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Aging and disease    2015, Vol. 6 Issue (6) : 466-477     DOI: 10.14336/AD.2015.0503
Original Article |
Influence of Pulmonary Rehabilitation on Lung Function Changes After the Lung Resection for Primary Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease
Mujovic Natasa1,2,*(), Mujovic Nebojsa2,3, Subotic Dragan2,4, Ercegovac Maja2,4, Milovanovic Andjela1,2, Nikcevic Ljubica5, Zugic Vladimir2,6, Nikolic Dejan2,7
1Clinic for Physical Medicine and Rehabilitation, Clinical Center of Serbia, Belgrade, Serbia
2Faculty of Medicine, University of Belgrade, Belgrade, Serbia
3Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
4Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
5Special Hospital for Cerebrovascular Disorders “Saint Sava“, Belgrade, Serbia
6Clinic for Pulmonary disease and TB, Clinical Center of Serbia, Belgrade, Serbia
7Department of Physical Medicine and Rehabilitation, University Children’s Hospital, Belgrade, Serbia
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Abstract  

Influence of physiotherapy on the outcome of the lung resection is still controversial. Study aim was to assess the influence of physiotherapy program on postoperative lung function and effort tolerance in lung cancer patients with chronic obstructive pulmonary disease (COPD) that are undergoing lobectomy or pneumonectomy. The prospective study included 56 COPD patients who underwent lung resection for primary non small-cell lung cancer after previous physiotherapy (Group A) and 47 COPD patients (Group B) without physiotherapy before lung cancer surgery. In Group A, lung function and effort tolerance on admission were compared with the same parameters after preoperative physiotherapy. Both groups were compared in relation to lung function, effort tolerance and symptoms change after resection. In patients with tumors requiring a lobectomy, after preoperative physiotherapy, a highly significant increase in FEV1, VC, FEF50 and FEF25 of 20%, 17%, 18% and 16% respectively was registered with respect to baseline values. After physiotherapy, a significant improvement in 6-minute walking distance was achieved. After lung resection, the significant loss of FEV1 and VC occurred, together with significant worsening of the small airways function, effort tolerance and symptomatic status. After the surgery, a clear tendency existed towards smaller FEV1 loss in patients with moderate to severe, when compared to patients with mild baseline lung function impairment. A better FEV1 improvement was associated with more significant loss in FEV1. Physiotherapy represents an important part of preoperative and postoperative treatment in COPD patients undergoing a lung resection for primary lung cancer.

Keywords pulmonary rehabilitation      preoperative physiotherapy      lung cancer      lobectomy      pneumonectomy     
Corresponding Authors: Mujovic Natasa     E-mail: natashamujovic68@gmail.com
About author:

present address: Kunming Biomed International, Kunming, Yunnan, 650500, China

Issue Date: 01 December 2015
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Mujovic Natasa
Mujovic Nebojsa
Subotic Dragan
Ercegovac Maja
Milovanovic Andjela
Nikcevic Ljubica
Zugic Vladimir
Nikolic Dejan
Cite this article:   
Mujovic Natasa,Mujovic Nebojsa,Subotic Dragan, et al. Influence of Pulmonary Rehabilitation on Lung Function Changes After the Lung Resection for Primary Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease[J]. Aging and disease, 2015, 6(6): 466-477.
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http://www.aginganddisease.org/EN/10.14336/AD.2015.0503     OR     http://www.aginganddisease.org/EN/Y2015/V6/I6/466
Group A (n=56)Group B (n=47)p
Age (years) MV±SD62±759±90.134
Male gender N (%)49(88)41(87)0.968
Smoking history N (%)50(89)44 (94)0.438
Co-morbidities N (%)50(89)34(72)0.027
Hypertension N (%)28(50)18(38)0.234
Coronary disease N (%)11(20)9(19)0.950
Heart failure N (%)4(7)1(2)0.238
Diabetes mellitus N (%)7(13)4(8)0.514
Chronic renal failure N (%)0(0)2(4)0.119
COPD stage: I/II/III/IV N (%)10(18)/ 39(69)/ 6(11)/ 1(2)24(51)/ 22(47)/ 1(2)/ 0(0)0.002
Basal spirometry:
FEV1 (mL) MV±SD1948±5692509±741<0.001
FEV1% pred. MV±SD65±1479±18<0.001
VC (mL) MV±SD3352±8733731±10880.055
VC% pred. MV±SD88±1594±210.116
Tiffneau index % MV±SD56±862±6<0.001
FEF50% MV±SD29±1444±24<0.001
IC% MV±SD74±1184±12<0.01
FEF25% MV±SD27±1842±240.001
Pulmonary resection:
Pneumonectomy N (%)13(23)5(11)0.094
Lobectomy N (%)43(77)42(89)0.094
Total hospital stay (days) MV±SD36±1925±12<0.001
Preop.hospital stay (days) MV±SD21±129±6<0.001
Postop.hospital stay (days) MV±SD16±916±80.571
Total complications N (%)20(36)21(45)0.354
Pulmonary complications N (%)17(30)20(43)0.199
In-hospital mortality N (%)2(4)0(0)0.191
Table 1  Baseline patients characteristics
Figure 1.  Changes in FEV1 parameter. (A) Correlation between the gain in FEV1 and prolongation of the 6MWD during the preoperative physiotherapy. (B) Inverse correlation between the amplitude of FEV1 improvement after preoperative physiotherapy and postoperative loss in FEV1. FEV1=forced expiratory volume in the first second, in liters; 6MWD=six minute walking distance, in meters; Pre-PR=preoperative pulmonary rehabilitation.
n = 43Before Pre-PR (T1)after Pre-PR (T2)after resection (T3)Δ [T2-T1]Δ [T2-T3]Δ [T1-T3]
mean [95% CI]mean changemean [95% CI]mean changemean [95% CI]mean change
FEV1 (ml)1985±5442334±6201795±544346** [ 259, 434]20%566** [ 470, 661]23%189* [ 77, 300]7%
FEV1 % pred.64±1476±1558±1311** [ 9, 13]20%19** [ 15, 22]23%6** [ 3, 10]7%
VC (ml)3394±8413877±8783068±858469** [369, 569]17%763** [590, 935]20%284* [93, 475]6%
VC % pred.89±16103±1681±1513** [ 11, 16]18%22** [ 18, 26]21%8** [3, 12]6%
Tiffeneau index (%)55±959±955±103** [ 1, 5]7%5** [ 2, 7]7%1* [-2, 4]1%
IC (%)75±1184±777±9-*9%-*7%-2%
FEF50 (%)30±1534±1419±113** [1, 6]18%12** [8, 16]39%10** [5, 14]29%
FEF25 (%)30±1632±1619±122* [-1, 5]16%11** [ 7, 16]36%11** [5, 16]25%
6MWD (m)375±99428±91349±9153** [42, 64]16%85** [71, 100]19%31** [18, 44]6%
Dyspnea before 6MWT2.2±0.91.2±0.82.0±0.6-1.0** [-0.8, -1.2]--0.8** [-0.5, -1.1]-0.2 [-0.2, 0.6]-
Dyspnea after 6MWT3.2±0.92.1±0.82.9±0.7-1.1** [-0.9, -1.3]--1.0** [-0.7, -1.3]-0.2 [-0.2, 0.6]-
Table 2  Changes of the lung function, effort tolerance and symptomatic status in patients of the Group Awith lobectomy
n=13before Pre-PR (T1)after Pre-PR (T2)after resection (T3)Δ [T2-T1]Δ [T2-T3]Δ [T1-T3]
mean [95% CI]% changemean [95% CI]% changemean [95% CI]% change
FEV1 (ml)1888±6252127±5011344±392236 [45, 426]17824** [640, 1009]38576** [390, 763]29
FEV1 % pred.65±1274±1248±69* [3, 16]1628** [22, 35]3618** [13, 24]27
VC (ml)3216±9273565±8312187±672296 [17, 574]131385** [1071, 1700]391105** [820, 1391]33
VC % pred.89±1699±1862±1010 [1, 18]1338** [29, 47]3729** [23, 35]31
Tiffeneau index (%)58±660±857±123 [0, 7]44 [-2, 10]70 [-8, 7]1
IC (%)73±1382±1470±11-*9-**12-3
FEF50 (%)30±1033±818±113 [-1, 7]1515** [6, 24]4412* [1, 23]32
FEF25 (%)31±932±1117±111 [-6, 9]1215* [5, 26]3813* [3, 23]39
6MWD (m)354±78422±82327±7455** [34, 76]2187** [66, 108]2331** [16, 46]8
Dyspnea before 6MWT2.5±0.91.4±0.92.1±0.5-1.0** [-0.7, -1.3]--0.9* [-0.3, -1.5]-0 [-0.7, 0.7]-
Dyspnea after 6MWT3.5±0.92.4±0.63.3±0.6-1.0** [-0.7, -1.3]--1.0** [-0.5, -1.5]-0 [-0.7, 0.7]-
Table 3  Changes of the lung function, effort tolerance and symptomatic status in patients of the Group A with pneumonectomy
Figure 2.  Changes of lung function parameters before and after resection. (A) Change in FEV1 (mL) before and after resection in the Group A and Group B, [*] p<0.001. (B) Change in VC (mL) before and after resection in the Group A and Group B, [*] p=0.055. (C) Change in FEF50 (black line) and FEF25 (gray line) before and after resection in the Group A and Group B, [*, #] p<0.001, [†, ‡, §] p<0.05. (D) Change in 6MWD (in meters) before and after lung resection in the Group A and Group B, [*] p<0.05. FEV1=forced expiratory volume in the first second; VC=vital capacity; 6MWD=six minute walking distance; FEF50/25=forced expiratory flow; T1=values at admission to hospital; T2=values before resection (after physiotherapy); T3=values after surgery. Filled line and dotted line represent Group A and Group B, respectively.
Figure 3.  Changes in IC% before and after lung resection. Group A (full line) and Group B (dotted line), * p<0.05 Group A T1 vs Group B T1, # p<0.05 Group A Δ(T1-T2). T1=values at admission to hospital; T2=values before resection (after physiotherapy); T3=values after surgery.
FEV1<50% mean [95% CI] (n=7)50%≤FEV1<80% mean [95% CI] (n=39)FEV1≥80% mean [95% CI] (n=10)p-value
Δ[T2-T1]FEV1 (mL)427 [27, 827]328 [242, 414]235 [74, 396]0.631
FEV1 % pred.40 [-4, 86]18 [14, 22]9 [3, 16]0.107
FEF50 (%)7 [-14, 27]3 [0, 6]3 [1,6]0.857
FEF25 (%)2 [-21, 24]4 [1, 7]-4 [-15, 6]0.220
Δ[T2- T3]FEV1 (mL)442 [180, 703]580 [491, 667]749 [511, 987]0.152
FEV1 % pred.25 [14, 36]26 [22, 30]27 [19, 34]0.980
FEF50 (%)9 [3, 16]11 [7, 15]*22 [16, 28]*0.004
FEF25 (%)6 [2, 11]9 [5, 14]†21 [12, 31]†0.039
Table 4  Postoperative lung function changes depending on severity of COPD at admission in the Group A.
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