Pulmonary rehabilitation for bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.
Pulmonary rehabilitation for bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.
复制标题
造血干细胞移植后闭塞性细支气管炎综合征的肺康复。
DOI：
10.1016/j.bbmt.2012.01.017
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Wood,KarenL
中科院分区：
文献类型：
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作者：
Tran,Jerry;Norder,EmilyE;Diaz,PhilipT;Phillips,GaryS;Elder,Pat;Devine,StevenM;Wood,KarenL
闭塞性细支气管炎综合征（BOS）是影响异基因造血干细胞移植受者的一种进行性、隐匿性肺部疾病。不幸的是，没有标准化的方法来治疗造血干细胞移植后患者的BOS。肺康复是肺气肿的标准治疗方法，肺气肿是一种继发于烟草滥用的不可逆阻塞性肺病。国家肺气肿治疗试验（NETT）表明，肺康复后，严重肺气肿患者的运动耐量提高，呼吸困难减少，生活质量提高。我们假设肺康复可能有益于BOS患者。从2005年1月至今，对BOS患者进行了回顾性研究。参加肺康复的患者被纳入该研究。我们通过图表审查获得了每个患者在各自康复中心登记肺康复后的进展情况。在完成肺康复治疗之前和之后，比较6分钟步行距离、肺功能测定和肺部症状。我们确定了11例BOS患者，这些患者从他们的肺科医生的临床记录中记录，并被纳入肺康复治疗。11例患者中有10例完成了肺康复。所有患者在完成肺康复后的6分钟步行距离均有改善，平均改善307英尺（P值= 0.005）。10例患者中有6例在康复前后完成了SF-36问卷调查。身体功能评分有显著改善（P值= 0.029）。肺康复似乎可以改善BOS患者的6分钟步行距离、呼吸困难的主观症状和运动耐量。这可能是一个重要的连续治疗的衰弱性疾病与有限的治疗选择。
Bronchiolitis obliterans syndrome (BOS) is a progressive, insidious lung disease affecting allogeneic hematopoietic stem cell transplantation recipients. Unfortunately, there is no standardized approach for treatment of BOS in post–hematopoietic stem cell transplantation patients. Pulmonary rehabilitation is a standard treatment in emphysema, an irreversible obstructive lung disease secondary to tobacco abuse. The National Emphysema Treatment Trial (NETT) demonstrated improved exercise tolerance, decrease dyspnea, and increase of quality of life in patients with severe emphysema after pulmonary rehabilitation. We hypothesized that pulmonary rehabilitation may benefit patients with BOS. Patients with BOS were identified retrospectively from January 2005 to the present. Patients who enrolled in pulmonary rehabilitation were included in the study. We obtained summaries via chart review of each patient’s progress after pulmonary rehabilitation enrollment from his or her respective rehabilitation centers. Six-minute walk distances, spirometry, and pulmonary symptoms were compared before and after the completion of pulmonary rehabilitation. We identified 11 patients with BOS documented from their pulmonologist’s clinical notes who were enrolled into pulmonary rehabilitation. Ten of the 11 patients completed pulmonary rehabilitation. All patients had improvement in their 6-minute walk distances after the completion of pulmonary rehabilitation, with an average improvement in distance of 307 feet (P value = .005). Six of the 10 patients completed Short Form-36 (SF-36) questionnaires before and after rehabilitation. There was a significant improvement in the physical functioning score (P value = 0.029). Pulmonary rehabilitation seems to improve 6-minute walk distance, subjective symptoms of dyspnea, and exercise tolerance in patients with BOS. This may be an important adjunctive therapy for a debilitating disease with limited treatment options.