Nonpharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis.
Study Goal
The researchers aimed to evaluate the effectiveness and adverse events of nonpharmacologic interventions, including walking-related exercises, in patients with exacerbation of chronic obstructive pulmonary disease (COPD).
Results Summary
The study found that resistance training, pulmonary rehabilitation, whole body vibration, and transcutaneous electrical nerve stimulation improved 6-minute walking test distance and quality of life in COPD patients. Oxygen titration with a target saturation of 88% to 92% was associated with reduced mortality.
Population
Adults hospitalized for exacerbation of COPD.
Effective Dosage
Not specified for walking interventions.
Duration
Not specified for walking interventions.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
resistance training | increase | 6-minute walking test distance | adults with exacerbation of COPD | weighted mean difference (WMD), 74.42; 95% CI, 46.85 to 101.99 | Improvement in 6-minute walking test distance was associated with | #1 |
pulmonary rehabilitation | increase | 6-minute walking test distance | adults with exacerbation of COPD | weighted mean difference (WMD), 20.02; 95% CI, 12.06 to 28.67 | Improvement in 6-minute walking test distance was associated with | #2 |
whole body vibration | increase | 6-minute walking test distance | adults with exacerbation of COPD | weighted mean difference (WMD), 89.42; 95% CI, 45.18 to 133.66 | Improvement in 6-minute walking test distance was associated with | #3 |
transcutaneous electrical nerve stimulation | increase | 6-minute walking test distance | adults with exacerbation of COPD | weighted mean difference (WMD), 64.54; 95% CI, 53.76 to 75.32 | Improvement in 6-minute walking test distance was associated with | #4 |
resistance training | increase | quality of life | adults with exacerbation of COPD | weighted mean difference (WMD), 18.7; 95% CI, 5.06 to 32.34 | Improvement in quality of life was associated with | #5 |
combined breathing technique and range of motion exercises | increase | quality of life | adults with exacerbation of COPD | weighted mean difference (WMD), 14.89; 95% CI, 5.30 to 24.50 | Improvement in quality of life was associated with | #6 |
whole body vibration | increase | quality of life | adults with exacerbation of COPD | weighted mean difference (WMD), -12.02; 95% CI, -21.41 to -2.63 | Improvement in quality of life was associated with | #7 |
intramuscular vitamin D | increase | quality of life | adults with exacerbation of COPD | weighted mean difference (WMD), -4.67; 95% CI, -6.00 to -3.35 at the longest follow-up | Improvement in quality of life was associated with | #8 |
Oxygen titration with a target oxygen saturation range of 88% to 92% | decrease | mortality | adults with exacerbation of COPD | odds ratio, 0.36; 95% CI, 0.14 to 0.88 | was associated with reduced mortality compared with high flow oxygen | #9 |
exercise interventions and pulmonary rehabilitation programs | decrease | functional decline | patients hospitalized for exacerbation of COPD | - | may ameliorate functional decline | #10 |
Oxygen titration with a target oxygen saturation of 88% to 92% | neutral | - | patients hospitalized for exacerbation of COPD | - | should be titrated | #11 |
OBJECTIVE: To evaluate the effectiveness and adverse events of nonpharmacologic interventions in patients with exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We searched Embase, MEDLINE, Cochrane databases, Scopus, and clinicaltrials.gov from database inception to January 2, 2019, for randomized controlled trials that enrolled adults with exacerbation of COPD and evaluated the effect of nonpharmacologic interventions on clinical outcomes and/or lung function. RESULTS: We included 30 randomized controlled trials with 2643 participants. Improvement in 6-minute walking test distance was associated with resistance training (weighted mean difference [WMD], 74.42; 95% CI, 46.85 to 101.99), pulmonary rehabilitation (WMD, 20.02; 95% CI, 12.06 to 28.67), whole body vibration (WMD, 89.42; 95% CI, 45.18 to 133.66), and transcutaneous electrical nerve stimulation (WMD, 64.54; 95% CI, 53.76 to 75.32). Improvement in quality of life was associated with resistance training (WMD, 18.7; 95% CI, 5.06 to 32.34), combined breathing technique and range of motion exercises (WMD, 14.89; 95% CI, 5.30 to 24.50), whole body vibration (WMD, -12.02; 95% CI, -21.41 to -2.63), and intramuscular vitamin D (WMD, -4.67; 95% CI, -6.00 to -3.35 at the longest follow-up). Oxygen titration with a target oxygen saturation range of 88% to 92% was associated with reduced mortality compared with high flow oxygen (odds ratio, 0.36; 95% CI, 0.14 to 0.88). All findings were based on low strength of evidence. CONCLUSION: In patients hospitalized for exacerbation of COPD, exercise interventions and pulmonary rehabilitation programs may ameliorate functional decline. Oxygen should be titrated with a target oxygen saturation of 88% to 92% in these patients. TRIAL REGISTRATION: PROSPERO Identifier: CRD42018111609.