Effects of external diaphragm pacing combined with breathing training on pulmonary function of chronic obstructive pulmonary disease patients
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Abstract
Background: Pulmonary rehabilitation training is effective for patients with chronic obstructive pulmonary disease (COPD). External diaphragm pacing is a method to induce the change of nerve potential of the diaphragm by electrical stimulation and then stimulate the regular contraction of the diaphragm to improve the function of the diaphragm.
Objective: To explore the effects of external diaphragm pacing combined with breathing training on pulmonary function of COPD patients.
Methods: One hundred COPD patients admitted to our hospital from January 2021 to January 2023 were chosen and divided into control group (CG) and observation group (OG). Patients in the CG received breathing training. Patients in the observation group received external diaphragmatic pacing intervention after 30 minutes of respiratory training, with the pulse frequency adjusted to 30 ~ 40 Hz according to the patient's comfort level, and the pacing frequency adjusted to 9-12 times/minute, 30 minutes/times, 2 times/day. The clinical efficacy, lung function, arterial blood gas, oxidative stress, adverse effects that occurred during the treatment process along with quality of life in both groups was compared.
Results: Due to the patient's own reasons to fall off 3 cases, the final completion of 97 cases, including 48 cases in the control group and 49 cases in the observation group. The indicators and scores of the two groups of patients before treatment were not statistically different, and were comparable between the two groups (P>0.05). After treatment, the total effective rate, FEV1, FVC , and FEV1/FVC levels of OG were higher than those of CG group indicating that the improvement of lung function by combined treatment was better (P<0.05). Compared with CG, OG had lower PaCO2 levels and higher PaO2 levels, suggesting that combined treatment improved patients' ventilatory function (P<0.05). In addition, lower MDA levels and higher SOD and GSH levels suggested that the combination therapy reduced COPD-induced oxidative stress. The probability of adverse events in OG (8.89%) increased somewhat compared to CG (4.17%), but there was no statistical difference (P>0.05).The CAT score of OG was higher than that of CG, suggesting that the combination therapy gave patients a better experience.
Conclusion: Compared with respiratory training, external diaphragmatic pacing combined with respiratory training has a better effect on improving lung function and quality of life in patients with chronic obstructive pulmonary disease. However, due to the small sample size of this study, the single source of the sample, and the limitations of the sample selection, the conclusions drawn from this study need to be further justified. This study also suggests the potential of external diaphragmatic pacing combined with respiratory training in the clinical treatment of obstructive lung disease.
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References
[1] Ritchie AI, Wedzicha JA. Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations. Clin Chest Med. 2020;41(3):421-38.
[2] Rabe KF, Watz H. Chronic obstructive pulmonary disease. Lancet. 2017;389(10082):1931-40.
[3] Labaki WW, Rosenberg SR. Chronic Obstructive Pulmonary Disease. Ann Intern Med. 2020;173(3):Itc17-itc32.
[4] Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study. Lancet Respir Med. 2018;6(6):421-30.
[5] Gloeckl R, Schneeberger T, Jarosch I, Kenn K. Pulmonary Rehabilitation and Exercise Training in Chronic Obstructive Pulmonary Disease. Dtsch Arztebl Int. 2018;115(8):117-23.
[6] Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, et al. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med. 2020;14(2):149-61.
[7] Cornelison SD, Pascual RM. Pulmonary Rehabilitation in the Management of Chronic Lung Disease. Med Clin North Am. 2019;103(3):577-84.
[8] Duffy SP, Criner GJ. Chronic Obstructive Pulmonary Disease: Evaluation and Management. Med Clin North Am. 2019;103(3):453-61.
[9] Xu Y, Yang D, Lu B, Zhang Y, Ren L, Shen H. Efficacy of aerobic training and resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease: A randomized controlled study. Clin Rehabil. 2023;37(11):1479-91.
[10] Taton O, Gevenois PA, Van Muylem A, Bondue B, Van Laethem S, Leduc D. Improvements of the shape and strength of the diaphragm after endoscopic lung volume reduction. Thorax. 2024;79(8):711-7.
[11] Morris IS, Bassi T, Bellissimo CA, de Perrot M, Donahoe L, Brochard L, et al. Proof of Concept for Continuous On-Demand Phrenic Nerve Stimulation to Prevent Diaphragm Disuse during Mechanical Ventilation (STIMULUS): A Phase 1 Clinical Trial. Am J Respir Crit Care Med. 2023;208(9):992-5.
[12] Zhou F, Fan D, Feng Y, Zhou C, Chen X, Ran X, et al. Effectiveness of neuromuscular electrical stimulation in severe acute pancreatitis complicated patients with acute respiratory distress syndrome: study protocol for a randomized controlled trial. Trials. 2023;24(1):600.
[13] Bao Q, Chen L, Chen X, Li T, Xie C, Zou Z, et al. The effects of external diaphragmatic pacing on diaphragm function and weaning outcomes of critically ill patients with mechanical ventilation: a prospective randomized study. Ann Transl Med. 2022;10(20):1100.
[14] He C, Ren S, Du Q, Wang Y, Liu H, Zhao H, et al. Adjuvant Therapy: YiqiDitanTongfu Decoction With External Diaphragm Pacer for Chronic Obstructive Pulmonary Disease Patients With Difficulty Weaning From Mechanical Ventilation. Altern Ther Health Med. 2020;26(3):32-8.
[15] Chervin RD, Guilleminault C. Diaphragm pacing for respiratory insufficiency. J Clin Neurophysiol. 1997;14(5):369-77.
[16] Lareau SC, Fahy B, Meek P, Wang A. Chronic Obstructive Pulmonary Disease (COPD). Am J Respir Crit Care Med. 2019;199(1):P1-p2.
[17] Segal LN, Martinez FJ. Chronic obstructive pulmonary disease subpopulations and phenotyping. J Allergy Clin Immunol. 2018;141(6):1961-71.
[18] Dean E. Chronic obstructive pulmonary disease. Nurs Older People. 2017;29(4):12.
[19] Beaumont M, Mialon P, Le Ber-Moy C, Lochon C, Péran L, Pichon R, et al. Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial. Chron Respir Dis. 2015;12(4):305-12.
[20] Cai YY, Xu FP, Niu SF. [Effects of external diaphragm pacing on transdiaphragmatic pressure, ventilation and arterial blood gases in healthy volunteers]. Zhonghua Nei Ke Za Zhi. 1990;29(12):730-2, 65-6.
[21] Chen X, Li C, Zeng L, Rong T, Lin P, Wang Q, et al. Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer: a randomised controlled trial. BMC Cancer. 2023;23(1):282.
[22] Galmén K, Jakobsson JG, Freedman J, Harbut P. High Frequency Jet Ventilation during stereotactic ablation of liver tumours: an observational study on blood gas analysis as a measure of lung function during general anaesthesia. F1000Res. 2019;8:386.
[23] Cortopassi F, Gurung P, Pinto-Plata V. Chronic Obstructive Pulmonary Disease in Elderly Patients. Clin Geriatr Med. 2017;33(4):539-52.
[24] Lacasse Y, Casaburi R, Sliwinski P, Chaouat A, Fletcher E, Haidl P, et al. Home oxygen for moderate hypoxaemia in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2022;10(11):1029-37.
[25] Neunhäuserer D, Reich B, Mayr B, Kaiser B, Lamprecht B, Niederseer D, et al. Impact of exercise training and supplemental oxygen on submaximal exercise performance in patients with COPD. Scand J Med Sci Sports. 2021;31(3):710-9.
[26] Adury RZ, Siu R, Jung R. Co-activation of the diaphragm and external intercostal muscles through an adaptive closed-loop respiratory pacing controller. Front Rehabil Sci. 2023;4:1199722.
[27] Stuessi C, Spengler CM, Knöpfli-Lenzin C, Markov G, Boutellier U. Respiratory muscle endurance training in humans increases cycling endurance without affecting blood gas concentrations. Eur J Appl Physiol. 2001;84(6):582-6.
[28] Makena P, Kikalova T, Prasad GL, Baxter SA. Oxidative Stress and Lung Fibrosis: Towards an Adverse Outcome Pathway. Int J Mol Sci. 2023;24(15).
[29] Cannavò L, Perrone S, Viola V, Marseglia L, Di Rosa G, Gitto E. Oxidative Stress and Respiratory Diseases in Preterm Newborns. Int J Mol Sci. 2021;22(22).
[30] MacNee W. Oxidative stress and lung inflammation in airways disease. Eur J Pharmacol. 2001;429(1-3):195-207.
[31] Barnes PJ. Oxidative stress-based therapeutics in COPD. Redox Biol. 2020;33:101544.
[32] Li TT, Wang HY, Zhang H, Zhang PP, Zhang MC, Feng HY, et al. Effect of breathing exercises on oxidative stress biomarkers in humans: A systematic review and meta-analysis. Front Med (Lausanne). 2023;10:1121036.
[33] Giberson CE, Cheshier SH, Poree LR, Saulino MF. Diaphragm Pacing: A Safety, Appropriateness, Financial Neutrality, and Efficacy Analysis of Treating Chronic Respiratory Insufficiency. Neuromodulation. 2023;26(3):490-7.
[34] Ceyhan Y, Tekinsoy Kartin P. The effects of breathing exercises and inhaler training in patients with COPD on the severity of dyspnea and life quality: a randomized controlled trial. Trials. 2022;23(1):707.
[35] Zhu T, Jin HP, Liu SS, Zhu HJ, Wang JW. Effects of extracorporeal diaphragm pacing combined with inspiratory muscle training on respiratory function in people with stroke: a randomized controlled trial. Neurol Res. 2024;46(8):727-34