@article{2998353,
    title = "Effect of pulmonary rehabilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients",
    author = "Theodorakopoulou, E.P. and Gennimata, S.-A. and Harikiopoulou, M. and Kaltsakas, G. and Palamidas, A. and Koutsoukou, A. and Roussos, C. and Kosmas, E.N. and Bakakos, P. and Koulouris, N.G.",
    journal = "Respiratory Physiology and Neurobiology",
    year = "2017",
    volume = "238",
    pages = "47-54",
    publisher = "Elsevier B.V.",
    doi = "10.1016/j.resp.2017.01.008",
    keywords = "aged;  airway pressure;  Article;  breathing pattern;  chronic obstructive lung disease;  clinical article;  clinical outcome;  controlled study;  dynamic hyperinflation;  dyspnea;  exercise;  exercise test;  expiratory flow;  female;  forced expiratory volume;  forced vital capacity;  human;  hyperinflation;  inspiratory capacity;  male;  negative expiratory pressure;  positive end expiratory pressure;  priority journal;  pulmonary rehabilitation;  quality of life;  questionnaire;  respiratory function;  rest;  Saint George Respiratory Questionnaire;  therapy effect;  tidal expiratory flow limitation;  dyspnea;  exercise;  middle aged;  pathophysiology;  physiology;  Pulmonary Disease, Chronic Obstructive;  rest;  spirometry;  tidal volume, Aged;  Dyspnea;  Exercise;  Exercise Test;  Female;  Forced Expiratory Volume;  Humans;  Inspiratory Capacity;  Male;  Middle Aged;  Pulmonary Disease, Chronic Obstructive;  Rest;  Spirometry;  Surveys and Questionnaires;  Tidal Volume",
    abstract = "We hypothesized that severe COPD patients who present with the disadvantageous phenomenon of Expiratory Flow Limitation (EFL) may benefit as COPD patients without EFL do after implementation of a Pulmonary Rehabilitation (PR) program. Forty-two stable COPD patients were studied at rest and during exercise. EFL and dynamic hyperinflation (DH) were documented using the negative expiratory pressure (NEP) technique and inspiratory capacity (IC) maneuvers, respectively. Patient centered outcomes were evaluated by the Saint-George's Respiratory Questionnaire (SGRQ) and the mMRC dyspnea scale. Before PR, 16 patients presented with EFL at rest and/or during exercise. After PR, EFL was abolished in 15 out of those 16 EFL patients who exhibited a significant increase in IC values. These were mainly accomplished through a modification of the breathing pattern. In the 26 NFL patients no increase was noted in their IC or a modification of their breathing pattern. However, both NFL and EFL COPD patients improved exercise capacity and patients centered outcomes undergoing the same PR program. © 2017 Elsevier B.V."
}