Search results

1

Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review

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Tymruk-Skoropad K., Pavlova I., Stupnytska S.

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2019

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vol. 33

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issue 4

51-65

EN

Introduction Chronic obstructive pulmonary disease is a chronic disorder that involves high-priced treatment and management, 45–75% of which may be associated with exacerbation. Treatment, rehabilitation, adherence to a healthy lifestyle, and following recommendations for self-management require a patient’s high motivation and self-organization. Analysis and the search for effective strategies that could be implemented to enhance the effectiveness of an educational component in rehabilitation for people with COPD have become the purpose of the study. Material and methods The search was conducted on a resource of the National Center for Biotechnology Information. From the initial database searches, 2487 unique papers were identified, 895 were retrieved for full-text evaluation, 39 of those were included for further data extraction. Results Publications selected for analysis based on the main content were grouped into 5 categories; most articles were focused on the self-management strategy. Conclusions The current practice of conducting and recommending education for COPD patients, as well as modern technologies, will make it possible to properly implement this component in pulmonary rehabilitation programs, achieve the objectives and positive impacts. Effective educational strategies ensure long-term benefits for the patients, fewer exacerbations, better physical performance, and quality of life. The correct inhaler technique is the fundamental practical skill to be learned by COPD patients during training sessions. A set of recommendations has been developed, and they should be considered when elaborating on the curriculum within the pulmonary rehabilitation for COPD patients.

2

Impact of education on dimensions of adherence in patients with chronic obstructive pulmonary disease

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Olah M., Kresznerits S., Gonda X., Perczel-Forintos D., Szabo M., Csanky E., Meszaros A.

Acta Poloniae Pharmaceutica - Drug Research

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2020

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vol. 77

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issue 1

195-204

EN

Objectives To assess the impact of patient education on medication adherence and quality-of-life (QoL) in Hungarian subjects with chronic obstructive pulmonary disease (COPD). Study Design Longitudinal, non-interventional study conducted at three pulmonology outpatient centers in and around Budapest, Hungary. Experimental Subjects visiting the center with COPD were invited to participate in the study. Data collected at baseline included subject demographics, medical history, and responses to the adherence (Morisky Medication Adherence Scale-8 (MMAS-8)) and QoL (EuroQoL-5D-5L (EQ5D), St. George’s Respiratory Questionnaire (SGRQ), and COPD Assessment Tool (CAT)) scales. Subjects were also provided with patient education designed with standardized content. Subjects were asked to provide responses to adherence and QoL scales again at the 3-month follow-up visit. Medication was left unchanged during the course of study. Statistical analysis included independent and paired-samples t-tests, one-way ANOVA, mixed-measures ANOVA and ANCOVA. Results Mean (± standard deviation (SD)) overall adherence score on MMAS-8 scale increased from 6.72 (± 1.46) at baseline to 7.01 (± 1.15) at follow-up (P = .040). A similar increase in mean (± SD) score was observed for question 4 on the MMAS-8 which deals with remembering to carry COPD medication when leaving house (baseline = 0.81 (± 0.40) versus follow-up = 0.89 (± 0.31); P = 0.018). Conclusions Patient education has a positive outcome on medication adherence in subjects with COPD. Further studies will be required to assess if these benefits are translated to patients’ QoL.

3

Depressive Disorders in COPD Patients - Economic Aspects

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Rysiak E., Prokop I., Zaręba I., Osińska M., Mróz R.

Acta Poloniae Pharmaceutica - Drug Research

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2019

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vol. 76

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issue 1

167-174

EN

Chronic obstructive pulmonary disease is one of the most important health problems and one of the most common chronic diseases. The occurrence of COPD is associated with a particular dimension of physical suffering, the source of which is the difficulty in breathing. A significant percentage of patients experience the mental consequences of illness such as depression and anxiety disorders. The aim of the study was to analyze the prevalence of depressive symptoms in patients with medium-severe and severe forms of COPD and to assess the cost of coexistence of depression in this group of patients. The retrospective study, based on medical records, included two groups of patients: Group 1- 63 persons and Group 2– 60 persons. The study evaluated the following parameters: degree of severity of COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD), degree of severity of dyspnea using the mMRC scale of dyspnea developed by the Medical Research Council and occurrence of depressive symptoms and their severity using the Beck Depression Scale questionnaire. Patients were treated at the CENTER for Respiratory Medicine between January 2016 and December 2016. Results of our study showed that in both treatment groups analysis of the answers received from the Beck’s Depression Scale questionnaire revealed that all these patients have depressive symptoms of varying severity.

4

Influence of COPD Assessment Text (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of COPD patients

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Liu J., Meng G., Ma Y., Zhang X., Chen D., Chen M.

Open Medicine

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2014

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vol. 10

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issue 1

EN

The study aimed to evaluate the influence of the COPD Assessment Test (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of patients with chronic obstructive pulmonary disease (COPD). Forty-five patients with COPD admitted from Nov. 2012 to Nov. 2013 were treated with combined bronchodilators and inhaled corticosteroids. Thirty-five patients admitted from Nov. 2012 to Nov. 2013 and classified as a study group received rehabilitation education guidance on the basis of the treatment of the control group to compare the quality-of-life-scale score, dyspnea index score, and motor function of the two groups of patients after 48 weeks of treatment. After treatment, the CAT score of both groups of patients was significantly lowered. After 48 weeks of treatment, the respiratory function of both groups was significantly improved, but the Medical Research Council (MRC) scale for the study group after treatment was significantly lower than that for the control group. After 48 weeks of rehabilitation exercises, the 6-minute walk test (6MWT) for patients with COPD was significantly prolonged, but the test results were significantly higher for the study group after treatment than for the control group. After receiving CAT rehabilitation education, COPD patients had significantly improved life quality and significantly enhanced exercise tolerance. The treatment mode may be gradually introduced in future clinic and nursing work.

5

The production of reactive oxygen species in peripheral blood neutrophils is modulated by airway mucous

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Babusyte A., Jeroch J., Stakauskas R., Sakalauskas R.

Open Medicine

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2009

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vol. 4

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issue 2

245-252

EN

Neutrophils are a major source of reactive oxygen species (ROS). The role of airway mucous on ROS production is unknown. The aim of our study was to investigate the direct influence of bronchoalveolar lavage fluid (BALF) and induced sputum (IS) alone or in combination with chemical/biological stimulus on ROS production in peripheral blood neutrophils during chronic obstructive pulmonary disease (COPD). Neutrophils were isolated from peripheral blood of 47 patients with moderate COPD and 14 healthy individuals (HI). BALF/RPMI (1:1) or IS/RPMI (1:1) from COPD patients were used to stimulate neutrophils alone or in combination with phorbolmyristate- acetate (PMA) (0.1–30 nM) or Staphylococcus aureus bacteria (0.7–500 bact/neutrophil). Relative generation of ROS was measured flow cytometrically. BALF/RPMI and in combination with relatively low PMA or all bacteria concentrations stimulated ROS; while, combination with relatively high PMA concentrations suppressed ROS in of COPD patients and HI. IS/RPMI and its combination with PMA inhibited ROS generation in both groups; whereas, IS stimulated or had a tendency to stimulate ROS production with relatively high bacteria concentrations. In conclusion, BALF and IS directly or in combination with chemical/biological factors modulated ROS production. This effect was stronger in neutrophils from COPD patients and depended on chemical/biological stimulus intensity.

6

Assessment of disease-related knowledge among patients with chronic obstructive pulmonary disease: a cross-sectional study

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Tymruk-Skoropad K., Pavlova I., Sydoryk N., Kulitka Y., Kruk B.

Physical Activity Review

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2020

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vol. 2

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issue 8

72-85

EN

Introduction. The main task of this study was to study the level of knowledge of the Ukrainian patient about chronic obstructive pulmonary disease (COPD), and the factors that cause and affect this indicator, with the help of a validated instrument. Methods. 41 patients were involved in the study. Socio-demographic data, information on the duration, course of the disease and cooperation with a physical therapist were collected. Anthropometric measurements, spirometry, pulse oximetry, tonometry were performed. Patients were surveyed with Modified Medical Research Council Dyspnea Scale, Hospital Anxiety and Depression Scale, Clinical COPD Questionnaire score, and Bristol COPD Knowledge Questionnaire (BCKQ). Bristol COPD Knowledge Questionnaire was translated, crossculturally adapted and validated. Regression analysis was performed to determine relationships between the level of knowledge about the disease, socio-demographic data, indicators of respiratory system functional status, and survey data. Results. The average total score for BCKQ was 24.71±9.62 points. Patients gave the least number of correct answers to the question related to medical treatment. The level of knowledge depends on the factors such as age (β=-0.557; 95% CI: -1.041-0.086, p=0.086), duration of the disease (β=-0.114; 95% CI: -0.077-0.055, p=0.048), respiratory ratings, functional limitations, and own psychosocial dysfunction according to the CCQ scale (β =-0.506; 95% CI: -0.0070.752, p=0.053), and the HADS depression score (β =-0.655; 95% CI: -4.257- -0.085, p=0.043). Conclusion. The level of knowledge of Ukrainian patients about COPD is low. More experience of the disease did not affect the increase in the level of knowledge. Older patients had a lower level of knowledge about their disease. Impact of body mass index, spirometry results, level of severity of shortness of breath, and symptoms of the disease on the level of knowledge was not revealed.

7

LABA in patients with stage I COPD and mild sleep apnea syndrome: a pilot study

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Kopitovic I., Kojicic M., Drvenica M., Ilic M.

Open Medicine

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2011

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vol. 6

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issue 1

26-30

EN

Patients suffering from both sleep apnea-hypopnea syndrome (SAHS) and chronic obstructive pulmonary disease (COPD) have a more severe form of sleep apnea. Knowing all pathophysiological aspects that mutually interact in sleep disorders and COPD, we aimed to investigate if the introduction of long-acting β2 agonists (LABA) during the night could improve overnight oxygenation and the ability to perform daily activities in stage I COPD patients with mild SAHS. We conducted a prospective study of 22 patients with stage I COPD and SAHS confirmed by overnight polygraph screening, without nocturnal CPAP treatment. During twelve weeks, all patients used LABA (salmeterol 50 mcg) with a metered dose inhaler before bedtime. The levels of apnea hypopnea index, oxygen saturation, heart rate, and Epworth daytime sleepiness scale (ESS) were recorded before and after the treatment. There was a significant improvement of lowest and average overnight oxygenation compared to baseline (mean difference 2.1±0.42, p<0.0001; 1.7±0.3, p<0.0001, respectively). In addition, patients reported reduction in daytime sleepiness according to ESS (mean difference 1.23±0.51; p=0.03). Fewer patients exhibited tachycardia when on salmeterol (68 vs. 41%; p=0.01). Use of inhaled salmeterol improves overnight oxygenation in patients with stage I COPD and SAHS. Future prospective studies are warranted to confirm this potentially beneficial effect of long-acting β2 agonists.

8

Czynniki ryzyka przewlekłej obturacyjnej choroby płuc u pacjentów leczonych szpitalnie

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Iwanicka-Michałowicz M., Grzelewska-Rzymowska I.

Pediatria i Medycyna Rodzinna

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2009

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vol. 5

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issue 1

27-32

EN

COPD is currently one of the most important health problems all over the world. The most frequent factor responsible for COPD development is smoking of cigarettes, both active and passive. Other reasons influencing COPD development are occupational exposure to dust, chemical substances, irritant gases. The risk factor is congenital deficiency of α1-antitrypsin (genetic factor). The aim of the paper was to analyse any risk factors influencing development of COPD. The study was performed in 200 people with diagnosed COPD treated between 2005 and 2007. A patient medical history based on a questionnaire prepared for the study was performed in all patients. The study results then underwent statistical analysis. Of the subjects 124 (62%) were males and 76 (38%) were females. Mean age of the males – 66.1 years and of the females – 66.4 years. The main risk factor of the disease in the group studied was cigarette smoking – found in 170 patients (85%), from them 37.5% were current smokers, 47.5% were former smokers. Smoking history of current and former smokers averaged 42 pack-years (range 1-160). COPD was also found in 30 lifelong non-smokers (15%). Exposure to passive smoking at work and/or at home was observed in 175 people (87.5%). The inhalation of hazardous substances in the work environment was reported in 150 of the people studied (75%). Due to the fact that the smoking habit is very frequently found among COPD patients, it seems necessary to intensify actions taken to spread knowledge regarding COPD’s causes and effects, increase anti-smoking education and implement cheap and effective test screening methods.

PL

POChP należy obecnie do najpoważniejszych problemów zdrowotnych na świecie. Najczęstszym czynnikiem, który odpowiada za rozwój POChP, jest palenie tytoniu, zarówno czynne, jak i bierne. Kolejnymi przyczynami warunkującymi rozwój POChP są narażenie zawodowe na pyły, substancje chemiczne, gazy drażniące. Czynnikiem ryzyka jest także wrodzony niedobór α1-antytrypsyny (czynnik genetyczny). Celem pracy była analiza czynników ryzyka warunkujących rozwój POChP. W badaniu wzięło udział 200 osób z rozpoznaniem POChP leczonych szpitalnie w latach 2005-2007. U wszystkich chorych przeprowadzono wywiad według kwestionariusza przygotowanego na potrzeby badania. Wyniki badania poddano analizie statystycznej. W badanej grupie było 76 kobiet (38%) i 124 mężczyzn (62%). Średnia wieku mężczyzn wynosiła 66,1 roku, kobiet – 66,4 roku. Głównym czynnikiem ryzyka rozwoju choroby w badanej grupie było palenie tytoniu – stwierdzono je u 170 badanych (85%), przy czym 37,5% chorych było aktualnymi palaczami, a 47,5% byłymi palaczami. Średni czas trwania nałogu w grupie obecnych i byłych palaczy wyniósł 42 paczkolata (rozpiętość 1-160). POChP rozpoznano również u 30 osób nigdy niepalących papierosów (15%). Narażenie na bierne palenie w pracy i/lub w domu podawało 175 chorych (87,5%). Narażenie na wdychanie szkodliwych substancji w środowisku pracy zgłaszało 150 badanych (75%). W związku z faktem, że nałóg palenia tytoniu jest zjawiskiem bardzo częstym wśród chorych na POChP, konieczne wydaje się zintensyfikowanie działań mających na celu upowszechnianie wiedzy na temat przyczyn i skutków POChP, realizację edukacji antytytoniowej oraz wdrożenie taniej i skutecznej metody badań przesiewowych.

9

Ocena lokalnego i systemowego stanu zapalnego u chorych na przewlekły obturacyjną chorobę płuc w okresie stabilnym i w zaostrzeniu

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Kwiatkowska S., Urbaniak A., Szkudlarek U., Zięba M.

Pediatria i Medycyna Rodzinna

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2008

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vol. 4

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issue 3

183-188

EN

Introduction: Chronic obstructive pulmonary disease (COPD) is characterised by the airflow limitation as a consequence of progressive inflammatory response to inhaled noxious particles and gases, particularly cigarette smoke. Three factors play a main role in pathogenesis of the disease: inflammatory process, oxidative stress and imbalance between proteases and antiproteases. Recently there are some evidences that also extrapulmonary changes like cachexia, osteoporosis or depression are associated with COPD. The aim of the study was to access local and systemic inflammation in patients with COPD. Material and methods: The study group consisted of 23 patients with COPD during stable and exacerbation phase of the disease. As a control served 16 asymptomatic smokers. We investigated: 1) concentration of hydrogen peroxide (H2O2) and proinflammatory cytokines like TNF-a and IL-6 in expired breath condensate (EBC); 2) serum levels of TNF-a and IL-6. Results: It was showed that the level of H2O2 in EBC of patients with stable COPD was significantly higher as compared with healthy smokers. Additional significant enhanced in H2O2 exhalation was demonstrated during exacerbation of COPD. There was no difference in IL-6 concentration between the study groups (p>0,05). Discernible level of TNF-a in exhaled air was measured only in those with COPD exacerbation. Exhaled H2O2 correlated with FEV1% predicted value in patients with stable as well as with exacerbation phase of COPD. Also serum levels of TNF-a and IL-6 of patients with stable disease were higher compared to the values of healthy smokers. The serum concentrations of studied cytokines did not change significantly during exacerbation of COPD. Conclusions:Our results demonstrated the occurrence of local oxidative stress in patients with stable COPD. This process significantly increased during exacerbation of the disease. Besides of local reaction in respiratory compartment of patients with stable COPD we revealed systemic inflammatory process measured by serum levels of TNF-a and IL-6. Exhaled H2O2 correlated with lung function (FEV1% pred).

PL

Wstęp: Przewlekłą obturacyjną chorobę płuc (POChP) charakteryzuje ograniczenie przepływu powietrza przez drogi oddechowe będące wynikiem nadmiernej reakcji zapalnej na wdychane pyły i gazy, głównie dym tytoniowy. W patogenezie tej choroby odgrywają rolę trzy czynniki: proces zapalny, stres oksydacyjny oraz zaburzenia równowagi pomiędzy proteinazami i antyproteinazami. W ostatnich latach coraz więcej danych wskazuje na obecność u chorych na POChP zmian pozapłucnych, takich jak wyniszczenie, osteoporoza czy depresja. Celem pracy była ocena stanu zapalnego lokalnego oraz systemowego u chorych na POChP. Materiał i metody: Badania przeprowadzono u 23 chorych na POChP dwukrotnie - w stabilnym okresie choroby oraz w zaostrzeniu. Grupę kontrolną stanowiło 16 asymptomatycznych palaczy papierosów. Analizie poddano: 1) w kondensacie powietrza wydechowego (kpw) stężenie nadtlenku wodoru (H2O2) oraz proza-palnych cytokin TNF-α i IL-6; 2) w surowicy poziom TNF-a i IL-6. Wyniki: Stwierdzono, że u chorych na POChP w okresie stabilnym w kpw poziom H2O2 był znamiennie wyższy niż w grupie kontrolnej osób zdrowych. W trakcie zaostrzenia choroby ulegał on dalszemu wzrostowi (p<0,05). Natomiast stężenie IL-6 w powietrzu wydechowym było w badanych grupach podobne (p>0,05). Mierzalny poziom TNF-α zanotowano jedynie u chorych z zaostrzeniem POChP. Zarówno w okresie stabilnym, jak i w zaostrzeniu choroby poziom H2O2 w kpw korelował z FEV1% wartości należnej. Chorych na stabilną POChP charakteryzowało podwyższone w surowicy zarówno stężenie TNF-α, jak i IL-6 w porównaniu z grupą asymptomatycznych palaczy. W okresie zaostrzenia badane cytokiny nie ulegały istotnym zmianom (p>0,05). Wnioski: U chorych na POChP wykazano obecność lokalnego stresu oksydacyjnego, który w trakcie zaostrzenia choroby ulegał dalszemu znamiennemu nasileniu. Obok reakcji w kompartmencie oddechowym chorzy ze stabilną postacią POChP charakteryzowali się obecnością systemowej reakcji zapalnej mierzonej poziomem TNF-α i IL-6 w surowicy. Poziom nadtlenku wodoru w powietrzu wydechowym korelował z wartościami spirometrycznymi (FEV1% wartości należnej).

10

Ambulatory pulmonary rehabilitation programme in patients suffering from chronic obstructive pulmonary disease (COPD): a preliminary study

63%

Majewski M., Rożek K., Alawale O.

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2010

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vol. 18

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issue 4

11-20

PL

Celem pracy było przedstawienie ambulatoryjnego programu rehabilitacji pulmonologicznej, opartego na formie stacyjnej oraz wstępna ocena jego skuteczności na wybrane parametry wydolności fizycznej i jakości życia chorych na POChP. Siedmiu pacjentów z ciężkim i bardzo ciężkim stadium POChP ukończyło program rehabilitacji pulmonologicznej. W programie pacjenci wykonywali 9 ćwiczeń w systemie stacyjnym i 10-minutowy marsz. Wykorzystano następujące metody pomiaru: Kwestionariusz Szpitala Św. Jerzego (SGRQ), Chronic Respiratory Questionnaire (CRQ), London Chest Activities of Daily Living Scale, skalę HADS, a także narastający i wytrzymałościowy wahadłowy test chodu (ISWT i ESWT). HR, SaO2 i stopień duszności (wg skali Borga) oceniono przed i po testach chodu. Zbyt mała liczba badanych i zbyt mała częstość zajęć nie pozwoliły na uzyskanie istotnej statystycznie poprawy badanych parametrów.

EN

The aim of the study was to present an ambulatory pulmonary rehabilitation programme, based on a circuit form and a preliminary evaluation in order to verify whether such a programme has an impact on exercise capacity and quality of life in patients suffering from COPD. Seven patients with severe and very severe COPD completed the rehabilitation programme. In each training session patients performed 9 circuit exercises and a 10-minute walk. In this study following assessments were used: St. George Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), London Chest Activities of Daily Living Scale, HAD scale, Incremental and Endurance Shuttle Walk Tests (ISWT & ESWT). HR, SaO2 and dyspnoea (Borg scale) were measured by means of pre- and post-exercise tests. A small number of patients who finished this programme and a little frequency of training sessions a week resulted in a lack of statistically significant outcomes.

11

Analysis of selected fatigue determinants in patients with COPD

63%

Wiśniewska A. E., Ślusarska B., Klepacka J., Jędrzejkiewicz B., Nowicki G.

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issue 73

274-282

EN

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a partially irreversible narrowing of the respiratory tract that hinders air flow through the lungs. Airflow impairment in patients with COPD causes fatigue. MATERIAL AND METHODS: The aim of the study was to determine the sense of fatigue in patients diagnosed with COPD on the basis of sociodemographic and biomedical factors. The study was conducted in 2016 in a group of 120 patients with COPD. The method of a diagnostic survey using the Brief Fatigue Inventory scale was used. RESULTS: According to the Brief Fatigue Inventory scale, 1.67% of respondents experienced mild fatigue, while 98.33% moderate. Statistical analysis of the study results indicates that the fatigue intensity was significant in the group of women (p < 0.001), people over 60 and 50 to 60 years old (p < 0.001), overweight and underweight (p < 0.001), patients with secondary and primary education (p < 0,001), living in a city (p < 0.001), in a single-family house or block of flats (p < 0.001), smokers (p < 0.001) or passive smokers (p < 0.001), physical workers (p < 0.001), suffering for 3–5 years (p < 0.001). The reasons for the presence of ailments such as coughing or shortness of breath exacerbating fatigue were physical activity (61.67%), respiratory infections (58.33%), contact with chemical agents (55.83%), and rarely stress (28.33%). CONCLUSIONS: In the group of patients with COPD, fatigue is more pronounced in the over 60 age group, in women, overweight patients and those living in the city. Fatigue is intensified by the duration and severity of the disease, physical activity and physical work, as well as cigarette smoking.

PL

WSTĘP: Przewlekła obturacyjna choroba płuc (POChP) polega na częściowo nieodwracalnym zwężeniu dróg oddechowych, które utrudnia przepływ powietrza przez płuca. Upośledzenie przepływu powietrza u chorych z POChP powoduje zmęczenie. MATERIAŁ I METODY: Celem badawczym pracy było określenie poczucia zmęczenia u pacjentów z rozpoznaniem POChP na podstawie czynników socjodemograficznych oraz biomedycznych. Badania przeprowadzono w 2016 r. w grupie 120 pacjentów z POChP. Wykorzystano metodę sondażu diagnostycznego z zastosowaniem skali Krótkiego Inwentarza Zmęczenia. WYNKI: Według skali Krótki Inwentarz Zmęczenia u 1,67% badanych występowało łagodne zmęczenie, natomiast umiarkowane u 98,33%. Analiza statystyczna wyników badań wskazuje, że nasilenie zmęczenia było istotne w grupie kobiet (p < 0,001), osób powyżej 60 lat i 50–60 lat (p < 0,001), u osób z nadwagą oraz niedowagą (p < 0,001), pacjentów z wykształceniem średnim i podstawowym (p < 0,001), mieszkających w mieście (p < 0,001), w domu jednorodzinnym lub bloku (p < 0,001), u osób palących (p < 0,001) lub palących biernie (p < 0,001), w grupie pracującej fizycznie (p < 0,001), chorujących od 3 do 5 lat (p < 0,001). Przyczyną występowania u chorych dolegliwości, takich jak kaszel lub duszność, nasilających zmęczenie były wysiłek fizyczny (61,67%), infekcje dróg oddechowych (58,33%), kontakt z czynnikami chemicznymi (55,83%), rzadko zaś stres (28,33%). WNIOSKI: W grupie pacjentów z POChP zmęczenie w większym nasileniu występuje w grupie wiekowej powyżej 60 lat, u kobiet, pacjentów z nadwagą oraz mieszkających w mieście. Na nasilenie poczucia zmęczenia wpływa czas trwania choroby i stopień jej zaawansowania, aktywność fizyczna oraz wykonywanie pracy fizycznej, a także palenie papierosów.

12

Tests of the functional performance of patients with COPD: A proposal for the application of the Expanded Timed ‘Get Up and Go Test’ (ETGUG)

51%

Bromboszcz J., Włoch T.

Medical Rehabilitation

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2010

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vol. 14(1)

30-42

PL

Badanie sprawności czynnościowej nie jest częstą praktyką w postępowaniu z chorymi na przewlekłą obturacyjną chorobę płuc (POChP). Test marszu 6-minutowego (6MWT) znajduje zastosowanie w diagnostyce i ewaluacji wyników rehabilitacji jedynie w wyspecjalizowanych ośrodkach pulmonologicznych. Zastosowanie innych badań, bezpośrednio lub pośrednio oceniających sprawność czynnościową, jest na ogół ograniczone do placówek badawczych. Stan wiedzy o uwarunkowaniach i konsekwencjach POChP wskazuje na konieczność oceniania sprawności czynnościowej, a w przypadku prowadzenia rehabilitacji pulmonologicznej powinno to być rutynowe postępowanie. Upowszechnione powinno być stosowanie testu 6MWT i innych testów przedstawianych w artykule, jednak potrzebne jest takŜe poszukiwanie nowych testów czynnościowych. Potrzebne są zwłaszcza testy do badania chorych z zaawansowaną postacią POChP, którzy mają trudności ze skutecznym wykonaniem testu 6MWT. Interesującą propozycją wydaje się w tym względzie Wydłużony Test Wstań i Idź (ang. Expanded Timed ‘Up and Go Test’, ETGUG), którego jak dotąd nie stosowano w grupie chorych z POChP. MoŜliwość odniesienia wyników testu do siły i wytrzymałości mięśni kończyn dolnych, do zdolności utrzymywania równowagi oraz aktywności ruchowej typowej dla Ŝycia codziennego, odpowiada zmianom patologicznym i ograniczeniom spotykanym w POChP. Badania dotyczące Testu „Wstań i Idź” (ang. Timed ‘Up and Go Test’, TUG) pokazują, że może on być stosowany u chorych z POChP, jednak bardzo krótki dystans marszu zastosowany w tym teście ogranicza możliwość interpretacji jego wyników tylko do oceny sprawności wstawania z pozycji siedzącej i siadania oraz zdolności utrzymywania równowagi. Wydaje się, Ŝe 20- metrowy dystans marszu w teście ETGUG może być wystarczający do ocenienia zdolności chodzenia chorych z POChP, szczególnie z grup zaawansowania choroby III i IV wg GOLD. Niezbędne są zatem badania testu ETGUG dotyczące trafności, rzetelności i zdolności reagowania na zmiany stanu chorych z POChP

EN

The testing of physical performance is not a common practice in the treatment of patients with COPD. Only a 6-minute walking test (6MWT) is more often used in the diagnosis and evaluation of the results of rehabilitation conducted in specialist pulmonary clinics. The use of other tests either directly or indirectly assessing physical performance is generally limited to research units. The state of knowledge about the conditioning and consequences of COPD point to the necessity of evaluating physical performance, while in the case of conducting pulmonary rehabilitation it should constitute a routine procedure. Without doubt the 6MWT and other tests presented in the paper should be widely used, though there exists the need to find other activity tests easier to conduct amongst patients with an advanced form of COPD, who have difficulty with effectively carrying out the 6MWT. An interesting proposition appears to be in this case Expanded Timed ‘Get Up and Go Test’ (ETGUG) which has previously not been used with COPD patients. The possibility of relating the results to the strength and endurance of the muscles of the lower limbs, to the ability of maintaining balance as well as physical activity typical for everyday life, corresponds to the pathological changes and limitations encountered in COPD. Research into the TUG test shows that it may be used in patients with COPD, however the extremely short walking distance in this test limits the possibility for result interpretation to an evaluation of the ability to stand from a seated position and to sit as well as the ability to maintain balance. It appears that a 20 metre walking distance for the ETGUG test would be sufficient to assess the walking abilities of patients with COPD, particularly for groups with advanced stages III and IV of the disease according to GOLD. Hence it is necessary to examine the ETGUG test in relation to its validity, reliability and responsiveness for patients with COPD.

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