1. EFFECT OF PULMONARY REHABILITATION ON
EXERCISE TOLERANCE,DYSPNEA AND QUALITY OF
LIFE IN COPD PATIENTS IN A TERTIARY CARE
HOSPITAL- AN INTERVENTIONAL STUDY
REFERENCE ID- STS2024-3Y-05070
NAME OF THE STUDENT- JERUSHA ROSLIN.A
NAME OF THE GUIDE – DR.RAJESH PITCHAI
2. OBJECTIVES
➢ To assess the socio-demographic profiles,exercise tolerance,
respiratory distress and Health Related Quality of life(HRQOL) among
COPD patients before and after 3months of pulmonary rehabilitation
intervention
➢ To estimate the effect of this intervention in the treatment of COPD
patients in increasing their health status
3. METHODOLOGY
• Study Design: An Interventional study
• Study Population: Patients attending the outpatient department of
Respiratory Medicine
• Study Centre: Tertiary Care Hospital, Sivagangai ,Tamilnadu.
• Study Duration: Three months from the date of IEC approval
• Study Department:
1. Department of Community Medicine
2. Department of Thoracic Medicine
3. Department of Orthopedics and Physical Rehabilitation
4. Inclusion criteria:
⮚ COPD patients of age 18-65 years of both sexes
➢ Patients with clinical,radiological and spirometry evidence of COPD.
➢ FEV1 values 45% to 75% of the predicted value in spirometry
Exclusion criteria:
➢ Subjects with FEV1 values < 45%( requires assisted ventilation)
⮚ Subjects not willing to participate in the study.
⮚ Subjects who have previous history of angina or any cardiovascular pathologies.
⮚ Subjects who have any type of physical disability.
⮚ Terminally ill patients, patients with cancer, HIV and TB patients will be excluded
5. Sample size
• Sample size: The sample size for the present study is calculated by
considering the most probable prevalence(p) of COPD in rural India as
5.6% and the permissible error(d) as 5% ,with a 95% confidence
interval. Fixing the permissible error as 5%, the minimum sample size
is calculated to be 82 by the formula
n= Z2 pq/d2.
• Adding the non-responsive rate of 10%, the sample size is estimated
to be 92.
6. STUDY PROCEDURE
• The study is conducted on the approval of the Instituitional Ethics Committee.
• The informed consent from all the participants will be obtained. The patient’s history is taken
along with sociodemographic data, name, age, sex, address, marital status, duration of COPD ,the
current drug therapy details, duration of treatment, dosage of medication and the class of drugs
will be recorded in a proforma prepared for the study.
• General examination as well as the respiratory system exam is done. Blood investigations like
CBC is to be done followed by sputum examination to rule out TB. An ECG is taken to rule out
any cardiac pathologies. The diagnosis of COPD is confirmed by Pulmonary function test, by
calculating the forced expiratory volume FEV1 values and FEV/FVC ratio .The intervention is
given along with ongoing pharmacological drug treatment in all patients, the primary therapy is
with Long acting beta agonist(LABA), Inhaled corticosteroids is continued.
7. INTERVENTIONS IMPLEMENTED IN PULMONARY
REHABILITATION:
1. Chest mobilisation exercises
2. Coughing techniques
3. Upper limb and lower limb extremity resistance training
4. Chest Physiotherapy: a) breath retraining-purse lip breathing, diaphragmatic breathing exercises
8. • The recommended target session each is about 30 min sessions of 5 times a week.
Diaphragmatic breathing and inspiratory muscle breathing will be practised daily for
5minutes every 3hours in the morning.
• Exercise training begins at a level which can be tolerated by a patient without discomfort.
Subsequently, exercises are increased in graded manner. Telephonic calls will be made
every week to ensure that they are continuing to perform the exercises at home and any
clarifications sought will be addressed. The participants will be assessed after 3 months .
• Pre- and post-rehabilitation outcomes will be assessed by CAT score, SGRQ, modified
MRC dyspnea scale, 6MWT and spirometry values.
9. DATA ANALYSIS
• The data collected will be entered into Microsoft- office excel and the
statistical analysis will be done using Epi Info 7 software.
10. REFERENCES
• Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I; NIHR RESPIRE Global Respiratory Health
Unit. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary
disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022
May;10(5):447-458. doi: 10.1016/S2213-2600(21)00511-7. Epub 2022 Mar 10. PMID: 35279265; PMCID:
PMC9050565
• Daniel RA, Aggarwal P, Kalaivani M, Gupta SK. Prevalence of chronic obstructive pulmonary disease in
India: A systematic review and meta-analysis. Lung India. 2021 Nov-Dec;38(6):506-513. doi:
10.4103/lungindia.lungindia_159_21. PMID: 34747730; PMCID: PMC8614617.
• Rochester CL, Alison JA, Carlin B, et al. Pulmonary Rehabilitation for Adults with Chronic Respiratory
Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med.
2023;208(4):e7-e26. doi:10.1164/rccm.202306-1066ST
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