺康复在职业性呼吸系统疾病的复杂环境中也是有效的，能持续改善功能能力并减少医疗保健的利用。
