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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.

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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)

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Correspondence to U. Ochmann.

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Diese Studie wurde unterstützt und gefördert durch die DGUV.

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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

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

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