Overview
This study aims to evaluate the effectiveness of photobiomodulation therapy (PBMT) as an adjunct to the pulmonary rehabilitation program on the functional capacity of patients with COPD. This is a randomized, placebo-controlled, double-blind clinical trial conducted with 20 patients from the outpatient clinic of the Integrated Cardiopulmonary and Metabolic Rehabilitation Service of Santa Casa de Porto Alegre. Patients will be allocated to the active PBMT group, receiving photobiomodulation treatment prior to the exercise protocol of the pulmonary rehabilitation program, in the respiratory and peripheral muscles, or the placebo group, which will receive the therapy application at the same points but without the therapeutic dose, prior to rehabilitation. Sixteen PBMT applications will be performed over eight weeks, with a frequency of twice a week. The exercises performed in the institution's pulmonary rehabilitation program by the patients will not be interfered with by the researchers. Evaluations will be carried out in three stages: immediately after recruitment, after 8 interventions, and after 16 interventions.
Description
Chronic obstructive pulmonary disease (COPD) is a global health problem and the third leading cause of death worldwide. It is characterized by chronic inflammation and remodeling of the airways, inflammation and destruction of the lung parenchyma, resulting in various pulmonary and extrapulmonary manifestations. Symptoms such as cough, mucus production, dyspnea, and fatigue are predominant clinical manifestations and limit the daily life activities of patients with COPD. Associated with this, sarcopenia and impaired functional capacity strongly impact the quality of life of this population and increase mortality rates.
In this sense, pulmonary rehabilitation programs, focusing on physical exercise, are widely validated as a non-pharmacological treatment to improve COPD symptoms and reduce hospitalizations due to complications of the disease. PBMT consists of the application of non-thermal radiation through low-intensity laser or light-emitting diode (LED), with the aim of stimulating or inhibiting cellular activity. The photons emitted by these devices are absorbed by photoreceptors, increasing the availability of cellular energy and promoting tissue repair, as well as anti-inflammatory and analgesic effects.
There is ample evidence highlighting the positive effects of PBMT on improving muscle performance and reducing fatigue in healthy individuals and athletes. Studies in populations with chronic diseases such as heart failure, chronic kidney disease, and COPD are still scarce in the literature, and the benefits of this therapy need to be further investigated.
It is hypothesized that PBMT may be an additional resource to pulmonary rehabilitation programs, facilitating exercise execution, reducing symptoms of dyspnea and fatigue, and improving long-term functional capacity, since these patients would have better performance during the training program.
Eligibility
Inclusion Criteria:
- Patients diagnosed with COPD, in the maintenance phase, with GOLD classification 3 and 4;
- Ability to walk.
Exclusion Criteria:
- Cognitive dysfunction that prevents the completion of assessments, as well as inability to understand and sign the informed consent form (ICF);
- Patients with sequelae of stroke;
- Recent acute myocardial infarction (within two months);
- Uncontrolled hypertension;
- Heart failure grade IV according to the New York Heart Association or decompensated;
- Unstable angina or arrhythmia;
- Peripheral vascular alterations in lower limbs such as deep vein thrombosis;
- Disabling osteoarticular or musculoskeletal disease;
- Patients with cancer and/or undergoing cancer treatment;
- Patients with systemic lupus erythematosus;
- Pacemaker or cardiac defibrillator;
- Hemophilia;
- Recent skin lesions or tattoos at the site of therapy application.
