Efficacy of osteopathic treatment in patients with stable moderate-to-severe chronic obstructive pulmonary disease

Participants

• Number: 32 people (5 female and 27 male, mean age 71 years)
• Criteria of inclusion: clinical diagnosis of moderate-to-severe COPD
• Criteria of exclusion: a history or current diagnosis of asthma or other relevant respiratory or cardiovascular diseases from a clinical point of view
• Groups of study: 2 groups obtained by randomization
  • Group 1: standard pharmacologic treatment with the addition of OMT
    • 1 person was on oxygen therapy, but he chose to suspend it during the study
  • Group 2: standard pharmacologic treatment
    • all the participants were smokers or they had been in the past

Interventions and evaluations

• Evaluation of quality of life through COPD Assessment Test (CAT) and respiratory function through 6 minutes walking test (6MWT) monitored by using pulse oximetry and spirometry at the beginning of the study, after 4 weeks, after 8 weeks and at a 15-day follow-up
• Evaluation of adverse effects through regular control of the physical and mental health
• 8 weekly sessions of OMT
• OMT: myofascial release techniques directed to maxillary sinus, vertebral-pleural ligaments, phrenic nerves, ribs, pleura, lungs, bronchi, subclavian muscles, and trapezoid and conoid ligaments with the aim to mobilize the thoracic cage and the surrounding tissues
• Standard pharmacological treatment: indacaterol and glycopyrronium

Results

• Primary outcomes: after 4 weeks, the OMT group showed a statistically significant improvement in the CAT questionnaire, while the control group showed no changes. The same result was found in the walking test, where the OMT improved the distance covered and reduced dyspnea.
  On the contrary, no changes were detected in the spirometry (forced vital capacity and forced expiratory volume in 1 second) and in the perceived fatigue during the walking test in none of the 2 groups.

After 8 weeks from the start of the study, the OMT group showed a further statistically significant improvement in the CAT, while the distance covered returned to the initial levels (again statistically significantly). The control group did not show any changes.
At the final follow-up, the OMT saw a further improvement of the CAT score. Moreover, the distance covered improved, overtaking the level reached after 4 weeks, the sense of dyspnea and also the sense of fatigue improved. All these results were statistically significant. The control group, on the other hand, did not show any changes.

• Secondary outcomes:no chest pain was relieved after OMT. Although some patients showed an increase in mucus secretion while one of the patients experienced maxillary sinus pain 12 hours after treatment, this pain resolved spontaneously.

• Further analyses: as the study progressed, people in the OMT group were increasingly enthusiastic and motivated to follow the OMT.

Discussion

OMT has been shown to positively affect the health of moderate-to-severe COPD patients, as emerged from the CAT results (which evaluates how much the disease affects a person’s life) and the walking test (which evaluates cardiorespiratory function).
This is a particularly important result because several symptoms of COPD (eg, difficulty sleeping, impaired motor function due to shortness of breath) are definitely disabling. Already after 4 weeks several people resumed taking the stairs or improved resistance to physical exertion. These results favored the establishment of an optimal therapeutic relationship between participants and osteopaths.
Future study will have to evaluate OMT on bigger samples.