Over 200 million people worldwide have chronic obstructive pulmonary disease. That number is growing rapidly and experts believe that COPD will be the third leading cause of death by 2020. It was the sixth leading cause of death in 1990. The social burden and cost is enormous and in 2005 expenses related to the management of COPD was estimated to be $38.8 billion dollars.
Chiropractors have several opportunities to assist in preventing and controlling this serious respiratory problem. Smoking continues to be one of the major contribution factors for COPD and smoking cessation should be on the top of mind for all prevention practices. For those millions that have already developed COPD, chiropractors can provide important patient education as well as both osteopathic and chiropractic manual procedures. As reflected in studies below, these treatments may reduce the severity of the symptoms associated with COPD, especially for the elderly.
Note: These mini-reviews are designed as updates and direct the reader to the full text of current research. The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research. Where permitted we will direct the reader to that full text.
Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: a pilot study.
] Complement Ther Med.
2012 Feb-Apr;20(1-2):16-22. Epub 2011 Nov 27.
Zanotti E, Berardinelli P, Bizzarri C, Civardi A, Manstretta A, Rossetti S, Fracchia C. Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Montescano, UO di Pneumologia Riabilitativa, 27040 Montescano (PV), Italy. firstname.lastname@example.orgOBJECTIVES:
Few and contrastingly data are available about use of osteopathic manipulative treatment (OMT) in patients with chronic obstructive pulmonary disease (COPD). DESIGN:
Comparing the effects of the combination of pulmonary rehabilitation
and OMT compared with pulmonary rehabilitation (PR) in patients with severely impaired COPD. SETTING: Rehabilitative pulmonary department. INTERVENTIONS:
Patients underwent exercise
training, OMT, educational support and nutritional and psychological counselling. MAIN OUTCOMES MEASURES:
Exercise capacity through 6 min walk test (6MWT--primary outcome) and pulmonary function test (secondary outcomes) were evaluated at the beginning and at the end of the training. Patients were randomly assigned to receive PR+soft manipulation
(G1) or OMT+PR (G2) for 5 days/week for 4 weeks. RESULTS:
20 stable COPD patients (5 female--mean age, 63.8±5.1 years; FEV1 26.9±6.3% of predicted) referred for in-patient pulmonary rehabilitation were evaluated. Respect to the baseline, 6 MWT statistically improved in both group. In particular, G2 group gained 72.5±7.5 m (p=0.01) and G1 group 23.7±9.7 m. Between group comparison showed a difference of 48.8 m (95% CI: 17 to 80.6 m, p=0.04). Moreover, in G2 group we showed a decrease in residual volume (RV--from 4.4±1.5 l to 3.9±1.5 l, p=0.05). Between group comparison showed an important difference (-0.44 l; 95% CI: -0.26 to -0.62 l, p=0.001). Furthermore, only in G2 group we showed an increase in FEV1. CONCLUSIONS:
This study suggests that OMT+PR may improve exercise capacity and reduce RV in severely impaired COPD patients with respect to PR alone.
Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease.
] J Am Osteopath Assoc.
Noll DR, Degenhardt BF, Johnson JC, Burt SA. Department of Internal Medicine, Kirksville (Mo) College of Osteopathic Medicine-A.T. Still University, USA. email@example.comCONTEXT:
Osteopathic manipulative treatment (OMT) has long been advocated for patients with respiratory disorders, but little definitive evidence exists to support its use in this population. OBJECTIVE:
To investigate the immediate effect of OMT on pulmonary function parameters in elderly subjects with chronic obstructive pulmonary disease. METHODS:
Subjects aged 65 years or older with a forced expiratory volume in 1 second to forced vital capacity ratio of less than 70% were recruited and randomly assigned to receive either OMT or sham therapy. The OMT protocol consisted of seven standardized osteopathic manipulative techniques, while the sham therapy protocol comprised light touch applied to the same anatomic regions and for the same duration (20 min). All subjects received baseline and posttreatment pulmonary function testing. A telephone survey was conducted 1 day after the intervention to collect subjective feedback and assess the success of blinding protocols. RESULTS:
Of the 35 study participants, 18 were randomly assigned to the OMT group and 17 to the sham group. Compared with the sham group, the OMT group showed a statistically significant decrease in the forced expiratory flow at 25% and 50% of vital capacity and at the midexpiratory phase; the expiratory reserve volume; and airway resistance. The OMT group also had a statistically significant increase in the residual volume, total lung capacity, and the ratio of those values compared with the sham group. Most subjects (82%, OMT group; 65%, sham group) reported breathing better after receiving their treatment. Only 53% of subjects in the OMT group and 41% in the sham group correctly guessed their group assignment. CONCLUSION:
Results suggest an overall worsening of air trapping during the 30 minutes immediately following one multitechnique OMT session relative to the sham group.
The role of spinal manipulation, soft-tissue therapy, and exercise in chronic obstructive pulmonary disease: a review of the literature and proposal of an anatomical explanation.
] J Altern Complement Med.
2011 Sep;17(9):797-801. Epub 2011 Aug 12.
Engel R, Vemulpad S. Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia. firstname.lastname@example.org
The premise that lung function can regulate chest wall mobility is an accepted concept. Descriptions of the primary and accessory respiratory structures do not usually include spinal components as a part of these classifications. The case for including these components as a part of the respiratory mechanism and their role in the development of dyspnea and chest wall rigidity in chronic obstructive pulmonary disease (COPD) is reviewed. Mechanical impairment of the chest wall is a contributing factor in the prognosis of COPD. Reducing this impairment improves prognosis. Because spinal manipulation and soft-tissue therapy increase joint mobility and decrease muscle hypertonicity, respectively, applying these interventions to the chest wall in COPD could reduce chest wall rigidity, thereby improving breathing mechanics. Improvements in breathing mechanics reduce the work of the respiratory muscles and delay the onset of dyspnea. Exercise capacity is reliant on the ability to overcome activity-limiting dyspnea, which usually occurs prior to maximum exercise capacity being reached. Delaying the onset of dyspnea permits more exercise to be performed before dyspnea develops. Spinal manipulation and soft-tissue therapy have the potential to deliver such a delay. Because exercise tolerance is considered to be a strong predictor of quality of life and survival in COPD, any increase in exercise capacity would therefore improve prognosis for the disease.
Spinal manipulative therapy for elderly patients with chronic obstructive pulmonary disease: a case series.
] J Manipulative Physiol Ther.
J Manipulative Physiol Ther.
Dougherty PE, Engel RM, Vemulpad S, Burke J. New York Chiropractic College, Seneca Falls, NY 13148, USA. email@example.comOBJECTIVE:
The objective of this case series is to report the results of spinal manipulative therapy (SMT) for people with chronic obstructive pulmonary disease (COPD) who were older than 65 years. METHODS:
The study design was a prospective case series. Six patients of a long-term care center who were older than 65 years and having COPD underwent a course of 12 SMT sessions over a 4-week period. Each SMT session consisted of manually applied spinal manipulation and instrument-assisted spinal manipulation delivered by a doctor of chiropractic. Lung function measurements were recorded at baseline and at 2 and 4 weeks. The occurrence and type of any adverse events (AEs) related to SMT were recorded at each SMT session. RESULTS:
One male and 5 female patients took part in the study. The average age was 79.1 years (range, 68-89 years). There was a clinically significant increase in forced expiratory volume in the first second after SMT in 4 of the 6 patients at 2 weeks. This was sustained in only 1 patient at 4 weeks. No clinically significant changes were observed for forced vital capacity at 2 or 4 weeks. One hundred forty-four manually applied spinal manipulations and 72 instrument-assisted spinal manipulations were administered during the intervention period. No major or moderate AEs were reported. Only minor AEs were reported after 29% of the intervention sessions, with 1 AE being reported for each patient. All AEs resolved within 48 hours. CONCLUSIONS:
This case series offers preliminary evidence that SMT may have the potential to benefit lung function in patients with COPD who are older than 65 years.
Progression to chronic obstructive pulmonary disease (COPD): could it be prevented by manual therapy and exercise during the 'at risk' stage (stage 0)?
] Med Hypotheses.
2009 Mar;72(3):288-90. Epub 2008 Nov 26.
Engel RM, Vemulpad S. Department of Health and Chiropractic, Macquarie University, Bldg E7A 222, Balaclava Road, Sydney, NSW 2109, Australia. firstname.lastname@example.org
A number of predisposing factors are recognised as increasing the risk of developing chronic pulmonary obstructive disease (COPD). There is increasing recognition that COPD may be an inflammatory disease with systemic consequences. However, the trigger for the transition from 'at risk' (stage 0) to COPD state remains unclear. The current approach to intervention for the 'at risk' group is risk factor avoidance. We propose that if interventions shown to improve chronic respiratory symptoms in COPD sufferers could be applied to the 'at risk' group, then moderation or even reversal of the changes typical of this transition becomes a possibility. Exercise training has been shown to be beneficial at all stages of COPD. Mobility of the chest wall influences lung function. We hypothesise that the application to 'at risk' individuals (stage 0) of therapeutic interventions known to improve chronic respiratory symptoms and cardiovascular function in mild/moderate COPD (stages 1 and 2) could delay progression of the disease (i.e. manifestation of mild/moderate COPD). If the hypothesis were confirmed, the potential to delay or even prevent the onset of COPD would be feasible.
The Effect of Rib Adjusting on Tissue Oxygenation and Chest Expansion
] J CHIRO EDUC 2000.
SPR; 14(1) pp. 30 - 31
Cox SF, Tornatore RA, Marquina N.
The objective of this study was to measure the effects, if any, of standing high-velocity, low-amplitude (HVLA) chiropractic rib adjustments on vital lung capacity as measured by chest expansion during forced inspirationand on tissue oxygenation. BACKGROUND: There appears to be limited documentation regarding any adjusting procedures and their effects on tissue oxygenation. The only study found was done at Kirksville Osteopathic School in 1965. This study concluded that an increase in tissue oxygenation, even if the oxygen levels were within the normal range, is obtained after osteopathic manipulation. Research publishedin Belgium examined the rib motion of dogs. The normal biomechanics of these dogs were altered by locking two ribs together and analyzing EMG activity in these muscles. due to the nature of the rib locking, the muscle spindles should have been unable to be stretched. The researchers found that when the ribs were displaced in varying directions, EMG recorded powerful reflexive activity in the external intercostal and levator costae muscles. It was concluded that due to the quiescient state of the sindles, this reflexive activity was arising from joint mechanoreceptors. This research laid the groundwork for the justification of ensuring proper joint mechanics for proper respiration. It was also found that the magnitude of receptor discharge was directly proportional to the velocity of rib displacement. If these findings are due to the graded nature of receptor potentiation, the high-velocity, low-amplitude chiropractic adjustment
may affect proprioceptive information. METHODS: Sixty subjects were recruited for this study. Th Healthdyne Pulse Oximeter 950 shines red and infrared lights through the tissue and detects the fluctuating signals caused by arterial blood pulses. The study design was a double-blind, randomized, controlled trial. The chest expansion measurement was taken around the T-4 dermatone with the subject in the standing position. After placing the oximeter on the subject's left index finger, tissue oxygenation was read at 30-second intervals for a period of 5 minutes. The treatment (30 subjects) group received an HVLA adjustment to the involved rib. The chese expansion and tissue oxygenation was then again measured for both control and treatment groups. RESULTS: The preadjstment sample mean oximeter percentage values for treatment (adjusted) and control (nonadjusted) groups were both 95.67. The postadjustment sample mean for the control group was 95.57. These three groups received no chiropractic intervension. The mean preadjustment chest expansion for the treatment group was 2.90 cm. The postadjustment mean chest expansion for the control group was 2.88 cm. These three groups did not receive chiropracic intervention. The postadjustment mean oximeter value for the treatment group was 96.62, which supports a statistical significant increase (p<.001) in tissue oxygenation. The post-treatment mean chest expansion for the reatment group was 3.84 cm, which is statistically significant at p<.001. DISCUSSION: Although this study showed statistically significant increase in both outcome parameters due to the rib adjustment, the authors question the clinical significance of the increase in tissue oxygenation. A future study might homogenize the subjects by choosing a specific population, such as subjects diagnosed with chronic obstructive pulmonary disease or asthma. CONCLUSION: The results of this study support the hypothesis that the standing chiropractic adjustment does in fact increase chest expansion and blood tissue oxygenation and therefore improves function.
Chiropractic management of chronic obstructive pulmonary disease.
] J Manipulative Physiol Ther.
Masarsky CS, Weber M. Virginia Chiropractic Association Research Committee, Vienna 22180.
A patient with a history of chronic obstructive pulmonary disease going back more than 20 years was treated with a combination of chiropractic manipulation, nutritional advice, therapeutic exercises, and intersegmental traction. Improvements were noted in forced vital capacity, forced expiratory volume in one second, coughing, fatigue, and ease of breathing (sign test significant at 0.005 level). Improvement was also noted in laryngospasm. Studies are made and speculation as to the mechanism of the treatment effect is provided.
Epidemiology of COPD.
] Eur Respir Rev.
Raherison C, Girodet PO. Dept of Respiratory Diseases, CHU Bordeaux, Institute of Public Health, Epidemiology and Development, University of Bordeaux 2. email@example.com
Chronic obstructive pulmonary disease (COPD) is responsible for early mortality, high death rates and significant cost to health systems. The projection for 2020 indicates that COPD will be the third leading cause of death worldwide (from sixth in 1990) and fifth leading cause of years lost through early mortality or handicap (disability-adjusted life years) (12th in 1990). Active smoking remains the main risk factor, but other factors are becoming better known, such as occupational factors, infections and the role of air pollution. Prevalence of COPD varies according to country, age and sex. This disease is also associated with significant comorbidities. COPD is a disorder that includes various phenotypes, the continuum of which remains under debate. The major challenge in the coming years will be to prevent onset of smoking along with early detection of the disease in the general population.