Терапевтический архив (Mar 2017)
A personalized approach to the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease
Abstract
Aim. To elaborate and introduce personalized pulmonary rehabilitation (PR) programs adapted in terms of the types of disease response in patients with chronic obstructive pulmonary disease (COPD) and to evaluate the effectiveness of the programs. Subjects and methods. A total of 85 patients with COPD of more than 2 years’ duration (the shortest time frame that was valid to assess the type of disease response) were examined. All the patients underwent adequate physical, instrumental, laboratory, and psychiatric examinations, during which the type of COPD response was determined. Before a rehabilitation cycle, after its termination, and 1, 3, and 6 months later, each patient underwent evaluation of the symptoms of COPD, the frequency of its exacerbations, the level of basic knowledge about COPD according to the author’s questionnaire, assessment of the quality of life and the symptoms of anxiety and depression, and functional tests. Results. The final sample included 30 patients who met the inclusion criteria and agreed to voluntarily participate in the PR programs. According to the type of a response to the underlying disease, the patients were divided into 2 polar groups: A) those who were anxious about their illness (excessive apprehension, fears that were associated with the perception of lung disease and that led to distress) and depression (despondency, an agonizing understanding of a possible poor outcome and consequences of the impact of COPD on their lives) and B) those who had a newly diagnosed type of COPD response — hyponosognosia (underestimation of disease severity, perception of the symptoms of COPD as age-related changes, and preservation of the old way of life to the detriment of their health). Effective personalized PR programs were elaborated and applied to both groups. Conclusion. Group measures focused on learning how to cope with the disease and its symptoms and on the ability to distinguish its manifestations from the signs of psychological distress and to combat them are effective in patients who are anxious about the disease and depressed (Group A). Individual inpatient activities aimed at the formation and maintenance of motivation, the formation of an image of the disease and its manifestations, and early specialized care for smoking cessation are indicated for patients with hyponosognosia (Group B).
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