Authored by Tracy Fasolino
COPD: Chronic Obstructive Pulmonary Disease; QOL: Quality of Life; CPD: Chronic Pulmonary Disease; CAM: Complementary and Alternative Medicines; MT: Massage Therapy; GI: Guided Imagery; AQLQ: Asthma Quality of Life Questionnaire; SAS: Self-Rating Anxiety Scale; PNS: Parasympathetic Nervous System
Introduction
Chronic pulmonary diseases, such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, pulmonary fibrosis, and asthma, affect 40 million people in the United States [1]. As these diseases progress, patients experience uncontrolled symptoms, such as dyspnea (shortness of breath), anxiety, and pain. Furthermore, patients and the caregivers describe decreased quality of life (QOL). Management of chronic pulmonary disease (CPD) focus on pharmaceutical interventions with medicines to open and relax the smooth muscles of the airway, thin secretions, and decrease inflammation. At times, these medications may worsen patient symptoms or cause unwanted side effects, such as tremors associated with short-acting beta agonists [2] or weakened respiratory muscles with corticosteroid use [3]. Other therapies, such as pulmonary hygiene and postural drainage are often uncomfortable and worsen dyspnea. Certain pulmonary rehabilitation exercises targeting the shoulder muscles can also make breathing more difficult [4].When prescribed medications and therapies are no longer effective, the patient, caregiver, and healthcare team struggle to find ways to help reduce the burden of the disease. Physicians, Nurse Practitioners, and Physician Assistants may opt to introduce opiates and anti-anxiety medications for patients with uncontrolled dyspnea. However, patients and family members are familiar with the stigma and skepticism related to these therapies. Society associates addiction, dependence, and adverse drug effects with opiates and anti-anxiety medications. The challenge is finding other therapies that can reduce dyspnea without introducing unwanted side effects. Integrating massage therapy, acupuncture, and/or guided imagery into routine care for patients with CPD could reduce symptoms and likely decrease use of opiates and antianxiety medications. Massage therapy, acupuncture, and guided imagery are relatively easy to integrate, have few associated side effects, and can be used as an adjunct for controlling physiological and psychological impact as part of complementary and alternative medicines (CAM) [5]. Furthermore, caregivers can become an active part of the management by learning how to administer these therapies.The objective of this paper is to present findings of the systematic review of the role of massage therapy, acupuncture, and guided imagery for patients with CPD. The basic methods of each therapy, impact on CPD related symptoms, and associated precautions will be covered.
Methods
The review of the literature was protocol-based and conducted in accordance with the PICO [6] and the PRISMA recommendations for reporting systematic reviews [7]. We conducted the review using a keyword search in the electronic databases of PubMed, Psych INFO, Web of Science, Cochrane Library and CINAHL. All databases were searched using relevant MeSH terms. Keywords related to the population (Chronic pulmonary disease OR chronic obstructive pulmonary disease OR COPD OR asthma OR chronic bronchitis OR emphysema) were combined with key words related to the intervention (massage therapy OR acupuncture OR guided imagery OR mindfulness OR relaxation OR meditation) and outcomes (dyspnea OR shortness of breath OR breathlessness OR fatigue OR anxiety OR panic OR quality of life OR functional status). The search was conducted by each author on the specific topic with the primary author reviewing all results. Initially, articles were to be extracted with the past 5 years (2014-2019). Due to a low number of relevant articles, we expanded the search to the past 15 years.Selection Procedure and Data Extraction
Only English-language reports published in peer-reviewed journals were considered eligible for the present study. Eligible studies were those that evaluated individual, or group-based MT, acupuncture, and GI interventions aimed at alleviating symptoms associated with CPD, including the physiological and psychological impact. Papers were excluded if the concentration was on the use of other CAM therapies, such as hypnosis. Initially, we focused on designs that utilized control groups. The search results did not yield adequate articles, so we expanded to include all designs.
In the first round of assessment, the primary author (TF) discussed the articles extracted with the other authors (MC, HH, HM). The team identified and removed duplicates and screened the titles and abstracts of the identified references with the purpose of excluding irrelevant studies. In the second round of assessment, full texts of the remaining references were read, and ineligible reports were excluded. Disagreements and uncertainties were discussed until a negotiated conclusion was reached. Using a Microsoft Excel spreadsheet, essential elements were extracted and organized. Data from the included studies were extracted independently and cross-checked by the primary author. The initial search yielded 184 articles, out of which 48 articles were screened to match with inclusion criteria. The authors agreed on 20 articles for the systematic review, keeping in mind the broad and complex nature of the field of MT, acupuncture, and GI interventions.
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