An integrated approach to the implementation of the stage of pulmonary rehabilitation of patients with chronic obstructive pulmonary disease: the importance of lifestyle modification

Abstract

Aim. To evaluate the effectiveness of an integrated approach to the implementation of the outpatient stage of reha­bilitation of patients with chronic obstructive pulmonary disease (COPD) after outpatient treatment of moderate exa­cerbation.Materials and methods. The analysis of the effectiveness of 100 programs of the outpatient stage of rehabilitation of COPD patients who have suffered an exacerbation of moderate severity with the inclusion of the stage of correction of risk factors, physical therapy and physiotherapy procedures was carried out. The effectiveness was evaluated with the determination of high-speed indicators, the severity of shortness of breath according to the modified Medical Re­search Council Scale (mMRC) questionnaire and the Borg's scale, the level of blood oxygen saturation, body mass index, the six-minute walk test and the BODE index (Body-mass index, airflow Obstruction, Dyspnea, and Exercise). In order to assess the impact of the outpatient stage of rehabilitation on the quality of life, in addition to using the MOS SF-36 questionnaire and COPD Assessment Test (CAT), tests were conducted to assess the global health status and quality of treatment by the patient and the doctor.Results. In patients of the clinical observation group with mandatory inclusion of lifestyle modification (complete cessation of smoking and the use of alternative methods of nicotine delivery), 4 weeks after the beginning of the out­patient stage of pulmonary rehabilitation, there was a tendency to increase the maximum volumetric flow rate (MOS) at the level of 50 (p = 0.078) and 75 % (p1 = 0.061, p2 = 0.085) from the forced vital capacity of the lungs, the severity of dyspnea on the mMRC scale decreased by 18.6 % (p = 0.03); exercise tolerance improved - by 10.2 % on the Borg's scale (p < 0.01), by 4.9 % on the six-minute walk test (p < 0.01); the BODE (Body-mass index, airflow Obstruction, Dyspnea, and Exercise) index decreased by 31.7 % (p < 0.01). In both subgroups of the clinical observation group, there was a statistically significant improvement in quality of life indicators characterizing the state of physical health: physical functioning, role functioning and the total level of physical health; as well as indicators characterizing mental health indicators: vitality and social functioning (at p < 0.05)Conclusion. The effectiveness of an integrated approach to the implementation of the outpatient stage of rehabilitation of COPD patients who have suffered an exacerbation of moderate severity, with the inclusion of mandatory lifestyle modification (smoking cessation and the use of alternative techniques), physiotherapeutic methods of treatment (me­dicinal electrophoresis on the chest area) and methods of physical rehabilitation. Pulmonary rehabilitation of COPD patients with mandatory correction of risk factors, both during remission and during exacerbation, should be carried out in a planned form within the framework of primary health care to the population, primarily determining the quality of life of patients.

Keywords

• chronic obstructive pulmonary disease
• outpatient stage of pulmonary rehabilitation
• physical methods of treatment
• quality of life
• quitting smoking traditional cigarettes
• lifestyle modification
• alternative methods of combating smoking
• physical health
• mental health
• exacerbation of moderate severity