Efficacy and applicability of expiratory pressure load training in patients with chronic obstructive pulmonary disease

2023 Fiscal Year Final Research Report

• Project/Area Number: 21K11307
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 59010:Rehabilitation science-related
• Research Institution: Osaka Toneyama Medical Center
• Principal Investigator: MIKI Keisuke 独立行政法人国立病院機構大阪刀根山医療センター(臨床研究部), 独立行政法人国立病院機構大阪刀根山医療センター, 研究員(移行) (50740388)
• Co-Investigator(Kenkyū-buntansha): 福井 基成 公益財団法人田附興風会, 医学研究所, 副所長 (50342697)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Keywords: COPD / 息切れ / 換気制限 / 上気道 / 声門 / 呼気圧負荷トレーニング / 運動耐容能

Outline of Final Research Achievements

Ventilatory limitation in chronic obstructive pulmonary disease (COPD), which is a lower respiratory tract disease, has usually been attributed to the peripheral airways, and although treatment has long focused on inhalation therapy, it has not led to improvements in exercise tolerance. In this study, a multicenter, randomized, controlled trial of 3-month expiratory pressure load training (EPT) for the upper airway, specifically the glottis, during exercise was performed for patient with all stages of COPD, with exercise tolerance as the endpoint. After EPT, patients with all stages of COPD showed an increase in peak oxygen uptake on incremental exercise testing and an increase in endurance time evaluated by constant work rate exercise testing, along with laryngeal widening during exercise. In patients with severe and very severe COPD, subjective symptoms also improved after EPT. There were no serious adverse events with EPT, which was well tolerated.

Free Research Field

呼吸－循環

Academic Significance and Societal Importance of the Research Achievements

下気道疾患である慢性閉塞性肺疾患(COPD)の換気制限は永らく末梢気道閉塞によるとされ、吸入薬中心の治療がなされるも運動耐容能の十分な改善には至らなかった。本研究において、EPT後、重症度に拘わらず運動耐容能の改善が得られたことは、下気道疾患であるCOPDの換気制限が上気道の声門閉塞に影響しているとういう新たな疾患概念、更には上気道調節が日常生活における機能的活動レベルを超えた運動耐容能の獲得という新たな治療概念に結び付く可能性があり、又一方で、EPTは安価であり、高齢者でも自宅で簡単に出来ることから、医学的のみならず、本研究の経済的、社会的意義は高い。