IJCS | Volume 31, Nº5, September / October 2018

500 Babkina et al. Influence of pulmonary rehabilitation Int J Cardiovasc Sci. 2018;31(5)499-504 Original Article COPD should provide rational conversion of standard schemes of therapy and rehabilitation in accordance with their clinical, pathogenic, functional and economic feasibility. Pulmonary rehabilitation is currently viewed as a key strategy in themanagement of respiratory system diseases. 5 The selection process for the rehabilitation of patients take into account their functional status, severity of dyspnea, motivation level, and smoking status, although the creation of individualized programs for the integrated treatment of patients with COPD remains an unsolved problem of scientific and practical medicine. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations,6 the minimum length of an effective rehabilitation is 6-12 weeks (at least 12 sessions, 2 times per week, for at least 30 minutes). A complete rehabilitation program should include physical exercise, smoking cessation, nutritional therapy, patient education and psycho-emotional support. 7 However, until now we have no effective program to maintain a therapeutic effect for a long time especially for the patient with comorbid pathology COPD and chronic heart failure (CHF). A perspective area of pulmonary rehabilitation is a full yogic breathing exercise. 8 Therefore, the aim of the present study was to assess the effectiveness of pulmonary rehabilitation in addition to the standard medical care of patients with COPD and CHF. Methods Sample This was a prospective, single-center, non-blinded trial conducted in the Donetsk National Medical University, based on Department of Urgent Cardiology and Rehabilitation of Institute of Emergency and Reconstructive Surgery, enrolling 102 participants between September 2013 and November 2015. Patients were included if theymet theGOLDcriteria for a diagnosis of COPD: 6 a post-bronchodilator ratio [forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC)] < 0.70 and a < 15% or 200-mL increase in FEV1 following inhalation of a β 2 agonist; age ≥ 18 years; stable ischemic heart disease in history and decompensation of CHF with symptoms leading to hospitalization. Chronic heart failure was diagnosed with the presence of history of CHF and at least one symptom (dyspnea, orthopnea, or edema) and one sign (moist rales, peripheral edema, ascites, or pulmonary vascular congestion on chest radiography). Patients with a gastroesophageal reflux disease, diaphragmatic hernia, cancer, pregnancy, cardiac surgerywithin 90 days of enrollment, comorbid conditions with an expected survival of less than 6 months, acute myocardial infarction at time of hospitalization, retinal detachment, increased intracranial and intraocular pressure were excluded. All participants read and signed the informed consent formbefore the participation in the study. Both informed consent form and the prospective analysis of the data for research purposes were approved by the Ethics Committee (report number 108/7). Full yogic breathing Patients were assigned to either standard CHF and COPD therapy alone (control group, CG) or standardCHF andCOPD therapy plus full yogic breathing (intervention group, IG). Patients of IG were additionally taught the full yogic breathing - deep slow breathing, consisting of three consecutive phases: abdominal, thoracic and clavicular. Inhale was made wavelikely, with consistent use of abdominal muscles and diaphragm, intercostal muscles rather than the muscles of the shoulder girdle. Exhale was done in the same sequence. At the beginning, participants of IG practiced full breathing in the supine or sitting position 4 times per day, 8-10 breaths at a time; then during exercise they increased the number of rounds up to 10 per day and performed it also while sitting, standing or walking when they encountered unbearable shortness of breath. All patients kept diaries while they performed breathing exercises during the observation period. Then investigators estimated their compliance to this method of treatment according to their diaries. Assessment of physical fitness components: clinical evaluation scale, 6-minute walk test, pre- and post- bronchodilator spirometry data, SpO 2 Calculations of points by clinical evaluation scale (CES), assessment of CHF FC and 6-minute walk test (6MWT - with the evaluation of dyspnea by the Borg scale) were performed in all patients on the admission to the department and at discharge. Pre- andpost-bronchodilator spirometry assessments were performed with a portable spirometer (BTL-08 Spiro Pro; BTL, United Kingdom), in accordance with the American Thoracic Society criteria. 9 Values of FEV1 were expressed in liters, as percentages of the FVC, and as percentages of the reference values. The peripheral capillary oxygen saturation (SpO 2 )was assessed