ASSESSMENT OF THE EFFECT OF PULMONARY REHABILITATION ON THE RESPIRATORY MUSCLES AND REGIONAL THORACIC MOTION BY USING NEW IMAGING TECHNIQUES AND MOLECULAR BIOLOGICAL METHOD IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD)

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To assess the effect of pulmonary rehabilitation on the respiratory muscles and regional respiratory mechanics, the six-week comprehensive pulmonary rehabilitation program supported by an interdisciplinary team was organized and conducted in 18 patients with COPD (age 67±7[SD]years, FEVl 1.05±0.44 L). The program consists of patient education, physiotherapy, exercise training, and nutritional consultation. The significant improvements in dyspnea (100mm VAS 41±24 to 28±20 mm), quality of life (SGRQ Score 47.8±12.1 to 39.1±15.5), TGV (5.99±0.93 to 5.64±1.06 L), respiratory muscle strength (PImax -58±16 to -71±19, PE max 149±42 to 162±39 cmH_2O), 6MWD (435±63 to 471±51m) were obtained. The dynamic breathing magnetic resonance imaging (MRI) was performed in ten COPD patients with before and after the rehabilitation. The images were acquired with field echo method at sagittal and coronal planes over three slow deep respiratory cycles (18 sec / cycle, 48 sequential image, scanning time : 1se … More c / image). Ten patients had six week outpatient (n=8) or two week inpatient (n=2) program. A significant increase in motion (Δ = D inspiration - D expiration [D : distance]) was observed in the upper rib cage (coronal and right sagittal plane) and the left diaphragm (left sagittal plane). The coordination among the chest wall expansion, rib cage elevation, widening of the apex, back stretch, and downward displacement of the diaphragm was assessed by using visual score and improvement was also obtained in each plain. It is suggested that the thoracic dynamic MRI may provide quantitative assessment both in initial disorder and post rehabilitation improvement which is otherwise undetectable and it can promote better physiological understanding. To confirm the evidence of the mitochondrial damage in the diaphragm by oxygen-based free radicals, we examined the diaphragms of 26 subjects with pulmonary diseases. The costal parts of diaphragms were obtained within 8 hrs of post mortem. Twenty-four of 26 DNA samples(92%) from diaphragms showed a 5kb deletion of mtDNA regardless of age. However, the effect of pulmonary rehabilitation on oxidative stress was not able to be evaluated since a 5kb deletion of mtDNA in the peripheral blood was not observed in all 18 COPD patients. We are planning the use of more sensitive PCR techniques such as realtime PCR or the biopsied specimens of other skeletal muscles in the near future. Less