Effectiveness of Early Inpatient and Community Pulmonary Rehabilitation on Clinical Outcome and Inflammatory Biomarkers during and after Hospitalization for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

  • Lin, Horng-Chyuan (PI)
  • Kuo, Han-Ping (CoPI)

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details

Abstract

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been shown to accelerate FEV1 decline, to increase mortality, and to have a profound influence on the decline in quality of life scores. COPD disease severity and number of comorbidities are associated with readmission rates of patients with AECOPD. Therefore, it is important to set up a treatment strategy for AECOPD. Previous studies have documented the positive benefit in stable COPD patients undergoing exercise training, however, the ideal model of inpatient pulmonary rehabilitation for AECOPD patients has not, to our knowledge, yet been studied. Only few studies had focused on the changes in lung function, exercise capacity, and quality of life in patients discharged from hospital for an episode AECOPD. Similarly, the effects of early outpatient pulmonary rehabilitation in the acute recovery phase after hospital admission for AECOPD have not previously been studied. Therefore, we conduct the present study to determine whether an early inpatient, multidisciplinary pulmonary rehabilitation programme during hospital combined with an early and long-term community pulmonary rehabilitation programme after hospital discharge result in greater benefits in patients with AECOPD, including improving respiratory functional capacity, quality of life, comorbidity and mortality. In addition, the mechanisms by which pulmonary rehabilitation is effective in AECOPD have not been fully elucidated. Patients with COPD have shown to have a systemic low-grade inflammation in stable condition, which increases during AECOPD. The systemic inflammatory responses associated with exacerbations may affect comorbid conditions, such as ischemic heart disease, pneumonia, and diabetes, thus contributing to accelerated deterioration and early death. This is an area that is particularly urgent for the AECOPD patients, either during admission, or after discharge. Our study will illustrate the mechanism that down-regulation of inflammatory and metabolic biomarkers facilitates the benefits of rehabilitation for AECOPD. Although it is presumed that AECOPD are associated with increased airway and systemic inflammation, there is little information on the nature of regulatory intracellular signals. The therapeutic benefits of pulmonary rehabilitation on the subsequent underlying cellular and molecular processes will also be explored by an in-vitro and ex-vivo study. Thus, our results may not only shed light on the mechanisms, either physical regulation or inflammatory modulation, underlying the potential action of inpatient and community pulmonary rehabilitation in AECOPD patients, but also provide a new therapeutic direction.

Project IDs

Project ID:PC9907-0738
External Project ID:NSC99-2314-B182-034
StatusFinished
Effective start/end date01/08/1031/07/11

Keywords

  • Early childhood weight gain
  • infant sleep
  • children sleep

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