In-phase chest wall vibration decreases dyspnea during arm elevation in chronic obstructive pulmonary disease patients. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. High-frequency chest wall oscillation in ALS: an exploratory randomized, controlled trial. Effect of a walking aid on disability, oxygenation, and breathlessness in patients with chronic airflow limitation. Relaxation to reduce dyspnea and anxiety in COPD patients. The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD. Effect of progressive relaxation on dyspnea and state anxiety in patients with chronic obstructive pulmonary disease. Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease. Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli. The acute effects of a rollator in individuals with COPD. Feasibility of distractive auditory stimuli on upper extremity training in persons with chronic obstructive pulmonary disease. Effect of rollator use on health-related quality of life in individuals with COPD. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD). The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Evaluating the effects of music on dyspnea during exercise in individuals with chronic obstructive pulmonary disease: a pilot study. Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Can a standardized acupuncture technique palliate disabling breathlessness: a single-blind, placebo-controlled crossover study. Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Effects of a walking aid in COPD patients receiving oxygen therapy. Effect of chest wall vibration on dyspnea during hypercapnia and exercise in chronic obstructive pulmonary disease. Effect of chest wall vibration on dyspnea during exercise in chronic obstructive pulmonary disease. The effects of guided imagery relaxation in people with COPD. Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: a clinical trial. The psychologic consequences of chronic dyspnea in chronic pulmonary obstruction disease: the effects of acupressure on depression. Acupressure as an adjunct to a pulmonary rehabilitation program. Effect of chest wall vibration on dyspnea in patients with chronic respiratory disease. A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Effects of music on exercise and perceived symptoms in patients with chronic obstructive pulmonary disease. Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management. A randomized control trial of nursing-based case management for patients with chronic obstructive pulmonary disease. Does encouraging good compliance improve patients' clinical condition in heart failure? An evaluation of the acute impact of pursed lips breathing on walking distance in nonspontaneous pursed lips breathing chronic obstructive pulmonary disease patients. Non-pharmacological intervention for breathlessness in lung cancer. Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial. Effects of psychotherapy in moderately severe COPD: a pilot study.
In-phase chest wall vibration (IPV) is known to decrease dyspnea in patients with chronic obstructive pulmonary disease (COPD) at rest and during leg exercise. In the present study, the effects of IPV (100 Hz) on dyspnea and arm fatigue during upper extremity activity were studied in 9 patients with COPD (mean FEV1, 0.95 l). Dyspnea and arm fatigue (modified Borg scale) and ventilatory variables were measured during arm elevation (AE) with weights lifted straight above the head with and without IPV. Mean dyspnea during AE was 3.3 without IPV and 2.1 with IPV (p<0.05), but, arm fatigue, oxygen saturation and end-tidal FCO2 were not affected by IPV. Minute ventilation during AE was significantly increased with IPV in 5 of 9 patients. The results suggest that IPV decreases dyspnea during AE. Previous studies demonstrated the effects of progressive muscle relaxation training (PMRT) on improvements in the health outcomes of cardiac patients. This study examined the effects of PMRT on the psychologic status and symptoms of older Chinese patients with heart failure.
                In a longitudinal, randomized, and controlled study, 59 patients were allocated to receive a PMRT program and 62 were provided with the attention placebo. The PMRT program included two PMRT sessions, one revision workshop, twice-daily PMRT home practices, and a biweekly telephone follow-up call. The attention placebo included a regular telephone call at a schedule similar to that made by the interventionist of the PMRT program with the intervention group. Main outcome measures, including psychologic distress, dyspnea, and fatigue, were taken at baseline, the 8th week, and the 14th week.
                A medium effect on psychologic distress in favor of the PMRT program was detected. Patients practicing PMRT however only demonstrated a nonsignificant trend of greater improvement in symptom status.
                Progressive muscle relaxation training seems to be useful as an adjunctive nonpharmacologic treatment modality in the management of heart failure. To evaluate changes in respiratory function in patients with ALS after using high-frequency chest wall oscillation (HFCWO).
                This was a 12-week randomized, controlled trial of HFCWO in patients with probable or definite ALS, an Amyotrophic Lateral Sclerosis Functional Rating Scale respiratory subscale score < or = 11 and > or = 5, and forced vital capacity (FVC) > or = 40% predicted.
                We enrolled 46 patients (58.0 +/- 9.8 years; 21 men, 25 women); 22 used HFCWO and 24 were untreated. Thirty-five completed the trial: 19 used HFCWO and 16 untreated. HFCWO users had less breathlessness (p = 0.021) and coughed more at night (p = 0.048) at 12 weeks compared to baseline. At 12 weeks, HFCWO users reported a decline in breathlessness (p = 0.048); nonusers reported more noise when breathing (p = 0.027). There were no significant differences in FVC change, peak expiratory flow, capnography, oxygen saturation, fatigue, or transitional dyspnea index. When patients with FVC between 40 and 70% predicted were analyzed, FVC showed a significant mean decrease in untreated patients but not in HFCWO patients; HFCWO patients had significantly less increased fatigue and breathlessness. Satisfaction with HFCWO was 79%.
                High-frequency chest wall oscillation was well tolerated, considered helpful by a majority of patients, and decreased symptoms of breathlessness. In patients with impaired breathing, high-frequency chest wall oscillation decreased fatigue and showed a trend toward slowing the decline of forced vital capacity. This study assessed the effect of a wheeled walking aid on disability, oxygenation, and breathlessness in patients with severe disability secondary to chronic irreversible airflow limitation.
                Eleven subjects with chronic irreversible airflow limitation, mean forced expired volume in 1 second (FEV1) 0.71 L +/- .33 L, were studied. Subjects performed four 6-minute walk tests, two on each of two study days, twice unaided and twice with the assistance of a wheeled walking aid. A randomized cross-over design was used. All subjects were oriented to 6-minute walk tests, use of bronchodilators was controlled, and standard encouragement was given during each walk test. Outcome measures were the distance walked in 6 minutes, change in oxyhemoglobin saturation during the walk, and breathlessness using a modified Borg Scale.
                The use of a wheeled walker resulted in a significant increase in 6-minute walking distance, a significant reduction in hypoxemia with walking and a significant reduction in breathlessness during the walk test.
                The use of a wheeled walker resulted in significant decreases in disability, hypoxemia, and breathlessness during a 6-minute walk test. By reducing disability and breathlessness, a wheeled walker may improve quality of life in individuals with severe impairment in lung function. The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease (COPD) patients. Twenty-six adult COPD patients with dyspnea were randomly assigned to two groups. The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly. Skin temperature, heart rate, and respiratory rate were recorded for all subjects during a total of four weekly sessions. Anxiety, dyspnea, and airway obstruction were measured at the beginning and end of the study. The relaxation group achieved the preset relaxation criteria. Dyspnea, anxiety, and airway obstruction were reduced in the relaxation group while the control group remained the same or became worse. This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use.
                Repeated-measures randomized crossover design using the 6-min walk test (6MWT) as the primary outcome measure.
                Respiratory rehabilitation center.
                Forty stable subjects who had received a diagnosis of COPD.
                Two 6MWTs were performed on each study day. One 6MWT was performed unaided, and the other was performed with a rollator. The order was randomized on the first day and reversed on the second day.
                Use of the rollator was associated with a significant reduction in dyspnea (p < 0.001) and duration of rest (reduction for the total group, 19 s; and reduction for those who walked < 300 m unaided, 40 s; p = 0.001) during the 6MWT. For subjects who walked < 300 m unaided, there was also a significant improvement in distance walked (p = 0.02). No changes were found for the measures of cardiorespiratory function or gait (p > 0.05). The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator (p < 0.005). The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided.
                Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD. Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea, reduced rest time, and improved distance walked. The symptom of dyspnea and the associated anxiety is a primary concern of millions of patients with chronic obstructive pulmonary disease (COPD). An experimental study was conducted of 20 outpatients with COPD to measure the effect of progressive muscle relaxation (PMR) on dyspnea and anxiety. Patients were divided into a treatment group (n = 12) and a control group (n = 8). Patients in the treatment group underwent four weekly sessions of live PMR plus daily home practice with taped instructions. The effect of the independent variable, PMR, was measured during each session and at the end of 4 weeks. Measurements were made before and after treatment of the dependent variables, dyspnea and anxiety. Instruments used were Spielberger's State Anxiety Inventory for anxiety and a 20 cm visual analogue scale for dyspnea. Heart rate (HR), respiratory rate (RR), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) were also measured. Data analysis was done by using two-tailed t tests and Pearson's correlation coefficient. Reductions in anxiety and dyspnea were positively correlated during each session (r = 0.37) and at the end of 4 weeks (r = 0.60). PMR was shown by t tests to be more effective than the control in reducing dyspnea (p = 0.04), anxiety (p = 0.001), RR (p = 0.000), and HR (p = 0.05) during each session but only RR (p = 0.04) at the end of the 4-week period. Dyspnea and RR were correlated positively during each session (r = 0.21). Dyspnea and state anxiety were correlated positively at the end of 4 weeks with RR (r = 0.62) and HR (r = 0.50). To evaluate usefulness of limited community based care for patients with chronic obstructive pulmonary disease after discharge from hospital. Design: Randomised controlled trial.
                Liverpool Health Service and Macarthur Health Service in outer metropolitan Sydney between September 1999 and July 2000.
                177 patients randomised into an intervention group (84 patients) and a control group (93 patients) which received current usual care.
                Home visits by community nurse at one and four weeks after discharge and preventive general practitioner care.
                Frequency of patients' presentation and admission to hospital; changes in patients' disease-specific quality of life, measured with St George's respiratory questionnaire, over three months after discharge; patients' knowledge of illness, self management, and satisfaction with care at discharge and three months later; frequency of general practitioner and nurse visits and their satisfaction with care.
                Intervention and control groups showed no differences in presentation or admission to hospital or in overall functional status. However, the intervention group improved their activity scores and the control group worsened their symptom scores. While intervention group patients received more visits from community nurses and were more satisfied with their care, involvement of general practitioners was much less (with only 31% (22) remembering receiving a care plan). Patients in the intervention group had higher knowledge scores and were more satisfied. There were no differences in general practitioner visits or management.
                This brief intervention after acute care improved patients' knowledge and some aspects of quality of life. However, it failed to prevent presentation and readmission to hospital. To determine if distractive auditory stimuli (DAS) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program (PRP) and, thereby, maintenance of gains achieved during the program.
                Experimental, randomized, two-group design with testing at baseline, 4 weeks, and 8 weeks.
                Outpatient.
                Twenty-four patients (4 men and 20 women) with moderate-to-severe COPD (FEV(1) 41.3 +/- 13% predicted [mean +/- SD]).
                Experimental group subjects (n = 12) were instructed to walk at their own pace for 20 to 45 min, two to five times a week, using DAS with a portable audiocassette player. The control group (n = 12) received the same instructions, but no DAS.
                Primary outcome measures were perceived dyspnea during activities of daily living (ADL) and 6-min walk (6MW) distance. Secondary outcome measures were anxiety, depressive symptoms, health-related quality of life (QoL), global QoL, and breathlessness and fatigue at completion of the 6MW. In addition, all subjects recorded the distance and time walked using self-report (pedometers and daily logs). There was a significant decrease in perceived dyspnea during ADL (p = 0.0004) and a significant increase in 6MW distance (p = 0.0004) over time in the DAS group compared to the control group. DAS subjects increased 6MW distance 445 +/- 264 feet (mean +/- SD) from baseline to 8 weeks, whereas control subjects decreased 6MW distance to 169 +/- 154 feet. No significant differences were noted for the remaining variables. The cumulative distance walked by the DAS group was 19.1 +/- 16.7 miles compared to 15.4 +/- 8.0 miles for the control group, a 24% difference (p = 0.49). Despite this difference, self-report exercise log data were similar for the two groups.
                Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea, whereas control subjects could not maintain post-PRP gains. DAS is a simple, cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training. To investigate whether the acute benefits of rollator use are consistent over time in individuals with moderate to severe chronic obstructive pulmonary disease.
                Thirty-one stable subjects with chronic obstructive pulmonary disease (13 men, 18 women), aged 68 +/- 8 years, with a forced expiratory volume in 1 second of 0.7 +/- 0.2 L (33% +/- 12% predicted) and a baseline 6-minute walk (6MW) of 261 +/- 68 m, were recruited from a respiratory clinic after completion of a pulmonary rehabilitation program. Two 6MWs were performed at baseline, 4 weeks, and 8 weeks, one walking unaided and the other walking with the assistance of a rollator. The test order was randomly chosen at baseline, and the same test order was used at each time point. The primary outcome measures were distance walked in 6 minutes (meters), perceived dyspnea using a modified Borg scale, and number of rests taken.
                Subjects achieved higher 6MW distances during assisted compared with unassisted walking at baseline (292 +/- 67 vs 263 +/- 67 m), 4 weeks (296 +/- 62 vs 275 +/- 63m), and 8 weeks (283 +/- 65 vs 259 +/- 68 m) (P = .013), with no time effect (P = .5). In addition, use of a rollator resulted in a significant improvement in dyspnea (P = .004) at baseline, 4 weeks, and 8 weeks, with no time effect (P = .7). The use of a rollator also reduced the number of rests taken during the 6MW (P < .001), with no time effect (P = .9).
                Rollator use resulted in improvements in performance in the 6MW, which were consistent over time among individuals with moderate to severe chronic obstructive pulmonary disease who walk less than 375 m during an unaided 6MW. To determine the feasibility of distractive auditory stimuli (DAS) used during an upper extremity training (UET) program on perceived dyspnea, functional performance, and health-related quality of life. In addition, to determine the appropriate music tempo used during the UET.
                Experimental, randomized, 3-group design with testing at baseline and 4 weeks.
                Outpatient.
                Thirty patients (13 male and 17 female) with moderate to severe chronic obstructive pulmonary disease (FEV1 41.27% +/- 18% predicted).
                Moderate DAS group (n = 10) and slow DAS group (n = 10) subjects were instructed to perform UET for up to 15 minutes 3 to 5 times a week using DAS (walkman, audiocassettes). The control group (n = 10) received the same instructions, but no DAS.
                Primary outcome measures were perceived dyspnea, functional performance using the 6-minute peg and ring board (6MRPB) count and health-related quality of life. In addition, all subjects recorded the time of UET performance using self-report (daily logs). A significant increase was seen in 6MRPB count (P = .002) between groups. Moderate DAS subjects increased 6MPRB count 46 +/- 21 rings and slow DAS subjects increased 46 +/- 20 rings from baseline to 4 weeks whereas control subjects increased only 5 +/- 4 rings. No significant differences were noted for the remaining variables.
                Subjects who used DAS (music) while performing UET improved functional performance whereas controls failed to continue improvement. The DAS is a feasible adjunct to UET that may have the potential to augment the effectiveness of pulmonary rehabilitation training. The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD.
                Randomized controlled trial.
                Thirty-one postrehabilitation patients with COPD were randomized to receive a rollator (n = 18) or usual care (n = 13) for 8 weeks and to record the frequency of rollator use. Outcome measures at baseline, 4 weeks, and 8 weeks included the Chronic Respiratory Questionnaire (CRQ) and the 6-min walk (6MW).
                During acute testing, subjects consistently walked further when assisted (baseline 6MW: 292 +/- 67 m vs 263 +/- 67 m; 8 weeks: 283 +/- 65 m vs 259 +/- 68 m [+/-SD]; p = 0.013). However, provision of a rollator at home was not associated with group differences in the CRQ (p > 0.08) or in the unassisted 6MW (p = 0.4) or the assisted 6MW (p = 0.5). Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week. Regular users demonstrated a consistent improvement in mastery compared with infrequent users (4 weeks: 4.7 +/- 0.6 vs 5.2 +/- 0.8, respectively; 8 weeks: 5.3 +/- 0.8 vs 4.7 +/- 0.4; p = 0.014).
                Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it. Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation (NMES) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease (COPD). It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD.
                Fifteen patients with advanced COPD (nine men) were randomly assigned to either a home based 6 week quadriceps femoris NMES training programme (group 1, n=9, FEV(1)=38.0 (9.6)% of predicted) or a 6 week control period before receiving NMES (group 2, n=6, FEV(1)=39.5 (13.3)% of predicted). Knee extensor strength and endurance, whole body exercise capacity, and health related quality of life (Chronic Respiratory Disease Questionnaire, CRDQ) were assessed.
                All patients were able to complete the NMES training programme successfully, even in the presence of exacerbations (n=4). Training was associated with significant improvements in muscle function, maximal and endurance exercise tolerance, and the dyspnoea domain of the CRDQ (p<0.05). Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity (p<0.01).
                For severely disabled COPD patients with incapacitating dyspnoea, short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance, whole body exercise tolerance, and breathlessness during activities of daily living. Little is known about the use of palliative care for outpatients who continue to pursue treatment of their underlying disease or whether outpatient palliative medicine consultation teams improve clinical outcomes.
                We conducted a year-long controlled trial involving 50 intervention patients and 40 control patients in a general medicine outpatient clinic. Primary care physicians referred patients with advanced congestive heart failure, chronic obstructive pulmonary disease, or cancer who had a prognosis ranging from 1 to 5 years. In the intervention group, the primary care physicians received multiple palliative care team consultations, and patients received advance care planning, psychosocial support, and family caregiver training. Clinical and health care utilization outcomes were assessed at 6 and 12 months.
                Groups were similar at baseline. Similar numbers of patients died during the study year (P =.63). After the intervention, intervention group patients had less dyspnea (P =.01) and anxiety (P =.05) and improved sleep quality (P =.05) and spiritual well-being (P =.007), but no change in pain (P =.41), depression (P =.28), quality of life (P =.43), or satisfaction with care (P =.26). Few patients received recommended analgesic or antidepressant medications. Intervention patients had decreased primary care (P =.03) and urgent care visits (P =.04) without an increase in emergency department visits, specialty clinic visits, hospitalizations, or number of days in the hospital. There were no differences in charges (P =.80).
                Consultation by a palliative medicine team led to improved patient outcomes in dyspnea, anxiety, and spiritual well-being, but failed to improve pain or depression. Palliative care for seriously ill outpatients can be effective, but barriers to implementation must be explored. In this study, we examined the effects of music on the dyspnea and anxiety experienced by people with chronic obstructive pulmonary disease (COPD) when they are walking. A crossover design was used. Patients walked for 10 minutes without music and for 10 minutes while listening to music. The order of the interventions was determined by chance. The levels of perceived dyspnea (modified Borg scale) and anxiety (State-Trait Anxiety Inventory-State) were measured at baseline (before a 6-minute walk), at pretest (after that walk and before the 10-minute walks), and after the walks. Thirty subjects with a mean age of 70 +/- 7 years participated in the study. There were no differences in dyspnea or anxiety levels between the walks with music and with no music (p > 0.05). Despite some positive trends, this study did not provide conclusive evidence to support the efficacy of listening to music during exercise; further research is needed to support this intervention. We analyzed the effects of the use of a rollator on walking distance and physiologic variables: pulmonary gas exchange, heart rate, minute ventilation (Ve), oxygen saturation, and symptoms during the 6-min walk test (6MWT) in patients with COPD.
                Outpatient clinic at university hospital.
                Fourteen patients with COPD in stable clinical condition. One patient had mild COPD, five patients had moderate COPD, six patients had severe COPD, and two patients had very severe COPD.
                Two 6MWTs were performed with a portable metabolic system (VmaxST 1.0; Viasys Healthcare; MEDA; Aartselaar, Belgium) with a rollator and without a rollator, in random order. In addition, maximal voluntary ventilation (MVV) was measured with and without a rollator, randomly.
                The median 6MWT distance increased significantly with a rollator: 416 m without a rollator (interquartile range [IQR], 396 to 435 m), vs 462 m with a rollator (IQR, 424 to 477 m) [p = 0.04]. Significant increases were also seen in oxygen uptake (0.04 L/min [IQR, - 0.002 to 0.09 L/min]); tidal volume (0.06 L/min [IQR, - 0.001 to 0.11 L/min]); and Ve (0.95 L/min [IQR, - 0.67 to 7.1 L/min]), recorded in the last minute of the 6MWT; as well as in MVV (3 L/min [IQR, 0 to 12 L/min]) [p < 0.05 for all]. Borg dyspnea scores tended to be lower with a rollator: 6 (IQR, 4 to 7) without a rollator, vs 5 (IQR, 4 to 7) with a rollator (p = 0.10). The variation in the 6MWT was explained by individual changes in walking efficiency (partial R(2) = 0.31) and changes in Ve (partial R(2) = 0.36) [p model < 0.04].
                The use of a rollator improves walking distance of patients with COPD through an increased ventilatory capacity and/or better walking efficiency. The management of disabling breathlessness is poor, and a standardized form of acupuncture has been reported as offering benefit. This study was designed to evaluate the efficacy of standardized acupuncture treatment.
                A single-blind, randomized, crossover study.
                This study was carried out on a domiciliary basis in Southampton (UK).
                This study evaluated a standardized acupuncture technique vs an appropriately validated placebo/control (mock transcutaneous electrical nerve stimulation [TENS]) for disabling, nonmalignant breathlessness (largely COPD). The acupuncture was provided by an appropriately trained nurse acupuncturist. Each patient received six treatments in each phase of the study, with an intervening 2-week washout period.
                The primary outcome was worst breathlessness (visual analog scale, 0 to 100 mm), with the sample size based on an 80% power to detect a 10-mm difference between treatment means. Secondary outcomes included the St George's respiratory questionnaire score and treatment credibility.
                Thirty-six patients were entered into the study (33 with COPD), and 24 patients completed both treatment phases. The primary outcome improved significantly during the course of the study, but there were no significant treatment differences between acupuncture and the placebo/control of mock TENS for either primary or secondary outcomes. The placebo was shown to be a credible control. There was no evidence of a carryover effect from the first to second phase of the study.
                This standardized acupuncture technique does not show specific efficacy in disabling nonmalignant breathlessness, but those entered into the study did experience clinically significant benefit from both treatments. Although exercise training improves exercise tolerance in most patients with chronic obstructive pulmonary disease (COPD), some patients with severe disease may not be able to tolerate exercise training due to incapacitating breathlessness. Transcutaneous electrical muscle stimulation (TCEMS) has been shown to improve muscle strength, muscle mass, and performance in paraplegics, patients with knee ligament injury, and patients with peripheral vascular disease. We hypothesised that TCEMS of the lower extremities can improve muscle strength and exercise tolerance in patients with moderate to severe COPD.
                A randomised controlled trial of TCEMS of the lower extremities was performed in 18 medically stable patients of mean (SD) age 60.0 (1.5) years with a mean forced expiratory volume in 1 second (FEV(1)) of 1.03 (0.10) l (38% predicted) and residual volume/total lung capacity (RV/TLC) of 59 (2)%. Stimulation of the lower extremities was performed three times a week, 20 minutes each session, for six continuous weeks. Quadriceps and hamstring muscle strength, exercise capacity, and peak oxygen uptake were measured at baseline and after 6 weeks of stimulation.
                TCEMS improved both the quadriceps strength (by 39.0 (20.4)% v 9.0 (8.1)%, p=0.046) and hamstring muscle strength (by 33.9 (13.0)% v 2.9 (4.7)%, p=0.038) in the treated (n=9) and sham treated (n=9) groups, respectively. The improvement in muscle strength carried over to better performance in the shuttle walk test in the treated group (36.1% v 1.6% in the treated and sham groups respectively, p=0.007, Mann-Whitney U test). There was no significant change in lung function, peak workload, or peak oxygen consumption in either group. Muscle stimulation was well tolerated by the patients with no dropouts and better than 95% compliance with the protocol.
                TCEMS of peripheral muscles can be a useful adjunct to the comprehensive pulmonary rehabilitation of patients with COPD. To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister.
                Randomized crossover trial.
                Physiopathology laboratory of three rehabilitation centers.
                We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality).
                The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline.
                This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity. Vibration of chest wall inspiratory muscles during inspiration (in-phase) reduces breathlessness associated with hypercapnia and resistive loading in normal subjects and in patients with chronic obstructive pulmonary disease (COPD) at rest. To evaluate further the effect of chest wall vibration on breathlessness ("breathing discomfort") in patients, we studied 10 subjects 52 to 79 yr of age with severe dyspnea (mean FEV1, 0.75 L, 27% predicted). On a single day, we used two separate stimuli to produce mild to moderate breathlessness (BR): Protocol 1, steady-state hypercapnia; Protocol 2, exercise with a lower extremity ergometer. During each protocol, we applied in-phase chest wall vibration (CW) randomly alternating with one of two controls: deltoid vibration (DV) or no vibration (NV). During hypercapnia, CW significantly reduced BR (DV, 2.9 +/- 2.1; CW, 2.3 +/- 1.4; p < 0.05; NV, 3.3 +/- 2.1; CW, 2.6 +/- 2.0; p < 0.01) without significant changes in ventilation. During exercise, CW did not significantly alter BR relative to controls. These findings may be explained by the effect of vibration on the sense of respiratory effort and/or by improvement of the match between efferent motor commands and afferent information from the respiratory system. The lack of effect during exercise on BR suggests there may be a "therapeutic window" or range of conditions within which CW is effective in reducing dyspnea in patients with COPD. To elucidate the effect of in-phase chest wall vibration (IPV) during exercise, 17 COPD male patients performed two constant-load exercise tests on a cycle ergometer with and without IPV. The Borg dyspnea score significantly decreased from IPV (-) to IPV (+) (from 13.6+/-2.9 to 12.5+/-2.9, P<0.01). IPV elicited a significant increase in V(O(2)) (P<0.005) and significant decreases in both VE/V(O(2)) (P<0.05) and respiratory frequency (P<0.05), but it did not elicit any changes in VE. The change in Borg score between IPV (+) and IPV (-) showed a significant positive correlation with % predicted V(O(2),max) (r=0.71) and FEV(1)/FVC (r=0.69). Patients in the responsive group (n=11) showed significantly lower FEV(1) (P<0.05) and higher DeltaN(2)/L (P<0.01) than patients in the non-responsive group (n=6). We conclude that IPV reduces dyspnea and improves respiratory efficiency during aerobic exercise in severe COPD. The aim of this study was to explore the effects of guided imagery relaxation in people with chronic obstructive pulmonary disease (COPD) using a randomized controlled design. Half of 26 participants were allocated to the treatment group in which six practice sessions on guided imagery were conducted, while the control group was instructed to take rest quietly during the six sessions. At the seventh session, physiological changes: partial percentage of oxygen saturation; heart rate; upper thoracic surface electromyography; skin conductance; and peripheral skin temperature were recorded during a 30-minute session with a sampling frequency of one minute. Repeated measures analysis of variance was used to explore the changes of the parameters between the groups. Mann-Whitney U test was used to compare the change of perceived dyspnoea between the groups. Results showed there was a statistically significant (p < 0.05) increase in partial percentage of oxygen saturation in the treatment group, but no significant effects on the other physiological parameters. Further study exploring the psychological effects of guided imagery is suggested. To test an intervention for hospice caregivers designed to help them better manage symptoms experienced by patients with cancer.
                A three-group comparative design with repeated measures.
                A large nonprofit hospice that primarily provides home care.
                329 hospice homecare patients with cancer and their caregivers were randomized into three groups: a control group (n = 109) receiving standard care, a group (n = 109) receiving standard care plus friendly visits, and a group (n = 111) receiving standard care plus the COPE intervention.
                Caregivers received experimental training in the COPE intervention (creativity, optimism, planning, expert information) over nine days to assist with symptom management.
                Intensity of pain, dyspnea, and constipation, overall symptom distress, and quality of life (QOL). Data were collected on admission and days 16 and 30.
                Although symptom intensity for three target symptoms did not decrease, symptom distress was significantly improved (p = 0.009) in the COPE intervention group. QOL was not significantly different.
                Symptom distress, a measure that encompasses patient suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage patient symptoms.
                The COPE intervention is effective and immediately translatable to the bedside for hospice homecare patients with advanced cancer. The onset of depression is often triggered by breathlessness in persons with chronic obstructive pulmonary disease (COPD). It is hypothesized that these are the psychologic consequences of chronic dyspnea. Lessening dyspnea might alleviate depressive symptoms. Acupressure has been shown in other studies to produce relaxation. The aim of this study was to determine if it would lessen dyspnea and reduce depression in patients with COPD.
                Subjects diagnosed with COPD were chosen from one medical center and three regional hospitals in Taipei, Taiwan. A randomized, block experimental design was used, with subjects and the data collector blinded. Using age, gender, pulmonary function, smoking, and steroid use as matching factors, 44 subjects were randomly assigned to either the true acupressure or the sham acupressure groups. The true acupressure group received a program of acupressure using appropriate acupoints that promote relaxation and relieve dyspnea. The sham acupressure group received acupressure using sham acupoints different from the meridians and ganglionic sections of the true acupressure group. Both acupressure programs lasted 4 weeks, with five sessions per week that lasted 16 minutes per session.
                The Geriatric Depression Scale (GDS) and Dyspnea Visual Analogue Scale (DVAS) were administered prior to the program as a baseline, and again following the completion of the 4-week program. Oxygen saturation and other physiological indicators were measured before and after each session.
                The results of this study showed that the GDS scores, DVAS scores, oxygen saturation, and physiological indicators of the true acupressure group were significantly improved, compared to those of the sham acupressure group.
                These findings provide health professionals with an evidence-based intervention to use with persons with COPD. Applying this acupressure program in clinical practice, communities, and long-term care units may lessen chronic dyspnea and depression in persons with COPD. Acupressure is a therapy in which gentle pressure is applied with fingers at specific acupoints on the body. It is reported to relieve pain and have other beneficial effects. This study was designed to ascertain the value of self-administered acupressure as an adjunct to a pulmonary rehabilitation program (PRP) for relief of dyspnea and other symptoms in patients with chronic obstructive pulmonary disease (COPD).
                A single-blind pretest-posttest, cross-over design was used. Thirty-one new patients beginning a 12-week PRP at two private hospitals were randomly assigned to one of two groups. Patients in group 1 were taught acupressure and practiced it daily at home for 6 weeks, then sham acupressure for the following 6 weeks. In group 2, the order of acupressure and sham acupressure was reversed. During weeks 1, 6, and 12, patient dyspnea, other symptoms associated with COPD, activity tolerance, lung function, and functional exercise capacity were assessed.
                Real acupressure was more effective than sham acupressure for reducing dyspnea as measured by a visual analog scale (P = .009, one-tailed), and was minimally effective for relieving decathexis (P = .044, one-tailed). Sham acupressure seemed to be more effective than real acupressure for reducing peripheral sensory symptoms (P = .002, two-tailed), but the presence of these symptoms may also be an indication that the acupressure is affecting the body.
                Acupressure seems to be useful to patients with COPD as an adjunct to a PRP in reducing dyspnea. Some persons who are not initially familiar with traditional Chinese medicine can learn and will accept self-administered acupressure as part of their self-care. The effect of chest wall vibration on dyspnea at rest was investigated in 15 patients with severe chronic respiratory diseases. The magnitude of their baseline dyspnea was 17.9 +/- SE 3.3 mm on a 150-mm visual analog scale. One hundred hertz out-of-phase vibration (OPV; inspiratory intercostal muscles vibrated during expiration and expiratory intercostal muscles vibrated during inspiration) increased dyspnea an average of 21.9 +/- SE 7.8 mm (p < 0.05). One hundred hertz in-phase vibration (IPV; inspiratory intercostal muscles vibrated during inspiration and expiratory intercostal muscles vibrated during expiration) decreased dyspnea an average of 6.9 +/- SE 2.8 mm (p < 0.05). Changes in the respiratory pattern and arterial blood gas determinations elicited by 5-min IPV were investigated in eight of the 15 patients. Tidal volume was significantly increased in all eight of these patients. Respiratory frequency was decreased in seven patients and increased in one. Functional residual capacity, measured before and during the application of IPV for a period of about 10 breaths, was increased in one patient and decreased in the remaining seven. PaCO2 decreased by 1.3 +/- 1.0 mm Hg (p < 0.05), from 49.6 +/- 8.4 mm Hg; PaO2 increased by 3.4 +/- 2.3 mm Hg (p < 0.05), from 67.7 +/- 12.7 mm Hg. The results indicate that in-phase chest wall vibration decreased pathologic dyspnea in patients with chronic respiratory disease and suggest that the effects on respiratory sensation are mediated by afferent information from chest wall respiratory muscles to supraspinal centers. A steady increase in chronic obstructive pulmonary disease (COPD) admissions was addressed by enhancing primary care to provide intensive chronic disease management.
                To compare the effect of a disease management programme, including a COPD management guideline, a patient-specific care plan and collaboration between patients, general practitioners, practice nurses, hospital physicians and nurse specialists with conventional care, on hospital admissions and quality of life.
                One hundred and thirty-five patients with a clinical diagnosis of moderate to severe COPD were identified from hospital admission data and general practice records. General practices were randomized to either conventional care (CON), or the intervention (INT). Pre- and post-study assessment included spirometry, Shuttle Walk Test, Short Form-36, and the Chronic Respiratory Questionnaire (CRQ). Admission data were compared for 12 months prior to and during the trial.
                For respiratory conditions, mean hospital bed days per patient per year for the INT group were reduced from 2.8 to 1.1, whereas those for the CON group increased from 3.5 to 4.0 (group difference, P = 0.030) The INT group also showed an improvement for two dimensions of the CRQ, fatigue (P = 0.010) and mastery (P = 0.007).
                A chronic disease management programme for COPD patients that incorporated a variety of interventions, including pulmonary rehabilitation and implemented by primary care, reduced admissions and hospital bed days. Key elements were patient participation and information sharing among healthcare providers. Low body weight in COPD patients is associated with worsening dyspnea, reduced leg strength, and poor prognosis. Classical rehabilitation strategies are then limited by reduced exercise tolerance. Thus, we proposed to evaluate whether electrostimulation (ES) was a beneficial technique in the rehabilitation programs for severely deconditioned COPD patients after an acute exacerbation.
                Randomized, controlled study.
                Pulmonary rehabilitation center.
                Seventeen patients with severe COPD (mean [ +/- SD] FEV(1), 30 +/- 3% predicted) and low body mass index (BMI) [18 +/- 2.5 kg/m(2)].
                Patients were randomly assigned either to usual rehabilitation (UR) alone or to a UR-plus-ES program for 4 weeks. Quadriceps muscle strength, total muscle mass (MM), exercise capacity, and health-related quality of life were measured before and after rehabilitation.
                The training with ES plus UR induced a significant twofold improvement in the mean number of maximal voluntary contraction (MVC) compared to UR alone (97 +/- 71 vs 36 +/- 34 contractions, respectively; p = 0.03) and resulted in a more significant improvement in dyspnea when performing daily tasks (decrease in the dyspnea domain score of the 28-item Maugeri Foundation Respiratory Failure questionnaire, -1.7 +/- 1.0 vs -0.2 +/- 1.2 points, respectively; p = 0.05). There was also a significant increase in walking distance (63 +/- 40 m; p = 0.01) and BMI (0.6 +/- 0.5 kg/m(2); p = 0.02) after training in the ES + UR group. A significant relationship was found between changes in MVC and changes in MM after training in the ES + UR group (r = 0.94; p = 0.03).
                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. The purpose of this study was to examine the effects of music on exercise tolerance and perceived symptoms during treadmill walking in patients with chronic obstructive pulmonary disease (COPD).
                Nineteen patients with COPD recruited from a pulmonary rehabilitation program participated in treadmill walking sessions on three separate days. The first session consisted of a practice walk. The second and third walking sessions were 6-minute timed tests in which the subjects were asked to walk as fast as possible under two conditions: a control walk and a music walk. Subjective assessments of perceived dyspnea and effort were obtained during the walks by the modified Borg scale.
                Distances walked were 331m +/- 19 (SE) for the music walk and 321m +/- 21 (SE) for the control walk (P = .25). Within each condition, ratings of perceived exertion and dyspnea increased from minute 1 to minute 6 (P < 0.05).
                There were no statistically significant differences observed between treatment conditions for distance walked, perceived dyspnea or ratings of perceived exertion. It should be noted that 60% of the subjects voluntarily commented that they enjoyed listening to music while they exercised. To evaluate the effectiveness of nursing intervention for breathlessness in patients with lung cancer.
                Patients diagnosed with lung cancer participated in a multicentre randomised controlled trial where they either attended a nursing clinic offering intervention for their breathlessness or received best supportive care. The intervention consisted of a range of strategies combining breathing control, activity pacing, relaxation techniques, and psychosocial support. Best supportive care involved receiving standard management and treatment available for breathlessness, and breathing assessments. Participants completed a range of self assessment questionnaires at baseline, 4 weeks, and 8 weeks.
                Nursing clinics within 6 hospital settings in the United Kingdom.
                119 patients diagnosed with small cell or non-small cell lung cancer or with mesothelioma who had completed first line treatment for their disease and reported breathlessness.
                Visual analogue scales measuring distress due to breathlessness, breathlessness at best and worst, WHO performance status scale, hospital anxiety and depression scale, and Rotterdam symptom checklist.
                The intervention group improved significantly at 8 weeks in 5 of the 11 items assessed: breathlessness at best, WHO performance status, levels of depression, and two Rotterdam symptom checklist measures (physical symptom distress and breathlessness) and showed slight improvement in 3 of the remaining 6 items.
                Most patients who completed the study had a poor prognosis, and breathlessness was typically a symptom of their deteriorating condition. Patients who attended nursing clinics and received the breathlessness intervention experienced improvements in breathlessness, performance status, and physical and emotional states relative to control patients. This paper describes a study of the outcome of psychotherapy with patients disabled by chronic obstructive airways disease giving rise to dyspnoea. Forty-three men and 22 women with severe COAD were randomly allocated for 8 weeks to one of three types of psychotherapy or to an untreated control group, and were followed up six months later. The group treated by a medical nurse without training in psychotherapy experienced sustained relief of dyspnoea but tended to undergo less psychodynamic change; psychiatric symptoms were reduced in those receiving supportive, but not analytical, psychotherapy. The psychosomatic mechanisms involved and the implications for medical and nursing practice and for liaison psychotherapy are discussed. This study assessed the impact of a randomized trial of nursing-based case management for patients with chronic obstructive pulmonary disease, their caregivers, and nursing and medical staff. Sixty-six patients were matched by FEV on admission to hospital, and randomized into an intervention or control group. Intervention group patients reported significantly less anxiety at 1 month postdischarge; however, this effect was not sustained. There was little difference between groups in terms of unplanned readmissions, depression, symptoms, support, and subjective well being. Interviews with patients and caregivers found that the case management improved access to resources and staff-patient communication. Interviews with nursing and medical staff found that case management improved communication between staff and enhanced patient care.(1) The aim of this study was to determine whether improved compliance by intensive medication counselling, given by a pharmacist, to elderly patients with chronic stable heart failure can influence both objective and subjective measures of heart failure. Elderly patients were randomly allocated to receive a 3-month counselling programme, or no counselling. Measures recorded at the beginning and end of the study included; submaximal 6-minute exercise tests, visual analogue scores of breathlessness, the Nottingham Health Profile, and clinical signs of heart failure. Compliance was measured by a tablet count and medication knowledge assessed by means of a questionnaire. There was no significant difference between the groups in their initial level of compliance, medication knowledge or other assessments. Compliance improved for the counselled group by 32% (P < 0.001) but remained unchanged for controls. Medication knowledge improved for the counselled group only. The 6-minute exercise test improved by 20 metres from a baseline of 137 m for the counselled group (P < 0.005) but worsened by 22 m for the control group (P < 0.01). Distance to breathlessness improved for the counselled patients and worsened for controls. In contrast bodyweight, jugular venous pressure and Nottingham Health Profile scores did not change significantly for either group. Peripheral and pulmonary oedema scores improved for the counselled group (P < 0.01) but remained unchanged for controls. A small improvement was seen in the visual analogue scores (P < 0.05) for the counselled group only. Improved compliance due to intensive medication counselling had a small but measurable beneficial effect on objective measures of heart failure.(ABSTRACT TRUNCATED AT 250 WORDS) This study was designed to test the effects of pursed lips breathing (PLB) during exercise in patients with chronic obstructive pulmonary disease (COPD) who did not spontaneously perform PLB. Sixty-nine COPD patients, mean FEV1 (SD) 1.09 (0.5), age 68 (51-83) were recruited to the study. They performed three incremental shuttle walk tests (ISWT). The first walk was designed to identify natural PLBs and the next two walks were performed in a random order; ISWT + PLB or ISWT whilst breathing normally. Measures of respiratory rate (RR), breathlessness and oxygen saturation were taken before and after walks. Data was analysed using the t-test. Fifteen patients demonstrated PLB on baseline ISWT and were therefore excluded from further walking tests although baseline data was included in the analysis. There was no significant difference between walks, mean (SD), 298.5 (173.7) PLB and non-PLB; 292.5 (161.9) nor any difference in dyspnoea. There was a significant reduction in end exercise RR and recovery time with PLB, mean difference (95% CI); 6.2 (4.5-7.9) and 24.9 (2.8-47.0) seconds, respectively. Patients who showed a good response with the PLB walk (41%) had significantly higher baseline breathlessness, Borg score, mean (SD), 1.5 (1.0) versus 0.74 (0.96) (P = 0.02). Natural PLB patients demonstrated lower exercise tolerance on the baseline walk (P = 0.01) and a trend towards greater resting breathlessness than those who did not. This study shows PLB during exercise and recovery results in lower post exercise RR and speeds return to pre exercise breathlessness, compared with exercise and non-PLB. Reductions in RR appear to be greatest in those patients with resting breathlessness. To evaluate the effect of non-pharmacological intervention for breathlessness in lung cancer on breathlessness ratings and patient functioning.
                Randomised controlled pilot study.
                A nurse led clinic in a specialist cancer centre.
                20 patients with advanced small cell and non-small cell lung cancer.
                Weekly sessions with a nurse research practitioner over 3-6 weeks using counselling, breathing re-training, relaxation and teaching coping and adaptation strategies.
                Visual analogue scale ratings of breathlessness, distress caused by breathlessness, functional capacity, ability to perform activities of daily living and the Hospital Anxiety and Depression Scale.
                Improvements in median scores on all measures were observed in the intervention group with the exception of depression, compared with the control group where median scores were static or worsened. Distress from breathlessness was improved by a median of 53%, breathlessness at worst by 35% and functional capacity by 21%. In contrast, distress in the control group worsened by a median of 10%. Significant improvements compared with the control group were observed in breathlessness at best (p < 0.02), breathlessness at worst (p < 0.05), distress caused by breathlessness (p < 0.01), functional capacity (p < 0.02) and ability to perform activities of daily living (p < 0.03) but were not observed for anxiety or depression.
                Lung cancer patients suffering from breathlessness benefited from this rehabilitative approach to breathlessness management and strategies employed in this pilot study warrant further multicentre research. Macmillan nurses and palliative care teams are recommended to explore the potential of adopting similar approaches. To assess the effectiveness of nurse led follow up in the management of patients with lung cancer.
                Randomised controlled trial.
                Specialist cancer hospital and three cancer units in southeastern England.
                203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months.
                Nurse led follow up of outpatients compared with conventional medical follow up. Outcome measures: Quality of life, patients' satisfaction, general practitioners' satisfaction, survival, symptom-free survival, progression-free survival, use of resources, and comparison of costs.
                Patient acceptability of nurse led follow up was high: 75% (203/271) of eligible patients consented to participate. Patients who received the intervention had less severe dyspnoea at 3 months (P=0.03) and had better scores for emotional functioning (P=0.03) and less peripheral neuropathy (P=0.05) at 12 months. Intervention group patients scored significantly better in most satisfaction subscales at 3, 6, and 12 months (P<0.01 for all subscales at 3 months). No significant differences in general practitioners' overall satisfaction were seen between the two groups. No differences were seen in survival or rates of objective progression, although nurses recorded progression of symptoms sooner than doctors (P=0.01). Intervention patients were more likely to die at home rather than in a hospital or hospice (P=0.04), attended fewer consultations with a hospital doctor during the first 3 months (P=0.004), had fewer radiographs during the first 6 months (P=0.04), and had more radiotherapy within the first 3 months (P=0.01). No other differences were seen between the two groups in terms of the use of resources.
                Nurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes. Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".
Breathing training, walking aids, NMES and CWV appear to be effective non-pharmacological interventions for relieving breathlessness in advanced stages of disease.