Associations of Upper-Extremity Exercise Capacity and Grip Strength With Cognitive Domains in Patients With COPD.

BACKGROUND: Cognitive impairment (CI), which has been reported in COPD, has been related to physical performance. However, the association between CI and upper-extremity functions is unknown. We aimed to compare upper-extremity exercise capacity and grip strength between subjects with COPD with and without CI and to determine the relationship of upper-extremity functions with specific cognitive domains. METHODS: In this cross-sectional study, 76 subjects with COPD (mean age 66.8 ± 7.5 y, FEV1% 47.12 ± 14.10) were classified as with and without CI according to the Montreal Cognitive Assessment. Clinical characteristics, upper-extremity exercise capacity (6-min pegboard ring test [6PBRT]), grip strength (hand dynamometer), dyspnea severity (modified Medical Research Council dyspnea scale), disease-specific health status (COPD Assessment Test), and disease-specific quality of life (St George Respiratory Questionnaire) were compared between groups, and the relationship of upper-extremity functions with cognitive subdomains was analyzed by multivariate regression analysis. RESULTS: The number of 6PBRT rings (P = .01) and the grip strength (P = .033) were lower in subjects with CI. Subjects with CI had lower FEV1% (P = .038), arterial oxygenation (P = .002), exercise habits (P = .033), health status (P = .01), quality of life (P = .042); and higher dyspnea (P < .001), smoking consumption (P = .032), emergency admission (P = .02), and hospitalization (P = .042). The adjusted model showed that executive functions and attention were related to upper-extremity capacity (ß = 14.4 and ß = 10.2, respectively) and hand-grip strength (ß = 1.85 and ß = 1.49, respectively). CONCLUSIONS: These findings suggest that upper-extremity functions might be decreased especially concerning executive functions and attention in subjects with COPD with CI.

Effects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors: a randomized controlled clinical study.

OBJECTIVE: To compare the effects of a home-based pulmonary rehabilitation (PR) program with and without telecoaching on health-related outcomes in COVID-19 survivors. METHODS: A total of 42 COVID-19 patients who completed medical treatment were randomly divided into two groups: the study (telecoaching) group (n = 21) and the control (no telecoaching) group (n = 21). Both groups participated in an 8-week home-based PR program including education, breathing exercises, strength training, and regular walking. The study group received phone calls from a physiotherapist once a week. Both groups of patients were assessed before and after the program by means of the following: pulmonary function tests; the modified Medical Research Council dyspnea scale; the six-minute walk test; extremity muscle strength measurement; the Saint George's Respiratory Questionnaire (to assess disease-related quality of life); the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, to assess overall quality of life); and the Hospital Anxiety and Depression Scale. RESULTS: In both groups, there were significant improvements in the following: FVC; the six-minute walk distance; right and left deltoid muscle strength; Saint George's Respiratory Questionnaire activity domain, impact domain, and total scores; and SF-36 social functioning, role-physical, role-emotional, and bodily pain domain scores (p < 0.05). Decreases in daily-life dyspnea, exertional dyspnea, and exertional fatigue were significant in the study group (p < 0.05), and the improvement in SF-36 social functioning domain scores was greater in the study group (p < 0.05). CONCLUSIONS: A home-based PR program with telecoaching increases social functioning and decreases daily-life dyspnea, exertional dyspnea, and exertional fatigue in COVID-19 survivors in comparison with a home-based PR program without telecoaching.

Chronic obstructive pulmonary disease phenotypes in Turkey: the COPET study-a national, multicenter cross-sectional observational study.

BACKGROUND: While mortality rates decrease in many chronic diseases, it continues to increase in COPD. This situation has led to the need to develop new approaches such as phenotypes in the management of COPD. We aimed to investigate the distribution, characteristics and treatment preference of COPD phenotypes in Turkey. METHODS: The study was designed as a national, multicenter, observational and cross-sectional. A total of 1141 stable COPD patients were included in the analysis. RESULTS: The phenotype distribution was as follows: 55.7% nonexacerbators (NON-AE), 25.6% frequent exacerbators without chronic bronchitis (AE NON-CB), 13.9% frequent exacerbators with chronic bronchitis (AE-CB), and 4.8% with asthma and COPD overlap (ACO). The FEV1 values were significantly higher in the ACO and NON-AE than in the AE-CB and AE NON-CB (p < 0.001). The symptom scores, ADO (age, dyspnoea and FEV1 ) index and the rates of exacerbations were significantly higher in the AE-CB and AE NON-CB phenotypes than in the ACO and NON-AE phenotypes (p < 0.001). Treatment preference in patients with COPD was statistically different among the phenotypes (p < 0.001). Subgroup analysis was performed in terms of emphysema, chronic bronchitis and ACO phenotypes of 1107 patients who had thoracic computed tomography. A total of 202 patients had more than one phenotypic trait, and 149 patients showed no features of a specific phenotype. DISCUSSION: Most of the phenotype models have tried to classify the patient into a certain phenotype so far. However, we observed that some of the patients with COPD had two or more phenotypes together. Therefore, rather than determining which phenotype the patients are classified in, searching for the phenotypic traits of each patient may enable more effective and individualized treatment.

Outcomes of pulmonary rehabilitation after lung resection in patients with lung cancer.

Background: In this study, we aimed to examine the effectiveness of pulmonary rehabilitation applied after resection in patients with lung cancer. Methods: Between October 2017 and December 2019, a total of 66 patients (53 males, 13 females; median age: 65 years; range, 58 to 70 years) who underwent lung resection for non-small cell lung cancer and who were not administered any chemotherapy or radiotherapy regimen were included in the study. An eight-week comprehensive outpatient pulmonary rehabilitation program was applied to half of the patients, while the other half received respiratory exercise training. After the intervention, the results of both groups were compared. Results: In the pulmonary rehabilitation group, forced vital capacity value (p=0.011), six-minute walking distance (p<0.001), and Short Form-36 physical function, mental health, vitality scores increased significantly, while all scores of St. George's Respiratory Questionnaire, dyspnea (p<0.001) and anxiety score (p=0.041) significantly decreased. In the group given breathing exercise training, only dyspnea (p=0.046) and St. George's Respiratory Questionnaire symptom scores (p=0.038) were decreased. When the changes in the groups after pulmonary rehabilitation were compared, the decrease in dyspnea perception was significantly higher in the pulmonary rehabilitation group (p<0.001). Conclusion: Pulmonary rehabilitation program applied after lung resection in patients with non-small cell lung cancer reduces dyspnea and psychological symptoms, increases exercise capacity, and improves quality of life. It should be ensured that patients with lung cancer who have undergone lung resection are directed to the pulmonary rehabilitation program and benefit from this program.

Is the repeated pulmonary rehabilitation program as effective as the first one in COPD patients?

Introduction: Although it is known that the effects of pulmonary rehabilitation (PR) programs in patients with chronic obstructive pulmonary disease (COPD) decrease over time, the results of the repeat PR programs are contradictory. Our study aimed to compare the effectiveness of the initial and the repeat PR programs on functional outcomes in COPD patients. Materials and Methods: Thirty two COPD patients who completed a second PR program were included in our retrospective cohort study. Eight-week PR program was applied to the patients twice with at least a one-year interval in between. mMRC Dyspnea Scale, Six-Minute Walk Test, Hospital Anxiety and Depression Scale, 36 Item Short Form Survey (SF-36), and St. George's Respiratory Questionnaire (SGRQ) were performed before and after both programs. The gains from the initial and the repeated programs were compared. Result: Six-minute walk distance, dyspnea, and quality of life improved following both programs (p<0.05). Improvements in six-minute walk distance (p= 0.009), dyspnea (p= 0.003), and SGRQ quality of life (p= 0.037 for activity score, p= 0.050 for total score) were found to be significantly higher in the initial PR program. Conclusions: Although many of the gains obtained from the repeated PR programs were similar to the initial PR program, the improvements in walk distance, perception of dyspnea, and quality of life obtained in the initial PR program were higher compared to the repeated PR program.

Static and Dynamic Postural Characteristics in Patients with Chronic Obstructive Pulmonary Disease: The Relationship with Dyspnea and Pulmonary Functions.

BACKGROUND: There is little evidence about posture influence and its relationship with pulmonary functions in chronic obstructive pulmonary diseases(COPD) patients. OBJECTIVES: To compare spinal curvature, mobility, and postural competency in participants with and without COPD and investigate the relationship of postural characteristics with dyspnea and pulmonary functions in COPD patients. METHODS: We included 47 COPD patients and 47 age and gender-matched controls in our cross-sectional study. Participants underwent the following evaluations: modified Medical Research Council Dyspnea Scale, respiratory function test, and postural measurements in the sagittal plane in a standing position using a non-invasive, computer-assisted electromechanical device. Postural variables were compared between groups, and the relationship between postural variables with dyspnea and pulmonary functions was analyzed by multivariate regression analysis. RESULTS: Thoracic and lumbar curvature were higher (p<0.05), thoracic mobility and spinal inclination were lower (p=0.011, p=0.030, respectively) in patients with COPD. Thoracic angle and spinal inclination increased in COPD patients (p=0.040, p=0.011, respectively) while only spinal tilt increased in the control group (p=0.010) under spinal loading. Thoracic angle and mobility were related with dyspnea (r2=0.25, p<0.001), forced expiratory volume in the first second (r2=0.56, p<0.001), forced vital capacity (r2=0.41, p<0.001), and RV (r2 = 0.42, p<0.001). CONCLUSION: COPD patients had greater thoracic and lumbar angles in the static upright posture and lower thoracic mobility and spinal inclination in the sagittal plane. It was observed that patients increase their thoracic angles to maintain postural stability in dynamic conditions. Thoracic angle and mobility were related to dyspnea and pulmonary functions.

Predictors of improvement in resting heart rate after exercise training in patients with chronic obstructive pulmonary disease.

BACKGROUND: High resting heart rate (RHR) is associated with multiple morbidity in chronic obstructive pulmonary disease (COPD) patients. Factors regarding the effectiveness of exercise training (ET) on RHR in COPD patients are unclear. AIMS: The main objective of the current study is to determine the predictors of the eventual change in RHR after ET. METHODS: One hundred and ten COPD patients (mean age: 63.1 ± 8.1 years, FEV1%: 43.6 ± 16.6) who participated in the ET program that consisted of supervised breathing, aerobic, strengthening, and stretching exercises for 8 weeks, 2 days a week, were included in the study. RHR, pulmonary functions, 6-min walk distance (6-MWD), Modified Medical Research Council Dyspnea Scale, St. George Respiratory Questionnaire, and Hospital Anxiety and Depression scores were compared before and after ET. Multivariate regression analysis was performed to correlate factors related to changes in RHR before and after exercise. RESULTS: There was a significant improvement in RHR after the ET program (p < 0.001). Improvement in RHR was correlated with baseline RHR, 6-MWD, partial arterial oxygen pressure, dyspnea sensation, forced expiratory volume in the first second (r = 0.516, -0.388, -0.489, 0.369, -0.360, p < 0.05, respectively), and change in 6-MWD, partial arterial oxygen pressure, and symptom score (r = 0.523, 0.451, -0.325, p < 0.05, respectively) after ET. Baseline RHR, 6-MWD, and the change in 6-MWD were the independent factors that predicted the change in RHR after ET. CONCLUSIONS: Patients with a high RHR and low functional capacity and whose functional capacity improves more have a greater decrease in RHR after the ET program. By considering these related factors, clinicians can focus on improving the cardiovascular system in COPD patients. CLINICAL TRIAL NUMBER: NCT04890080 (retrospectively registered-date of registration: 05.17.2021).

Efficacy of pulmonary rehabilitation on patients with non-cystic bronchiectasis according to disease severity.

INTRODUCTION: The European Respiratory Society guidelines support pulmonary rehabilitation (PR) in bronchiectasis through high-quality evidence. This study aimed to evaluate the efficacy of PR on bronchiectasis patients according to disease severity assessed by the Bronchiectasis Severity Index (BSI). MATERIALS AND METHODS: This prospective study included patients with stable bronchiectasis. Demographic data of all patients were questioned. All patients underwent an 8-week PR program. The patients were grouped into three according to disease severity (mild, moderate and severe) based on their BSI scores. The following parameters were evaluated at baseline (pre-PR) and after PR (post-PR): pulmonary function test results, carbon monoxide diffusion capacity, body mass index, exercise capacity (6-minute walking test), quality of life (QoL; St. George's Respiratory Questionnaire), and Hospital Anxiety and Depression scores. RESULT: The study included 69 patients (55 males; mean age, 62.6 ± 9 years). After PR, the patients were observed to have significantly improved QoL and exercise capacity (p< 0.05). According to BSI, 16 (23.2%), 29 (42.0%), and 24 (34.8%) patients had mild, moderate, and severe bronchiectasis, respectively. These patient groups significantly differed regarding age, exercise capacity, and QoL (p< 0.05). Comparing the change between post-PR and pre-PR values of the study parameters (∆ = post-PR value - pre-PR value), no significant differences were observed regarding the exercise capacity and QoL (p> 0.05) in the groups. CONCLUSIONS: PR increases exercise capacity and QoL in bronchiectasis patients, and its efficacy does not differ according to disease severity. Thus, appropriate bronchiectasis patients should be referred to PR program regardless of disease severity.

The effect of pulmonary rehabilitation on smoking and health outcomes in COPD patients.

OBJECTIVES: Although several positive effects of pulmonary rehabilitation (PR) are known in COPD patients, the results of PR in smoker COPD patients are unclear. We aimed to compare the effect of PR on smoking behaviour and health outcomes between COPD patients who are smoker and ex-smoker. METHODS: In our study; 62 COPD patients (31 of them active smoker and 31 of them were ex-smoker) who completed in an 8-week outpatient PR programme were included. Pulmonary function test, blood gas analysis, mMRC Dyspnoea Scale, 6-minute walk test, St. George's Respiratory Questionnaire, SF-36 Quality of Life Questionnaire and Hospital Anxiety Depression Scale were performed. Smoking behaviour and nicotine dependence of the study group was evaluated. RESULTS: At baseline assessment; TLCO was found to be lower in the currently smoking group (p = 0.042) and significantly increased after PR (p = 0.012). FEV1 , PaO2 , arterial saturation, 6-min walk distance and quality of life improved in both groups (p < 0.05). Anxiety score decreased in both groups; depression score decreased only in the ex-smoker group. When comparing changes between groups; mMRC score was observed to be decreased more in the smoker group (p = 0.01). At the end of the programme, nicotine dependence score and the daily number of cigarettes were significantly decreased in the smoker group (p < 0.001), also 2 patients completely quit smoking. CONCLUSION: Smoker COPD patients benefited from the PR programme at least as much as the patients who do not smoke. Furthermore, nicotine dependence and amount of cigarette decreased in smoker patients. Therefore, COPD patients who smoke should be referred to the PR programmes.

Which scoring system is better in association with exercise capacity and health status in noncystic fibrosis bronchiectasis patients?

Background/aim: Two different scoring systems were developed to determine the severity of bronchiectasis: FACED scoring and the bronchiectasis severity index (BSI). In this study, we aim to compare these 2 scoring systems according to the 6-min walking distance test and a disease-specific health status questionnaire in patients with noncystic fibrosis bronchiectasis (NCFB). Materials and methods: Smoking history, emergency and hospital admissions, and body mass index were obtained from NCFB patients admitted to our hospitals' pulmonary rehabilitation unit between 2013 and 2018. Detailed pulmonary function tests were performed for all participants. Dyspnea perceptions were determined according to the mMRC dyspnea scale. The 6-min walking test was used to determine exercise capacity. The Saint George respiratory questionnaire (SGRQ) was applied to determine health status. Both FACED and BSI scores were calculated for all participants. Results: There were a total of 183 participants, 153 of whom were men. A significant and strong correlation was found between FACED and BSI scores. As the severity of bronchiectasis increased, walking distance was significantly decreased and health status was significantly worse in both FACED and BSI scoring. A statistically significant but weak negative correlation was found between FACED score and walking distance. There was a significant negative correlation between BSI and walking distance, a stronger negative correlation than with FACED. Similarly, there was a significant negative correlation between health status and both FACED and BSI, but this correlation was stronger in the BSI score. Conclusions: Although both FACED and BSI scores were negatively correlated with walking distance and health status in patients with NCFB, BSI was more strongly associated.

Inappropriate Utilization of Antibiotics in COPD Exacerbations.

OBJECTIVE: Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD. MATERIAL AND METHODS: This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report. RESULTS: There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049). CONCLUSION: This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD.

The effect of the presence and severity of bronchiectasis on the respiratory functions, exercise capacity, dyspnea perception, and quality of life in patients with chronic obstructive pulmonary disease.

BACKGROUND: Bronchiectasis is common in patients with advanced chronic obstructive pulmonary disease (COPD) and adversely affects the patients' clinical condition. This study aimed to investigate the effects of bronchiectasis on exercise capacity, dyspnea perception, disease-specific quality of life, and psychological status in patients with COPD and determine the extent of these adverse effects by the severity of bronchiectasis. METHODS: A total of 387 COPD patients (245 patients with only COPD [Group 1] and 142 COPD patients with accompanying bronchiectasis [Group 2]) were included in the study. The patients in Group 2 were divided into three subgroups as mild, moderate, and severe using the Bronchiectasis Severity Index. Six-minute walk distance, dyspnea perception, St. George's Respiratory Questionnaire (SGRQ), and hospital anxiety and depression scores were compared between the groups. RESULTS: In Group 2, dyspnea perception, SGRQ total scores, depression score were higher, and walking distance was lower (P = 0.001, P = 0.007, P = 0.001, and P = 0.011, respectively). Group 2 had significantly worse arterial blood gas values. Dyspnea perception increased with the increasing severity in Group 2 (P < 0.001). Walking distance was lower in patients with severe bronchiectasis (P < 0.001). SGRQ total score, anxiety, and depression scores were significantly higher in the severe subgroup (P < 0.001, P = 0.003, and P = 0.002, respectively). CONCLUSIONS: In patients with Stage 3 and 4 COPD, the presence of bronchiectasis adversely affects the clinical status of the patients, decreases their exercise capacity, deteriorates their quality of life, and disrupts their psychological status. Investigating the presence of bronchiectasis in COPD patients is crucial for early diagnosis and proper treatment.

Effect of Pulmonary Rehabilitation on the Value of the Inspiratory Capacity-to-Total Lung Capacity (IC/TLC) Ratio to Determine Response to Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVES: In patients with chronic obstructive pulmonary disease (COPD), the inspiratory capacity-to-total lung capacity (IC/TLC) ratio has been found to be correlated with mortality and a reduced exercise capacity. Pulmonary rehabilitation (PR) is known to improve the exercise capacity and respiratory functions of patients with COPD. Our study aims to examine the impact of PR on the IC/TLC ratio in patients with COPD. MATERIALS AND METHODS: We included a total of 122 patients with COPD who received PR therapy twice a week over a period of 8 weeks in an outpatient clinic. RESULTS: Patients' mean age was 62.5 (±8.2), and 15 patients (12.3%) were female. Post-PR FEV1, TLCO, and pO2 values, and the 6mWD, dyspnea, and quality-of-life (QoL) scores indicated a statistically significant improvement (p<0.05 for all). Patients were grouped as follows: patients with IC/TLC >0.25 as Group 1 and IC/TLC ≤0.25 as Group 2. Both groups exhibited a significantly increased post-PR 6 mWT distance (375-420, 336-400 meters) with no difference between the groups. We observed a significantly increased FEV1% in both groups after the PR (p=0.007, 0.004). Again, QoL questionnaires and Modified Medical Research Council scores significantly improved for both groups (p<0.001). Although no post-PR IC/TLC improvement was detected in patients with good prognosis, we identified an IC/TLC improvement in the poor prognosis group (Group 2) (p=0.002). CONCLUSION: COPD patients with IC/TLC ≤0.25 benefit from the PR just as those COPD patients with IC/TLC >0.25.

Ischemic Preconditioning and Iloprost Reduces Ischemia-Reperfusion Injury in Jejunal Flaps: An Animal Model.

BACKGROUND: Free jejunal flaps are among the most commonly used flaps for esophageal reconstruction. However, ischemia-reperfusion injury caused by warm ischemia seen during transfer limits their use. Iloprost, a prostacyclin analogue, has been shown to reduce ischemia-reperfusion injury in various organs. The authors investigated tissue damage in jejunal flaps with iloprost and ischemic preconditioning and compared the effectiveness of these two modalities. METHODS: Thirty-four Sprague-Dawley rats were randomized into five groups: sham, ischemia-reperfusion (control), ischemic preconditioning, iloprost, and ischemic preconditioning plus iloprost. All flaps, except those in the sham group, underwent ischemia for 60 minutes and reperfusion for 2 hours. Flap perfusion was assessed by laser Doppler perfusion monitoring. Histologic sections were scored using the Chiu scoring system. Superoxide dismutase and myeloperoxidase levels were measured spectrophotometrically. RESULTS: Animals that were administered iloprost and/or underwent ischemic preconditioning had better postischemic recovery of mesenteric perfusion (ischemic preconditioning, 78 percent; iloprost, 83 percent; ischemic preconditioning plus iloprost, 90 percent; versus ischemia-reperfusion, 50 percent; p < 0.05). All intervention groups showed improved histology of jejunal flaps following ischemia-reperfusion injury (ischemic preconditioning, 3; iloprost, 2.3; ischemic preconditioning plus iloprost, 3.2; versus ischemia-reperfusion, 4.7; p < 0.01, p < 0.001, and p < 0.05, respectively). Superoxide dismutase levels were higher in ischemic preconditioning, iloprost plus ischemic preconditioning, and iloprost groups (ischemic preconditioning, 2.7 ± 0.2; ischemic preconditioning plus iloprost, 2.5 ± 0.3; versus ischemia-reperfusion, 1.2 ± 0.1; p < 0.01; iloprost, 2.4 ± 1.1; versus ischemia-reperfusion, 1.2 ± 0.1; p < 0.05). Myeloperoxidase, a marker for neutrophil infiltration, was lower in the iloprost group (iloprost, 222 ± 5; versus ischemia-reperfusion, 291 ± 25; p < 0.05). CONCLUSIONS: This study showed that both iloprost and ischemic preconditioning reduced reperfusion injury in jejunal flaps. Based on histologic results, iloprost may be a novel treatment alternative to ischemic preconditioning.

In Which the Gain is more from Pulmonary Rehabilitation? Asthma or COPD?

OBJECTIVES: Pulmonary rehabilitation (PR) is useful for patients with chronic obstructive pulmonary disease (COPD) but not clear for patients with asthma. The aim of the present study was to evaluate the effectiveness of PR in patients with asthma by comparing patients with COPD. The study was designed as a retrospective case series. We recruited patients with COPD and asthma. MATERIALS AND METHODS: Demographics, respiratory symptoms, medications, smoking history, comorbidities, exercise capacity, respiratory function tests, and quality of life (QOL) were recorded. Exercise capacity was evaluated by the 6-minute walk test (6MWT), QOL with St. George's Respiratory Questionnaire (SGRQ), 36-item Short Form Health Survey (SF-36) Quality of Life Questionnaire, and Hospital Anxiety and Depression (HAD) Scale. RESULTS: Forty-two patients with asthma and 25 COPD who completed PR were included in the study. There was no difference in terms of age and sex between the groups (p=0.100 and p=0.365, respectively); however, body mass index was higher in the asthmatic group (p=0.007). Partial oxygen pressure (pO2) difference and arterial oxygen saturation (SpO2) difference were significantly higher in the COPD group than in the asthma group after PR (p<0.05). When the patients were compared before and after PR in both groups, a significant increase was detected in exercise capacity and QOL (6MWT, HADa, SGRQ, and SF-36 in all domains) (p<0.05). When two groups are contrasted according to the difference between pre- and post-PR of variables, there was no significant difference except pO2, SpO2, and Medical Research Council (p>0.05). CONCLUSION: Physicians refer patients with COPD to PR; however, patients with asthma are not generally referred to the same frequency. We would like to emphasize that PR may be as effective as COPD in asthma.

Comparing the effect of pulmonary rehabilitation in patients with uncontrolled and partially controlled asthma.

OBJECTIVE: Pulmonary rehabilitation (PR) is an important therapeutic approach in asthmatic patients. Lack of asthma control is associated with high morbidity, poor health outcomes, and decrease in quality of life (QOL). However, there is no clear information about the effectiveness of PR in patients with differing levels of asthma control. This study aimed to compare the efficacy of PR in patients with uncontrolled and partially controlled asthma. METHODS: Before undergoing an 8-week outpatient PR program, patients were classified according to the asthma control test (ACT) as having partially controlled asthma or uncontrolled asthma. Changes in asthma control, exercise capacity, dyspnea perception, pulmonary function tests, arterial blood gas analysis, QOL, and psychological symptoms before and after PR were compared between groups. RESULTS: A total of 49 patients, 21 of whom were in partially controlled and the rest 28 were in uncontrolled asthma, participated in the study. After PR, asthma control perceived dyspnea, exercise capacity, QOL, anxiety, and depression significantly improved in both groups (p < 0.05). When the two groups were compared in terms of the benefits of PR, the improvement in ACT score was significantly greater in patients with uncontrolled asthma than in partially controlled asthma (p < 0.001), whereas the improvements in other parameters were similar between groups (p > 0.05). CONCLUSIONS: Improvement in asthma control is greater in patients with uncontrolled asthma than in patients with partially controlled asthma after PR. Therefore, patients with uncontrolled asthma, in particular, should be given opportunities to benefit from PR programs.

The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients.

CLINICAL TRIAL NUMBER: NCT03319108.

Effects of two different aquatic exercise trainings on cardiopulmonary endurance and emotional status in patients with knee osteoarthritis.

BACKGROUND: Aquatic exercises are often recommended for people with osteoarthritis (OA), however, there is a lack of evidence about the effects of these exercises. OBJECTIVES: The purpose of this study was to investigate the effects of two different aquatic exercise trainings on cardiopulmonary endurance and emotional status in patients with knee osteoarthritis. METHODS: Eighty-nine patients who had been diagnosed with knee osteoarthritis were divided into three groups as two different aquatic exercise training groups (only lower extremity training vs. lower extremity + upper extremity and trunk exercises) or the control group. All groups have received the conventional therapy which consisted of hotpack, ultrasound, transcutaneous electrical nerve stimulation (TENS), and home exercises. Six-minute walk test (6MWT) and the Hospital Anxiety and Depression Scale (HAD) were used for assessing cardiopulmonary endurance and emotional status, respectively. RESULTS: Following the treatment, all groups improved in terms of systolic blood pressure, walking distance and total HAD scores. Group 1 showed additional improvements in diastolic blood pressure, heart rate and perceived exertion, while Group 2 showed additional improvements only in perceived exertion. Greater changes before and after the treatment in diastolic blood pressure at rest and following 6MWT, perceived exertion following 6MWT, walking distance, HAD depression scores and HAD anxiety scores were observed in Group 1. CONCLUSIONS: Exercise therapy consisting of only lower extremity exercises in water might be more effective in improving exercise capacity and depression levels in comparison to upper extremity and trunk added exercises or conventional physical therapy.