Atatürk Chest Disease and Chest Surgery Center/ PULMONARY REHABILITATION and HOME CARE UNIT

1. Evaluating the effects of pulmonary rehabilitation in patients with COPD in early and late diseases stages • Atatürk Chest Disease and Chest Surgery Center/ PULMONARY REHABILITATION and HOME CARE UNIT • Dr. Pınar Ergün, Dr. Ülkü Yılmaz Turay, • Dr. Dicle Kaymaz, Dr. Yurdanur Erdoğan, • Fzt. Neşe Demir, Fzt. Ebru Çanak, Dr. Atalay Çağlar

2. PULMONARY REHABILITATION Pulmonary rehabilitation is an evidence-based, multidisciplinary and compherensive intervention for patient with chronic respiratory diseases who are symptomatic and often have decreased daily life aktivities. ATS/ERS Am J. Resp Crit . Care Med 2006

3. GOLD Pulmonary rehabilitation was recomended from FEV1<80% COPD patients • Stage 1: FEV1≥ %80 • Stage 2:%50 ≤ FEV1<%80 • Stage 3:%30≤ FEV1<%50 • Stage 4:FEV1<30 or chronic respiratory failure

5. Aim of the study; To evaluate the effects of pulmonary rehabilitation in patients with COPD in early and late disease stages

6. Material and Metods 1 Thirty patients with stable COPD were undergone a comprehensive 8 weeks, 2 days in a week, 1,5 hours in a day Pulmonary Rehabilitation program at Atatürk Chest Diseases and Chest Surgery Center’s Pulmonary rehabilitation unit. Early stage (Stage1+2):10 patient Late stage (Stage 3+4):20 patient

7. Material and Metods 2 • Patients were assessed prior to beginning of the pulmonary rehabilitation programme and at the end of the 8 weeks program. • Dyspnea measurements; MRC and Modified Borg Scales, • Exercise capacity; Incremental (ISWT) and • Endurance Shuttle Walking Test (ESWT) • Health releated quality of life; SGRQ ,CRDQ

8. Pulmonary rehabilitation programme components Exercise Training Lower and upper limb strenght training Endurance Training (Interval ,continous training) • Training of respiratory muscle • EMS • Managment of Breathlessness Nutritional support Psychocial support Patient and families education

9. Group I (Stages1+2) Results: (n=10) Age: 59.80 ± 7.8 Smoking habit:43.10 ± 27.46

10. Group II (Stage 3+4) results:(n=20) Age: 62.45±7.27Smoking habit:40.9±29.54

11. Results 1 Patients’ (Stages 1+2) results in group I after the 8 week Pulmonary rehabilitation programme; • In Group I the only statistically meaningful differance was found in health releated quality of life evaluated with CRDQ (92.50±13.00 , 108.10±12.70 , p<0.05). • Dyspnea sensetion measured with MRC and Modified Borg scales did not reach statistically meaninfull levels. • Gains in exercise capacity did not reach statistically meaninfull levels.

12. Results 2 Patients’ (Stages 3+4) results in group II after the 8 week Pulmonary rehabilitation programme; • The differances in Dyspnea sensetion measured with MRC was found statistically meaningfull • The differances in Symptom scores of St.GRDQ and total scores of CRDQ were found statistically meaninfull. • The differances in exercise capacity didnot reach statistically meaningfull level.

13. CONCLUSION

14. Probable reasons for ;Why the gains in exercise capacity could not reach statistically meaningfull level in early disease stage? 1: Patient releated ; • Initial exercise capacity assessed with ISWT was not so low in this group of patients (256± 126m) • Exercise capacity was better than the late disease stage • Insufficient patient number Assessment releated; ISWT’s validty and sensitivity were shown in assessing exercise capacity in pulmonary rehabilitation patients. It was much more seldom from patient releated factors. This factor should not be the reason

15. Probable reasons for ;Why the gains in exercise capacity could not reach statistically meaningfull level in early disease stage? : 2 Feasiblty of exercise density; Exercise densities that were identified from ISWT at %85 of VO2 prescribed, and modified to patients tolerance Duration of pulmonary rehabilitation programs 4-12 weeks PR program duration accepted necessary for the program effectivness in guidelines. The gains in longer program duration is much more feasible. In our study patients undergone an 8 week out patient PR programs.

16. These results are consistant with the other study results In late disease stages, severe impairments would be responsible in small gains in exercise capacity Late disease stage, • Reductions in sensetion of dyspnea, • Increases in daily living activities • Though there were some gains in exercise capacity,they did not reach statistically meaningful level.

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