Original Articles
19 February 2025
Vol. 40 No. 1 (2018)
[Related care in pulmonary rehabilitation: can pulmonary rehabilitation in chronic obstructive pulmonary disease benefit from a multidisciplinary approach?]
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation.
Cardiovascular diseases, osteoporosis, depression/ anxiety, musculoskeletal impairment and obstructive sleep apnea are frequent and important comorbidities in COPD, often under-diagnosed, and associated with poor health status and prognosis.
Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care in patients with chronic respiratory disease. By definition it is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change and designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.
Exercise limitation in patients with COPD is multifactorial and includes ventilatory limitation, gas transfer abnormalities, pulmonary vascular and cardiac dysfunction, limb muscle dysfunction, and comorbid impairments.
Overall, pulmonary rehabilitation aims to improve cardiorespiratory and skeletal muscle function improving respiratory symptoms and quality of life in daily life activities adding a synergic support to the pharmacologic inhaled therapy.
COPD has a variable natural history, but most of the time chronic respiratory failure complicates disease progression. Supplemental oxygen and noninvasive mechanical ventilation have been proven to improve survival and reduce hospital admissions in COPD patients. Furthermore additional studies have shown that exercise performance benefit from supplemental oxygen and NIV used both during rehabilitation exercise programs and over the night.
In conclusion, an overarching approach to diagnosis, assessment of severity of COPD and its frequent comorbidities should guide to a multidisciplinary and synergic approach in terms of pharmacological and nonpharmacological management of a systemic inflammatory syndrome.
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1) Ambrosino N, Xie L. The use of non invasive ventilation during exercise training in COPD patients. COPD 2017; 14: 396-400. 4. 2) Bateman ED, Chapman KR, Singh D, et al. Aclidinium bromide and formoterol fumarate as a fixed-dose combination in COPD: pooled analysis of symptoms and exacerbations from two six-month, multicentre, randomised studies (ACLIFORM and AUGMENT). Respir Res 2015; 16: 92.
3) Beeh KM, et al. The lung function profile of once-daily tiotropium and olodaterol via Respimat is superior to that of twice-daily salmeterol and fluticasone propionate via Accuhaler (ENERGITO study). Int J Chron Obstruct Pulmon Dis 2016; 11: 193-205.
4) Beeh KM, Korn S, Beier J, Jadayel D, Henley M, D'Andrea P Banerji D. Effect of QVA149 on lung volumes and exercise tolerance in COPD patients: The BRIGHT study. Respiratory Medicine 2014; 108(4): 584-592.
5) Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R, Greening NJ, Heslop K, Hull JH, Man WD, Morgan MD, Proud D, Roberts CM, Sewell L, Singh SJ, Walker PP, Walmsley S; British Thoracic Society Pulmonary Rehabilitation Guideline Development Group; British Thoracic Society Standards of Care Committee. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax 2013 Sep; 68 Suppl 2: ii1-30.
6) Camillo CA, Osadnik CR, van Remoortel H, Burtin C, Janssens W, Troosters T. Effect of "add-on" interventions on exercise training in individuals with COPD: a systematic review. ERJ Open Res 2016 Mar 29; 2(1).
Carone M. Patessio A. Ambrosino N. Baiardi P. Balbi B. Balzano 1omo V. Donner CF. Fracchia C. Nava S. Ner M. Pozzi E. Vitac M, Spanevello A. Efficacy of pulmonary rehabilitation in chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD): The Maugeri Study Respiratory Medicine 2007; 101: 2447-2453.
8) Visca D, Aiello M, Chetta A. Cardiovascular function in pulmonary emphysema. Biomed Res Int 2013; 2013: 184678.
9) Casaburi R, Kukafka D, Cooper CB, Witek TJ Jr, Kesten S. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005 Mar; 127(3): 809-17.
10) Canoi bolingo M. The sisti ando or combino.
Pulm Pharmacol Ther 2010; 23(4): 257-67).
11) Cirio S, Piran M, Vitacca M, Piaggi G, Ceriana P, Prazzoli M Paneroni M, Carlucci A. Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation. Respir Med 2016 Sep; 118: 128-32. 12) Dreher M, Storre JH, Windisch W. Noninvasive ventilation during walking in patients with severe COPD: a randomised cross-over trial. Eur Respir J 2007; 29: 930-6.
13) Duiverman ML, Wempe JB, Bladder G, Jansen DF, Kerstjens HA, Zijlstra JG, Wijkstra PJ. Nocturnal noninvasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Thorax 2008; 63: 1052-7.
14) Duiverman ML, Wempe JB, Bladder G, Vonk JM, Zijlstra JG, Kerstjens HA, Wijkstra PJ. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: a randomized controlled trial. Respir Res 2011; 12: 112.
15) Fabbri LM, Luppi F, Beghe B, Rabe KF Complex chronic comorbidities of COPD Eur Respir J 2008; 31: 204-212.
16) Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet 2007 Sep 1; 370(9589): 797-9. 17) Furlanetto KC, Pitta F. Oxygen therapy devices and portable ventilators for improved physical activity in daily life in patients with chronic respiratory disease. Expert Rev Med Devices 2017 Feb; 14(2): 103-115.
18) Garrod R, Mikelsons C, Paul EA, Wedzicha JA. Randomized controlled trial of domiciliary non-invasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000 Oct; 162(4 Pt 1): 1335-41.
19) Global initiative on Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD. 2017. Available from: http: //www.goldcopd.org/edition.
20) Higgins BG, Powell RM, Cooper S, Tattersfield AE. Effect of salbutamol and ipratropium bromide on airway calibre and bronchial reactivity in asthma and chronic bronchitis. Eur Respir J 1991; 4(4): 415-20.).
21) Lowie EGW Vanfleteren, Martijn A Spruit, Miriam Groenen, Swetlana Gaffron, Vanessa PM van Empel, Piet LB Bruijnzeel, Erica PA Rutten, Jos Op 't Roodt, Emiel FM Wouters, Frits ME Franssen. Clusters of Comorbidities Based on Validated Objective Measurements and Systemic Inflammation in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med Vol 187, Iss. 7, pP 728-735, Apr 1, 2013.
22) Mahler DA, Decramer M, D'Urzo A, et al. Dual bronchodilation with QVA149 reduces patient-reported dyspnoea in COPD: the BLAZE study. Eur Respir J 2014; 43(6): 1599-609.
23) Mahler DA, et al. INTRUST-1 and INTRUST-2 study investigators. Concurrent use of indacaterol plus tiotropium in patients with COPD provides superior bronchodilation compared with tiotropium alone: a randomised, double-blind comparison. Thorax 2012; 67(9): 781-8. 24) Maltais F, Galdiz Iturri JB, Kirsten A, Singh D, Hamilton A, Tetzlaff, K, ... Casaburi R. Effects of 12 weeks of once-daily tiotropium and olodaterol fixed-dose combination on exercise endurance in patients with COPD. Thorax 2015; 69(Suppl 2): A1-A233.
25) Maltais F, Singh D, Donald AC, Crater G, Church A, Goh AH, Riley, JH. Effects of a combination of umeclidinium/vilanterol on exercise endurance in patients with chronic obstructive pulmonary disease: two randomized, double-blind clinical trials. Therapeutic Advances in Respiratory Disease 2014; 8(6): 169-81.
26) Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM, Dowson L, Duffy N, Gibson GJ, Hughes PD, Hurst JR, Lewis KE, Mukherjee R, Nickol A, Oscroft N, Patout M, Pepperell J, Smith I, Stradling JR, Wedzicha JA, Polkey MI, Elliott MW, Hart N. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA 2017 Jun 6; 317(21): 2177-2186.
27) O'Donnell DE, Casaburi R, Frith P, Kirsten A, De Sousa D, Hamilton A, ... Maltais F. Effects of combined tiotropium/olodaterol on inspiratory capacity and exercise endurance in COPD. Eur Respir J 2017 Арг 19; 49(4).
28) Marciniuk DD, Brooks D, Butcher S, Debigare R, Dechman G, Ford G, Pepin V, Reid D, Sheel AW, Stickland MK, Todd DC, Walker SL, Aaron SD, Balter M, Bourbeau J, Hernandez P, Maltais F, O'Donnell DE, Bleakney D, Carlin B, Goldstein R, Muthuri SK; Canadian Thoracic Society COPD Committee Expert Working Group.
29) Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease-practical issues: a Canadian Thoracic Society Clinical Practice Guideline. Can Respir J 2010 Jul-Aug; 17(4): 159-68. 30) Paneroni M, Simonelli C, Vitacca M, Ambrosino N. Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2017 Aug; 96(8): 541-548.
31) Price D, Ostrem A, Thomas M, Welte T. Dual bronchodilation in COPD: lung function and patient-reported outcomes - a review. International Journal of COPD 2017; 12: 141-168.
32) Singh D, Ferguson GT, Bolitschek J, et al. Tiotropium + olodaterol shows clinically meaningful improvements in quality of life. Respir Med 2015; 109(10): 1312-9.
33) Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AB, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF; ATS/ERS Task Force on Pulmonary Rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013 Oct 15; 188(8): e 13-6.
34) Van der Molen T, Cazzola M. Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes. Prim Care Respir J 2012; 21(1): 101-8. 35) Vitacca M, Kaymaz D, Lanini B, Vagheggini G, Ergün P, Gigliotti F, Ambrosino N, Paneroni M. Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on longterm ventilatory support: A randomized controlled trial. Respirology 2017 Sep 22. doi: 10.1111/resp.13181. [Epub ahead of print].
36) Waschki B, Spruit MA, Watz H, Albert PS, Shrikrishna D, Groenen M, Smith C, Man WD, Tal-Singer R, Edwards LD, Calverley PM, Magnussen H, Polkey MI, Wouters EF. Physical activity monitoring in COPD: compliance and associations with clinical characteristics in a multicenter study. Respir Med 2012 Apr; 106(4): 522-30. 37) Watz H, Troosters T, Beeh KM, Garcia Aymerich J, Paggiaro P, Molins E, Notari M, Zapata A, Jarreta D, Garcia Gil E. ACTIVATE: The effect of aclidinium/formoterol on hyperinflation, exercise capacity, and physical activity in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017 Aug 24; 12: 2545-2558.
38) Watz H. Chronic obstructive pulmonary disease: inhale deeply and start to exercise. Eur Respir J 2017 Apr 19; 49(4).
39) Wedzicha JA, et al. Indacaterol-Glycopyrronium versus SalmeterolFluticasone for COPD. N Eng J Med 2016; 374(23): 2222-34.
How to Cite
[Related care in pulmonary rehabilitation: can pulmonary rehabilitation in chronic obstructive pulmonary disease benefit from a multidisciplinary approach?]. (2025). Giornale Italiano Di Medicina Del Lavoro Ed Ergonomia, 40(1), 37-41. https://doi.org/10.4081/gimle.529
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