Ask an answerable question (PICO)：
In addition to drugs, the treatment and care of chronic obstructive pulmonary disease (COPD) requires pulmonary rehabilitation to reduce hyperventilation and improve the function of respiratory muscles to maintain and strengthen the patient's lung function.
In clinical practice, lung rehabilitation exercises are often based on pouting and abdominal breathing, but patients cannot maintain the training effectively. Tai Chi is a traditional Chinese martial art, which mainly adjusts the breathing state. With the coordination of body movements, the diaphragm contracts and relaxes, to improve lung function. The patient's question prompted the author to discuss the effect of Tai Chi on lung function in patients with chronic obstructive pulmonary disease.
The Method and Analysis of Literature Review：
Establish PICO according to the empirical steps: whether Tai Chi can improve lung function in patients with chronic obstructive pulmonary disease. Search electronic databases including Cochrane Library, PubMed, Embase, Airiti Library (Chinese Electronic Periodical Services, CEPS) and China Journal Full Text Database (CJFD) and Google Scholar for search. Then use Boolean logic to combine OR union and AND intersection. The constraints are Randomized Controlled Trial and Systematic Review. The languages are Chinese, English and articles from 2011 to present. The inclusion criteria are those that meet the keywords, and the exclusion criteria The experimental group or control group has other randomized controlled clinical trials that have been included in lung rehabilitation exercises, systematic literature review and meta-analysis, and the systematic literature review, systematic 1 literature review and 1 meta-analysis each.
Critical Appraisal：
The literature review tool used the 2018 version of the CASP systematic literature review checklist, and the level of evidence was based on the Oxford Centre for Evidence-Based Medicine Levels. The results of the first systematic literature review showed that seven out of nine (78%) had significant effects, 1 article (11%) said no and the other (11%) said that there will be significant results after 3 to 12 months of Tai Chi exercise; the results of the second systematic literature review and meta-analysis show that in line with the article, the Tai Chi exercise group predicts the forced expiratory volume in first second (% Pre FEV1) with a statistically significant effect (MD: 1.67% , 95% CI: 0.41 - 2.93; P = 0.009); there was low heterogeneity among the literature (P = 0.3, I2 =15%).
Results, Conclusions and Recommendations：
According to the included literature, it is suggested that the use of Tai Chi in patients with chronic obstructive pulmonary disease can improve the forced expiratory volume in first second (FEV1) and predict the forced expiratory volume in first second (% Pre FEV1). In the systematic literature review, there are many kinds of interventions in Tai Chi, and no adverse events were found, so it is considered to be a safe intervention.
However, Tai Chi has different moves and factions. The authors of the two articles did not propose or suggest that Tai Chi should be used in clinical classification of patients, frequency and time of appropriate intervention. For patients with chronic obstructive pulmonary disease, when the severity is from grade 3 to grade 4, due to physical factors, the suitability of the clinical application of Tai Chi should be considered.
