Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
Flanders International College of Osteopathy, Warsaw, Poland.
Adv Exp Med Biol. 2019;1222:17-25. doi: 10.1007/5584_2019_418.
Osteopathic manual therapy (OMT) may reduce hyperinflation in patients with chronic obstructive pulmonary disease (COPD) by improving breathing mechanics. The aim of the study was to evaluate the immediate effects of OMT on hyperinflation in stable COPD patients with forced expired volume in 1 s (FEV) <50% predicted. Nineteen COPD patients of the median age 68 (IQR 63-72) years and the median FEV 39.8 (IQR 33.4-46.6) % predicted were enrolled into the study. For the first session, patients were randomly assigned to either OMT or sham therapy. During the second session, the two groups of patients were crossed over. Pulmonary function and dyspnea were compared before and after both procedures. Neither pulmonary function nor dyspnea differed significantly before and after OMT or sham procedures. However, 36.7% and 47.4% patients achieved the minimally important difference for residual volume (RV) reduction after both OMT and sham therapy, respectively. Responders to OMT had a greater median (IQR) baseline sense of dyspnea compared to non-responders, assessed on a visual analog scale, of 7.0 (4.5-7.0) vs. 3.0 (0.0-5.0), p = 0.040, respectively. Although OMT did not have an immediate effect on hyperinflation or dyspnea, a subgroup experienced a reduction in RV following OMT and sham therapy. Future studies are needed to identify the characteristics of responders.
整脊手法治疗（OMT）可能通过改善呼吸力学来减少慢性阻塞性肺疾病（COPD）患者的过度充气。本研究的目的是评估 OMT 对用力呼气量 1 秒率（FEV）<50%预计值的稳定 COPD 患者过度充气的即刻影响。19 名 COPD 患者的中位年龄为 68（IQR 63-72）岁，中位 FEV 为 39.8（IQR 33.4-46.6）%预计值。在第一次治疗中，患者被随机分配到 OMT 或假治疗组。在第二次治疗中，两组患者进行交叉。在两次治疗前后比较肺功能和呼吸困难。OMT 或假治疗前后，肺功能和呼吸困难均无显著差异。然而，分别有 36.7%和 47.4%的患者在 OMT 和假治疗后达到残气量（RV）减少的最小临床重要差异。与非应答者相比，对 OMT 有反应的患者在视觉模拟量表上的基线呼吸困难感觉的中位数（IQR）更高，分别为 7.0（4.5-7.0）和 3.0（0.0-5.0），p=0.040。尽管 OMT 对过度充气或呼吸困难没有即刻影响，但亚组在接受 OMT 和假治疗后 RV 减少。需要进一步的研究来确定应答者的特征。
