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Can FOT reliably detect EFL in COPD?
ARTICLE IN PRESS Literature review Results: The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction (MVC) compared to UR alone (97771 vs. 36734 contractions, respectively; p ¼ 0.03) and resulted in a more significant improvement in dyspnea when performing daily tasks (decrease in the dyspnea domain score of the 28item Maugeri Foundation Respiratory Failure questionnaire, 1.771.0 vs. 0.271.2 points, respectively; p ¼ 0.05). There was also a significant increase in walking distance (63740 m; p ¼ 0.01) and BMI (0.670.5 kg/m2; p ¼ 0.02) after training in the ES+UR group. A significant relationship was found
157 between changes in MVC and changes in MM after training in the ES+UR group (r ¼ 0.94; p ¼ 0.03). Conclusions: The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI. In this population, ES has been revealed as a useful procedure, complementing the usual pulmonary rehabilitation. Reproduced with permission from the American College of Chest Physicians.
Commentary by Thomas Jagoe Senior Lecturer and Honorary Consultant, University of Liverpool and Aintree Chest Centre, Liverpool Prior studies have suggested transcutaneous muscle electrical stimulation (ES) alone can improve muscle function and reduce dyspnea in non-depleted patients with severe COPD. Given that ES is a practical and logical mode of treatment, it is puzzling that its usage is not more widespread, and that progress in defining its role has been so slow. This study focuses on subjects with severe COPD, very poor functional state with reduced quadriceps strength and nutritional depletion. The authors attempted to determine whether ES enhances the effects of a normal pulmonary rehabilitation program. Subjects were recruited after admission for an acute exacerbation, but the time interval between exacerbation and intervention is unclear. Furthermore, no sham ES was offered, and anthropometric measures of limb fat and muscle mass were only performed on a subset of patients. Despite these reservations, after 4 weeks’ treatment, additional improvement in muscle strength, walking distance and dyspnea were observed in those receiving ES. Much remains to be defined about ES as a treatment modality in COPD, including the optimum stimulation sites, frequency, contraction-relaxation ratio, and treatment duration. However, there does seem to be a message emerging that for severely functionally impaired patients with COPD, ES is a potentially useful treatment either alone or in combination with pulmonary rehabilitation.
Original article reference: Vivodtzev I, Pepin JL, Vottero G, Mayer V, Porsin B, Levy P, et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest 2006;129:1540–8.
10.1016/j.rmedu.2006.11.009
Can FOT reliably detect EFL in COPD?
This study examined the role of Forced Oscillation Technique (FOT) in detecting expiratory flow limitation (EFL) in COPD patients receiving non-invasive ventilation support. The results suggest that it may be a useful technique, with the potential to be used in clinical practice.
157 between changes in MVC and changes in MM after training in the ES+UR group (r ¼ 0.94; p ¼ 0.03). Conclusions: The combination of ES and UR was associated with greater improvement in quadriceps strength and dyspnea during the performance of daily tasks than UR alone in severely disabled COPD patients with low BMI. In this population, ES has been revealed as a useful procedure, complementing the usual pulmonary rehabilitation. Reproduced with permission from the American College of Chest Physicians.
Commentary by Thomas Jagoe Senior Lecturer and Honorary Consultant, University of Liverpool and Aintree Chest Centre, Liverpool Prior studies have suggested transcutaneous muscle electrical stimulation (ES) alone can improve muscle function and reduce dyspnea in non-depleted patients with severe COPD. Given that ES is a practical and logical mode of treatment, it is puzzling that its usage is not more widespread, and that progress in defining its role has been so slow. This study focuses on subjects with severe COPD, very poor functional state with reduced quadriceps strength and nutritional depletion. The authors attempted to determine whether ES enhances the effects of a normal pulmonary rehabilitation program. Subjects were recruited after admission for an acute exacerbation, but the time interval between exacerbation and intervention is unclear. Furthermore, no sham ES was offered, and anthropometric measures of limb fat and muscle mass were only performed on a subset of patients. Despite these reservations, after 4 weeks’ treatment, additional improvement in muscle strength, walking distance and dyspnea were observed in those receiving ES. Much remains to be defined about ES as a treatment modality in COPD, including the optimum stimulation sites, frequency, contraction-relaxation ratio, and treatment duration. However, there does seem to be a message emerging that for severely functionally impaired patients with COPD, ES is a potentially useful treatment either alone or in combination with pulmonary rehabilitation.
Original article reference: Vivodtzev I, Pepin JL, Vottero G, Mayer V, Porsin B, Levy P, et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest 2006;129:1540–8.
10.1016/j.rmedu.2006.11.009
Can FOT reliably detect EFL in COPD?
This study examined the role of Forced Oscillation Technique (FOT) in detecting expiratory flow limitation (EFL) in COPD patients receiving non-invasive ventilation support. The results suggest that it may be a useful technique, with the potential to be used in clinical practice.