Pulmonary rehabilitation protocols in urgent lung transplantation patients

BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe underlying diseases and complex conditions.The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.METHODS:A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation(IMV)and ECMO between January 2018 and January 2023.Data were retrieved from electronic medical records at our lung transplant center.RESULTS:Fourteen patients(mean age 57.43±10.97 years;12 males,2 females)underwent ULTx with bridging ECMO and IMV.The mean body mass index was 23.94±3.33 kg/m²,and the mean Acute Physiology and Chronic Health Evaluation(APACHE)II score was 21.50±3.96.The Nutritional Risk Screening 2002(NRS 2002)scores were≥3.ULTx was performed after an 8.5-day waiting period(interquartile interval[IQR]5.0-26.5 d).Following the surgeries,the average lengths of ECMO and IMV were 1.0(IQR 1.0-2.0)d and 5.0(IQR 3.0-7.3)d,respectively.The total length of hospital stay was 60.1±30.8 d,with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d.Two patients died within 30 d after ULTx,with a 30-day survival rate of 85.71%.CONCLUSION:Patients receiving ULTx showed an acceptable short-term survival rate,validating the practicality and safety of the treatment protocols implemented in our center.

Research Progress on Pulmonary Rehabilitation in Children with Bronchial Asthma

Bronchial asthma is a chronic respiratory disease that poses a significant threat to the physical and mental health of children globally.Currently,pulmonary rehabilitation is a non-pharmacological intervention that has shown promise in treating chronic respiratory diseases.However,most studies related to pulmonary rehabilitation only focus on chronic conditions such as chronic obstructive pulmonary disease(COPD),lung cancer,and bronchiectasis.Research on bronchial asthma in children is still in the preliminary stages.This article reviews the concept,basic content,and application mode of pulmonary rehabilitation,to provide reference for the clinical research of pulmonary rehabilitation in children with bronchial asthma,and to carry out multimodal pulmonary rehabilitation to improve the disease control level and quality of life of asthma in children.

Home versus centre-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background: To evaluate the effects of home versus centre-based pulmonary rehabilitation on exercise capacity, quality of life, and dyspnoea scores in patients with chronic obstructive pulmonary disease by meta-analysis. Methods: We searched the Cochrane library, Embase, PubMed and CINAHL (EBSCO) up to April 2020 without language restriction to collect randomized controlled trials of home versus centre-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease. Literatures screening, risk of bias assessment and data extraction for the included studies were conducted by two reviewers independently. The data analysis was carried out by RevMan 5.3 software. Results: A total of 9 studies, which comprised a total of 859 participants were included in the meta-analysis. Centre and home-based pulmonary rehabilitation were equally effective at improving exercise capacity (MD = 2.30, 95% CI: 12.02 to 7.42, P > 0.05) and dyspnoea scores (MD = 0.15, 95% CI: 0.46 to 0.17, P > 0.05). They were also equally effective at improving health-related quality of life on the chronic respiratory questionnaire (dyspnea: MD = 0.08, 95% CI: 0.30 to 0.13, P > 0.05;fatigue: MD = 0.19, 95% CI: 0.45 to 0.07, P > 0.05;emotional function: MD = 0.18, 95% CI, 0.40 to 0.40, P > 0.05 and mastery: MD = 0.13, 95% CI: 0.38 to 0.11, P > 0.05), and on the St George's respiratory questionnaire (MD = 1.77, 95% CI: 4.54 to 0.99, P > 0.05). Conclusion: Home and centre-based pulmonary rehabilitation has similar effects on exercise capacity, quality of life, and dyspnoea scores in individuals with chronic obstructive pulmonary disease. Home-based pulmonary rehabilitation has the potential to be an alternative to centre-based pulmonary rehabilitation.

Evaluation of the intervention of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Objective:Chronic obstructive pulmonary disease(COPD)can be prevented and treated,although presenting with persistent airflow restriction;the airflow restriction caused by COPD is mostly progressive.In recent years,more attention has been paid to the home-based pulmonary rehabilitation(PR)and its influence on COPD.Exercise training is the basic constituent of PR.However,it is not clear which exercise trainings are the ideal ways to deliver home-based PR.Methods:In this review,we focus on the effect of home-based exercise training on patients with COPD.We searched literature,which was necessarily required to be randomized controlled trails(RCTs)from the establishment of the four respective databases(Medline,PubMed,Web of Science,and China National Knowledge Infrastructure)from January 2008 to January 2018.We used the Cochrane collaborative“risk of bias”tool to assess the quality of evidence.A total of 21 trials(1694 participants)were included.Through the analysis of the literature,we find that a simple,low-cost,and low-intensity family-based lung-rehabilitation plan to adapt to the real life may lead to the improvement of the ability to exercise,the reduction of the difficulty in breathing,and the improvement of carrying out daily activities.Results:In the exercise training of home-based PR,lower limb exercise(LLE)training demonstrated a more perceptible effect in improving the quality of life of patients with COPD.At the same time,the combination of LLE training,breathing training,and upper limb exercise training is more obvious than the simple LLE training.In addition,home-based low-intensity aerobic training may sometimes be no less than the outpatient or center intervention to improve dyspnea,health status,and exercise tolerance.In conclusion,the simple and easy home-based PR exercise program is useful.Long-term home-based PR may require an enhanced need for maintenance.Conclusions:A simple,low-cost,and low-intensity high blood pressure response(HBPR)plan to adapt to the real life may lead to an augmentation in the ability to exercise,a reduction of the difficulty in breathing,and an improvement in carrying out day-to-day activities.HBPR strategies can benefit patients(elderly patients with COPD at home)in the long term.

Effects of modified pulmonary rehabilitation on patients with moderate to severe chronic obstructive pulmonary disease:A randomized controlled trail

Objectives:This study aimed to assess the effects of modified pulmonary rehabilitation(PR)on patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods:A total of 125 patients(63 in the PR group and 62 in the control group)were recruited in this study.The patients in the PR group received 12 weeks of conventional treatment,nursing,and modified pulmonary rehabilitation,while the patients in the control group underwent 12 weeks of conventional treatment,nursing,pursed-lip breathing training,and abdominal breathing training.Baseline characteristics,St.George's Respiratory Questionnaire(SGRQ),the six-minute walk test(6MWT),modified medical research council(MMRC)dyspnea scale,and lung function were compared between the two groups.Results:A total of 112 patients(58 patients in the PR group and 54 patients in the control group)completed the 12-week monitoring and follow-up.The SGRQ scores,symptoms(54.933±11.900),activity(52.644±14.334),impact(55.400±9.905),and total score(54.655±10.681)of the PR group did not significantly differ in pre-and post-treatments(P<0.05).No significant change was also observed in the control group(P>0.05).6MWT[(372.089±67.149)m]was significantly improved in the PR group(P<0.05)but was not significantly different in the control group(P>0.05).MMRC(actual rank sum 1719,rank sum 2047.5)was significantly reduced in the PR group(P<0.05)but not in the control group(P>0.05).The lung function(FVC,FEV1,FEV1/FVC,FEV1%and PEF)of the patients in both groups did not significantly change(P>0.05).Conclusion:Modified PR reduces the symptoms of dyspnea,increases exercise capacity,and improves the quality of life of patients with moderate to severe COPD.

Nursing Effect of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

Objective:To study the effect of pulmonary rehabilitation nursing in nursing of patients with chronic obstructive pulmonary disease(COPD).Methods:30 cases of experimental subjects,diagnosed with COPD,were included in the observation group with pulmonary rehabilitation nursing,while the control group received routine nursing,and the data between the groups were compared.Results:After nursing,the observation group showed significantly improved lung function,higher nursing satisfaction,6-minute walking test(6WMT),World Health Organization Quality of Life(WHOQOL-BREF)score,and self-care ability score,compared to the control group,with P<0.05,indicating a statistical difference.Conclusion:Pulmonary rehabilitation nursing is applied in the nursing of COPD patients with ideal effect.

The Benefits of Pulmonary Rehabilitation Program on Post-Tuberculosis Bronchiectasis

Pulmonary rehabilitation has emerged as a recommended standard of care for patients with chronic lung disease. As in chronic obstructive pulmonary disease (COPD), persons with other forms of chronic respiratory disease commonly experience deconditioning and decreased quality of life. The aim of this prospective study is to determine the effect of a 4-week pulmonary rehabilitation program (PRP) on patients diagnosed with post-pulmonary tuberculosis bronchiectasis in the Philippines. The participants were above 18 years of age, diagnosed to have stable Post-Pulmonary tuberculosis bronchiectasis with chest computerized tomography (CT) scan or chest radiograph showing bronchiectatic changes, consented to attend the PRP sessions and be included in the study. The subjects underwent PRP for 4 weeks with a total of 8 sessions and determination of Forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), quality of life determination using the Saint George Respiratory Disease Questionnaire (SGRQ), and exercise endurance using the 6-minute walking test (6 MWT), before and after the PRP. A total of fourteen patients, six males and eight females, aged from 28 - 72 years old, completed the 4-week pulmonary rehabilitation program. There were four ex-smokers and ten non-smokers with concomitant asthma and COPD in some patients. There was significant improvement in the 6-minute walk test and quality of life after 4 weeks of rehabilitation program among the subjects with p value for 6 MWT at p = 0.0001 and p = 0.008 for SGRQ. Conclusion: Pulmonary rehabilitation program led to a significant improvement in exercise capacity and health related quality of life among patients with post-pulmonary tuberculosis bronchiectasis.

Patients’ Experiences and Opinions on Pulmonary Rehabilitation and Use of It as a Tool of Palliative Care on Idiopathic Pulmonary Fibrosis (IPF)

Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and life-limiting condition. It has no cure hence it is vital to establish effective methods of improving the quality of remaining life in these patients. One of the key components of improving quality of life is pulmonary rehabilitation. However little research has been conducted to understand the perspectives and lived experience of people with IPF on pulmonary rehabilitation. Hence, we aim to fill this gap in the existing literature. Methods: We sought to understand how patients coped with pulmonary rehabilitation. A patient-centred approach was used to explore the physical and psychological impact of pulmonary rehabilitation. Semi-structured interviews were conducted by experienced academics. Interviews used a topic guide but mostly led by the participants. An inductive thematic approach was used to analyse data, allowing us to identify common themes in the participants’ experiences. Results: Of fifty invited participants, ten took part in the study (aged 53 - 81 years). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: “motivation” and “Advantages and disadvantages”. Overall, participants found the pulmonary rehabilitation programme to be useful and they experienced an increase in their quality of life following rehabilitation.

Pulmonary rehabilitation restores limb muscle mitochondria and improves the intramuscular metabolic profile

Background: Exercise, as the cornerstone of pulmonary rehabilitation, is recommended to chronic obstructive pulmonary disease (COPD) patients. The underlying molecular basis and metabolic process were not fully elucidated. Methods: Sprague-Dawley rats were classified into five groups: non-COPD/rest ( n = 8), non-COPD/exercise ( n = 7), COPD/rest ( n = 7), COPD/medium exercise ( n = 10), and COPD/intensive exercise ( n = 10). COPD animals were exposed to cigarette smoke and lipopolysaccharide instillation for 90 days, while the non-COPD control animals were exposed to room air. Non-COPD/exercise and COPD/medium exercise animals were trained on a treadmill at a decline of 5° and a speed of 15 m/min while animals in the COPD/intensive exercise group were trained at a decline of 5° and a speed of 18 m/min. After eight weeks of exercise/rest, we used ultrasonography, immunohistochemistry, transmission electron microscopy, oxidative capacity of mitochondria, airflow-assisted desorption electrospray ionization-mass spectrometry imaging (AFADESI-MSI), and transcriptomics analyses to assess rectal femoris (RF). Results: At the end of 90 days, COPD rats’ weight gain was smaller than control by 59.48 ± 15.33 g ( P = 0.0005). The oxidative muscle fibers proportion was lower ( P < 0.0001). At the end of additional eight weeks of exercise/rest, compared to COPD/rest, COPD/medium exercise group showed advantages in weight gain, femoral artery peak flow velocity (Δ58.22 mm/s, 95% CI: 13.85-102.60 mm/s, P = 0.0104), RF diameters (Δ0.16 mm, 95% CI: 0.04-0.28 mm, P = 0.0093), myofibrils diameter (Δ0.06 μm, 95% CI: 0.02-0.10 μm, P = 0.006), oxidative muscle fiber percentage (Δ4.84%, 95% CI: 0.15-9.53%, P = 0.0434), mitochondria oxidative phosphorylate capacity ( P < 0.0001). Biomolecules spatial distribution in situ and bioinformatic analyses of transcriptomics suggested COPD-related alteration in metabolites and gene expression, which can be impacted by exercise. Conclusion: COPD rat model had multi-level structure and function impairment, which can be mitigated by exercise.

Current opinion on the importance of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Multidisciplinary pulmonary rehabilitation （PR） is a .widely accepted non-pharmacological treatment method that tries to improve exercise tolerance and quality of life in chronic obstructive pulmonary disease （COPD） and non-COPD patients, together with reduction in medical services use.1 The aim of PR is to help respiratory patients to reach and keep a maximal functioning and independence level within community^2 The patients severely affected by other pulmonary diseases than COPD are benefiting of intensive PR and the degree of improvement is similar to that obtained in COPD^3

Pulmonary rehabilitation for patients with coronavirus disease 2019(COVID-19)

As a highly infectious respiratory tract disease,coronavirus disease 2019(COVID-19)can cause respiratory,physical,and psychological dysfunction in patients.Therefore,pul mo nary rehabilitation is crucial for both admitted and discharged patients of COVID-19.In this study,based on the newly released pulmonary rehabilitation guidelines for patients with COVID-19,as well as evidence from the pulmonary rehabilitation of patients with severe acute respiratory syndrome,we investigated pulmonary rehabilitation for patients with COVID-19 having complications,such as chronic pulmonary disease,and established an intelligent respiratory rehabilitation model for these patients.

Mechanical ventilation strategy for pulmonary rehabilitation based on patient-ventilator interaction

Mechanical ventilation is an effective medical means in the treatment of patients with critically ill,COVID-19 and other pulmonary diseases.During the mechanical ventilation and the weaning process,the conduct of pulmonary rehabilitation is essential for the patients to improve the spontaneous breathing ability and to avoid the weakness of respiratory muscles and other pulmonary functional trauma.However,inappropriate mechanical ventilation strategies for pulmonary rehabilitation often result in weaning difficulties and other ventilator complications.In this article,the mechanical ventilation strategies for pulmonary rehabilitation are studied based on the analysis of patient-ventilator interaction.A pneumatic model of the mechanical ventilation system is established to determine the mathematical relationship among the pressure,the volumetric flow,and the tidal volume.Each ventilation cycle is divided into four phases according to the different respiratory characteristics of patients,namely,the triggering phase,the inhalation phase,the switching phase,and the exhalation phase.The control parameters of the ventilator are adjusted by analyzing the interaction between the patient and the ventilator at different phases.A novel fuzzy control method of the ventilator support pressure is proposed in the pressure support ventilation mode.According to the fuzzy rules in this research,the plateau pressure can be obtained by the trigger sensitivity and the patient’s inspiratory effort.An experiment prototype of the ventilator is established to verify the accuracy of the pneumatic model and the validity of the mechanical ventilation strategies proposed in this article.In addition,through the discussion of the patient-ventilator asynchrony,the strategies for mechanical ventilation can be adjusted accordingly.The results of this research are meaningful for the clinical operation of mechanical ventilation.Besides,these results provide a theoretical basis for the future research on the intelligent control of ventilator and the automation of weaning process.

Renewed vision on pulmonary rehabilitation service delivery for chronic obstructive pulmonary disease management beyond COVID-19

Pulmonary rehabilitation(PR)is a cornerstone management for chronic obstructive pulmonary disease(COPD).International respiratory societies defined PR is more than"just an exercise program";it is a comprehensive care delivered by a team of dedicated healthcare professionals with a strong emphasis on long-term health-enhancing Behaviors.However,"Uncertainty"exists with varied reasons for the political and geographical barriers of referral,uptake,attendance,and completion of PR in both primary and secondary care.Besides,COVID-19 pandemic has sparked many global controversies and challenges on pulmonary rehabilitation service delivery.Post-COVID-19 guidelines emphasize on integrated care rehabilitation for patients with COPD.Thus,this concise review intends to understand the gaps in United Kingdom healthcare policies,practices,and PR services resources.To date,there is no clear consensus on PR integrated care model pathway to address the unmet needs,measure the health and social care disparities;adds to the disease burden of COPD.Based on the culmination of evidence,this perspective offers a theoretical framework of PR integrated service model,a pathway to deliver high-value personalized care to patients with COPD.

Perceived Improvements of Quality of Life (QoL) among Patients with Idiopathic Pulmonary Fibrosis (IPF) in Response to a 6-Week Rehabilitation Program

Idiopathic pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life expectancy of 05 years following the onset of the disease, with no curative treatments. These patients need palliative care and rehabilitation is one of the methods that can be used to improve quality of life (QoL) among these patients. Yet the research conducted to assess benefits of pulmonary rehabilitation (PR) in terms of improving physical activity and QoL in IPF patients remains limited. Hence this study aims to evaluate the effect of a bespoke pulmonary rehabilitation programme, on the physical, physiological and psychological parameters and improvements of QoL among IPF patients. Eleven (11) subjects with IPF received 6 weeks of pulmonary rehabilitation. An interviewer administered quality of life questionnaire, six-minute walking test (6MWT), Incremental bicycle exercise tests were performed, and cardiac and respiratory parameters were assessed pre- and post-rehabilitation. The 6MWT was significantly increased following training (Pre 312.55 ± 89.99;Post, 380.73 ± 59.60). A significant improvement was observed in overall QoL (2.226 ± 0.026), dyspnoea (-0.455 ± 0.004) anxiety (-2.070 ± 0.038), depression (-2.217 ± 0.027) scores. No significant changes were found in the VO2 max and other cardiopulmonary parameters, while non-significant improvement was seen in SpO2 at peak exercise from 85.8 - 86.5. Bespoke pulmonary rehabilitation program is beneficial in short term improvement of the functional exercise capacity, dyspnoea and QoL among IPF patients.

Effect of nursing on postoperative respiratory function and mental health of lung cancer patients

BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer.However,few studies have combined the two to explore their combined effect.Therefore,this study aimed to investigate the effects of pulmonary rehabil-itation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients.AIM To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients.METHODS 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group.The control group performed the routine care intervention.The obser-vation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions.Forced expiratory volume,forced vital capacity.Maximum ventilatory volume(MVV)in one second was measured,and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition.The Connor-Davidson resilience scale(CD-RISC),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)were used to evaluate the mental health of the patients.RESULTS There was no difference between the two groups regarding age,gender,education level,surgical procedure,type of pathology,and treatment(P>0.05).After treatment,MVV,6-min walking distance,toughness,strength,optimism,and total CD-RISC scores were significantly higher in the observation group(P<0.05),dyspnoea scores,SAS,and SDS scores were substantially lower in the control group compared to the observation group(P<0.05).CONCLUSION Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function,enhance daily activities,effectively relieve negative emotions such as anxiety and depression,and reduce complications.

Does Liuzijue Qigong affect anxiety in patients with chronic obstructive pulmonary disease,even during the COVID-19 outbreak?a randomized,controlled trial

Background:Anxiety is a common comorbidity associated with chronic obstructive pulmonary disease(COPD),but no well-recognized method can provide effective relief.Liuzijue Qigong(LQG)is a traditional Chinese fitness method,based on breath pronunciation.This study aimed to examine the efficacy of LQG to relieve anxiety in COPD patients and to explore the factors that influence anxiety,including whether LQG is effective during the coronavirus disease 2019(COVID-19)outbreak.Methods:We conducted an open-label,randomized,controlled,clinical trial.A total of 60 patients with stable COPD were randomly assigned to two groups.Both groups were given routine medical treatment,and the patients in the pulmonary rehabilitation(PR)group were given an extra intervention in the form of LQG,performed for 30 minutes each day for 12 weeks.Data collection was performed at baseline and 12 weeks(during the COVID-19 epidemic).The primary outcomes were the self-rating anxiety scale(SAS)scores,and the secondary outcomes were relevant information during the epidemic and analyses of the related factors that influenced SAS scores during the COVID-19 outbreak.Results:Compared with baseline,patients in both groups demonstrated varying degrees of improvements in their SAS scores(all P<0.01).An analysis of covariance,adjusted for baseline scores,indicated that the SAS scores improved more dramatically in the PR group than in the control group(F=9.539,P=0.004).During the outbreak,the SAS scores for sleep disorder were higher than all other factors,reaching 1.38±0.67,and the scores for“I can breathe in and out easily”for the PR group were lower than the scores for the control group(Z=−2.108,P=0.035).Significant differences were identified between the two groups for the categories“How much has the outbreak affected your life”,“Do you practice LQG during the epidemic”and“Do you practice other exercises during the epidemic”(all P<0.05).Compared with current reports,LQG had a relatively high adherence rate(80.95%).A multiple linear regression analysis revealed multiple predictors for SAS scores during the outbreak:group(b=−3.907,t=−3.824,P<0.001),COPD assessment test score(b=0.309,t=2.876,P=0.006),SAS score at baseline(b=0.189,t=3.074,P=0.004),and living in a village(b=4.886,t=2.085,P=0.043).Conclusion:LQG could effectively reduce the risks of anxiety among COPD patients,even during the COVID-19 outbreak.For those COPD patients with high COPD assessment test and high baseline SAS scores or who live in villages,we should reinforce the management and intervention of psychological factors during the epidemic.

Progress in frailty assessment in the treatment of patients with chronic obstructive pulmonary disease

This paper reviews the asthenia´s occurrence status,adverse outcomes and assessment tools of patients with chronic obstructive pulmonary disease,as well as safety management strategies such as preventing or improving pulmonary rehabilitation and nutritional therapy in patients with asthenia´s.It can provide reference for clinical nurses or researchers to find or develop assessment tool asthenia suitable for domestic patients with chronic obstructive pulmonary disease and set down intervention measurements.

Health Education for Chronic Obstructive Pulmonary Disease (COPD): Observational Study

Health Education has shown itself as essential for the understanding of individuals about psychological and physical changes caused by diseases. The chronic obstructive pulmonary disease (COPD) is a severe public health problem, and it depends on health education measures for its control. A group of patients with COPD, in pneumatological medical treatment, were investigated to find information about the disease. An observational, descriptive and analytical study with analysis and application of a semistructured questionnaire to evaluate the individuals’ knowledge about the COPD. Collected data were registered and analyzed using Google Docs. The software used for the calculation of statistical measures was Microsoft Excel®. For the research participants’ characterization analysis, the use of grouped data for the frequency distribution of Sturges Rule was necessary. This study provided knowledge about which information a group of bearers of COPD receives at a college hospital providing treatment. The interviewed have an average age of 70 years old and most are women with education level between elementary and high school and diagnose time of 6.8 years. Most of the sample reported knowledge and consciousness about the disease, informed by the doctors, followed by physiotherapists. Although the role of the Ministry of Health in health education, subjects were better informed about the disease by their doctors instead of public campaigns.

Application of "dredging meridians and dispersing lung exercises" based on meridian theory of traditional Chinese medicine in patients with stable chronic obstructive pulmonary disease

Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total of 130 patients with Chronic obstructive pulmonary disease at stable stage from the Department of Pulmonary Diseases,Qingdao Haici Medical Group during September 2018 to September 2020 were collected and randomly divided into a observation group and a control group,with 65 patients in each group.The control group was given routine pulmonary rehabilitation nursing,and the observation group was given Tongjing Xuanfei exercise treatment combined with routine pulmonary rehabilitation nursing,12 months for treatment.The changes of symptoms and pulmonary function index were observed before and after treatment.Results:FEV1,FVC,FEV1%pred,FEV1/FVC,exercise endurance and CAT score,mMRC dyspnea index score and TCM clinical symptom score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Tongjing Xuanfei exercise is helpful to improve the clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.

Muscle energy technique for chronic obstructive pulmonary disease:A feasibility study

Objective:This study aimed to investigate the feasibility of implementing a manual therapy technique(muscle energy technique,MET)protocol in a hospital pulmonary rehabilitation(PR)program for patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods:Participants aged 40 years and over,with moderate to severe COPD,were recruited into this 12-week study.The primary outcome measures were feasibility(acceptability of the intervention and attendance/adherence to the trial)and safety(adverse events,AEs).All participants received the MET and PR therapies.Participants and assessors were unblinded.Semi-standardized MET was delivered on 6 occasions(a maximum of once per week)at the hospital directly before a PR session.Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks.Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.Results:Thirty-three participants were enrolled,with a median age of 74 years(range 45-89 years).The median number of MET sessions that participants attended was 5(range O-6)out of a possible 6 sessions(83%attendance).At follow-up,participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing.There were no major AEs related to the intervention,with the majority of AEs classified as expected events related to COPD exacerbations.Conclusion:It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting.Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.