Read Time: 4 Minutes

Chronic obstructive pulmonary disease (COPD) includes progressive inflammatory lung conditions like emphysema and chronic bronchitis that make breathing difficult for millions of people. In 2019, COPD was the third leading cause of death worldwide.¹ Statistics from the same year estimated that chronic lower respiratory disease, mainly COPD, was the fourth leading cause of death within the United States.²

With the emergence and devastation of the COVID-19 pandemic, COPD continues to be one of the top causes of death worldwide, and chronic lower respiratory disease (primarily COPD) has remained the fourth leading cause of death for those between 65 and 74 years of age in the US.^3,4 Reporting indicates that more than 16 million Americans currently suffer from COPD,⁵ and smoking is the primary cause of the disease. Other risk factors such as second-hand smoke, occupational exposure to dusts and chemicals, exposure to air pollutants, and asthma in childhood may also contribute to COPD development.¹

While COPD is common among seniors and is treatable, there is no cure. Medications, supplemental oxygen, and rehabilitation programs such as pulmonary rehabilitation are common disease treatment options. Other adjunctive interventions for symptom management include lifestyle components such as a healthy diet and stress management. Mind-body therapies have also been investigated for their potential positive influence on COPD outcomes. In 2022, one of the largest meta-analyses to investigate the efficacy of pulmonary rehabilitation in patients with COPD was published online and was reportedly the first to include mind-body therapy components in the evaluation.⁶ How can clinicians use this latest research to support their patients diagnosed with COPD?

Mind-Body Exercise & COPD Meta-Analysis

Pulmonary rehabilitation is a patient-centered program that first evaluates both the medical situation of an individual patient and their health goals.⁷ After a comprehensive assessment, a personalized treatment approach is implemented that usually includes the components of functional exercise, education, oxygen therapy, nutritional support, and psychotherapy.^6,7 The 2022 meta-analysis of 39 randomized controlled trials (RCTs) with a total of 2,397 participants evaluated the effects of pulmonary rehabilitation programs that included the components of yoga and Tai Chi in individuals with COPD.⁶ While a large number of RCTs have investigated the impact of mind-body exercises such as yoga and Tai Chi on COPD, previous meta-analysis has not included them.

Overall, the Zhang et al study results indicated efficacy and positive patient outcomes with the personalized treatment plans that included yoga and Tai Chi.⁶

• Improvements were reported for the general health, dyspnea, and quality of life of patients in the pulmonary rehabilitation groups that included yoga, Tai Chi, and conventional exercises.⁶
• Compared to controls, the six-minute walk test was significantly improved in the pulmonary rehabilitation groups (weighted mean difference (WMD), 36.34; 95% confidence interval (CI): 26.51-46.17; p < .001) that included yoga, Tai Chi, or the conventional exercises.⁶
• In addition, only the yoga (WMD, 0.35; 95% CI: 0.04-0.66; p = .027) and Tai Chi (WMD, 0.20; 95% CI: 0.08-0.32; p = 0.002) pulmonary rehabilitation groups showed significant positive changes in the FEV1% (forced expiratory volume in one second percentage) predicted value, an important tool for evaluating and monitoring disease progression.⁶

Investigators concluded that a pulmonary rehabilitation program improved the exercise capacity, the quality of life, and dyspnea in patients with COPD.⁶ Further, the mind-body therapies of yoga and Tai Chi not only showed statistical improvement in the FEV1% predicted value but also contributed to positive patient outcomes by improving aspects of COPD that the conventional exercise approach did not.⁶

The Collaborative Care Impact

Current reports indicate that pulmonary rehabilitation is an underutilized approach to COPD symptom management in standard medical treatments worldwide.^7,8 In addition to potential healthcare system barriers,⁹ practitioners may not be aware of the program and may not provide a referral for the treatment or offer it as an option.⁷ Patients may not fully understand the program and decline or not complete the treatment due to a lack of perceived benefit, lack of transportation options, or the disruption of established daily routines.⁸

Collaborative team-based care, including nutritionists and health coaches, may be appropriate to increase access to lifestyle-based COPD treatment options, to increase patient empowerment, and to help understand and address potential healthcare and intervention barriers. A 2019 meta-analysis involving patients with COPD reported that in addition to improving self-care behaviors, health coaching significantly reduced COPD-related hospital admissions and positively impacted health-related quality of life.¹⁰ The evaluated health coaching interventions included goal setting, motivational interviewing, and health education.

While beneficial, incorporating new COPD-related therapies into daily routines and schedules can be a challenge. Clinical trials from the Zhang et al meta-analysis included yoga treatments that were practiced 30 to 90 minutes from two times per week up to every day, sometimes twice per day. The Tai Chi treatments were noted as lasting approximately one hour and practiced from two to five times per week.  A collaborative care team may be essential to support and sustain a patient’s behavioral change and health goals.

The Zhang et al meta-analysis indicates a positive health impact from patient-centered, whole health, and lifestyle-based approaches that improve outcomes and quality of life for patients with COPD. While there is currently no cure for the disease, the study reflects promising therapeutic approaches that support an individual patient and their optimal health and wellness.

References

1. World Health Organization. Chronic obstructive pulmonary disease (COPD). Published May 20, 2022. Accessed August 1, 2022. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
2. Centers for Disease Control and Prevention. Disease or condition of the week: COPD. Reviewed July 29, 2021. Accessed July 12, 2022. https://www.cdc.gov/dotw/copd/index.html#:~:text=COPD%20refers%20to%20a%20group,1%20death%20every%204%20minutes
3. National Center for Health Statistics. Leading causes of death. Centers for Disease Control and Prevention. Reviewed January 13, 2022. Accessed August 1, 2022. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
4. Shiels MS, Haque AT, Berrington de González A, Freedman ND. Leading causes of death in the US during the COVID-19 pandemic, March 2020 to October 2021. JAMA Intern Med. 2022;182(8):883-886. doi:1001/jamainternmed.2022.2476
5. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease (COPD): what is COPD? Reviewed April 8, 2022. Accessed July 12, 2022. https://www.cdc.gov/copd/index.html
6. Zhang H, Hu D, Xu Y, Wu L, Lou L. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2022;54(1):262-273. doi:1080/07853890.2021.1999494
7. Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. An official American Thoracic Society Workshop report. Ann Am Thorac Soc. 2021;18(5):e12-e29. doi:1513/AnnalsATS.202102-146ST
8. Barradell AC, Bourne C, Alkhathlan B, Larkin M, Singh SJ. A qualitative assessment of the pulmonary rehabilitation decision-making needs of patients living with COPD. NPJ Prim Care Respir Med. 2022;32(1):23. doi:1038/s41533-022-00285-9
9. Augustine A, Bhat A, Vaishali K, Magazine R. Barriers to pulmonary rehabilitation – a narrative review and perspectives from a few stakeholders. Lung India. 2021;38(1):59-63. doi:4103/lungindia.lungindia_116_20
10.  Long H, Howells K, Peters S, Blakemore A. Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. Br J Health Psychol. 2019;24(3):515-546. doi:1111/bjhp.12366