Comprehensive Lung Function Assessment Does not Allow to Infer Response to Pulmonary Rehabilitation in Patients with COPD

Augustin, Ingrid; Wouters, Erniel E. M.; Houben-Wilke, Sarah; Gaffron, Swetlana; Janssen, Daisy J.A.; Franssen, Frits M.E.; Spruit, Martijn A.

doi:10.3390/jcm8010027

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…However, collectively, existing evidence does not support the use of severity of lung function impairment as a selection criterion. First, measures of pulmonary function such as the forced expiratory volume in 1 s (FEV 1 ) are poor predictors of individuals' exercise tolerance, level of disability, symptoms or psychological status . While some people with a mild degree of airflow obstruction may be highly symptomatic with dyspnoea and exercise intolerance, others with severe airflow obstruction may not experience significant limitations.…”

Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 99%

“…In a recent study, the efficacy of PR was assessed among 518 COPD patients with varying degrees of lung function impairment . Patients were clustered into groups based on comprehensive lung function assessment; mean improvements in exercise performance, dyspnoea, health status, ADL performance and mood after PR were comparable across patient clusters despite significant differences in lung function, and there were no significant relationships found between lung function impairment and responses to these outcomes in PR .…”

Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 99%

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Patient assessment and selection for pulmonary rehabilitation

Rochester

2019

Respirology

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Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co‐morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of ‘responsiveness to PR’, to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health‐related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self‐efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.

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Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 99%

Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 99%

Patient assessment and selection for pulmonary rehabilitation

Rochester

2019

Respirology

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“…The degree of baseline pulmonary function was not found to predict individual improvement in dyspnea, motor performance, activities of daily living, emotional state, or disease-specific health status after lung rehabilitation. These findings suggest that baseline pulmonary function cannot be used to identify good responders to lung rehabilitation therapy; therefore, the results of pulmonary function tests cannot be used as a criterion to recommend lung rehabilitation for COPD patients [23]. Thus, pulmonary function is not enough to capture the heterogeneity of COPD, and there are some limitations of its use to guide individual diagnosis and treatment [24].…”

Section: Discussionmentioning

confidence: 99%

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

Zhang

et al. 2020

BMC Pulm Med

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Background: Chronic obstructive pulmonary disease (COPD) patients with different phenotypes show different clinical characteristics. Therefore, we conducted a meta-analysis to explore the clinical characteristics between the non-exacerbator (NE) phenotype and the frequent exacerbator with chronic bronchitis (FE-CB) phenotype among patients with COPD. Methods: CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases were searched from the times of their inception to April 30, 2019. All studies that reported the clinical characteristics of the COPD phenotypes and which met the inclusion criteria were included. The quality assessment was analyzed by Cross-Sectional/Prevalence Study Quality recommendations. The meta-analysis was carried out using RevMan5.3.

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“…The degree of baseline pulmonary function was not found to predict individual improvement in dyspnea, motor performance, activities of daily living, emotional state, or disease-specific health status after lung rehabilitation. These findings suggest that baseline pulmonary function cannot be used to identify good responders to lung rehabilitation therapy; therefore, the results of pulmonary function tests cannot be used as a criterion to recommend lung rehabilitation for COPD patients [22] . Thus, pulmonary function is not enough to capture the heterogeneity of COPD, and there are some limitations of its use to guide individual diagnosis and treatment [23] .…”

Section: Fev 1 /Fvcmentioning

confidence: 99%

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

Zhang³

et al. 2020

Preprint

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Objective: To investigate the clinical characteristics between the frequent exacerbator with chronic bronchitis (FE-CB) phenotype and the non-exacerbator (NE) phenotype among patients with chronic obstructive pulmonary disease (COPD). Methods: We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for relevant studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and NE phenotypes and which qualified the inclusion criteria were included. Cross-Sectional/Prevalence Study Quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis. Results: Ten case-control studies (n=8848) were included. Compared with the NE phenotype, patients with the FE-CB phenotype showed significantly lower forced vital capacity percent predicted (FVC%pred) [mean difference (MD) -6.69, 95% confidence interval (CI) -7.73–-5.65, P<0.001, I2=5%], forced expiratory volume in one second percent predicted (FEV1%pred) (MD -8.50, 95% CI -11.36–-5.65, P<0.001, I2=91%), and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) (MD -3.76, 95% CI -4.58–-2.95,P<0.001, I2=0%); in contrast, the quantity of cigarettes smoked (pack-years) (MD 3.09, 95% CI 1.60–4.58, P<0.001, I2=41%), COPD assessment test (CAT) score (MD 5.61, 95% CI 4.62–6.60, P<0.001, I2=80%), modified Medical British Research Council (mMRC) score (MD 0.72, 95% CI 0.63–0.82, P<0.001, I2=57%), exacerbations in previous year (2.65, 95% CI 2.32–2.97, P<0.001, I2=91%), body mass index (BMI), obstruction, dyspnea, exacerbations (BODEx) (MD 1.78, 95% CI 1.28–2.28, P<0.001, I2=91%), I2=34%), and Charlson comorbidity index (MD 0.47, 95% CI 0.37–0.58, P<0.001, I2=0] were significantly higher in patients with FE-CB phenotype. No significant between-group difference was observed with respect to BMI (MD-0.14, 95% CI -0.70–0.42, P=0.62, I2=75%). Conclusion: COPD patients with the FE-CB phenotype had poorer pulmonary function and higher CAT score, the quantity of cigarettes smoked (pack-years), frequency of acute exacerbations, and mMRC scores than those with the NE phenotype.

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Comprehensive Lung Function Assessment Does not Allow to Infer Response to Pulmonary Rehabilitation in Patients with COPD

Cited by 22 publications

References 24 publications

Patient assessment and selection for pulmonary rehabilitation

Patient assessment and selection for pulmonary rehabilitation

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

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