Keniş-Coşkun Özge, Kocakaya Derya, Kurt Sefa, Fındık Büşranur, Yağcı İlker, Eryüksel Emel
Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Türkiye.
Department of Pulmonology, Marmara University Faculty of Medicine, Istanbul, Türkiye.
Turk J Phys Med Rehabil. 2022 Jun 1;68(2):195-204. doi: 10.5606/tftrd.2022.8239. eCollection 2022 Jun.
This study aimed to investigate the long-term use of bottle-positive expiratory pressure (PEP) in addition to breathing exercises as a home-based rehabilitation aid on exercise capacity, spirometric parameters, and quality of life in chronic obstructive pulmonary disease (COPD) patients.
From a total of 30 patients with stable moderate-to-severe COPD, 24 (22 males, 2 females; mean age: 62.4+7.2 years; range, 40 to 75 years) were included in the final study and randomized into two groups: the group that performed breath retaining techniques and the group that was instructed to use the bottle-PEP in addition to these techniques. Patients were evaluated with modified Medical Research Council scale, COPD assessment test (CAT), spirometry, St. George`s Respiratory Questionnaire (SGRQ), and 6-min walk distance (6MWD) before, three months and six months after the initiation of the program.
In the bottle-PEP group, patients` mean 6MWD increased from 380.6±67.6 to 444.1±22.0 m (p=0.002), the mean CAT score decreased from 17.8±36.8 to 12.9±6.2 (p=0.03), and the mean SGRQ total score significantly decreased from 57.1±23.1 to 47.6±21.9 (p<0.05) after three months. The improvement in 6MWD continued in six months but disappeared in SGRQ and CAT scores. In the exercise group, only the 6MWD improved, and there were no significant improvements in other parameters regardless of time. There were no significant differences between the groups in any of the parameters at any follow-up session.
While bottle-PEP does not significantly contribute when added to breathing exercises in patients with moderate-to-severe COPD in improving function and quality of life, it can be used as a safe choice in patients` home rehabilitation programs.
本研究旨在调查除呼吸锻炼外长期使用瓶式呼气末正压（PEP）作为家庭康复辅助手段对慢性阻塞性肺疾病（COPD）患者运动能力、肺功能参数和生活质量的影响。
从30例稳定期中度至重度COPD患者中，最终纳入24例（22例男性，2例女性；平均年龄：62.4±7.2岁；范围40至75岁）并随机分为两组：进行屏气技术的组和除这些技术外还被指导使用瓶式PEP的组。在项目开始前、开始后三个月和六个月，用改良的医学研究委员会量表、COPD评估测试（CAT）、肺功能测定、圣乔治呼吸问卷（SGRQ）和6分钟步行距离（6MWD）对患者进行评估。
在瓶式PEP组，患者的平均6MWD从380.6±67.6米增加到444.1±22.0米（p=0.002），平均CAT评分从17.8±36.8降至12.9±6.2（p=0.03），三个月后平均SGRQ总分从57.1±23.1显著降至47.6±21.9（p<0.05）。6MWD的改善在六个月时持续，但SGRQ和CAT评分的改善消失。在运动组，只有6MWD得到改善，其他参数无论时间如何均无显著改善。在任何随访阶段，两组在任何参数上均无显著差异。
虽然在中度至重度COPD患者中，瓶式PEP添加到呼吸锻炼中对改善功能和生活质量没有显著作用，但它可作为患者家庭康复计划中的一种安全选择。
