Treating COPD: Systematic Review and Evidence Map - Essay Sample

Treatment of Stable Chronic Obstructive Pulmonary Disease: Protocol for a Systematic Review and Evidence Map

Chronic obstructive pulmonary disease (COPD) is a lung disease that is characterised by severe obstruction of airflow as well as permanent damage to the air sacs thereby leading to breathing problems (Dobler, Farah, Morrow, Alsawas, Benkhadra, Hasan, & Murad, 2019). The primary cause of COPD is excessive tobacco smoking although there are other risk factors such as exposure to combustion outputs of biomass fuels or rather from environmental pollution. COPD has become a global epidemic for it has recently been ranked as among the top four most common causes of death globally. COPD patients need to frequently access the healthcare facilities alongside being admitted to the hospital regularly.

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There has been a rise in the adoption of inhaler therapies aiming to manage COPD. However, these inhalers have been brought under the spotlight for questioning because of their perceived risk of causing pneumonia due to the inhaled corticosteroids. The existence of several evidence-based practices involved in the management of patients with COPD has become challenging. Therefore, there is a need to establish critical tools of evidence synthesis that will offer collaborative deliberation of treatment options. Nonetheless, the fast growth of treatments for stable COPD calls for timely action to identify gaps in the current knowledge and also serve future research needs.

This article, therefore, analyses the evidence on treatments for patients with stable COPD and provides evidence which points out the gaps which can be filled through future research. Also, the review delivers information that can be used in assisting the decision-making process for both patients and clinicians. The methodology adopted follows the rules of the Preferred Reporting Items meant for Systematic Review as well as the Meta-Analysis Protocols.

This systematic review bears a strength in the sense that there exist no previously provided reviews with evidence for the treatment of stable COPD. Therefore, this review is the first of its kind. This review also employs a priori protocol which identifies recent reviews of top quality and so the level of evidence presented is high. The limitation lies in the point that this systematic review contains a single intervention and therefore creating a possibility that some studies are going to miss inclusion from the systematic review.

Effects of Different Modalities of Inspiratory Muscle Training as an Add-on to Conventional Treatment of Patients With Chronic Obstructive Pulmonary Disease (COPD): Study Protocol for a Randomised Controlled Trial

The chronic obstructive pulmonary disease leads to peripheral and respiratory muscle dysfunctions. The inspiratory muscle can, however, be trained to be healthy and therefore endure any form of pain (De Farias, Gualdi, da Silva, Parreira, Montemezzo, Resqueti, & Fregonezi, 2019). Other than pharmacological treatment, COPD patients should engage in pulmonary rehabilitation (PR) programs which are meant to improve the physical performance as well as the psychological status of COPD-infected patients apart from promoting long-term ability to adhere pain. Inspiratory muscle training (IMT) might develop an increase in the patients infected with COPD though recent studies suggest that the training can overload those muscles when inappropriately performed. It has been years with numerous studies ongoing regarding the IMT, but doubt still exists regarding its efficiency. Studies have revealed that IMT does not contribute to improvement on the COPD condition.

The literature explains two modalities to do with respiratory muscle training; isocapnic voluntary hyperpnea which involves training which requires the patient to carry out voluntary hyperventilation for some time, keeping up an isocapnea; while threshold valves of pressure loading, which demands the patient to carry out inhalation and exhalations against resistance. Today, there are electronic IMT valves which happen to provide benefits when it comes to volume increase when training compared to mechanical valves. However, these effects have not yet been clinically demonstrated. Until now, there still exist doubts and misunderstandings regarding the effects of IMT on patients infected with COPD.

As a result of the various effects posed by IMT in COPD individuals, this study digs on the impact brought about by an IMT protocol to be incorporated in PR programs. The research bears various outcomes, with the first outcome being the effects of training on exercise capacity. The investigation of multiple protocols in the study is meant to offer guidance to physiotherapists on the best mode to perform IMT. Nonetheless, the study aims to identify the effects of IMT on exercise tolerance as well as identify the consequences on strength and resistance of respiratory muscles when engaged in several types of training. Results of the study are also expected to initiate adjustments to the modalities used to strengthen respiratory muscles and also improve quality of life.

Strengths of the study are found in the fact that the survey is educational as it provides a better understanding of the effects that IMT can add to the pulmonary rehabilitation programs. Besides, the subjects are reviewed after the protocol by an evaluator who describes the impact of various IMT modalities on how they impact exercise capacity. The limitation of the study lies in the fact that the training protocol is partly carried out in the home environment by the studied subjects without clinical supervision.

References

Dobler, C. C., Farah, M. H., Morrow, A. S., Alsawas, M., Benkhadra, R., Hasan, B., & Murad, M. H. (2019). Treatment of stable chronic obstructive pulmonary disease: protocol for a systematic review and evidence map. BMJ Open, 9(5), e027935. Retrieved from https://bmjopen.bmj.com/content/9/5/e027935.abstract

De Farias, C. A. C., Gualdi, L. P., da Silva, S. B., Parreira, V. F., Montemezzo, D., Resqueti, V. R., & Fregonezi, G. A. (2019). Effects of different modalities of inspiratory muscle training as an add-on to conventional treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a randomised controlled trial. Trials, 20(1), 231. Retrieved from https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3271-1