Chronic Obstructive Pulmonary Disease Patients Treated with Korean Medicine Pulmonary Rehabilitation: Two case reports

Tae Hyun Kim; Su Won Lee; Yee Ran Lyu; Eun Jung Lee; In Chul Jung; Yang Chun Park; Kim, Tae Hyun; Lee, Su Won; Lyu, Yee Ran; Lee, Eun Jung; Jung, In Chul; Park, Yang Chun

doi:10.13048/jkm.20032

JKM > Volume 41(3); 2020 > Article

Kim, Lee, Lyu, Lee, Jung, and Park: Chronic Obstructive Pulmonary Disease Patients Treated with Korean Medicine Pulmonary Rehabilitation: Two case reports

Case Report

The Journal of Korean Medicine 2020; 41(3): 162-172.

Published online: September 01, 2020

DOI: https://doi.org/10.13048/jkm.20032

Chronic Obstructive Pulmonary Disease Patients Treated with Korean Medicine Pulmonary Rehabilitation: Two case reports

Tae Hyun Kim¹^{, †}

, Su Won Lee¹^{, †}

, Yee Ran Lyu¹

, Eun Jung Lee²

, In Chul Jung³

, Yang Chun Park¹

¹Division of Respiratory Medicine, Dep. of Internal Medicine, College of Korean Medicine, Daejeon University, Korea

²Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Daejeon University, Korea

³Department of Neuropsychology, College of Korean Medicine, Daejeon University, Daejeon, Korea

Correspondence to: Yang-Chun Park Korean Internal Medicine, Daejeon Korean Medicine Hospital of Daejeon University 75, Daedeok-daero 176-beongil, Seo-gu, Daejeon, Republic of Korea 35235 Tel: +82-42-470-9126(clinic), +82-42-229-6763 (office, Munchang Campus), Fax: +82-42-470-9486

† These authors contributed equally to this work

Received July 17, 2020 Revised August 30, 2020 Accepted August 31, 2020

Abstract

Objectives

The purpose of study was to report the clinical improvement of Chronic Obstructive Pulmonary Disease (COPD) patients treated with Korean medicine pulmonary rehabilitation.

Methods

The patients were treated with Lung-conduction exercise, Chuna manual therapy, Exercise therapy. To assess the treatment outcomes, we used the pulmonary function test (PFT), modified medical research council scale (mMRC), 6-minute walk distance (6MWD), peak expiratory flow rate (PEFR), COPD assessment test (CAT), St. George respiratory questionnaire (SGRQ).

Results

After treatments, the patient’s clinical symptoms were improved with CAT, SGRQ’s significant decrease and PFT, mMRC, 6MWD and PEFR were maintained or improved slightly.

Conclusions

The Korean medicine pulmonary rehabilitation was effective in the treatment of COPD patients. This study suggested the possibility of Korean Medicine pulmonary rehabilitation program in the clinic.

Keywords: Cchronic obstructive pulmonary disease, Korean medicine, Pulmonary rehabilitation

Fig. 1

Chest X-ray in case 1. [2019.07.12

Fig. 2

Chest X-ray in case 2. [2019.10.21]

Table 1

The Korean Traditional Pulmonary Rehabilitation Program.

Method	Composition	Course description	Objective	Time
Lung-conduction exercise	Breathing technique (Jogigyeol, Taesikbeop)	Sit up comfortably and slowly while inhaling through the nose. After sufficient inhalation, hold breath while counting as high as you can tolerate. Then gently breathe out through the mouth	Respiratory efficiency (Ventilation-perfusion ratio)	Set 3 (5 min)
	Lung-doyinbeop	While sitting on the ground with both hands curled, inhale, swell your back, and raise your back up	Chest mobilizing	Set 5 (4 min)
		Hold your fists, bend your arms behind your back and tap your spine to the left and right	Secretion removal	Set 15 (4 min)
		Hold your breath for a while, close your eyes, hit your teeth several times, and swallow if the saliva is stuck in your mouth	Relaxing	Set 3 (2 min)
Chuna manual therapy	Fascia Chuna (Diaphragm)	The patient lies down and the operator places the thumb under the xiphoid process (central tendon), the front and rear rib attachment site respectively. Keep it in the inhalation, and press it slightly back in the the exhalation to maintain a tension until it relaxes	Respiratory efficiency (Reducing the use of breathing accessory muscle, Lowering respiratory load)	Set 3–4 (3 min)
Chuna manual therapy	Fascia Chuna (Breathing accessory muscle)	The patient lies down and makes isometric contraction in the inhalation; simultaneously the operator gives the opposite force. After 6–7 seconds, the patient exhales and relaxes the muscles		Set 3–4 (3 min)
Exercise therapy	Strength exercise	Upper limb and lower limbs strengthening training(1 set of 10–15 times of each muscle)	Muscle endurance (performance-enhancing)	Set 2–3 (15min)
Exercise therapy	Cardiovascular exercise	Using an ergometer or by treadmill	Cardiopulmonary function (increasing walking distance)	20min

Table 2

The Changes of Outcome measures in Cases.

Case	1		2

Evaluation time	2019.07.12	2019.09.10	2019.10.21	2019.11.09
mMRC*	2	2	4	3
6MWD(m)†	415	420	150
PEFR(L/min)‡	300	330	110	130
CAT§	13	9	34	20
SGRQ\|\|	27.9	23.5	43.5	40.6

* mMRC: modified medical research council scale,

† 6MWD: 6-minute walk distance,

‡ PEFR: Peak expiratory flow rate,

§ CAT: COPD assessment test,

|| SGRQ: St. George respiratory questionnaire.

참고문헌

1. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. Journal of global health. 2015; 5:2.

2. Hwang YI, Park YB, Yoo KH. Recent trends in the prevalence of chronic obstructive pulmonary disease in Korea. Tuberculosis and respiratory diseases. 2017; 80:3. 226–9.

3. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine. 2007; 176:6. 532–55.

4. Celli BR, MacNee W, Agusti A, Anzueto A, Berg B, Buist AS, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. European Respiratory Journal. 2004; 23:6. 932–46.

5. Yohannes AM, Alexopoulos GS. Depression and anxiety in patients with COPD. European Respiratory Review. 2014; 23:133. 345–9.

6. Montuschi P. Pharmacological treatment of chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2006; 1:4. 409

7. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews. 2015:2.

8. The Korea Academy of Tuberculosis and Respiratory diseases. Consensus Document on Pulmonary Rehabilitation in Korea 2015. The Korea Academy of Tuberculosis and Respiratory diseases;2015. p. 4

9. Yee Ran Lyu JJP, Park So jung, Lee Eun Jung, Jung In Chul, Park Yang Chun. Application of Taesikbub and Lung-doyinbub in 「Dong-Ui-Bo-Gam」 as a Korean Traditional Pulmonary Rehabilitation Exercise. J Korean Med. 2018; 39:3. 41–50.

10. In : Korean Society of Chuna Manual medicine for Spine & Nerves, Chuna Manual medicine Academy 25th regular workshop; Korean Society of Chuna Manual medicine for Spine & Nerves;2019. p. 144–49.

11. Korean Society of Chuna Manual medicine for Spine & Nerves. 2.5th EdKorean Society of Chuna Manual medicine for Spine & Nerves;2017; 104:281–89.

12. Garvey C, Fullwood MD, Rigler J. Pulmonary rehabilitation exercise prescription in chronic obstructive lung disease: US survey and review of guidelines and clinical practices. Journal of cardiopulmonary rehabilitation and prevention. 2013; 33:5. 314–22.

13. Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests. American Journal of Respiratory and Critical Care Medicine. 2012.

14. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH. Significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. British medical journal. 1959; 2:5147. 257

15. Puhan MA, Mador M, Held U, Goldstein R, Guyatt G, Schünemann H. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. European Respiratory Journal. 2008; 32:3. 637–43.

16. Gibson PG. Outpatient monitoring of asthma. Current Opinion in Allergy and Clinical Immunology. 2002; 2:3. 161–6.

17. Jones P, Harding G, Berry P, Wiklund I, Chen W, Leidy NK. Development and first validation of the COPD Assessment Test. European Respiratory Journal. 2009; 34:3. 648–54.

18. Jones P, Quirk F, Baveystock C. The St George’s respiratory questionnaire. Respiratory medicine. 1991; 85:25–31.

19. YG Y. Dong-si Acupuncture Therapy. Ancient Chinese Medical Book Press;1994. p. 29–30.

20. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS medicine. 2006; 3:11. e442

21. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American thoracic society/European respiratory society statement on pulmonary rehabilitation. American journal of respiratory and critical care medicine. 2006; 173:12. 1390–413.

22. Jang HJPK. Analysis of Research about Pulmonary Rehabilitation of Patients with COPD. The Journal of Korean Community Nursing. 2003; 14:2.

23. Band J, Kim J, Choi G, Jung H, Jung S. A Clinical Case Report of a Severe Chronic Obstructive Pulmonary Disease (COPD) Patient Treated by Cheonsagunja-tang gagam. Korean J Orient Int Med. 2010; 238–46.

24. Suzuki M, Namura K, Ohno Y, Tanaka H, Egawa M, Yokoyama Y, et al. The effect of acupuncture in the treatment of chronic obstructive pulmonary disease. The Journal of Alternative and Complementary Medicine. 2008; 14:9. 1097–105.

25. Chan AW, Lee A, Suen LK, Tam WW. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial. Complementary therapies in medicine. 2011; 19:1. 3–11.

26. Chen Q, Shi M-y, Zhang W, Tian J. Effect of breathing and Daoyin exercises on the quality of life in patients with chronic obstructive pulmonary disease. Journal of Acupuncture and Tuina Science. 2015; 13:6. 353–60.

27. Lee SW, Lyu YR, Park SJ, Kwak JY, Yang WK, Kim SH, et al. The effect of lung-conduction exercise in chronic obstructive pulmonary disease; Study protocol for randomized, assessor-blind, multicenter trial. Medicine. 2020; 99:18. e19826

28. Galletti J, Mcheileh G, Hahne A, Lee AL. The clinical effects of manipulative therapy in people with chronic obstructive pulmonary disease. The Journal of Alternative and Complementary Medicine. 2018; 24:7. 677–83.

29. Ferrer M, Villasante C, Alonso J, Sobradillo V, Gabriel R, Vilagut G, et al. Interpretation of quality of life scores from the St George’s Respiratory Questionnaire. European Respiratory Journal. 2002; 19:3. 405–13.

30. Kon SS, Canavan JL, Jones SE, Nolan CM, Clark AL, Dickson MJ, et al. Minimum clinically important difference for the COPD Assessment Test: a prospective analysis. The lancet Respiratory medicine. 2014; 2:3. 195–203.