title: Effect of pulmonary rehabilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients.
abstract: We hypothesized that severe COPD patients who present with the disadvantageous phenomenon of Expiratory Flow Limitation (EFL) may benefit as COPD patients without EFL do after implementation of a Pulmonary Rehabilitation (PR) program. Forty-two stable COPD patients were studied at rest and during exercise. EFL and dynamic hyperinflation (DH) were documented using the negative expiratory pressure (NEP) technique and inspiratory capacity (IC) maneuvers, respectively. Patient centered outcomes were evaluated by the Saint-George's Respiratory Questionnaire (SGRQ) and the mMRC dyspnea scale. Before PR, 16 patients presented with EFL at rest and/or during exercise. After PR, EFL was abolished in 15 out of those 16 EFL patients who exhibited a significant increase in IC values. These were mainly accomplished through a modification of the breathing pattern. In the 26 NFL patients no increase was noted in their IC or a modification of their breathing pattern. However, both NFL and EFL COPD patients improved exercise capacity and patients centered outcomes undergoing the same PR program.
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece; Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Elpida P
authors.initials: EP
authors.lastname: Theodorakopoulou
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Sofia-Antiopi
authors.initials: SA
authors.lastname: Gennimata
authors.affiliation: Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Harikiopoulou
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kaltsakas
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Palamidas
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Koutsoukou
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.affiliation: Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Epameinondas N
authors.initials: EN
authors.lastname: Kosmas
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Bakakos
authors.affiliation: Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece. Electronic address: koulnik@med.uoa.gr.
authors.forename: Nickolaos G
authors.initials: NG
authors.lastname: Koulouris
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000503:physiopathology / Q000534:rehabilitation; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D007320:Inspiratory Capacity; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D012146:Rest / Q000502:physiology*; D013147:Spirometry; D011795:Surveys and Questionnaires; D013990:Tidal Volume / Q000502:physiology*
keywords: Breathing pattern; Dynamic hyperinflation; Expiratory flow limitation; Negative expiratory pressure; Pulmonary rehabilitation