Wonder drug for COPD patients 

Clinical news
19 October 2016

About 15% of all New Zealanders suffer from COPD – chronic obstructive pulmonary disease – an umbrella term for smoking-induced lung disease like emphysema or chronic bronchitis. They struggle to breathe and may find it hard to walk any distance.

 


As a GP, you now have a plethora of inhaler medication to choose from.  However, Professor Lutz Beckert, a respiratory physician, challenges us to consider exercise as the only ‘drug’ that improves quality of life for 63%-83% of COPD patients.

Patients who complete pulmonary rehabilitation not only walk further, they also feel better.

Lutz Beckert and Canterbury DHB physiotherapist Patricia Goulter presented at the recent GPCME in Christchurch about this wonder drug – exercise – in COPD treatment. 

The six minute walk test (6MWT) or incremental shuttle walk test (ISWT) are the simple and gold standard test in pulmonary rehabilitation.  A lower 6MWT is strongly associated with increased risk of hospitalisation and mortality. 
Lutz says that exercise is not about improving COPD patients’ lung function, but about improving their cardiovascular fitness. The key is for COPD patients to do moderate physical activity that gets them ‘moderately to somewhat severely breathless’ (3-4 on the Borg rating of perceived exertion scale). This leaves people thinking they could do more if they had to. 

Patricia talked about how teaching patients to manage their breathlessness is of immense benefit in improving their confidence about doing exercise. Pulmonary rehab classes include breathing techniques, such as pursed lip breathing, a simple way to ease shortness of breath by exhaling through tightly pressed (pursed) lips and inhaling through the nose with your mouth closed. The worst thing you can say to a breathless patient, she says, is “take a deep breath” – instead tell them to slow their breathing and use purse lip breathing.

You can encourage your patients to go to an exercise group, or the gym. Upper body exercise can be beneficial to get the breathing deeper, as well as doing standing press-ups, weights, working out how to relax, and dropping your shoulders. 

Hydrotherapy can be really useful too – you can use it for both cardio and COPD patients. Pedometers or Fitbits can make exercise more fun and get better results. 

Lutz concluded by talking about the measures to use for the key outcome areas for COPD - exercise capacity, symptoms, and health-related quality of life: 

• For exercise capacity, the key measures are distance walked and oxygen consumption, measured by 6MWT, ISWT, sit-to-stand and METS.
• For symptoms, the important ones are dyspnoea and fatigue, and you can measure those by using symptom-specific questionnaires, EQ-5D, Visual Analogue Scale (VAS), Borg rating of perceived exertion scale, and MRC breathlessness scale.
• For health-related quality of life, the areas measured cover several domains, varying by questionnaire: chronic respiratory questionnaire (CRQ); St George’s respiratory questionnaire (SGRQ), and COPD Assessment Test (CAT).

Lutz and Patricia recommended the Thoracic Society guidelines which are available on line – including a toolbox on website for assessments, BORG score. 

Patricia and Lutz are happy for GPs to call them or email on lutz.beckert@cdhb.health.nz or Patricia.goulter@cdhb.org.nz, with any questions about exercise and COPD.