Pneumologische Rehabilitation vor und nach Lungentransplantation

Zusammenfassung

Die pneumologische Rehabilitation von Patienten mit fortgeschrittenen Lungenerkrankungen, vor allem bei COPD-Patienten, hat in den letzten Jahren an Bedeutung gewonnen. Für die Indikation Lungentransplantation (LTx) fehlen größere Studien sowohl im Hinblick auf die prä- wie auf die postoperative Rehabilitation. Dennoch finden sich zunehmend Hinweise, dass die präoperative Stabilisierung und Vorbereitung ebenso wie eine gezielte postoperative Trainingstherapie unverzichtbar zum gesamten LTx-Therapiekonzept dazugehören sollten, da der Transplantationserfolg hierdurch verbessert werden kann. Die präoperative Phase kann durch Verbesserung von Kraft, Ausdauer und Alltagsmobilität zur Überbrückung der Wartezeit genutzt werden. Zusätzlich sind intensive Motivation und Wissensvermittlung möglich, um die Patienten auf die Transplantation vorzubereiten. Ziel der postoperativen Rehabilitation ist es, mit Hilfe einer verbesserten Atemleistung die körperliche Leistungsfähigkeit und die Lebensqualität zu steigern. Dieser Beitrag stellt den Stellenwert, die Zielsetzung und die Besonderheiten einer Rehabilitation vor und nach einer Lungentransplantation dar. Abschließend wird die Bedeutung dieses perioperativen Konzepts für ein ressourcenlimitiertes und sehr kostenintensives Therapieverfahren diskutiert.

Abstract

Pulmonary rehabilitation of patients with advanced lung diseases especially with COPD patients has become more important over past years. For patients in which lung transplantation is indicated major studies concerning pre- and postoperative rehabilitation are still missing. Nevertheless, growing evidence suggests that training therapy and other components of comprehensive rehabilitation should be an essential part of the whole concept in order to augment the therapeutic success of LTx. The time prior to LTx may be used as „bridging to transplant” by improving strength, endurance and mobility. Intensive motivation and knowledge transfer can prepare patients as good candidates. The rehabilitation after LTx aims at regaining physical abilities and health related quality of life using the increased breathing capacities. The manuscript presents the importance, aims and specific features of rehabilitation prior to and following LTx. Finally the therapeutic concept will be discussed with regard to the economic burden and the limited resources in lung transplantation.

Literatur

• 1 Langer D et al. Effects of exercise training after lung transplantation: preliminary results of a randomized controlled trial.  Am J Respir Crit Care Med. 2010;  181 A1206
• 2 Garrod R, Mikelsons C, Paul E A et al. Randomised controlled trail of domiciliary non-invasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  162 1335-1341
• 3 Kenn K, Schoenheit-Kenn U, Bösl T et al. Effects of pulmonary rehabilitation including exercise training in patients with indication for noninvasive ventilation therapy.  AJRCCM. 2002;  165 A735
• 4 Köhnlein T, Schönheit-Kenn U, Winterkamp S et al. Noninvasive ventilation in pulmonary rehabilitation of COPD patients.  Respiratory Medicine. 2009;  103 1329-1336
• 5 Schoenheit-Kenn U, Winterkamp S, Boensch M et al. Effects of pulmonary rehabilitation including exercise training in COPD Patients with indication for non-invasive ventilation therapy (NIV).  AJRCCM. 2009;  179 A1053
• 6 Taylor J L et al. Coping and quality of life in patients awaiting lung transplantation.  J of Psychosomatic Research. 2008;  65 71-79
• 7 Biggar D, Trulock E, Patterson G, Cooper J. Medium term results of pulmonary rehabilitation prior to lung transplantation (abstract).  Am Rev Respir Dis. 1993;  147 A333
• 8 Mathur S, Hornblower E, Levy R D. Exercise training before and after lung transplantation.  Phys Sportsmed. 2009;  37 78-87
• 9 Gottlieb J. Update on lung transplantation (Review).  Therapeutic Advances in Respiratory disease. 2008;  2 237-247
• 10 Kugler C, Fischer S, Gottlieb J et al. Symptom experience after lung transplantation: impact on quality of life and adherence.  Clin Transplant. 2007;  21 590-596
• 11 Kugler C, Fuehner T, Dierich M et al. Effect of adherence to home spirometry on bronchiolitis obliterans and graft survival after lung transplantation.  Transplantation. 2009;  88 129-134
• 12 DeVito Dabbs A, Dew M A, Myers B et al. Evaluation of a hand-held, computer-based intervention to promote early self-care behaviors after lung transplant.  Clin Transplant. 2009;  23 537-545
• 13 DeVito Dabbs A, Hoffman L A, Iacono A T et al. Are symptom reports useful for differentiating between acute rejection and pulmonary infection after lung transplantation?.  Heart Lung. 2004;  33 372-380
• 14 Schols A MWJ, Slangen J, Volovics L, Wouters E FM. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157 1791-1797
• 15 Dachverband Osteologie. DVO-Leitlinie 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen.  Osteologie. 2009;  18 304-328
• 16 Kühl K, Kuhn C, Kenn K, Rief W. Der COPD-Angst-Fragebogen (CAF): Ein neues Instrument zur Erfassung krankheitsspezifischer Ängste bei COPD-Patienten.  Psychother Psychosom Med Psychol . 2010;  [Epub ahead of print]
• 17 Curtis J R, Engelberg R A, Nielsen E L et al. Patient-physician communication about end-of-life care for patients with severe COPD.  Eur Respir J. 2004;  24 200-205
• 18 Fan V S. Sex, depression and risk of hospitalization and mortality in COPD.  Arch Intern Med. 2007;  167 2345-2353
• 19 Krieger A C, Szidon P, Kesten S. Skeletal muscle dysfunction in lung transplantation.  J Heart Lung Transplant. 2000;  19 392-400
• 20 Wang X N, Williams T J, McKenna M J et al. Skeletal muscle oxidative capacity, fiber type, and metabolites after lungtransplantation.  Am J Respir Crit Care Med. 1999;  160 57-63
• 21 Vogiatzis I, Terzis G, Nanas S et al. Skeletal muscle adaptations to interval training in patients with advanced COPD.  Chest. 2005;  128 3838-3845
• 22 Glöckl R, Weber-Lange B, Halle M, Kenn K. Ausdauertraining bei endgradiger Lungenerkrankung vor Lungentransplantation – welche Trainingsform ist geeignet?.  Pneumologie. 2010;  64 V251 DOI: 10.1055/s-0030-1251090
• 23 Mereles D, Ehlken N, Kreuscher S et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.  Circulation. 2006;  114 1448-1449
• 24 Ries A L, Bauldoff G S, Carlin B W et al. Pulmonary rehabilitation executive summary. Joint American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation Evidence-Based Clinical Practice Guidelines.  Chest. 2007;  131 1S-3S
• 25 Nici L, Raskin J, Rochester C L et al. Pulmonary rehabilitation: What we know and what we need to know.  J Cardiopulm Rehabil Prev. 2009;  29 141-151
• 26 Celli B R. Update on the management of COPD.  Chest. 2008;  133 1451-1462
• 27 Troosters T, Casaburi R, Gosselink R et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2005;  172 19-38
• 28 Lacasse Y, Goldstein R, Lasserson T J et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease.  Cochrane database of Systematic Reviews. 2006;  4 CD003793 DOI: 10.1002/14651858.CD003793.pub2
• 29 Casaburi R, Zu Wallack R. Pulmonary Rehabilitation for management of chronic obstructive pulmonary disease.  N Engl J Med. 2009;  360 1329-1335
• 30 Ambrosino N, Simonds A. The clinical management of extremely severe COPD.  Respiratory Medicine. 2007;  101 1613-1624
• 31 Puhan M A, Gimeno-Santos E, Scharplatz M et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.  Cochrane database of Systematic Reviews. 2009;  1 CD005305 DOI: 10.1002/14651858.CD005305.pub2
• 32 Holland A E et al. Small changes in six-minute walk distance are important in diffuse parenchymal lung disease.  Respiratory Medicine. 2009;  103 1430-1435
• 33 Ferreira A, Garvey C, Connors G L et al. Pulmonary rehabilitation in interstitial lung disease: benefits and predictors of response.  Chest. 2009;  135 442-447
• 34 Kaufmann U, Boensch M, Studnicka M, Kenn K. Effects of pulmonary rehabilitation in patients with interstitial lung disease (ILD).  ERSJ. 2009;  34 (Suppl. 53) 286s
• 35 Troosters T, Langer D, Vrijsen B et al. Skeletal muscle weakness, exercise tolerance and physical activity in adults with cystic fibrosis.  Eur Respir J. 2009;  33 99-106
• 36 Bradley J, Moran F. Physical training for cystic fibrosis.  Cochrane Database Syst Rev. 2008;  23 CD002768
• 37 Kenn K, Winterkamp S, Schoenheit-Kenn  et al. Effects of pulmonary rehabilitation prior to lung transplantation (LTx) in patients with end stage lung diseases.  AJRCCM. 2009;  179 A5381
• 38 Redelmeier D A, Bayoumi A M, Goldstein R S et al. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients.  Am J Respir Crit Care Med. 1997;  155 1278-1282
• 39 Puhan M A, Mador M J, Held U et al. Interpretation of treatment changes in 6-minute walk distance in patients with COPD.  Eur Resp J. 2008;  32 637-643
• 40 Decramer M. Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation.  Eur Respir J. 2003;  22 (Suppl. 47) 47-56
• 41 Langer D, Gosselink R, Pitta F et al. Physical activity in daily life 1 year after lung transplantation.  Heart Lung Transplant. 2009;  28 572-578
• 42 Vermeulen K M, Groen H, van der Bij W et al. The effect of bronchiolitis obliterans syndrome on health related quality of life.  Clin Transplant. 2004;  18 377-383
• 43 Vermeulen K M, Ouwens J P, van der Bij W et al. Long-term quality of life in patients surviving at least 55 months after lung transplantation.  General Hospital Psychiatry. 2003;  25 95-102
• 44 van den Berg J, Geertsma A, van der Bij W et al. Bronchiolitis obliterans syndrome after lung transplantation and health-related quality of life.  Am J Respir Crit Care Med. 2000;  161 1937-1941
• 45 Kenn K, Sczepanski B, Weber-Lange B et al. Effects of pulmonary rehabilitation performed more than one year after lung transplantation.  AJRCCM. 2009;  179 A5376
• 46 Sczepanski B, Schwarzl G, Winterkamp S et al. Knochendichte nach Lungentransplantation: Messungen kurz nach OP und in der Langzeitbetrachtung.  Pneumologie. 2010;  64 P308 DOI: 10.1055/s-0030-1251304
• 47 Braith R W, Conner J A, Fulton M N et al. Comparison of alendronate vs alendronate plus mechanical loading as prophylaxis for osteoporosis in lung transplant recipients: a pilot study.  J Heart Lung Transplant. 2007;  26 132-137
• 48 Künsebeck H W, Kugler C, Fischer S et al. Quality of life and bronchiolitis obliterans syndrome in patients after lung transplantation.  Prog Transplant. 2007;  17 136-141
• 49 Tynan C, Hasse J M. Current nutrition practices in adult lung transplantation.  Nutr Clin Pract. 2004;  19 587-596
• 50 Dolovich M, Rossman C, Chambers C et al. Mucociliary function in patients following single lung or Iung/heart transplantation.  Am Rev Respir Dis. 1987;  135 363
• 51 Downs A M. Physical therapy in lung transplantation.  Phys Ther. 1996;  76 626-642
• 52 Duarte A, Terminella L, Smith J et al. Restoration of Cough Reflex in Lung Transplant Recipients.  Chest. 2008;  134 310-316
• 53 Herve P, Silbert D, Cerrina J et al. Impairment of bronchial mucociliary clearance in long-term survivors of heart/lung and double-lung transplantation. The Paris-Sud Lung Transplant Group.  Chest. 1993;  103 59-63
• 54 Wells C L, Smiley-Oyen A L, Dauber J H. Psychomotor performance in lung transplant recipients: simple reaction time.  J Heart Lung Transplant. 2005;  24 282-288
• 55 Gaissert H A, Cooper J D, Pohl M S, Patterson G A. Comparison of early functional results after lung volume reduction or lung transplantation for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg. 1996;  111 296-306
• 56 Smeritschnig B, Jaksch P, Kocher A et al. Quality of life after lung transplantation: a cross-sectional study.  The Journal of Heart and Lung transplantation. 2005;  24 474-480
• 57 Tegtbur U, Sievers C, Busse M W et al. Lebensqualität und körperliche Leistungsfähigkeit bei Patienten nach Lungentransplantation.  Pneumologie. 2004;  58 72-78
• 58 Stiebellehner L, Quittan M, End A et al. Aerobic endurance training program improves exercise performance in lung transplant recipients.  Chest. 1998;  113 906-912
• 59 Maury G, Langer D, Verleden G et al. Skeletal muscle force and functional exercise tolerance before and after lung transplantation: a cohort study.  Am J Transplant. 2008;  8 1275-1281
• 60 Munro P E, Holland A E, Bailey M et al. Pulmonary rehabilitation following lung transplantation.  Transplant Proc. 2009;  41 292-295
• 61 Sczepanski B, Bönsch M, Kenn K. Effekte einer pneumologischen Rehabilitation in einem spezialisierten Zentrum nach Einzel- oder Doppellungentransplantation.  Pneumologie. 2010;  64 V310 DOI: 10.1055/s-0030-1251092
• 62 Anlage zu § 2 Versorgungsmedizin-Verordnung – VersMedV, vom 10. Dezember 2008, Bundesgesetzblatt Jahrgang 2008 Teil I Nr. 57. www.bgbl.de Stand: 12. 9. 2010
• 63 Kugler C, Tegtbur U, Gottlieb J et al. Health-related quality of life in long-term survivors after heart and lung transplantation: a prospective cohort study.  Transplantation. 2010;  90 451-457
• 64 Petrucci L, Ricotti S, Michelini I et al. Return to work after thoracic organ transplantation in a clinically-stable population.  Eur J Heart Fail. 2007;  9 1112-1119
• 65 Cicutto L, Braidy C, Moloney S. Factors affecting attainment of paid employment after lung transplantation.  J Heart Lung Transplant. 2004;  23 481-486

Bisher erschienene Beiträge dieser Serie

• 66 Schreder T et al. Lungentransplantation bei Lungenemphysem – Wer? Wann? Wie?.  Pneumologie. 2010;  64 632-639
• 67 Neurohr C et al. Immunsuppression und Infektionsprophylaxe nach Lungentransplantation.  Pneumologie. 2011;  65 94-102
• 68 Kroegel C et al. Atemwegskomplikationen nach Lungentransplantation – Klinik, Diagnose und interventionelle Behandlung.  Pneumologie. 2011;  65 293-307