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      International Journal of COPD (submit here)

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      Relationships Between Forced Oscillatory Impedance and 6-minute Walk Distance After Pulmonary Rehabilitation in COPD

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          Abstract

          Rationale

          Pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) reduces dyspnoea and improves exercise capacity and quality of life. The improvement in exercise capacity is variable and unpredictable, however. Respiratory system impedance obtained by forced oscillation technique (FOT) as a measure of ventilatory impairment in COPD may relate to improvement in exercise capacity with pulmonary rehabilitation. We aimed to determine if baseline FOT parameters relate to changes in exercise capacity following pulmonary rehabilitation.

          Methods

          At the start of rehabilitation, 15 COPD subjects (mean(SD) 75.2(6.1) years, FEV1 z-score −2.61(0.84)) had measurements by FOT, spirometry, plethysmographic lung volumes and 6-minute walk distance (6MWD). Respiratory system resistance (Rrs) and reactance (Xrs) parameters as the mean over all breaths (R mean, X mean), during inspiration only (R insp, X insp), and expiratory flow limitation (DeltaXrs = X insp−X exp), were calculated. FOT and 6MWD measurements were repeated at completion of rehabilitation and 3 months after completion.

          Results

          At baseline, Xrs measures were unrelated to 6MWD. X insp improved significantly with rehabilitation (from mean(SD) −2.35(1.02) to −2.04(0.85) cmH 2O.s.L −1, p=0.008), while other FOT parameters did not. No FOT parameters related to the change in 6MWD at program completion. Baseline X mean, DeltaXrs, and FVC z-score correlated with the change in 6MWD between completion and 3 months after completion of rehabilitation (r s=0.62, p=0.03; r s=−0.65, p=0.02; and r s=0.62, p=0.03, respectively); with worse ventilatory impairment predicting loss of 6MWD. There were no relationships between Rrs parameters, FEV1 or FEV1/FVC z-scores and changes in 6MWD.

          Conclusion

          Baseline reactance parameters may be helpful in predicting those patients with COPD at most risk of loss of exercise capacity following completion of pulmonary rehabilitation.

          Most cited references42

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          Pulmonary rehabilitation for chronic obstructive pulmonary disease.

          Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006.
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            Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.

            Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific mortality in COPD subjects. From a population-based sample recruited in Copenhagen in 1981-3 and 1991-4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories (very low, low, moderate, and high). Dates and causes of hospital admissions and mortality were obtained from Danish registers. Adjusted associations between physical activity and hospital admissions for COPD and mortality were obtained using negative binomial and Cox regression models, respectively. After adjustment for relevant confounders, subjects reporting low, moderate or high physical activity had a lower risk of hospital admission for COPD during the follow up period than those who reported very low physical activity (incidence rate ratio 0.72, 95% confidence interval (CI) 0.53 to 0.97). Low, moderate and high levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality (hazard ratio (HR) 0.76, 95% CI 0.65 to 0.90) and respiratory mortality (HR 0.70, 95% CI 0.48 to 1.02). No effect modification was found for sex, age group, COPD severity, or a background of ischaemic heart disease. Subjects with COPD who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality. The recommendation that COPD patients be encouraged to maintain or increase their levels of regular physical activity should be considered in future COPD guidelines, since it is likely to result in a relevant public health benefit.
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              Detection of expiratory flow limitation in COPD using the forced oscillation technique.

              Expiratory flow limitation (EFL) during tidal breathing is a major determinant of dynamic hyperinflation and exercise limitation in chronic obstructive pulmonary disease (COPD). Current methods of detecting this are either invasive or unsuited to following changes breath-by-breath. It was hypothesised that tidal flow limitation would substantially reduce the total respiratory system reactance (Xrs) during expiration, and that this reduction could be used to reliably detect if EFL was present. To test this, 5-Hz forced oscillations were applied at the mouth in seven healthy subjects and 15 COPD patients (mean +/- sD forced expiratory volume in one second was 36.8 +/- 11.5% predicted) during quiet breathing. COPD breaths were analysed (n=206) and classified as flow-limited if flow decreased as alveolar pressure increased, indeterminate if flow decreased at constant alveolar pressure, or nonflow-limited. Of these, 85 breaths were flow-limited, 80 were not and 41 were indeterminate. Among other indices, mean inspiratory minus mean expiratory Xrs (deltaXrs) and minimum expiratory Xrs (Xexp,min) identified flow-limited breaths with 100% specificity and sensitivity using a threshold between 2.53-3.12 cmH2O x s x L(-1) (deltaXrs) and -7.38- -6.76 cmH2O x s x L(-1) (Xexp,min) representing 6.0% and 3.9% of the total range of values respectively. No flow-limited breaths were seen in the normal subjects by either method. Within-breath respiratory system reactance provides an accurate, reliable and noninvasive technique to detect expiratory flow limitation in patients with chronic obstructive pulmonary disease.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                21 January 2020
                2020
                : 15
                : 157-166
                Affiliations
                [1 ]The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney , Glebe, NSW 2037, Australia
                [2 ]The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney , Camperdown, NSW 2006, Australia
                [3 ]Department of Respiratory Medicine, Royal North Shore Hospital , St Leonards, NSW 2065, Australia
                [4 ]School of Life Sciences, Faculty of Science, University of Technology Sydney , Ultimo, NSW 2007, Australia
                Author notes
                Correspondence: Sabine C Zimmermann The Woolcock Institute of Medical Research , 431 Glebe Point Road, Glebe, NSW2037, AustraliaTel +61 2 9114 0404Fax +61 2 9114 0010 Email sabine.zimmermann@sydney.edu.au
                Author information
                http://orcid.org/0000-0002-0658-9552
                http://orcid.org/0000-0003-3284-3558
                http://orcid.org/0000-0003-2559-3706
                http://orcid.org/0000-0002-8211-1817
                Article
                225543
                10.2147/COPD.S225543
                6982450
                164bd9d7-f253-4b4c-a636-13880c75b586
                © 2020 Zimmermann et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 31 July 2019
                : 19 December 2019
                Page count
                Figures: 4, Tables: 3, References: 51, Pages: 10
                Funding
                SCZ was supported by a NHMRC Postgraduate Scholarship. This research did otherwise not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
                Categories
                Original Research

                Respiratory medicine
                copd,forced oscillation technique,reactance,pulmonary rehabilitation,six-minute walk test,quality of life

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