Reducing Dynamic Hyperinflation through Breathing Retraining

描述(由申请人提供)： 摘要动态高通胀限制了慢性阻塞性肺疾病(COPD)患者的运动时间。为了限制运动过程中的动态过度充气，从而提高运动持续时间，我们成功地开发了一种视觉-听觉通风-反馈系统。该系统在锻炼期间重新训练患者的呼吸模式。当前方案的目标是开发一种具有新颖的听觉反馈系统的用户友好的通风反馈技术。我们的理由是，建议的反馈系统加上运动训练将优于单独的运动训练，同时有可能更容易地应用于临床实践。假设：基本假设是，成功完成为期12周的呼吸再训练加运动的中重度COPD患者的运动持续时间将比仅完成为期12周的跑步机运动训练的患者更长。我们还假设，运动持续时间延长的主要预测因素将是动态过度膨胀的减少，其次是外周肌肉功能的改善。最后，我们假设，与单纯运动训练相比，呼吸再训练加运动的患者呼吸困难将会减少。方法：本研究为随机对照临床试验。246名中到重度COPD患者将被纳入并随机进入呼吸再训练加运动或单独运动训练。两组都将接受为期12周的跑步机运动训练，每周三次。呼吸再训练加锻炼组也将接受听觉反馈，以降低呼吸频率，延长呼气。呼吸再训练的目的是为了减少运动引起的动态恶性通货膨胀。后续测试将在6周、12周和24周完成。测试将包括肺功能测试、症状受限和恒定工作速度跑步机测试、6分钟步行、呼吸困难测量、呼吸肌力量和耐力测试，以及股四头肌肌肉耐力测试。分析：将使用中心趋势度量来描述研究样本。采用双样本t检验(1=0.05)分析呼吸再训练加运动组和单纯运动训练组从基线到12周的变化。在数据分析中，将使用意向治疗原则。由于将对每个患者采取几项措施，因此将使用混合模型分析来比较两组之间随时间的变化。多元回归分析将被用来确定运动成绩提高的预测因素。 公共卫生相关性： 相关性--与退伍军人事务部的叙事相关性。在美国退伍军人健康管理局登记的退伍军人中，慢阻肺是第四大死因，也是第六大最常见的慢性疾病。美国有1600多万人患有慢性阻塞性肺病。与普通人群相比，慢性阻塞性肺病患者更有可能将自己的健康状况评为差，报告日常活动受到更多限制，去看医生，住院，并报告更多的残疾天数。慢性阻塞性肺病导致1700多万人次就诊和700 000多人次住院。COPD患者肺康复的创新方法可能有助于改变这种损伤增加导致更多住院和储备减少的循环模式，以应对日常生活的压力和紧张。

DESCRIPTION (provided by applicant): Abstract Dynamic hyperinflation limits exercise duration in chronic obstructive pulmonary disease (COPD). To limit dynamic hyperinflation during exercise and thus improve exercise duration, we successfully developed a visual-auditory ventilation-feedback system. The system retrains patient's breathing pattern during exercise. The goal of the current proposal is to develop a user-friendly ventilation-feedback technique with a novel auditory feedback system. We reason that the proposed feedback system plus exercise training will be superior to exercise training alone while having the potential for an easier application into clinical practice. Hypotheses: The primary hypothesis is that the exercise duration of patients with moderate-to-severe COPD who successfully complete a 12-week program of breathing retraining plus exercise will be longer than that of patients who complete a 12-week program of treadmill exercise training alone. We also hypothesize that the primary predictor of improved exercise duration will be a reduction in dynamic hyperinflation and to a lesser extent, improvement in peripheral muscle function. Lastly, we hypothesize that dyspnea will be reduced in patients assigned to breathing retraining plus exercise when compared to exercise training alone. Methods: The proposed study is a randomized controlled clinical trial. 246 patients with moderate-to-severe COPD will be enrolled and randomized into breathing retraining plus exercise or exercise training alone. Both groups will receive 12-weeks of treadmill exercise training three times weekly. The breathing retraining plus exercise group will also receive auditory feedback to decrease respiratory rate and prolong exhalation. The goal of breathing retraining is to reduce exercise- induced dynamic hyperinflation. Follow-up testing will be completed at 6, 12, and 24 weeks. Testing will include a pulmonary function test, symptom-limited and constant workrate treadmill tests, six-minute walk, dyspnea measurements, testing of respiratory muscle strength and endurance, and quadriceps muscle endurance testing. Analysis: Measures of central tendency will be used to describe the study sample. A two-sample t-test (1 = 0.05) will be used to analyze changes from baseline to 12-weeks between the breathing retraining plus exercise group and exercise training alone group. In data analysis, intention-to-treat principles will be used. Since several measures will be taken on each patient, mixed-models analysis will be used to compare changes over time between the two groups. Multiple regression analysis will be employed to determine the predictors of improved exercise performance. PUBLIC HEALTH RELEVANCE: Relevance_Narrative Relevance to the VA. COPD is the fourth leading cause of death in the United States and the sixth most common chronic condition cited among veterans enrolled in the Veterans Health Administration. Over 16 million individuals in the United States are afflicted with COPD. As compared with the general population, patients with COPD are more likely to rate their health as poor, to report more limitations in daily activities, to visit their physician, to stay in the hospital and to report more disability days. More than 17 million office-visits and over 700,000 hospitalizations resulted from COPD. Innovative approaches to pulmonary rehabilitation of patients with COPD may be instrumental in modifying this cyclical pattern of increasing impairment leading to more hospitalizations and decreasing reserve to cope with the stress and strain of daily living.