Integrative Medicine Service (Dr Deng and Ms Benusis), Pulmonary Medicine Service (Drs Feinstein and Stover), and Department of Epidemiology and Biostatistics (Ms Tin), Memorial Sloan Kettering Cancer Center, New York.
J Cardiopulm Rehabil Prev. 2019 Jan;39(1):56-59. doi: 10.1097/HCR.0000000000000368.
Dyspnea related to chronic pulmonary disorders is difficult to manage. In this single-arm study, we evaluated feasibility and potential efficacy of a self-care breath training program to reduce dyspnea that persists despite standard treatments in patients with chronic lung disease.
Adult patients with a chronic pulmonary disorder and stable moderate dyspnea received one 30-min training on specific breathing techniques, followed by audio-guided at-home practice 15 min twice daily for 6 wk, supported with weekly telephone monitoring/coaching. The feasibility endpoints, Baseline and Transition Dyspnea Indexes, 6-min walk test, Hospital Anxiety and Depression Scale, and oxygen saturation at rest and exercise were evaluated at baseline and wk 6.
Of the 23 patients enrolled over 2 yr, 19 completed the study. A majority (74%; 95% CI, 49%-91%) completed at least 75% of the home practice sessions. Significant objective improvements in physical performance, defined as distance walked, were observed after 6 wk of intervention. On average, patients walked significantly further in the 6-min walk test (59 ft; 95% CI, 18-99; P = .007). In addition, 53% reported clinically significant (20%, defined a priori) subjective improvement in the Transition Dyspnea Index, although the difference was not statistically significant (0.7; 95% CI, -0.8 to 2.3; P = .3). No significant differences were seen in the Hospital Anxiety and Depression Scale or oxygen saturation.
A low-burden, low-cost, self-care breath training program improved distance walked by patients with chronic dyspnea after 6 wk of home practice. Promising data suggest that a randomized trial of this breath training program is warranted.
与慢性肺部疾病相关的呼吸困难难以控制。在这项单臂研究中,我们评估了一种自我护理呼吸训练计划的可行性和潜在疗效,该计划旨在减轻慢性肺部疾病患者在接受标准治疗后仍持续存在的呼吸困难。
患有慢性肺部疾病且稳定的中度呼吸困难的成年患者接受一次 30 分钟的特定呼吸技术培训,然后在家中每天两次进行 15 分钟的音频引导练习,持续 6 周,每周通过电话监测/指导进行支持。在基线和第 6 周评估可行性终点(基础和过渡呼吸困难指数、6 分钟步行测试、医院焦虑和抑郁量表以及静息和运动时的血氧饱和度)。
在 2 年期间招募的 23 名患者中,有 19 名完成了研究。大多数(74%;95%置信区间,49%-91%)完成了至少 75%的家庭练习。干预 6 周后,观察到身体表现(定义为步行距离)的显著客观改善。平均而言,患者在 6 分钟步行测试中走得更远(59 英尺;95%置信区间,18-99;P=0.007)。此外,53%的患者报告过渡呼吸困难指数有临床显著(20%,预先定义)的主观改善,尽管差异无统计学意义(0.7;95%置信区间,-0.8 至 2.3;P=0.3)。医院焦虑和抑郁量表或血氧饱和度没有显著差异。
经过 6 周的家庭练习,一种低负担、低成本、自我护理的呼吸训练计划可提高慢性呼吸困难患者的步行距离。有希望的数据表明,该呼吸训练计划的随机试验是合理的。