Exercise Training with Oxygen Supply and Directed Breathing in Patients with Chronic Airway Obstruction

Abstract

15 patients with chronic airway obstruction were submitted to a program of pulmonary rehabilitation. After having been studied first with clinical, radiological and functional tests (spirometry, spontaneous breathing and arterial blood gases), they were treated in the respiratory ambulance care unit for about 4 weeks. Subsequently they were hospitalized. On entering the hospital, the same tests were performed and were completed by (a) plethysmographic measurements (TLC, FRC, Raw) and flow volume curves, (b) arterial blood gases (pH, PaCO<sub>2</sub>, PaO<sub>2</sub>) and hematocrit, at rest and at 40-watt exercise, and (c) determination of VO<sub>2max</sub>. The treatment consisted of (1) bronchodilators and, if necessary, antibiotics, (2) directed breathing (DB) and (3) a 30-min exercise session daily with an oxygen cart (FIO<sub>2</sub> 0.35) and DB. The length of the treatment varied between 3 and 6 weeks, and afterwards the whole set of clinical and functional tests was started again. There was no noticeable difference between the first consultation and just before treatment at the hospital. The lack of beneficial effects, while the patients were ambulatory, shows that the drugs used are not helpful in producing long-lasting changes. After pulmonary rehabilitation, subjective and objective improvement could be ascertained for most patients. There was an improvement in the maximal mobility of the diaphragm (3 ± 1.2 and 4 ± 1.4 cm to 5 ± 1.6 and 7 ± 2.1 cm on the right and left side, respectively; p < 0.001 in both cases) in VC (p < 0.001), FEV<sub>1</sub>/VC % (p < 0.01), maximal flow at 50% of VC (p < 0.05), PaO2 at rest (p < 0.01) and at 40-watt exercise (p < 0.001), and tidal volume at rest and at maximal exercise level (p < 0.01), while the respiratory rate was lower (p < 0.02). VO<sub>2max</sub> increased significantly (p < 0.01). These results, much more conclusive than the results of each of these three treatments taken one by one, confirm the objective efficacy of the association of the therapeutic means available.