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Letters to the Editor |
a Unit of Thoracic Surgery, Department of Surgical Science, University of Parma, Italy
b Division of Respiratory Diseases, Department of Clinical Science, University of Parma, Italy
Received 16 January 2008; accepted 17 January 2008.
* Corresponding author. Address: U.O. Chirurgia Toracica, Università di Parma, Azienda Ospedaliera di Parma, Viale Gramsci 14, 43100 Parma, Italy. Tel.: +39 3406874733; fax: +39 521 992019. (Email: antonio.bobbio{at}unipr.it; antonboa{at}hotmail.com).
Key Words: Pulmonary rehabilitation • Preoperative functional evaluation
We are very pleased by the interest shown in our paper ‘Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer’ by this distinguished group of investigators [1]. These authors have recently reported the results of inpatient preoperative pulmonary rehabilitation (PR) in patients with NSCLC and a concomitant extremely severe airflow limitation [2]. Similarly to the results of our study, in the Cesario et al. study, PR led to improvement in exercise capacity and patients were able to undergo surgery. In addition, unlike our study Cesario et al. reported that PR was able to significantly improve baseline lung function of the patients [2].
PR is considered to be beneficial for patients with chronic obstructive pulmonary disease and other chronic lung diseases, since it relieves dyspnoea and fatigue, improves emotional function and exercise tolerance and enhances patients’ sense of control over their condition [3]. However, PR has no effect on lung function of patients with COPD. A recent prospective long-term study further confirmed this finding [4].
One possible explanation of the results of the study by Cesario et al. [2] may be found in the selection criteria of the NSCLC patients. Unlike our study, where we selected only COPD patients with stable and irreversible airflow obstruction, in the study by Cesario et al. some patients could have bronchial asthma and a reversible airflow obstruction or, at least, a so-called asthmatic bronchitis with a partially reversible airflow obstruction. In these patients, the optimization of the therapy as well as the smoking cessation could have likely induced the significant improvement in the baseline lung function.
The second point of the letter by Cesario et al. is of particular interest, since it underlines the importance of a comprehensive approach to the patients with NSCLC and airflow obstruction in order to evaluate the PR effects. In this respect, the BODE index is an excellent indicator of PR effects in COPD patients, as it integrates some components, which can be significantly affected by PR, such as body mass index, dyspnoea and walking capacity. Indeed, it has been recently demonstrated that in COPD patients, changes in BODE index may reflect the effects of PR [5]. Further controlled studies are required to show the efficacy of BODE index as indicator of preoperative PR effects in COPD patients with NSCLC.
References
This article has been cited by other articles:
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  A. Bobbio and A. Chetta Reply to Ferri et al. Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 758 - 758. [Full Text] [PDF]
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