The Effect of Pulmonary Rehabilitation in Patients with Chronic Lung Disease

만성 폐질환 환자에서의 호흡재활치료의 효과

Background : It is known that pulmonary rehabilitation improves dyspnea and exercise tolerance in patient with chronic lung disease, although it does not improve pulmonary function. But there is a controversy whether this improvement after pulmonary rehabilitation is due to increased aerobic exercise capacity. We performed this study to evaluate the effect of pulmonary rehabilitation for 6 weeks on the pulmonary function, gas exchange, exercise tolerance and aerobic exercise capacity in patients with chronic lung disease. Methods : Pulmonary rehabilitations including education, muscle strengthening exercise and symptom-Umited aerobic exercise for six weeks, were performed in fourteen patients with chronic lung disease (COPD 11, bronchiectasis 1, IPF 1, sarcoidosis 1 ; mean age $57{\pm}4$ years; male 12, female 2). Pre- and post-rehabilitaion pulmonary function and exercise capacity were compared. Results: 1) Before the rehabilitation, FVC, $FEV_1$ and $FEF_{25-75%}$ of the patients were $71.5{\pm}6.4%$. $40.6{\pm}3.4%$ and $19.3{\pm}3.8%$ of predicted value respectively. TLC, FRC and RV were $130.3{\pm}9.3%$, $157.3{\pm}13.2%$ and $211.1{\pm}23.9%$ predicted respectively. Diffusing capacity and MVV were $59.1{\pm}1.1%$ and $48.6{\pm}6.2%$. These pulmonary functions did not change after pulmonary rehabilitation. 2) In the incremental exercise test using bicycle ergometer, maximum work rale ($57.7{\pm}4.9$) watts vs. $64.8{\pm}6.0$ watts, P=0.036), maximum oxygen consumption ($0.81{\pm}0.07$ L/min vs. $0.96{\mu}0.08$ L/min, P=0.009) and anaerobic threshold ($0.60{\pm}0.06$ L/min vs. $0.76{\mu}0.06$ L/min, P=0.009) were significantly increased after pulmonary rehabilitation. There was no improvement in gas exchange after rehabilitation. 3) Exercise endurances of upper ($4.5{\pm}0.7$ joule vs. $14.8{\pm}2.4$ joule, P<0.001) and lower extremity ($25.4{\pm}5.7$ joule vs. $42.6{\pm}7.7$ joule, P<0.001), and 6 minute walking distance ($392{\pm}35$ meter vs. $459{\pm}33$ meter, P<0.001) were significantly increased after rehabilitation. Maximum inspiratory pressure was also increased after rehabilitation ($68.5{\pm}5.4$ $CmH_2O$ VS. $80.4{\pm}6.4$ $CmH_2O$, P<0.001). Conclusion: The pulmonary rehabilitation for 6 weeks can improve exercise performance in patients with chronic lung disease.

배경: 호흡재활치료는 만성 폐질환 환자들의 폐기능을 호전시키지는 못하나 운동허용능(exercise tolerance)을 호전시키는 것으로 알려져 있다. 그러나 이러한 운동허용능이 증가하는 것이 유산소운동 능력 (aerobic exercise capacity)이 중가하기 때문인지는 논란이 있으며, 아직 국내에서 는 호흡재활치료에 대한 보고가 없었다. 방법: 14명의 만성 폐질환 환자(만성폐쇄성폐질환 11명, 유육종증 1명, 기관지확장증 1명, 특발성 폐섬유화증 1명, 평균 연령 $57{\pm}4$세, 남자 12명, 여자 2명)를 대상으로 6 주간의 호흡재활치료를 시행하여 치료 전후의 폐기능과 운동허용능의 변화를 관찰하였다. 결과: 1) 대상 환자의 호흡재활치료 전 평균 노력성 폐활량(FVC), 1초간 노력성호기량($FEV_1$) 및 노력성 호기중간 기류량($FEF_{25-75%}$)은 각각 예측치의 $71.5{\pm}6.4%$, $40.6{\pm}3.4%$ 및 $19.3{\pm}3.8%$ 였으며, 총 폐용량(TLC), 기능적잔기용량(FRC) 및 잔기량(RV)은 각각 $130.3{\pm}9.3%$, $157.3{\pm}13.2%$ 및 $211.1{\pm}23.9%$이었고, 확산능(diffusing capacity) 및 최대 환기량(MVV)은 각각 $59.1{\pm}1.1%$ 및 $48.6{\pm}6.2%$이었다. 이들 각 폐기능의 지표들은 호흡재활치료 전후 유의한 변화는 없었다. 2) 자전거운동력측정계 (bicycle ergometer)를 이용한 운동부하 검사상 최대 운동량(maximum work rate)은 치료전 $57.7{\pm}4.9$ watts 에서 치료후 $64.8{\pm}6.0$ watts로(P=0.036), 최대산소섭취량($VO_2$ max)은 $0.81{\pm}0.07$ L/mm에서 $0.96{\mu}0.08$ L/mm로 (P=0.004), 무산소역치 (anaerobic threshold)는 $0.60{\pm}0.06$ L/mm 에서 $0.76{\mu}0.06$ L/min로(P=0.009) 호흡재활치료후 유의하게 증가하였다. 가스교환은 호흡재활치료 전후에 변화가 없었다. 3) 지구력시험 (endurance test)상 운동일(work)이 상지는 $4.5{\pm}0.7$ joule 에서 $14.8{\pm}2.4$ joule로 (P<0.001), 하지는 $25.4{\pm}5.7$ joule에서 $42.6{\pm}7.7$로 (P<0.001) 모두 재활치료 후 유의하게 증가하였다. 6분 보행거리는 $392{\pm}35$ 미터 에서 $459{\pm}33$ 미터로(P<0.001) 치료 후 연장되었고, 최대 흡기압도 $68.5{\pm}5.4$ $CmH_2O$에서 $80.4{\pm}6.4$ $CmH_2O$로 증가하였다(P<0.001). 결론: 만성 폐질환 환자에서 6주간의 호흡재활치료는 폐기능 및 가스교환을 호전시키지는 못하였지만 운동허용능(exercise tolerance)을 호전시키는 것으로 사료되었다.