Journal of rehabilitation research and development
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Exercise training is the cornerstone of pulmonary rehabilitation. However, patients may not be able to exercise at a level that produces a training effect because of limitations related to their underlying lung disease. Adjuncts during exercise training may increase their exercise capacity and increase the benefit of pulmonary rehabilitation. ⋯ Work is needed to better define the benefits and appropriate patient populations. The subgroups that may derive the most benefit from these adjuncts are those with oxygen desaturation during exercise and those with severe chronic obstructive pulmonary disease (defined as a forced expiratory volume in 1 s (FEV1) < 1.0 L). Nocturnal noninvasive ventilation during pulmonary rehabilitation seems to be an effective adjunct and merits further study.
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Review
Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD).
Controlled breathing is included in the rehabilitation program of patients with chronic obstructive pulmonary disease (COPD). This article discusses the efficacy of controlled breathing aimed at improving dyspnea. In patients with COPD, controlled breathing works to relieve dyspnea by (1) reducing dynamic hyperinflation of the rib cage and improving gas exchange, (2) increasing strength and endurance of the respiratory muscles, and (3) optimizing the pattern of thoracoabdominal motion. ⋯ All interventions require careful patient selection, proper and repeated instruction, and control of the techniques and assessment of its effects. Despite the proven effectiveness of controlled breathing, several problems still need to be solved. The limited evidence of the successful transfer of controlled breathing from resting conditions to exercise conditions raises several questions: Should patients practice controlled breathing more in their daily activities? Does controlled breathing really complement the functional adaptations that patients with COPD must make? These questions need to be addressed in further research.