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J Thorac Cardiovasc Surg 2006;132:216
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Ospedale S. Giovanni Battista, Torino, Respiratory Diseases, 3, Via Genova, Torino 10126, Italy

(Email: baldi_sergio{at}hotmail.com).

We do agree with Cesario and colleagues that pulmonary rehabilitation (PR) could improve clinical conditions in patients with chronic obstructive pulmonary disease (COPD), as well as in patients operated on for lung cancer, although PR in patients with COPD takes into account different strategies compared with rehabilitation in surgical patients. Indeed, PR in patients with COPD, particularly long-term physical training programs, can ameliorate dyspnea, exercise capacity, and quality of life but not pulmonary volumes and gas exchange. ¹ On the other hand, preoperative and postoperative PR, including chest physiotherapy, deep-breathing exercises, continuous positive airways pressure, incentive spirometry and so on, can reduce respiratory complications and hospital stay ² by reducing bronchial sputum impaction and bronchial secretions and by alveolar recruitment. This approach is commonly adopted in most thoracic units and usually in general operations for high-risk patients.

In our study we evaluated patients submitted to lobar or limited lung resection, taking into account the late postoperative pulmonary recovery; for this reason, we have not considered the early functional outcome and postoperative pulmonary complications. The pulmonary function tests and blood gas analysis were performed after hospital discharge (usually between the 3rd and 15th month), and therefore in our study preoperative and postoperative PR has not been considered because of its limited role in this context. In our hospital we perform a short course of preoperative and postoperative PR (chest physiotherapy, incentive spirometry, huffing, coughing, and, when necessary, continuous positive airways pressure) in patients submitted to lung resection, and this contributes to reduce postoperative pulmonary complications, but I do not have experience on the effect on gas exchange and on hemodynamic and pulmonary function, although I suspect that this would occur mainly in patients with excessive bronchial secretion and postoperative atelectasis. Reports ^2,3 emphasize the importance of intensive PR (at least a 2- to 4-week course) in patients undergoing lung cancer surgery, and I think that in patients with moderate-to-severe COPD, this strategy can improve the outcome of lung resection, especially considering that these patients seem to deteriorate less compared with normal patients. ^4-8

	References

Top References

 

1. Lacasse Y, Brosseau L, Milne S, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002(3):CD003793.[Abstract/Free Full Text]
   
2. Sekine Y, Chiyo M, Iwata T, et al. Preoperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Jpn J Thorac Cardiovasc Surg 2005;53:237-243.[Medline]
   
3. Cardaci V, Cesario A, Granone L, et al. Efficacy of a pulmonary rehabilitation programme (PRP) after lung resection (LR) for cancer. Eur Respir J 2005;26(suppl):247.
   
4. Baldi S, Ruffini E, Harari S, et al. Does lobectomy for lung cancer in COPD patients affects lung function?. J Thorac Cardiovasc Surg 2005;130:1616-1622.[Abstract/Free Full Text]
   
5. Sekine Y, Iwata T, Chiyo M, et al. Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2003;76:356-362.[Abstract/Free Full Text]
   
6. Carretta A, Zannini P, Puglisi A, et al. Improvement of pulmonary function after lobectomy for non small cell lung cancer in emphysematous patients. Eur J Cardiothorac Surg 1999;15:602-607.[Abstract/Free Full Text]
   
7. Santambrogio L, Nosotti M, Baisi A, et al. Pulmonary lobectomy for lung cancer. a prospective study to compare patients with forced expiratory volume in 1 s more or less than 80% of predicted. Eur J Cardiothorac Surg 2001;20:684-687.[Abstract/Free Full Text]
   
8. Korst RJ, Ginsberg RJ, Ailawadi M, et al. Lobectomy improves ventilatory function in selected patients with severe COPD. Ann Thorac Surg 1998;66:898-902.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Enrico Ruffini Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baldi, S. Articles by Ruffini, E. Search for Related Content PubMed Articles by Baldi, S. Articles by Ruffini, E. Related Collections Lung - cancer Related Article