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Chronic obstructive pulmonary disease (COPD) accounts for a large number of hospital admissions and numerous interventions have attempted to reduce exacerbations requiring hospitalization. This paper describes the implementation of a community based COPD management programme led by a respiratory physiotherapist to improve home management of COPD and its effect on reducing readmissions and/or length of stay in hospital. One-hundred and twenty-five patients (median age 73) referred with COPD exacerbations met the criteria for the service; 95 received the intervention and data were available for 80. Median FEV1 was 0.86 L. Admission data, length of stay and total hospitalization days with COPD were compared for one year before and after the intervention. Overall there was no reduction in length of stay, admission frequency, or adjusted total hospitalization days with COPD, but median time interval to next exacerbation increased by 29%. In those who had had previous admissions (mean FEV1 0.58 L) total hospitalization days fell by 27%, length of stay fell by 58% despite an increase in admission frequency from one to two per year, and there was no change in median time interval to next hospitalized exacerbation. In our patients implementation of a Chronic Disease Management programme increased the time to next hospitalized exacerbation. Benefit was seen in the more severe patients however, with a significant reduction in both length of stay and total hospitalization days.

Introduction:Gait speed provides an integrated index of physical performance; changes in gait speed could reflect deterioration in the underlying medical disorder or a response to medical/surgical interventions. Slower gait speeds reflect the overall level of impairment, especially in patients with chronic lung disease.Methods:We retrospectively reviewed the medical files of 119 patients who completed the pulmonary rehabilitation program at the University Medical Center in Lubbock, Texas, and collected demographic, pulmonary function, and 6-minute walk test information. Gait speed was calculated using the 6-minute walk test information.Results:The patients in this study had a mean age of 68.8 ± 10.1 years. Most patients (95) had chronic obstructive pulmonary disease/asthma. The mean forced expiratory volume in the first second of expiration (FEV1) was 1.3 ± 0.7 L (47.2% ± 19.7% predicted). The baseline gait speed was 41 ± 15 m/min before rehabilitation and 47 ± 15 m/min after rehabilitation. Baseline gait speed, body mass index, and FEV1 predicted postrehabilitation gait speed (P < .05 for each variable). Ten patients had a gait speed >60 m/min before rehabilitation; this number increased to 29 postrehabilitation. Using multivariable analysis, it was found that only the baseline gait speed predicted a speed of more than 60 m/min postrehabilitation. Seventy-four patients had an increase in 6-minute walk distance of greater than 30 m.Conclusions:Patients with chronic lung diseases have slow gait speeds. Most patients improve their speed with rehabilitation but do not increase their speed above 60 m/min and remain frail by this criterion. However, the majority of patients increase their walk distance by 30 m, a distance that represents a minimal clinically important distance.

BACKGROUND:Pulmonary rehabilitation (PR) has inconsistent effects on health-related quality of life (HRQL) in patients with chronic lung diseases. We evaluated the effect of PR on HRQL outcomes using the 36-item short form of the medical outcomes (SF-36).METHODS:We retrospectively reviewed the files of all patients who completed PR in 2010, 2011, and first half of 2012. We collected information on demographics, symptoms, pulmonary function tests, 6-minute walk tests (6-MWT), and responses on the SF-36 survey, including the physical component score (PCS) and mental component score (MCS).RESULTS:The study included 19 women and 22 men. The mean age was 69.8 ± 8.5 years. The diagnoses included chronic obstructive pulmonary disease (COPD; n = 31), asthma (n = 3), interstitial lung disease (n = 5), and obstructive sleep apnea (OSA; n = 2). The mean forced expiratory volume-one second (FEV1) was 1.16 ± 0.52 L (against 60.5 ± 15.9% of predicted value). There was a significant improvement in 6-MWT (P < 0.0001). The PCS improved post-PR from 33.8 to 34.5 (P = 0.02); the MCS did not change.CONCLUSION:These patients had low SF-36 scores compared to the general population; changes in scores after PR were low. These patients may need frequent HRQL assessment during rehabilitation, and PR programs should consider program modification in patients with small changes in mental health.

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