The Efficacy of Pranayama in COPD

描述（由申请人提供）： 慢性阻塞性肺疾病（COPD）是世界范围内的主要健康问题，并且目前是美国的第三大死亡原因。COPD患者主要主诉呼吸急促，日常活动和运动。呼吸困难的一个关键机制是动态过度充气，或空气滞留，这是由严重的气流限制引起的，是这种疾病的特征。吸入性支气管扩张剂和皮质类固醇可能会有帮助，但这些疗法价格昂贵，可能有副作用。肺康复在减少呼吸困难和提高运动耐量方面非常有效，但对患者来说并不广泛。我们建议研究一个简单的呼吸练习的效果，称为调息，或瑜伽呼吸。我们的假设是，调息的做法将提高COPD患者的运动耐量。我们认为，所涉及的机制将包括减少动态过度充气以及对肺力学、炎症和氧化应激的有益作用。这一假设将在COPD患者调息与常规护理（教育）的随机、双盲、对照试验中进行检验。在具体目标1中，我们将通过6分钟步行距离来确定调息对运动耐量的影响;在具体目标2中，我们将通过运动前后吸气量的变化来确定调息对动态过度充气的影响;在具体目标3中，我们将确定调息对氧化应激的影响（呼出气H202、8-异前列烷、谷胱甘肽）、全身性炎症（血清C-反应蛋白、白细胞介素-6、谷胱甘肽和红细胞分布宽度）、呼吸困难水平（博格量表、MRC量表、BDI/TDI、CRQ）、BODE指数和生活质量（圣乔治呼吸问卷）。本研究旨在适用于各种临床环境，因为它将涉及两个不同的临床研究中心 （佛蒙特州伯灵顿和德克萨斯州休斯顿），需要最少的直接干预，并让参与者进行自我学习和实践。这项研究的数据将为以下方面提供基本的新见解： 调息的作用机制，并将在设计一个大的，多中心的试验至关重要 测试呼吸法对COPD患者的有效性。 公共卫生相关性： 慢性阻塞性肺疾病（COPD）是世界范围内的主要健康问题，患者主要在运动时遭受严重的呼吸急促。本研究将探讨瑜伽呼吸法调息练习对COPD患者运动耐量的影响。这种干预可能被证明是COPD治疗的重要辅助手段，因为它简单、廉价且广泛可用。 (End摘要）

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide, and is currently the third leading cause of death in the United Sates. Patients with COPD mainly complain of shortness of breath with daily activities and exercise. A key mechanism of dyspnea is dynamic hyperinflation, or air trapping, which results from the severe airflow limitation that characterizes the disease. Inhaled bronchodilators and corticosteroids may help, but these therapies are expensive and may have side effects. Pulmonary rehabilitation is very effective at reducing dyspnea and improving exercise tolerance, but it is not widely available to patients. We propose studying the effect of a simple breathing exercise known as pranayama, or yogic breathing. Our hypothesis is that the practice of pranayama will improve exercise tolerance in patients with COPD. We believe that the mechanisms involved will include reduced dynamic hyperinflation as well as beneficial effects on lung mechanics, inflammation and oxidative stress. This hypothesis will be tested in a randomized, double blind, controlled trial of pranayama vs. usual care (education) in COPD patients. In Specific Aim 1, we will determine the effect of pranayama on exercise tolerance as measured by 6 min walk distance; in Specific Aim 2, we will determine the effect of pranayama on dynamic hyperinflation as measured by changes in inspiratory capacity before and after exercise; and in Specific Aim 3, we will determine the effect of pranayama on oxidative stress (exhaled breath H202, 8-isoprostane, glutathione), systemic inflammation (serum c-reactive protein, interleukin-6, glutathione and red cell distribution width), dyspnea level (Borg scale, MRC scale, BDI/TDI, CRQ), the BODE index, and quality of life (St. George Respiratory Questionnaire). The study is designed to be applicable to a wide variety of clinical settings, since it will involve two diverse clinical sites (Burlington, VT and Houston, TX), require minimal direct intervention, and engage participants in self- learning and practice. The data from this study will provide fundamental new insights into the mechanisms of action of pranayama, and will be critical in designing a large, multicenter trial to test the effectiveness of pranayama in patients with COPD. PUBLIC HEALTH RELEVANCE: Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide, and patients mainly suffer from severe shortness of breath with exercise. This study will investigate the effects of the practice of the yogic breathing method pranayama on exercise tolerance in patients with COPD. This intervention may prove to be an important adjunct to COPD therapy, since it is simple, inexpensive, and widely available. (End of Abstract)