Skip to main content
SpringerLink
Log in

Rehabilitation bei berufsbedingten Atemwegs- und Lungenerkrankungen

Evaluation der Wirksamkeit und Nachhaltigkeit

Pulmonary rehabilitation in patients with occupational respiratory diseases

Long-term efficacy

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Rehabilitation führt bei chronisch obstruktiven Lungenerkrankungen evidenzbasiert zu einer Verbesserung von körperlicher Leistungsfähigkeit, Atemwegssymptomen und Lebensqualität. Für berufsbedingte pneumologische Erkrankungen gibt es bislang nur wenige Informationen.

Ziele

Die Wirksamkeit und Nachhaltigkeit einer Rehabilitation bei Patienten mit unterschiedlichen pneumologischen Berufskrankheiten und teilweise komplexen Einschränkungen der Lungenfunktion wurden evaluiert.

Methode

Wir untersuchten 263 Patienten (Asthma bronchiale, Silikose, Asbestose, chronisch-obstruktive Lungenerkrankung), die ein 4-wöchiges stationäres Rehabilitationsprogramm mit Folgeuntersuchungen nach 3 und 12 Monaten durchliefen. Evaluiert wurden: Lungenfunktion, 6-min-Gehtest [6MWD („6-min walk distance“)], maximale ergometrische Leistung (Wmax), Muskelkraft, Atemwegsymptome, Anzahl von Exazerbationen und assoziierten ärztlichen Konsultationen, Lebensqualität [SF-36 („36-item short form health survey“), SGRQ „Saint George′s respiratory questionnaire“)], Ängstlichkeit und Depressivität [HADS („hospital anxiety and depression scale“)], Luftnotempfinden [MRC („Medical Research Council dyspnea scale“), BDI/TDI („baseline/transition dyspnea index“)].

Ergebnisse

Verglichen mit den Ausgangsdaten fanden sich signifikante (p < 0,05) Verbesserungen von 6MWD, Wmax und Muskelkraft direkt nach der Rehabilitation. Diese Effekte waren auch noch 1 Jahr später nachweisbar, bei Asbestose in geringerer Ausprägung. In dem Jahr nach der Rehabilitation zeigte sich eine signifikante Reduktion der Exazerbationen um 35 %, der antibiotischen Therapien bei Atemwegsinfekten um 27 % und der Arztbesuche um 17 % im Vergleich zum vorhergehenden Jahr. Bei den Fragebögen fanden sich keine Änderungen.

Schlussfolgerung

Rehabilitation ist effektiv, auch bei komplexen pneumologischen Berufskrankheiten, mit anhaltender Verbesserung der körperlichen Leistungsfähigkeit und Reduktion der Inanspruchnahme des Gesundheitssystems.

Abstract

Background

Pulmonary rehabilitation is a well-recognized treatment option in chronic obstructive lung disease improving exercise performance, respiratory symptoms and quality of life. In occupational respiratory diseases very little information is available.

Objectives

The goal of this study was to evaluate the usefulness and sustainability of pulmonary rehabilitation in patients with occupational respiratory diseases, partly involving complex alterations of lung function.

Methods

We studied 263 patients (asthma, silicosis, asbestosis, chronic obstructive pulmonary disease) using a 4-week inpatient rehabilitation program and follow-up examinations 3 and 12 months later. The outcomes evaluated were lung function, 6-min walking distance (6MWD), maximum exercise capacity (Wmax), skeletal muscle strength, respiratory symptoms, exacerbations and associated medical consultations, quality of life [Short Form, 36 items (SF-36), Saint George’s Respiratory Questionnaire (SGRQ)], anxiety/depression [Hospital Anxiety and Depression Scale (HADS)] and breathlessness [Medical Research Council (MRC) dyspnea scale, Baseline/Transition Dyspnea Index (BDI/TDI)].

Results

Compared to baseline, there were significant (p < 0.05) improvements in 6MWD, Wmax and muscle strength immediately after rehabilitation, and these were maintained over 12 months (p < 0.05). Effects were less pronounced in asbestosis. Overall, significant reductions in the rate of exacerbations by 35 %, antibiotic therapy by 27 % and use of health care services by 17 % were observed compared to the previous year. No changes were seen in the questionnaire outcomes.

Conclusion

Pulmonary rehabilitation is effective even in the complex settings of occupational respiratory diseases, providing sustained improvement of functional capacity and reducing health care utilization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Abbreviations

6MWD:

6-min-Gehstrecke

ANOVA:

„Analysis of variance“

ATS:

„American Thoracic Society“

BDI, TDI:

„Baseline and transition dyspnea index“

BK:

Berufskrankheit

BMI:

Body-Mass-Index

COPD:

„Chronic obstructive pulmonary disease“

DGUV:

Deutsche Gesetzliche Unfallversicherung

FEV1 :

Einsekundenkapazität

FEV1%Soll :

Einsekundenkapazität in Prozent vom Soll

FVC:

Forcierte Vitalkapazität

FVC%Soll:

Forcierte Vitalkapazität in Prozent vom Soll

HDAS:

„Hospital anxiety and depression scale“

MdE:

Minderung der Erwerbsfähigkeit

Pimax :

Maximaler Inspirationsdruck

P0,1 :

Mundverschlussdruck 100 ms nach Inspirationsbeginn

PY:

„Pack years“

SD:

Standardabweichung

SEM:

Standardfehler

SF-36:

“36-item short form health survey“

SGRQ:

„Saint George′s respiratory questionnaire“

VC:

Vitalkapazität

Wmax :

Maximale Leistung (W)

Literatur

  1. Al Moamary MS (2010) Health care utilization among chronic obstructive pulmonary disease patients and the effect of pulmonary rehabilitation. Med Princ Pract 19:373–378

    Article  Google Scholar 

  2. Anzueto A (2010) Impact of exacerbations on COPD. Eur Respir Rev 19:113–118

    Article  PubMed  CAS  Google Scholar 

  3. Anzueto A (2010) Primary care management of chronic obstructive pulmonary disease to reduce exacerbations and their consequences. Am J Med Sci 340:309–318

    Article  PubMed  Google Scholar 

  4. Bullinger M, Kirchberger I (Hrsg) (1997) Der SF-36-Fragebogen zum Gesundheitszustand: Handbuch für die deutschsprachige Fragebogenversion. Hogrefe, Göttingen

  5. Buss AS, Silva LM (2009) Comparative study of two quality of life questionnaires in patients with COPD. J Bras Pneumol 35:318–324

    Article  PubMed  Google Scholar 

  6. Calverley PM (2005) Minimal clinically important difference – exacerbations of COPD. COPD 2:143–148

    Article  PubMed  Google Scholar 

  7. Carvalho NS, Ribeiro PR, Ribeiro M et al (2007) Comparing asthma and chronic obstructive pulmonary disease in terms of symptoms of anxiety and depression. J Bras Pneumol 33:1–6

    Article  PubMed  Google Scholar 

  8. Coventry PA (2009) Does pulmonary rehabilitation reduce anxiety and depression in chronic obstructive pulmonary disease? Curr Opin Pulm Med 15:143–149

    Article  PubMed  Google Scholar 

  9. Dalichau S, Demedts A, Im Sande A et al (2010) Improvement of lasting effects in outpatient pulmonary rehabilitation with special regard to exercise therapy and sports. Rehabilitation (Stuttg) 49:30–37

    Google Scholar 

  10. Dalichau S, Demedts A, Im Sande A et al (2010) Short- and long-term effects of the outpatient medical rehabilitation for patients with asbestosis. Pneumologie 64:163–170

    Article  PubMed  CAS  Google Scholar 

  11. Dimich-Ward H, Taliadouros V, Teschke K et al (2007) Quality of life and employment status of workers with Western red cedar asthma. J Occup Environ Med 49:1040–1045

    Article  PubMed  Google Scholar 

  12. Dougherty RH, Fahy JV (2009) Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype. Clin Exp Allergy 39:193–202

    Article  PubMed  CAS  Google Scholar 

  13. Emtner M, Finne M, Stalenheim G (1998) A 3-year follow-up of asthmatic patients participating in a 10-week rehabilitation program with emphasis on physical training. Arch Phys Med Rehabil 79:539–544

    Article  PubMed  CAS  Google Scholar 

  14. Ferreira G, Feuerman M, Spiegler P (2006) Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease. J Cardiopulm Rehabil 26:54–60

    Article  PubMed  Google Scholar 

  15. Foschino Barbaro MP, Lacedonia D, Palladino GP et al (2010) Dyspnea perception in asthma: role of airways inflammation, age and emotional status. Respir Med 105:195–203

    Article  Google Scholar 

  16. Gosselink R, Troosters T, Decramer M (1996) Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 153:976–980

    Article  PubMed  CAS  Google Scholar 

  17. Griffiths TL, Burr ML, Campbell IA et al (2000) Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 355:362–368

    Article  PubMed  CAS  Google Scholar 

  18. Hamilton AL, Killian KJ, Summers E et al (1996) Symptom intensity and subjective limitation to exercise in patients with cardiorespiratory disorders. Chest 110:1255–1263

    Article  PubMed  CAS  Google Scholar 

  19. Hurst JR, Vestbo J, Anzueto A et al (2010) Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 363:1128–1138

    Article  PubMed  CAS  Google Scholar 

  20. Janssen DJ, Spruit MA, Leue C et al (2010) Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chron Respir Dis 7:147–157

    Article  PubMed  Google Scholar 

  21. Jastrzebski D, Gumola A, Gawlik R et al (2006) Dyspnea and quality of life in patients with pulmonary fibrosis after six weeks of respiratory rehabilitation. J Physiol Pharmacol [Suppl 4] 57:139–148

    Google Scholar 

  22. Jones PW, Brusselle G, Dal Negro RW et al (2011) Health-related quality of life in patients by COPD severity within primary care in Europe. Respir Med 105:57–66

    Article  PubMed  CAS  Google Scholar 

  23. Kozu R, Senjyu H, Jenkins SC et al (2011) Differences in response to pulmonary rehabilitation in idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Respiration 81:196–205

    Article  PubMed  Google Scholar 

  24. Lavoie KL, Joseph M, Bacon SL (2009) Psychological distress and occupational asthma. Curr Opin Allergy Clin Immunol 9:103–109

    Article  PubMed  Google Scholar 

  25. Lowery EP, Henneberger PK, Rosiello R et al (2007) Quality of life of adults with workplace exacerbation of asthma. Qual Life Res 16:1605–1613

    Article  PubMed  Google Scholar 

  26. Man WD, Kemp P, Moxham J et al (2009) Exercise and muscle dysfunction in COPD: implications for pulmonary rehabilitation. Clin Sci (Lond)117:281–291

    Google Scholar 

  27. Mikkelsen RL, Middelboe T, Pisinger C et al (2004) Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nord J Psychiatry 58:65–70

    Article  PubMed  Google Scholar 

  28. Naji NA, Connor MC, Donnelly SC et al (2006) Effectiveness of pulmonary rehabilitation in restrictive lung disease. J Cardiopulm Rehabil 26:237–243

    Article  PubMed  Google Scholar 

  29. Nishiyama O, Kondoh Y, Kimura T et al (2008) Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology 13:394–399

    Article  PubMed  Google Scholar 

  30. Ochmann U, Jorres RA, Nowak D (2012) Long-term efficacy of pulmonary rehabilitation: a state-of-the-art review. J Cardiopulm Rehabil Prev 32:117–126

    PubMed  Google Scholar 

  31. Papadopoulos NG, Xepapadaki P, Mallia P et al (2007) Mechanisms of virus-induced asthma exacerbations: state-of-the-art. A GA2LEN and InterAirways document. Allergy 62:457–470

    Article  PubMed  CAS  Google Scholar 

  32. Putman-Casdorph H, Mccrone S (2009) Chronic obstructive pulmonary disease, anxiety, and depression: state of the science. Heart Lung 38:34–47

    Article  PubMed  Google Scholar 

  33. Rice KL, Dewan N, Bloomfield HE et al (2010) Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med 182:890–896

    Article  PubMed  Google Scholar 

  34. Ries AL (2008) Pulmonary rehabilitation: summary of an evidence-based guideline. Respir Care 53:1203–1207

    PubMed  Google Scholar 

  35. Rubi M, Renom F, Ramis F et al (2010) Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic obstructive pulmonary disease. Arch Phys Med Rehabil 91:364–368

    Article  PubMed  Google Scholar 

  36. Seemungal TA, Hurst JR, Wedzicha JA (2009) Exacerbation rate, health status and mortality in COPD – a review of potential interventions. Int J Chron Obstruct Pulmon Dis 4:203–223

    Article  PubMed  Google Scholar 

  37. Spencer LM, Alison JA, Mckeough ZJ (2010) Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial. Eur Respir J 35:571–577

    Article  PubMed  CAS  Google Scholar 

  38. Spruit MA, Troosters T, Trappenburg JC et al (2004) Exercise training during rehabilitation of patients with COPD: a current perspective. Patient Educ Couns 52:243–248

    Article  PubMed  Google Scholar 

  39. Troosters T, Probst VS, Crul T et al (2010) Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 181:1072–1077

    Article  PubMed  Google Scholar 

  40. Turner S, Eastwood P, Cook A et al (2011) Improvements in symptoms and quality of life following exercise training in older adults with moderate/severe persistent asthma. Respiration 81:302–310

    Article  PubMed  Google Scholar 

  41. Van Wetering CR, Hoogendoorn M, Mol SJ et al (2010) Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax 65:7–13

    Article  Google Scholar 

  42. Vogelmeier C, Hederer B, Glaab T et al (2011) Tiotropium versus salmeterol for the prevention of exacerbations of COPD. N Engl J Med 364:1093–1103

    Article  PubMed  CAS  Google Scholar 

  43. White RJ, Rudkin ST, Harrison ST et al (2002) Pulmonary rehabilitation compared with brief advice given for severe chronic obstructive pulmonary disease. J Cardiopulm Rehabil 22:338–344

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut und Poliklinik für Arbeits-, Sozial und Umweltmedizin, Ludwig-Maximilians-Universität, Ziemssenstraße 1, 80336, München, Deutschland

    U. Ochmann, J. Kellberger, D. Nowak & R.A. Jörres

  2. Rehabilitationsklinik Falkenstein, BG-Klinik für Berufskrankheiten, Lauterbacher Straße 16, 08223, Falkenstein, Deutschland

    N. Kotschy-Lang

  3. Klinik für Berufskrankheiten der Verwaltungs-Berufsgenossenschaft, Rehabilitationsklinik Bad Reichenhall, Münchner Allee 10, 83435, Bad Reichenhall, Deutschland

    W. Raab

Authors
  1. U. Ochmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Kotschy-Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Raab
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Kellberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Nowak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R.A. Jörres
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Ochmann.

Additional information

Diese Studie wurde unterstützt und gefördert durch die DGUV.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ochmann, U., Kotschy-Lang, N., Raab, W. et al. Rehabilitation bei berufsbedingten Atemwegs- und Lungenerkrankungen . Trauma Berufskrankh 15, 82–90 (2013). https://doi.org/10.1007/s10039-013-1953-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-013-1953-6

Schlüsselwörter

Keywords

Search

Navigation