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Title: Nonpharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis
Authors: Dobler, Claudia 
Morrow, Allison S
Farah, Magdoleen H
Beuschel, Bradley
Majzoub, Abdul M
Wilson, Michael E
Hasan, Bashar
Seisa, Mohamed O
Daraz, Lubna
Prokop, Larry J
Murad, M Hassan
Wang, Zhen
Issue Date: Jun-2020
Publisher: Elsevier
Source: Dobler CC, Morrow AS, Farah MH, Beuschel B, Majzoub AM, Wilson ME, Hasan B, Seisa MO, Daraz L, Prokop LJ, Murad MH, Wang Z. Nonpharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis. Mayo Clin Proc. 2020 Jun;95(6):1169-1183. doi: 10.1016/j.mayocp.2020.01.018
Journal: Mayo Clinic proceedings
Abstract: To evaluate the effectiveness and adverse events of nonpharmacologic interventions in patients with exacerbation of chronic obstructive pulmonary disease (COPD). We searched Embase, MEDLINE, Cochrane databases, Scopus, and from database inception to January 2, 2019, for randomized controlled trials that enrolled adults with exacerbation of COPD and evaluated the effect of nonpharmacologic interventions on clinical outcomes and/or lung function. We included 30 randomized controlled trials with 2643 participants. Improvement in 6-minute walking test distance was associated with resistance training (weighted mean difference [WMD], 74.42; 95% CI, 46.85 to 101.99), pulmonary rehabilitation (WMD, 20.02; 95% CI, 12.06 to 28.67), whole body vibration (WMD, 89.42; 95% CI, 45.18 to 133.66), and transcutaneous electrical nerve stimulation (WMD, 64.54; 95% CI, 53.76 to 75.32). Improvement in quality of life was associated with resistance training (WMD, 18.7; 95% CI, 5.06 to 32.34), combined breathing technique and range of motion exercises (WMD, 14.89; 95% CI, 5.30 to 24.50), whole body vibration (WMD, -12.02; 95% CI, -21.41 to -2.63), and intramuscular vitamin D (WMD, -4.67; 95% CI, -6.00 to -3.35 at the longest follow-up). Oxygen titration with a target oxygen saturation range of 88% to 92% was associated with reduced mortality compared with high flow oxygen (odds ratio, 0.36; 95% CI, 0.14 to 0.88). All findings were based on low strength of evidence. In patients hospitalized for exacerbation of COPD, exercise interventions and pulmonary rehabilitation programs may ameliorate functional decline. Oxygen should be titrated with a target oxygen saturation of 88% to 92% in these patients. PROSPERO Identifier: CRD42018111609.
DOI: 10.1016/j.mayocp.2020.01.018
Keywords: Chronic Obstructive Pulmonary Disease;Disease progression;Nonpharmacologic interventions;Randomized controlled trials
Type: Article
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