Issue 24-3, 2025

Experience of Hypoxic Conditioning in Rehabilitation Programs for Patients with Chronic Occupational Lung Diseases: a Pilot Study

Xinliang Zhang¹, Evgeny E. Achkasov¹, Elena N. Dudnik¹, Olga I. Rumyantseva², Oleg S. Glazachev^1,*

¹ I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia,
³ Izmerov Research Institute of Occupational Health, Moscow, Russia

ABSTRACT

INTRODUCTION.  Chronic occupational lung diseases (COLD) represent a serious medical and social problem associated with a high degree of comorbidity and systemic disorders, including cardiometabolic changes, pronounced oxidative stress, chronic inflammation, autonomous and immune dysregulation, and leading to disability and reduced quality of life. Hypoxic conditioning (HC), in particular, intermittent hypoxic-hyperoxic exposures (IHHE), which can improve adaptation mechanisms and reduce inflammatory processes, is a promising method of rehabilitation of patients with COLD, along with basic medication and physiotherapy.

AIM.  To evaluate the efficacy and safety of IHHE application in the programs of complex rehabilitation of patients with COLD.

MATERIALS AND METHODS.  A single-center blind randomized placebo-controlled study with participation of 60 patients (32 men, age 58,2 ± 14,1 years, desiase’s duration 15,9 ± 2,8 years) with COLD (occupational bronchial asthma — 59.3 %), occupational chronic bronchitis — 18.5 %, occupational chronic obstructive pulmonary disease — 11.1 %) and occupational exogenous allergic alveolitis — 11.1 %), divided into two groups was conducted: the main group received 12 sessions of IHHE in 3 weeks, control group — placebo procedures. Both groups underwent standard medical and physiotherapeutic rehabilitation. Clinical, functional and laboratory parameters before and after the rehabilitation course were evaluated.

RESULTS AND DISCUSSION.  In the IHHE group there was a significant improvement of hypoxic resistance (according to Stange’s and Gench’s tests, hypoxic test), reduction of broncho-obstructive manifestations, improvement of external respiratory function indices and reduction of blood pressure. There was also an increase in exercise tolerance according to the six-minute walk test (6MWT) (an increase of 11.9 ± 8.6 % from baseline), a decrease in the severity of dyspnea and subjective assessments of exercise severity according to the Borg scale. In the control group, the positive dynamics in the indicators of hypoxic tolerance, broncho-obstruction, and 6MWT tolerance were significantly less pronounced. The results of the study confirm that IHHE procedures can serve as a significant addition to the standard rehabilitation of patients with COLD, contributing to the improvement of clinical and functional parameters, correction of comorbid disorders.

CONCLUSION.  IHHE is a safe and effective method to be added to standard rehabilitation of patients with COLD, leading to more pronounced improvements of hypoxic resistance, exercise tolerance, reduction of broncho-obstruction and normalization of blood pressure.

KEYWORDS: chronic occupational lung disease, rehabilitation, intermittent hypoxic-hyperoxic exposures, exercise tolerance

FOR CITATION:

Zhang X., Achkasov E.E., Dudnik E.N., Rumyantseva O.I., Glazachev O.S. Experience of Hypoxic Conditioning in Rehabilitation Programs for Patients with Chronic Occupational Lung Diseases: a Pilot Study. Bulletin of Rehabilitation Medicine. 2025; 24(3):18–28. https://doi.org/10.38025/2078-1962-2025-24-3-18-28 (In Russ.). 

Oleg S. Glazachev, Е-mail: glazachev_o_s@staff.sechenov.ru, glazachev@mail.ru

References:

1.    Косарев В.В., Бабанов С.А. Профессиональная хроническая обструктивная болезнь легких. Consilium Medicum. 2014; 16(3): 22–26. [Kosarev V.V., Babanov S.A. Occupational chronic obstructive pulmonary disease. Consilium Medicum. 2014; 16(3):22–26 (In Russ.).]

2.    Murgia N. Gambelunghe A: Occupational COPD — The most underrecognized occupational lung disease? Respirology. 2022; 27(6): 399–410. https://doi.org/10.1111/resp.14272

3.    Tug T., Terzi S., Yoldas T. Relationship between the frequency of autonomic dysfunction and the severity of chronic obstructive pulmonary disease. Acta neurologica scandinavica. 2005; 112(3): 183–188. https://doi.org/10.1111/j.1600-0404.2005.00456.x

4.    Байкова А.Г., Бабанов С.А., Будаш Д.С. Профессиональная бронхиальная астма. Медицинская сестра. 2018; 20(7): 13–18. https://doi.org/10.29296/25879979-2018-07-03 [Baikova A.G., Babanov S.A., Budash D.S. Occupational asthma. Meditsinskaya Sestra. 2018; 20(7): 13–18. https://doi.org/10.29296/25879979-2018-07-03 (In Russ.).]

5.    Бухтияров И.В., Орлова Г.П., Андреенко О.Н., Землякова С.С. Эпидемиология профессиональных интерстициальных заболеваний лёгких в России. Медицина труда и промышленная экология. 2022;62(7): 430–436. [Bukhtiyarov I.V., Orlova G.P., Andreenko O.N., Zemlyakova S.S. The epidemiology of occupational interstitial lung diseases in Russia. Russian Journal of Occupational Health and Industrial Ecology. 2022; 62(7): 430–436. https://doi.org/10.31089/1026-9428-2022-62-7-430-436 https://doi.org/10.31089/1026-9428-2022-62-7-430-436 (In Russ.).]

6.    Васильева О.С., Кузьмина Л.П., Черняк А.В., Кравченко Н.Ю., Коляскина М.М. Профессиональные факторы и роль индиви­дуальной восприимчивости к развитию и течению бронхолегочных заболеваний. Пульмонология. 2021; 31(4): 463–468. [Vasilieva O.S., Kuzmina L.P., Chernyak A.V., Kravchenko N.Yu., Koljaskina M.M. The role of occupational factors and individual susceptibility in the development and course of bronchopulmonary diseases. Pulmonologiya. 2021; 31(4): 463–468. https://doi.org/10.18093/0869-0189-2021-31-4-463-468 https://doi.org/10.18093/0869-0189-2021-31-4-463-468 (In Russ.).]

7.    Макаров И.А., Потапова И.А., Мокеева Н.В. Особенности динамики профессиональной хронической обструктивной болезни легких у рабочих пылевых профессий. Пульмонология. 2017; 27(1): 37–40. [Makarov I.A., Potapova I.A., Mokeeva N.A. Clinical course of occupational chronic obstructive pulmonary disease in workers exposed to dust. Pulmonologiya. 2017; 27(1): 37–40. https://doi.org/10.18093/0869-0189-2017-27-1-37-40 https://doi.org/10.18093/0869-0189-2017-27-1-37-40 (In Russ.).]

8.    Chuang C.-S., Ho S.-C., Lin C.-L., et al. Risk of cerebrovascular events in pneumoconiosis patients: a population-based study, 1996–2011. Medicine 2016, 95(9): e2944. https://doi.org/10.1097/md.0000000000002944

9.    Shen H., Xu Y., Zhang Y., et al. Efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease and obstructive sleep apnea; a randomized controlled trial. J Rehabil Med. 2024; 56: jrm23757. https://doi.org/10.2340/jrm.v56.23757

10. Бурчер Й., Глазачев О.С., Копп М., Бурчер М. Эффекты интервальных гипоксических экспозиций и интервальных гипоксических тренировок на переносимость физических нагрузок (нарративный обзор). Спортивная медицина: наука и практика. 2024; 14(2): 16–23. [Burtscher J., Glazachev O.S., Kopp M., Burtscher M. Effects of intermittent hypoxia exposures and interval hypoxic training on exercise tolerance (narrative review). Sports medicine: research and practice. 2024; 14(2): 16–23. https://doi.org/10.47529/2223-2524.2024.2.5 https://doi.org/10.47529/2223-2524.2024.2.5 (In Russ.).]

11. Timon R., González-Custodio A., Vasquez-Bonilla A., et al. Intermittent hypoxia as a therapeutic tool to improve health parameters in older adults. International Journal of Environmental Research and Public Health. 2022; 19(9): 5339. https://doi.org/10.3390/ijerph19095339

12. Tessema B., Sack U., König B., et al. Effects of intermittent hypoxia in training regimes and in obstructive sleep apnea on aging biomarkers and age-related diseases: a systematic review. Frontiers in Aging Neuroscience. 2022; 14: 878278. https://doi.org/10.3389/fnagi.2022.878278

13. Schega L., Peter B, Brigadski T., et al. Effect of intermittent normobaric hypoxia on aerobic capacity and cognitive function in older people. Journal of Science and Medicine in Sport. 2016; 19(11): 941–945. https://doi.org/10.1016/j.jsams.2016.02.012

14. Lyamina N.P., Spirina G.K., Glazachev O.S. Hypoxic Conditioning in Rehabilitation and Secondary Prevention Programs in Cardiac Patients with Multimorbidity: a Review. Bulletin of Rehabilitation Medicine. 2022; 21(5): 78–86. https://doi.org/10.38025/2078-1962-2022-21-5-78-86

15. Tobin B, Costalat G, Renshaw G.M.C. Intermittent not continuous hypoxia provoked haematological adaptations in healthy seniors: hypoxic pattern may hold the key. Eur J Appl Physiol. 2020; 120(3): 707–718. https://doi.org/10.1007/s00421-020-04310-y

16. Гребенюк С.А., Озаровский Е.Е. Применение прерывистой нормобарической гипокситерапии в лечении больных с хроническими неспецифическими заболеваниями легких в условиях военного санатория. Военно-медицинский журнал. 2003; 324(1): 69–70. [Grebenyuk S.A., Ozarovsky E.E. Application of intermittent normobaric hypoxytherapy in the treatment of patients with chronic nonspecific lung diseases in the conditions of military sanatorium. Military Medical Journal. 2003; 324(1): 69–70 (In Russ.).]

17. Иванов А.Б., Борукаева И.Х., Шхагумов К.Ю., Абазова З.Х. Комбинированное применение гипокситерапии и оксигенотерапии — эффективный метод коррекции иммунологического статуса больных бронхиальной астмой. Здоровье и образование в XXI веке. 2015; 17(4): 12–317. [Ivanov A.B., Borukaeva I.Kh., Shhagumov K.Yu., Abazova Z.Kh. Combined application of hypoxytherapy and oxygentherapy is an effective method of correction of immunological status of patients with bronchial asthma. The journal of scientific articles health and education millennium. 2015; 17(4): 312–317 (In Russ.).]

18. Burtscher M., Haider T., Domej W., et al. Intermittent hypoxia increases exercise tolerance in patients at risk for or with mild COPD. Respiratory physiology & neurobiology. 2009; 165(1): 97–103. https://doi.org/10.1016/j.resp.2008.10.012

19. Burtscher J., Citherlet T., Camacho‐Cardenosa A., et al. Mechanisms underlying the health benefits of intermittent hypoxia conditioning. The Journal of physiology. 2024; 602(21): 5757–5783. https://doi.org/10.1113/jp285230

20. Kasima V.H.M., Mathiaa S., Perssona P.B., et al. Episodic hypoxia promotes defence against cellular stress. Cell Physiol Biochem. 2019; 52: 1075–1091. https://doi.org/10.33594/000000073

21. Zhang Q., Zhao W., Li S., et al. Intermittent Hypoxia Conditioning: A Potential Multi-Organ Protective Therapeutic Strategy. Int. J. Med. Sci. 2023; 20(12): 1551–1561. https://doi.org/10.7150/ijms.86622

22. Uzun AB, Iliescu M, Stanciu LE., et al. The Impact of Intermittent Hypoxia-Hyperoxia Therapy on Metabolism and Respiratory System in Obese Patients as Part of Comprehensive Medical Rehabilitation. Cureus. 2024; 16(10):e71501. https://doi.org/10.7759/cureus.71501

23. Mallet R.T., Burtscher J., Gatterer H., et al. Hyperoxia-enhanced intermittent hypoxia conditioning: mechanisms and potential benefits. Med. Gas. Res. 2024; 14(3): 127–129. https://doi.org/10.4103/mgr.medgasres-d-23-00046

24. Behrendt T., Bielitzki R., Behrens M., et al. Effects of Intermittent Hypoxia-Hyperoxia on Performance and Health-Related Outcomes in Humans: A Systematic Review. Sports Med. Open. 2022; 8(1): 70. https://doi.org/10.1186/s40798-022-00450-x

25. Dudnik E., Zagaynaya E., Glazachev O.S., Susta D. Intermittent hypoxia–hyperoxia conditioning improves cardiorespiratory fitness in older comorbid cardiac outpatients without hematological changes: a randomized controlled trial. High Altitude Medicine & Biology. 2018; 19(4): 339–343. https://doi.org/10.1089/ham.2018.0014

26. Wang S., Gao B., Shi M., et al. Exercise-Induced Oxygen Desaturation Increases Arterial Stiffness in Patients with COPD during the 6WMT. Int J Chron Obstruct Pulmon Dis. 2024; 19: 1479–1489. https://doi.org/10.2147/copd.s465843

27. Hedhli A., Slim A., Ouahchi Y., et al. Maximal Voluntary Breath-Holding Tele-Inspiratory Test in Patients with Chronic Obstructive Pulmonary Disease. Am J Mens Health. 2021; 15(3): 15579883211015857. https://doi.org/10.1177/15579883211015857

28. Stray-Gundersen S., Massoudian S.D., Wojan F., et al. Hypoxic preconditioning reduces endothelial ischemia-reperfusion injury in older adults. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2022; 323(5): R832–R838. https://doi.org/10.1152/ajpregu.00200.2022

29. Haider T., Casucci G., Linser T., et al. Interval hypoxic training improves autonomic cardiovascular and respiratory control in patients with mild chronic obstructive pulmonary disease. Journal of hypertension. 2009; 27(8): 1648–1654. https://doi.org/10.1097/hjh.0b013e32832c0018

30. Vogtel M., Michels A. Role of intermittent hypoxia in the treatment of bronchial asthma and chronic obstructive pulmonary disease. Curr Opin Allergy Clin Immunol. 2010; 10(3): 206–213. https://doi.org/10.1097/aci.0b013e32833903a6

31. Xinliang Z., Achkasov E.E., Gavrikov L.K., et al. Assessing the importance and safety of hypoxia conditioning for patients with occupational pulmonary diseases: A recent clinical perspective. Biomed. Pharmacother. 2024; 178: 117275. https://doi.org/10.1016/j.biopha.2024.117275

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This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.