This study was supported by the national fitness project of General Administration of Sport of China (No. 2017B021), the key basic research grants from Science and Technology Commission of Shanghai Municipality (No. 16JC1400500), the directed research grants from Science and Technology Commission of Shanghai Municipality (No. 18DZ1200600), and National Natural Science Foundation of China (No. 81472163).

The protocol has been approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated with Shanghai University of Traditional Chinese Medicine (Shanghai, China).
1. Video construction and study design
<ol>
	<li>Construct a video of the prescribed pulmonary exercise. Our video was based on the TCE video issued by the General Administration of Sport of China.
	<ol>
		<li>In the video, have a member of the research team in a spacious place display and give a general introduction to the different characteristics of the prescribed pulmonary exercises.</li>
		<li>Have the member simulate the exercises in different dimensions to clarify these characteristics. 
		NOTE: The video used here is in Chinese. The person in the video is of normal weight and is a middle-aged female in good physical shape, from Shanghai University of Traditional Chinese Medicine. The video structure and contents can be seen in Figure 1.</li>
	</ol>
	</li>
	<li>Use a parallel-designed single-blind randomized controlled trial to determine the effect of prescribed pulmonary exercise on COPD patients.
	<ol>
		<li>Obtain written, informed consent and collect basic characteristics including age, sex, body mass index (BMI), duration, and disease grade from recruited participants.</li>
		<li>Randomize the divided participants into two groups at a 1:1 ratio according to a random number table. 
		NOTE: Random numbers should be generated using a computer and enclosed in an opaque envelope by an independent individual who does not participate to achieve allocation concealment.</li>
	</ol>
	</li>
</ol>
2. Power calculation
<ol>
	<li>Conduct a power analysis using analysis software of choice to determine the minimal sample size necessary to obtain statistical results.
	<ol>
		<li>Choose an appropriate statistical test according to the study design.</li>
		<li>Select an assumed mean difference of the changes in quality of life after 3 months of intervention of prescribed pulmonary disease. This can be based on any previous work that may have been done.</li>
		<li>Select an assumed standard deviation (SD), as well as an appropriate alpha and power value.</li>
	</ol>
	</li>
	<li>Using a previous study as a reference (if possible) and considering the study design, define an assumed drop-out rate. 
	NOTE: The power analysis of this study was based on an independent t-test assuming equal variance. Based on the minimal clinical important difference of the total SGRQ and item scores21, the assumed mean difference was set at 4 scores, and the assumed SD in both groups was set at 3.6 scores according to previous studies17. The two-side significance level was set at an alpha-level of 0.05, and a power of 0.8. Results of the power calculation revealed that a total of 28 participants were needed (14/group). Considering a drop-out rate of about 15%, we planned to recruit 34 participants (17/group) (Figure 2).</li>
</ol>
3. Participant recruitment
NOTE: Participant recruitment in this example was conducted in the Department of Respiratory, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine.
<ol>
	<li>Recruit patients with stable COPD between the ages of 40 and 80. 
	NOTE: The COPD diagnosis was based on the guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC) &#60; 0.7, FEV1 &#60; 80% the predicted value)5.</li>
	<li>Exclude participants who have regularly exercised in the past 6 months (&#62;2x per week for &#62;60 min each). Also, exclude participants in acute exacerbation as well as those that have serious cardiovascular diseases or musculoskeletal disorders that could affect exercise intervention and testing programs.</li>
	<li>Ask participants for written consent after informing them about possible discomfort and risks during the training sessions and testing. The possible discomfort and risks include but are not limited to sourness of muscle, dizzy, dyspnea, and falling.</li>
</ol>
4. Training
<ol>
	<li>Give training instructions 3x within 2 weeks to PG participants before the formal training session. Ask participants to study the complete action and breathing requirements of each intervention.</li>
	<li>Deliver the video of the prescribed pulmonary exercises and the exercise record brochure to all participants.</li>
	<li>Instruct PG participants to perform the prescribed pulmonary exercises in accordance with the intervention program (60 min each, 2x per day, 7 days a week, for a total of 3 months). 
	NOTE: On Sunday afternoons, ask participants to gather in the hospital to perform exercises under the supervision and instruction of physiotherapists, and for the remaining 6 days to perform exercises at home.
	<ol>
		<li>Instruct PG participants to perform a warm-up exercise for 10 min, mainly focusing on dynamic flexibility exercises of involved muscle groups and stretching muscles.</li>
		<li>Instruct PG participants to perform prescribed pulmonary exercises for 40 min, which is composed of six characteristics including the &#8220;hu&#8221; and &#8220;si&#8221; sounds in liu zi jue, &#8220;pushing up the sky to regulate the triple warmer&#8221; and &#8220;drawing a bow to shoot a vulture&#8221; in ba duan jin, &#8220;the crane actions&#8221; in wu qin xi, and &#8220;cross-armed iron staff&#8221; in yi jin jing22. 
		NOTE: Evaluate the exercise intensity using the Borg category-ratio 10 (Borg CR-10) and ask participants to maintain a level of dyspnea in the range of 4 to 623. In the hospital, the Borg CR-10 and heart rate monitor (Polar team2)&#160;are both used to evaluate exercise intensity.</li>
		<li>Instruct PG participants to perform a cool-down exercise for 10 min, mainly focusing on stretching and relaxing the muscles.</li>
	</ol>
	</li>
	<li>Ask participants to record detailed information after each exercise session in the exercise record brochure, including details about exercise method, time, duration, intensity, and site.</li>
</ol>
5. Outcome assessment
NOTE: Conduct an assessment session within 7 days before and after the formal intervention.
<ol>
	<li>Assessment of height, weight, and body composition
	<ol>
		<li>Ask participants to remove all items and metal objects from their clothing and bodies.</li>
		<li>Ask participants to stand barefoot on the corresponding positions of the electrode pads with their back to the instrument column. Wait briefly for the apparatus to automatically print data including height, weight, body fat, and BMI.</li>
	</ol>
	</li>
	<li>Six minutes walking test (6MWT)
	<ol>
		<li>Perform the 6MWT in accordance with the technical standard described by European Respiratory Society/American Thoracic Society (ERS/ATS)24.</li>
		<li>Explain the test procedure and inform participants that temporary rest is available when discomfort or exhaustion arises. Encourage participants to walk as fast as they can during the 6 min duration.</li>
		<li>Prior to the test, inquire participants about their levels of dyspnea using the Borg CR10.</li>
		<li>Ask participants to walk back and forth as quickly as possible in a marked, 30 m straight line. Standardized phrases of encouragement are used for each minute.</li>
		<li>After 6 min, ask participants to stand stationary, then record their distance in meters and levels of dyspnea.</li>
		<li>After a 30 min rest, instruct participants to perform the test a second time.</li>
	</ol>
	</li>
	<li>30 seconds arm curl test 
	NOTE: The 30 s arm curl test was carried out according to the senior fitness test manual25.
	<ol>
		<li>Explain and demonstrate the test procedure and inform participants that the test should be performed as quickly as possible during a 30 s duration. 
		NOTE: The test is initiated from the down position to the arm curl position, and the wrist should not move during the motion.</li>
		<li>Ask participants to sit on a 43 cm tall straight-back armless chair with their backs upright and feet flat on the ground.</li>
		<li>Ask participants to perform the arm curl motion 1&#8211;2x to familiarize.</li>
		<li>Ask participants to hold the dumbbells (8 lbs for men, 5 lbs for women) using the dominant hand.</li>
		<li>On the signal &#8220;go&#8221;, instruct participants to curl the weight through a full range of motion as many times as possible in 30 s. A researcher should stand to the side to time and record the results.</li>
	</ol>
	</li>
	<li>30 seconds sit-to-stand test 
	NOTE: The 30 s SST was performed according to the senior fitness test manual25.
	<ol>
		<li>Place a chair with the backrest leaning against a wall.</li>
		<li>Explain and demonstrate the test procedure and inform participants that the test should be performed as quickly as possible in 30 s. 
		NOTE: The test is initiated from a seating position, with feet separated and knee flexed at about 90&#176;.</li>
		<li>Ask participants to sit in the middle of the chair with back straight, arms crossed on the chest and placed on the opposite shoulder.</li>
		<li>Ask participants to perform the sitting up motion 1&#8211;2x to familiarize.</li>
		<li>On the signal &#8220;go&#8221;, instruct participants to stand up and sit down as many times as possible in 30 s. A researcher should stand to the side to time and record the results. 
		NOTE: If participants conduct more than half of the motion at the end of the 30 s duration, this counts as a full motion.</li>
	</ol>
	</li>
	<li>Questionnaire for quality of life
	<ol>
		<li>Ask participants to complete the SGRQ to assess quality of life. The SGRQ consists of three subdomains including symptoms (cough, cough, asthma attacks, etc.), activity (climbing, dressing, housework, etc.), and impact (anxiety, pain, insecurity, etc.)26,27.</li>
		<li>Calculate final SGRQ scores (total and sub-domains) per previous protocols, using analysis software of choice26,27. 
		NOTE: Participants who display deficiency of knowledge or defects in vision should complete the questionnaire with the help of staff.</li>
	</ol>
	</li>
</ol>
6. Statistical analysis
<ol>
	<li>Carry out statistical analysis using software of choice.</li>
	<li>Conduct normality and variance homogeneity tests for continuous data.</li>
	<li>Conduct two paired t-tests or a Wilcoxon rank-sum test to analyze differences within the group according to data normality and variance.</li>
	<li>Calculate the changes after 3 months of intervention as post-values minus pre-values.</li>
	<li>Conduct an independent t-test or Mann-Whitney U test to analyze differences between the group according to change-value normality and variance.</li>
	<li>Conduct a chi-squared (&#967;2) test for category data. 
	NOTE: Conduct a two-sided test and use p &#60; 0.05 as the significance cut-off value.</li>
</ol>

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<li>Covey, M., Collins, E., Reynertson, S., Dilling, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Resistance+training+as+a+preconditioning+strategy+for+enhancing+aerobic+exercise+training+outcomes+in+COPD%5BTitle%5D)+AND+%22Respiratory+Medicine%22%5BJournal%5D)">Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD.</a> Respiratory Medicine. 108 (8), 1141-1152 (2014).</li>
<li>Chan, A., Lee, A., Lee, D., Sit, J., Chair, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+the+sustaining+effects+of+Tai+Chi+Qigong+in+the+sixth+month+in+promoting+psychosocial+health+in+COPD+patients%3A+a+single-blind%2C+randomized+controlled+trial%5BTitle%5D)+AND+%22ScientificWorldJournal%22%5BJournal%5D)">Evaluation of the sustaining effects of Tai Chi Qigong in the sixth month in promoting psychosocial health in COPD patients: a single-blind, randomized controlled trial.</a> ScientificWorldJournal. 2013, 425082(2013).</li>
<li>Wuytack, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+of+outpatient+and+home-based+exercise+training+programmes+for+COPD%3A+a+systematic+review+and+meta-analysis%5BTitle%5D)+AND+%22Respirology%22%5BJournal%5D)">Comparison of outpatient and home-based exercise training programmes for COPD: a systematic review and meta-analysis.</a> Respirology. 23 (3), 272-283 (2018).</li>
</ol>

The authors have nothing to disclose.

In this study, a modified TCE referred to as prescribed pulmonary exercise is used in an intervention program, and a number of fitness tests are used to investigate the effects of home-based prescribed pulmonary exercise on exercise capacity and quality of life in stable COPD patients. The main finding is that many improvements occurred in upper and lower limb exercise capacity, endurance exercise capacity, and quality of life after 3 months of intervention. The results indicate that prescribed pulmonary exercise as a CO...

Chronic non-communicable diseases have gradually become the biggest threat to global health, accounting for 70% of global mortality. A majority of such deaths have been caused by four main diseases, while COPD ranks third and only falls behind cardiovascular disease and cancer. Moreover, the ranking of COPD in leading to years of life lost has risen from eleventh in 2007 to seventh in 20171. This change indicates unsatisfactory effects of current treatments in the rehabilitation of COPD progression. More studies have recognized that COPD is not only a respiratory disease but also a complex, multi-systemic, and multi-complicative condition2,3. COPD complications (i.e., skeletal muscle dysfunction) exist in all stages of the disease and play an important role in progression and prognosis4. Considering interactions between the respiratory symptoms and exercise capacity, rehabilitation of exercise capacity has received a lot of attention.
Pulmonary rehabilitation as a comprehensive intervention program, including but not limited to exercise training, health education, and self-management, has demonstrated effectiveness on physical and psychological condition of COPD patients5. Among the different types of exercise training, aerobic exercise plays a critical role in the improvement of endurance performance and muscle power6. In contrast, resistance exercise shows advantages in the improvement of muscle strength and functional exercise capacity7. Moreover, the interventional mechanisms of these two exercise types are distinct. Compared to resistance exercise, aerobic exercise is more effective in modulating inflammatory cytokine levels and inducing oxidized phenotypes of the quadriceps8,9.
Although the effects of these two conventional exercises in pulmonary rehabilitation has been demonstrated, regardless of the location (in hospital or at home)10,11, implementation of conventional exercise training is still limited due to the requirements of specific equipment, spacious room, and safety monitoring. These constraints not only inflict a burden on a patient&rsquo;s family but also to the healthcare system. Alternative interventions such as neuromuscular electrical stimulation and whole-body vibration training share the same constraints12,13.
Traditional Chinese exercises (TCE), including tai chi, liu zi jue, wu qin xi, ba duan jin, and yi jin jing, belong to the self-exercise category, which focuses on adjustment of the breath accompanied with coordinated movement. These exercises also rely on psychological-physiological-morphological mechanisms to achieve health-related fitness. Previous studies have shown that 1) TCE as a low-and medium-intensity aerobic exercise induces a maximum heart rate of 43%&ndash;49%14, 2) exercise intensity ranges from 1.5 to 2.6 metabolic equivalents of energy (METs)15, and 3) it exerts positive effects in patients with stable COPD through clinical and family rehabilitation16,17,18,19. Compared to conventional exercise training, the advantage of TCE is that it is easy to execute at home without any equipment or spatial constraints.
As a modified TCE, the prescribed pulmonary exercise described in this protocol has been developed from the theory of traditional Chinese medicine and aims at the rehabilitation of COPD dyspnea and exercise capacity. Previous studies have showed significant improvements in the exercise capacity (assessed by 6 min walking test, 6MWT), daily life (Zhongshan COPD questionnaire for quality of life), and systemic inflammation levels in COPD patients after prescribed pulmonary exercise20. However, the effects of prescribed pulmonary exercise on the exercise capacity of upper and lower limbs and quality of life in COPD patients is still unclear.
This study compares 3 months of usual medicinal treatment without exercise intervention (control group, CG) vs. 3 months of prescribed pulmonary exercise intervention (PG) in stable COPD patients to investigate the effects of prescribed pulmonary exercise. The effects on upper limb exercise capacity are evaluated by the 30 s arm curl test, effects on lower limb exercise capacity evaluated by the 30 s sit-to-stand test (30 s SST), effects on endurance exercise capacity evaluated by the 6 min walking test (6MWT), and effects on quality of life evaluated by St. George&rsquo;s Respiratory Questionnaire (SGRQ).

<table><tbody><tr><td>4643a</td><td>Tanita</td><td></td><td>Used for the evaluation of height, weight, and body mass index</td></tr><tr><td>Borg CR10</td><td>None</td><td></td><td>Used for the evaluation of dyapnea</td></tr><tr><td>PASS 15.0</td><td>NCSS, LLC</td><td></td><td>Used for power calculation</td></tr><tr><td>Polar team 2</td><td>Polar</td><td></td><td>Used for supervising the heart rate of participants</td></tr><tr><td>SGRQ software</td><td>Developed by Peking Union Medical College</td><td></td><td>Used for calculating the score of quality of life</td></tr><tr><td>SPSS 24.0</td><td>IBM Corporation</td><td></td><td>Used for statistical analysis</td></tr></tbody></table>

home-based prescribed pulmonary exercise in patients with stable chronic obstructive pulmonary disease

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also impacts exercise capacity and forms a vicious circle in which it further aggravates the condition of patients and accelerates disease progression. As a functional holistic exercise, traditional Chinese exercises (TCE) play an important role in the rehabilitation of COPD on the basis of adjusting the breath and performing coordinated movements. This study investigates the effects of prescribed pulmonary exercises (which are modified from TCE) on exercise capacity of upper and lower limbs, endurance exercise capacity, and quality of life in stable COPD patients. The goal is to determine the accessibility of these prescribed exercises in COPD rehabilitation. Participants are randomly divided into a non-exercise control group (CG) or prescribed pulmonary exercise group (PG) at a ratio of 1: 1. The PG receives intervention for 60 min twice per day, 7 days a week, for a total of 3 months. The intensity is measured using the Borg category-ratio 10 scale and with a heart-rate monitor. Then, an exercise capacity test and quality of life questionnaire are scheduled at 1 week before and after the formal intervention. After 3 months of intervention, the 30 s arm curl test, 30 s sit-to-stand test, 6 min walking test, and quality of life show significant improvement in COPD patients (p &#60; 0.05). These findings indicate that prescribed pulmonary exercises can be applied as alternative, convenient, and effective home- and community-based exercises for stable COPD patients.

The protocol above describes a randomized controlled trial to investigate whether prescribed pulmonary exercise improves exercise capacity and quality of life in stable COPD patients. While 44 participants were recruited, only 37 (84%) participants completed the study (CG = 19, PG = 18). Thus, data analysis was carried out using the 37 participants, and the two groups showed no significant differences in basic characteristics including age, sex, BMI, duration, and disease grade (Table 1).
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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

Presented here is a protocol to investigate the effects of home-based prescribed pulmonary exercise in stable chronic obstructive pulmonary disease (COPD) patients, which is modified based on traditional Chinese exercises according to dyspnea and limited exercise capacity observed in COPD patients.

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also ...

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9.7K Views.  Shanghai University of Traditional Chinese Medicine. Dit protocol kan worden toegepast als een handig alternatief en effectief community-gebaseerd trainingsprogramma voor stabiele COPD-patiënten. De voorgeschreven longoefening is ontwikkeld vanuit de theorie van de traditionele Chinese geneeskunde en zijn gericht op de rehabilitatie van COPD dyspneuma en de oefeningscapaciteit. Deze methode kan ook worden gebruikt de geriatrische methode om de cardiovasculaire en bewegingsapparaat fitness te verbeteren en de geleidelijk gedaalde geschiktheid v...

Video: Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Pulmonary rehabilitation (PR) is an important component in the management of respiratory diseases. The effectiveness of PR is dependent upon adherence to exercise training recommendations. The study of exercise adherence is thus a key step towards the optimization of PR programs. To date, mostly indirect measures, such as rates of participation, completion, and attendance, have been used to determine adherence to PR. The purpose of the present protocol is to describe how continuous data tracking technology can be used to measure adherence to a prescribed aerobic training intensity on a second-by-second basis.
In our investigations, adherence has been defined as the percent time spent within a specified target heart rate range. As such, using a combination of hardware and software, heart rate is measured, tracked, and recorded during cycling second-by-second for each participant, for each exercise session. Using statistical software, the data is subsequently extracted and analyzed. The same protocol can be applied to determine adherence to other measures of exercise intensity, such as time spent at a specified wattage, level, or speed on the cycle ergometer. Furthermore, the hardware and software is also available to measure adherence to other modes of training, such as the treadmill, elliptical, stepper, and arm ergometer. The present protocol, therefore, has a vast applicability to directly measure adherence to aerobic exercise.

Pulmonary rehabilitation is widely recognized in the management of respiratory diseases. A key component to successful pulmonary rehabilitation is adherence to the recommended exercise training. The purpose of the present protocol is to describe how continuous data tracking technology can be used to precisely measure adherence to a prescribed aerobic training intensity.

Pulmonary rehabilitation (PR) is an important component in the management of respiratory diseases. The effectiveness of PR is dependent upon adherence to ...

Medicine

Generation of a Chronic Obstructive Pulmonary Disease Model in Mice by Repeated Ozone Exposure

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and lung parenchymal destruction. It has a very high incidence in aging populations. The current conventional therapies for COPD focus mainly on symptom-modifying drugs; thus, the development of new therapies is urgently needed. Qualified animal models of COPD could help to characterize the underlying mechanisms and can be used for new drug screening. Current COPD models, such as lipopolysaccharide (LPS) or the porcine pancreatic elastase (PPE)-induced emphysema model, generate COPD-like lesions in the lungs and airways but do not otherwise resemble the pathogenesis of human COPD. A cigarette smoke (CS)-induced model remains one of the most popular because it not only simulates COPD-like lesions in the respiratory system, but it is also based on one of the main hazardous materials that causes COPD in humans. However, the time-consuming and labor-intensive aspects of the CS-induced model dramatically limit its application in new drug screening. In this study, we successfully generated a new COPD model by exposing mice to high levels of ozone. This model demonstrated the following: 1) decreased forced expiratory volume 25, 50, and 75/forced vital capacity (FEV25/FVC, FEV50/FVC, and FEV75/FVC), indicating the deterioration of lung function; 2) enlarged lung alveoli, with lung parenchymal destruction; 3) reduced fatigue time and distance; and 4) increased inflammation. Taken together, these data demonstrate that the ozone exposure (OE) model is a reliable animal model that is similar to humans because ozone overexposure is one of the etiological factors of COPD. Additionally, it only took 6 - 8 weeks, based on our previous work, to create an OE model, whereas it requires 3 - 12 months to induce the cigarette smoke model, indicating that the OE model might be a good choice for COPD research.

This study describes the successful generation of a new chronic obstructive pulmonary disease (COPD) animal model by repeatedly exposing mice to high concentrations of ozone.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and lung parenchymal destruction. It has a very high ...

Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction (HF). However, in clinical cardiopulmonary exercise testing (CPET), cerebral hemodynamics is not assessed. NIRS is used to measure cerebral tissue oxygen saturation (SctO2) in the frontal lobe. This method is reliable and valid and has been utilized in several studies. SctO2 is lower during both rest and peak exercise in patients with HF than in healthy controls (66.3 &#177; 13.3% and 63.4 &#177; 13.8% vs. 73.1 &#177; 2.8% and 72 &#177; 3.2%). SctO2 at rest is significantly linearly correlated with peak VO2 (r = 0.602), oxygen uptake efficiency slope (r = 0.501), and brain natriuretic peptide (r = -0.492), all of which are recognized prognostic and disease severity markers, indicating its potential prognostic value. SctO2 is determined mainly by end-tidal CO2 pressure, mean arterial pressure, and hemoglobin in the HF population. This article demonstrates a protocol that integrates SctO2 using NIRS into incremental CPET on a calibrated bicycle ergometer.

This protocol integrated near-infrared spectroscopy into conventional cardiopulmonary exercise testing to identify the involvement of the cerebral hemodynamic response in exercise intolerance in patients with heart failure.

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction ...

Conducting Respiratory Oscillometry in an Outpatient Setting

Respiratory oscillometry is a different modality of pulmonary function testing that is increasingly used in a clinical and research setting to provide information regarding lung mechanics. Respiratory oscillometry is conducted through three acceptable measurements of tidal breathing and can be performed with minimal contraindications. Young children and patients who cannot perform spirometry due to cognitive or physical impairment can usually complete oscillometry. The main advantages of respiratory oscillometry are that it requires minimal patient cooperation and is more sensitive in detecting changes in small airways than conventional pulmonary function tests. Commercial devices are now available. Updated technical guidelines, standard operating protocols, and quality control/assurance guidelines have recently been published. Reference values are also available. 
We conducted oscillometry test audits before and after implementing a formal respiratory oscillometry training program and standard operating protocol. We observed improvement in the quality of tests completed, with a significant increase in the number of acceptable and reproducible measurements. 
The current paper outlines and demonstrates a standard operating protocol to conduct respiratory oscillometry in an outpatient setting. We highlight the key steps to ensuring acceptable and reproducible quality measurements according to the recommended European Respiratory Society (ERS) guidelines, as quality control is critical to measurement accuracies. Potential problems and pitfalls are also discussed with suggestions to resolve technical errors.

We demonstrate a standard operating protocol to conduct respiratory oscillometry, highlighting key quality control and assurance procedures.

Respiratory oscillometry is a different modality of pulmonary function testing that is increasingly used in a clinical and research setting to provide ...

Assessing Pulmonary Alveolar-Capillary Reserve During Exercise

Dual Test Gas Pulmonary Diffusing Capacity Measurement During Exercise in Humans Using the Single-Breath Method

The combined single-breath measurement of the diffusing capacity of carbon monoxide (DL,CO) and nitric oxide (DL,NO) is a useful technique to measure pulmonary alveolar-capillary reserve in both healthy and patient populations. The measurement provides an estimate of the participant&#39;s ability to recruit and distend pulmonary capillaries. The method has recently been reported to exhibit a high test-retest reliability in healthy volunteers during exercise of light to moderate intensity. Of note, this technique permits up to 12 repeated maneuvers and only requires a single breath with a relatively short breath-hold time of 5 s. Representative data are provided showing the gradual changes in DL,NO and DL,CO from rest to exercise at increasing intensities&#160;of up to 60% of maximal workload. The measurement of diffusing capacity and evaluation of alveolar-capillary reserve is a useful tool to evaluate the lung&#39;s ability to respond to exercise both in the healthy population as well as in patient populations such as those with chronic lung disease.

Author Spotlight: Integrating Alveolar-Capillary Reserve Measurements in Exercise Adaptation and Therapeutic Strategies

This protocol presents a method to assess pulmonary alveolar-capillary reserve measured by combined single-breath measurement of the diffusing capacity to carbon monoxide (DL,CO) and nitric oxide (DL,NO) during exercise. Assumptions and recommendations for using the technique during exercise form the foundation of this article.

The combined single-breath measurement of the diffusing capacity of carbon monoxide (DL,CO) and nitric oxide (DL,NO) is a useful technique to measure ...

Acupoint and Ear Plaster Therapy for Treating Sleep Disorders in AECOPD Patients

Acupoint Application Combined with Ear Plaster Therapy for Treating Sleep Disorders with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by persistent airflow limitation, which is not fully reversible and progressive. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) refers to acute changes in respiratory distress, cough, and sputum in COPD patients at baseline levels. Sleep disorders are a very common complication in patients with AECOPD. At present, long-term use of sedative-hypnotics alone has many side effects, such as mental and physical dependence and cognitive impairment. While the efficacy of other special intervention methods is not clear, and the cost is high, there is an urgent need for effective and safe treatment in clinics. Acupoint application and ear plaster therapy are considered the characteristic therapies of traditional Chinese medicine. They have the advantages of small side effects, high safety, and simple procedure. This study will elucidate in detail the specific process and efficacy of the two treatment methods for AECOPD complicated with sleep disorders, including medical devices used, selection of acupoints, procedure, and posttreatment care. This study is intended to provide a new reference for the clinical treatment modality of this type of disease.

Author Spotlight: Traditional Chinese Medicine for Sleep Disorders in Acute COPD &#8212; A Safe, Cost-Effective Approach

The present protocol describes the specific process and efficacy of the acupoint application combined with ear plaster therapy for sleep disorders in a patient with acute exacerbation of chronic obstructive pulmonary disease, including medical devices, selection of acupoints, operating methods, and posttreatment care.

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by persistent airflow limitation, which is not fully reversible and ...

Chest Physiotherapy

Chest Physiotherapy (CPT) is a therapeutic technique used in respiratory care to improve ventilation, clear bronchial secretions, and enhance the efficiency of respiratory muscles. This therapy includes three primary procedures: postural drainage, percussion, and vibration. It can be performed on spontaneously breathing patients and those who are intubated and mechanically ventilated.
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing them. This therapy helps loosen and mobilize these secretions, increasing mucous clearance and making it easier for the patient to expectorate. Conditions such as atelectasis, cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and pneumonia can all benefit from this therapy.
Procedure Guide for Nurses
Postural Drainage
Postural drainage utilizes positioning techniques to facilitate the drainage of secretions from targeted lung and bronchial segments into the trachea. The position used depends on the affected areas of the lungs. The patient stays in the chosen posture for about 5 minutes during percussion and vibration. Procedures should be scheduled at least one hour before or three hours after meals.
It&#39;s important to note that postural drainage can also be assisted by using a Chest physiotherapy vest or hospital beds equipped with vibration and percussion features, which can provide chest physiotherapy without manual techniques.
Percussion
Percussion is performed by placing the hands in a cup-like position with the fingers and thumbs closed. The cupped hand should create an air pocket between the patient&#39;s chest and the hand. Both hands alternate rhythmically, promoting the movement of thick mucus. To prevent tissue damage, it is essential to avoid performing percussion on bare skin and surgical incisions below the ribs, over the breasts, or over the spine.
Vibration
Vibration promotes the movement of secretions to the larger airways. It is performed by repeatedly tensing the hand and arm muscles and pressing mildly with the flat of the hand on the affected area while the patient slowly exhales a deep breath. To avoid causing discomfort, vibration should never be performed over the patient&#39;s breasts, spine, sternum, or lower rib cage.
Conclusion
Chest Physiotherapy is a critical procedure in managing patients with excessive bronchial secretions or conditions like CF, COPD, and pneumonia. When properly executed, it can significantly improve a patient&#39;s respiratory function and overall comfort.

Chest physiotherapy is a therapeutic technique for enhancing ventilation, removing bronchial secretions, and increasing respiratory muscle efficiency, ...

Fundamentals of Respiratory Care: Techniques and Management

KEY TERMS AND CONCEPTS

Chronic Obstructive Pulmonary Disease-I: Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a long-lasting respiratory condition requiring continuous attention and care. It is a progressive lung disease that leads to breathing challenges due to airflow obstruction. It manifests as persistent respiratory symptoms and restricted airflow resulting from abnormalities in the airways and alveoli, usually due to long-term exposure to harmful particles or gases. COPD mainly consists of two primary conditions: emphysema and chronic bronchitis.
Emphysema: Emphysema damages air sacs in the lungs, called alveoli, reducing their elasticity and causing air to become trapped in the lungs.
Chronic Bronchitis: Chronic bronchitis is distinguished by persistent coughing and mucus secretion due to inflammation of the bronchial tubes and airways within the lungs.
Risk Factors for COPD:
<ul>
	<li>&#8226; Cigarette Smoking: The primary risk factor for COPD, as it damages the lungs and airways.</li>
</ul>
<ul>
	<li>&#8226; Environmental Exposures include secondhand smoke and occupational exposure to dust, chemicals, and other irritants.</li>
</ul>
<ul>
	<li>&#8226; Air Pollution: COPD can be caused by both indoor and outdoor air pollution.</li>
</ul>
<ul>
	<li>&#8226; Genetic Factors: Genetic abnormalities like alpha-1 antitrypsin deficiency can raise the risk of developing COPD.</li>
</ul>
<ul>
	<li>&#8226; Age: The risk of COPD increases with age due to the cumulative effects of lung irritants and the natural aging of lung tissue.</li>
</ul>
<ul>
	<li>&#8226; Respiratory Infections: Frequent respiratory infections during childhood and adulthood can contribute to the development of COPD.</li>
</ul>
<ul>
	<li>&#8226; Socioeconomic Status: Lower socioeconomic status is often associated with higher exposure to risk factors for COPD.</li>
</ul>
Categories of COPD: COPD is typically categorized based on the severity of airflow limitation. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) offers a classification framework, based on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC):
<ul>
	<li>&#8226; FEV1 assesses the volume of air exhaled within one second during a forced breath.</li>
	<li>&#8226; FVC is the total air exhaled during a forced breath.</li>
</ul>
Understanding these stages helps determine the appropriate treatment and management strategies for individuals with COPD. The stages are
<ul>
	<li>&#8226; Mild COPD (GOLD 1): FEV1/FVC &#60; 70% and FEV1 &#8805; 80% predicted. Symptoms include minimal breathlessness, usually only during strenuous exercise, with chronic cough possibly being the only symptom.</li>
</ul>
<ul>
	<li>&#8226; Moderate COPD (GOLD 2): FEV1/FVC &#60; 70% and 50% &#8804; FEV1 &#60; 80% predicted. Increased breathlessness, especially during exertion, with chronic cough and frequent respiratory infections.</li>
</ul>
<ul>
	<li>&#8226; Severe COPD (GOLD 3): FEV1/FVC &#60; 70% and 30% &#8804; FEV1 &#60; 50% predicted. Further airflow limitations worsened with increased shortness of breath, reduced exercise capacity, and repeated exacerbations.</li>
</ul>
<ul>
	<li>&#8226; Very Severe COPD (GOLD 4): FEV1/FVC &#60; 70% and FEV1 &#60; 30% predicted, or FEV1 &#60; 50% predicted, plus chronic respiratory failure. Severe airflow limitations lead to life-threatening exacerbations and significant quality-of-life impairment.</li>
</ul>
Spirometry and imaging tests are the most commonly used diagnostic tools for COPD.
<ul>
	<li>&#8226; Spirometry is the primary test used to diagnose COPD is measuring lung function.</li>
	<li>&#8226; Imaging Tests, including Chest X-rays and CT scans, to visualize lung structure and any damage.</li>
</ul>
There are a variety of ways to manage and treat COPD.
<ul>
	<li>&#8226; Smoking Cessation: The most vital step in managing COPD.</li>
</ul>
<ul>
	<li>&#8226; Medications: Including bronchodilators and inhaled steroids to reduce inflammation and open airways.</li>
</ul>
<ul>
	<li>&#8226; Pulmonary Rehabilitation: A program of exercise, education, and support.</li>
</ul>
<ul>
	<li>&#8226; Oxygen Therapy: For patients with severe COPD and low blood oxygen levels.</li>
</ul>
<ul>
	<li>&#8226; Surgical Options: In select cases, lung volume reduction surgery or lung transplantation may be considered.</li>
</ul>
In conclusion, early detection and comprehensive management are vital for improving the quality of life for individuals with COPD.

Chronic Obstructive Pulmonary Disease, or COPD, is a progressive respiratory illness that causes airflow obstruction, affecting the bronchioles, bronchi, ...

Chronic Obstructive Pulmonary Disease-V: Management

Managing Chronic Obstructive Pulmonary Disease (COPD) involves a multifaceted approach to reduce symptoms, prevent exacerbations, improve overall health status, and slow disease progression. Key strategies include lifestyle modifications, pharmacotherapy, supportive therapies, and, in some cases, surgery. Here is an overview of the primary COPD management strategies:
Smoking Cessation
<ol style="list-style-type:circle;">
	<li>Primary Step: The most critical intervention for all COPD patients who smoke.</li>
	<li>Benefits: Slows disease progression, reduces the frequency of exacerbations, and improves lung function.</li>
	<li>Methods: Behavioral therapy, nicotine replacement therapy, and medications like bupropion or varenicline.</li>
</ol>
Pharmacotherapy
<ol style="list-style-type:circle;">
	<li>Bronchodilators: The mainstay of COPD treatment.
	<ol style="list-style-type:circle;">
		<li>Short-acting bronchodilators (SABAs and SAMAs): Used to relieve acute symptoms.</li>
		<li>Long-acting bronchodilators (LABAs and LAMAs): These drugs are used for long-term symptom control.</li>
	</ol>
	</li>
	<li>Corticosteroids:
	<ol style="list-style-type:circle;">
		<li>Inhaled Corticosteroids (ICS): Often combined with long-acting bronchodilators, particularly for patients with frequent exacerbations.</li>
		<li>Oral Corticosteroids: Used for acute exacerbations and should be avoided for long-term use due to significant side effects like osteoporosis, hyperglycemia, and muscle weakness.</li>
	</ol>
	</li>
</ol>
Oxygen Therapy
<ol style="list-style-type:circle;">
	<li>Long-term Oxygen Therapy (LTOT): For patients with severe resting hypoxemia.</li>
	<li>Benefits: Improves survival, enhances quality of life, and increases exercise capacity.</li>
</ol>
Pulmonary Rehabilitation
<ol style="list-style-type:circle;">
	<li>Components: Includes exercise training, nutritional counseling, and education.</li>
	<li>Goals: Improve physical and emotional participation and overall quality of life.</li>
</ol>
Surgery
<ol style="list-style-type:circle;">
	<li>Bullectomy: Removal of large bullae can improve lung function in selected patients.</li>
	<li>Lung Volume Reduction Surgery (LVRS): Removes damaged lung tissue, improving lung function and quality of life for certain patients with emphysema.</li>
	<li>Lung Transplant: Considered in advanced COPD cases when other treatments have failed.</li>
</ol>
Supportive Therapies and Lifestyle Modifications
<ol style="list-style-type:circle;">
	<li>Vaccinations: Administer annual influenza and pneumococcal vaccines to prevent infections.</li>
	<li>Nutritional Support: Address undernutrition, which is common in COPD patients.</li>
	<li>Physical Activity: Regular exercise improves overall strength and endurance.</li>
	<li>Airway Clearance Techniques: Chest physiotherapy and postural drainage help clear mucus.</li>
	<li>Management of Comorbidities: Address conditions like cardiovascular disease, osteoporosis, anxiety, and depression, which are common in COPD patients.</li>
</ol>
General Management
The management of COPD should be tailored to the individual&#39;s needs, disease severity, and response to treatment. Regular follow-up is essential to monitor disease progression and adjust treatment as necessary. Involving a multidisciplinary team, including pulmonologists, nurses, physical therapists and dietitians, can be beneficial in the comprehensive management of COPD.

Chronic obstructive pulmonary disease management, or COPD, includes several key components.
Firstly, smoking cessation is crucial. Healthcare providers ...

COPD: Management Using Bronchodilators and Corticosteroids

Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory and reversible airway obstruction seen in asthma with the progressive airflow limitation characteristic of COPD.
The symptoms of COPD can vary, but they often include persistent coughs, breathlessness, increased production of sputum, and intermittent exacerbations or flare-ups of severe symptoms that impact the quality of life for individuals with COPD.
Managing COPD involves a combination of medication and lifestyle changes. Bronchodilators, such as ipratropium bromide (an anticholinergic agent) and albuterol (a &#946;2-adrenergic agonist), form the backbone of COPD treatment. They relax the muscles around the airways in the lungs, reducing respiratory symptoms and improving lung function. They are typically administered through inhalers or nebulizers, with longer-acting forms requiring less frequent dosing.
While systemically active glucocorticoids, or corticosteroids, have demonstrated limited efficacy in treating COPD, inhaled corticosteroids can improve patients&#39; quality of life. However, it&#39;s important to note that these do not halt the decline in lung function that characterizes this disease.
Theophylline (Theolair), a type of bronchodilator, can be particularly beneficial for patients who retain CO2. It relaxes and opens the airways to the lungs, making breathing easier. It can also improve ventilatory capacity by enhancing the contractile function of the diaphragm. However, its use is limited by narrow therapeutic margins and the potential for side effects such as nausea, insomnia, and arrhythmias.
Antibiotics are another essential component of COPD management. They are typically used to treat COPD exacerbations due to lower airway bacterial infections, reducing the duration and severity of these episodes.
For patients with severe COPD and chronic hypoxemia, long-term oxygen therapy (LTOT) may be recommended. LTOT can help to reduce the symptoms of breathlessness and fatigue, improve sleep and mood, increase mobility, and, in some cases, extend life expectancy.
Lifestyle modifications are essential for COPD management. Most importantly, smoking cessation and avoiding smoke exposure are vital, as smoking is a significant risk factor for developing and exacerbating COPD. Regular physical activity, a balanced diet, and avoiding respiratory irritants can also contribute to better disease management and quality of life.

Chronic obstructive pulmonary disease, or COPD, encompasses progressive lung conditions, including chronic bronchitis, emphysema, and asthma.
Its symptoms ...

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

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