Valoración e intervención fisioterápica del paciente con exacerbación aguda de enfermedad pulmonar obstructiva crónica

Resumo

Assessment and physical therapy intervention of patients with acute exacerbation of chronic obstructive pulmonary disease Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease, characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. COPD patients suffer frequent exacerbations, defined as a sustained worsening of their condition from a stable state to beyond normal day-to-day variations that is acute in onset and may warrant additional treatment. Acute exacerbation of COPD is an important event in terms of patient management as these poses negative impact on health status, hospitalization rates and readmissions, as well as in the progression of the disease The main objective of this PhD thesis is to assess the effectiveness of physiotherapy during the hospital stay in patients admitted to hospital due to acute exacerbation of COPD. The specific aims are: To review clinical trials about the effectiveness of physiotherapy in acute exacerbation of COPD. To analyze the clinical profile of the patients admitted due to acute exacerbation of COPD. To assess physical and functional deterioration during and after hospitalization of patients admitted due to acute exacerbation of COPD. To evaluate the results of different physiotherapy programs in patients hospitalized due to acute exacerbation of COPD. This thesis has been developed by objectives. Four different experiments have been performed with different methodology. Firstly, a systematic review of clinical trials about physical therapy during acute exacerbation of COPD was performed. Secondly, we carried out a transversal study in which we evaluated the clinical profile of patients compared by sex, severity, body mass index and frailty levels. Thirdly, we performed an observational prospective study that included three assessments, at admission, at discharge and at one month follow-up of discharge in order to determine physical and functional impairment of the patients. Finally, we performed a randomized clinical trial where we compared the effects of three different interventions (standard medical treatment, standard medical treatment + physical therapy intervention (control breathing training + range of motion exercises) or standard medical treatment + physical therapy intervention (resistance exercises)) during the hospitalization period. Different modalities of physiotherapy analyzed in this review show a significant improvement on functional status in patients hospitalized due to acute exacerbation of COPD. However, more studies are needed to systematically evaluate the duration, frequency and intensity of the physiotherapy programs; to assess the effectiveness of the treatment on other variables and to combine different modalities of physiotherapy. The analysis of the clinical profile of patients admitted due to acute exacerbation of COPD shows that the groups generated by sex, severity, body mass index and frailty are significantly different in terms of clinical characteristics, perceived and physical variables in patients hospitalized due to acute exacerbation of COPD. Hospitalization in patients hospitalized due to acute exacerbation of severe COPD implies a deterioration of physical and functional status, including a deterioration of muscle strength and postural balance; This deterioration increases between discharge and one month follow-up. A physical therapy intervention added to standard medical care in patients hospitalized due to acute exacerbation of COPD achieves greater improvement in perceived health status, physical and functional status than the prescription of standard medical care alone. In conclusion this thesis shows that patients hospitalized due to acute exacerbation of COPD suffer deterioration in their physical and functional status during the hospitalization, that impairment persists at one month follow-up of discharge; a physical therapy intervention improves the perceived health status, physical and functional status of COPD patients.