F-4-05-02
EFFECACY OF BREATHING EXERCISE IN A POOL FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Hitoshi Kurabayashi, Kazuo Kubota, Izumi Machida
Division of Rehabilitation, Kusatsu Branch Hospital, Gunma University Hospital, Gunma, Japan
[Purpose] To evaluate respiratory function and arterial blood gas during breathing exercise in a pool.
[Methods] Respiratory function and arterial blood gas were examined before and after a 2-month exercise program, 20 minutes a day, in a pool filled with 38℃ hot-spring water in 22 patients (70.9±9.1 years old) with stable chronic obstructive pulmonary disease (COPD) treated at our hospital between 1991-1994. The patients immersed in a pool breathed in deeply in a standing position and breathed out slowly through the mouth into the water by sinking the nose by bending the knees.
[Results] The ratio of forced expired volume in a second to forced vital capacity (FEV1.0%) was significantly increased after the program, though the ratio of forced vital capacity to predicted normal value (%FVC) unchanged. A trend toward an increase in peak flow was observed, while maximal expiratory flow at 25 per cent (V25) unchanged. Though PaO2 was not increased, PaCO2 was decreased significantly after the exercise program. The base excess and pH of arterial blood were not changed.
[Conclusion] The improvement in respiratory function and arterial blood gas appeared to be resulted from respiratory muscle training, expiration against hydraulic pressure, and small air way clearance. Breathing exercise in a pool may be useful for COPD.
F-4-05-03
Pulmonary Rehabilitation Programme for patients with Silicosis in Hong Kong
Ma HM, Yeung A, Ngan J, Li R, Wong L, So HP. Wong Tai Sin Hospital, Hong Kong
We reviewed 31 male silicosis patients who joined pulmonary rehabilitation from April 1994 to August 1996. 27 completed the programme. Mean age 61.1+/--9.6.
60% had diagnosis >10 years. All had retired (15% Caisson workers) & relied on compensation financially. All had COPD, 52% old pulmonary tuberculosis. 15% hearing impairment. Baseline FEV1 0.83 +/-- 0.25 1, FVC 1.52+/--0.38 1, PaCO2 6.16 +/--1.16 kPa, PaO2 9.35 +/--1.96kPa. Programme lasted 5.40+/--1.25 weeks. No significant change in FEV1 but significant improvement in FVC (1.69 +/-- 0.44 1, p<0.01) was noted. 96% were smokers (44+/--27 pack-years). 38% required oxygen :12 % LTOT, 4% ambulatory oxygen & 22% both. 92% improved in symptomatology & ADL performance. Improvements in 6 minute walk distance (overall 14%, p<0.01) & 4 aspects of quality of life (dyspnoea, fatique, emotions & mastery) by Chronic Respiratory Disease Questionnaire were documented & peaked at 1 month's follow up (p<0.05) after which gradual loss of improvements occurred at 3 & 6 months' follow Up. Improvements in knowledge of disease, inhaler techniques & social resources utilization were also demonstrated. Average acute hospital admission rate & duration were also reduced. Mortality rate of the cohort at 1 year follow up was 22%.
The favourable outcomes are encouraging , but rehabilitation in silicotics with early morbidity and mortality should remind us to further improve community primary prevention strategies.
