Effect of comorbidities on response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Hassan, Maged; Mourad, Sahar; Wahab, Nashwa Hassan Abdel; Daabis, Rasha; Younis, Gihan

doi:10.1016/j.ejcdt.2015.11.006

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Compared to our study, Hassan et al [17] demonstrated similar results in number of comorbidities (85%). Crisafulli et al [18] showed that every second patient, from 2,962 patients, had at least one comorbidity, while in our study, it was 35.6%.…”

Section: Discussionsupporting

confidence: 78%

The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

et al. 2020

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Introduction/Objective The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI).Results Study included 1,674 patients (956 males, age 65.93 ± 8.45, current or ex-smokers 94.9%; 21 ≥ BMI 1,406 patients, 84%, FEV 1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV 1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307-0.577); p < 0.001) and BMI ≥ 21kg/m 2 (RR 0.605; 95% CI (0.380-0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720-3.280); p < 0.001) and FEV 1 < 80% (RR 2.021; 95% CI (1.303-3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.

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Section: Discussionsupporting

confidence: 78%

The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

et al. 2020

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“…The full-text versions of the remaining articles were reviewed for eligibility resulting in the exclusion of 224 for the reasons noted. Ultimately, 62 studies were included from the search, reporting on 60 unique patient samples 23 25–86…”

Section: Resultsmentioning

confidence: 99%

Exercise-based rehabilitation for major non-communicable diseases in low-resource settings: a scoping review

et al. 2019

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IntroductionWhile there is substantial evidence for the benefits of exercise-based rehabilitation in the prevention and management of non-communicable disease (NCD) in high-resource settings, it is not evident that these programmes can be effectively implemented in a low-resource setting (LRS). Correspondingly, it is unclear if similar benefits can be obtained. The objective of this scoping review was to summarise existing studies evaluating exercise-based rehabilitation, rehabilitation intervention characteristics and outcomes conducted in an LRS for patients with one (or more) of the major NCDs.MethodsThe following databases were searched from inception until October 2018: PubMed/Medline, Embase, CINAHL, Cochrane Library, PsycINFO and trial registries. Studies on exercise-based rehabilitation for patients with cardiovascular disease, diabetes, cancer or chronic respiratory disease conducted in an LRS were included. Data were extracted with respect to study design (eg, type, patient sample, context), rehabilitation characteristics (eg, delivery model, programme adaptations) and included outcome measures.ResultsThe search yielded 5930 unique citations of which 60 unique studies were included. Study populations included patients with cardiovascular disease (48.3%), diabetes (28.3%), respiratory disease (21.7%) and cancer (1.7%). Adaptations included transition to predominant patient-driven home-based rehabilitation, training of non-conventional health workers, integration of rehabilitation in community health centres, or triage based on contextual or patient factors. Uptake of adapted rehabilitation models was 54%, retention 78% and adherence 89%. The majority of the outcome measures included were related to body function (65.7%).ConclusionsThe scope of evidence suggests that adapted exercise-based rehabilitation programmes can be implemented in LRS. However, this scope of evidence originated largely from lower middle-income, urban settings and has mostly been conducted in an academic context which may hamper extrapolation of evidence to other LRS. Cost-benefits, impact on activity limitations and participation restrictions, and subsequent mortality and morbidity are grossly understudied.

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“…From these studies, Hassan et al stated that the number of comorbidities between responders and nonresponders for 6-MWD, MMRC, SGRQ, and VO 2 max measured after PR did not differ. 3,23 In another study by Higashimoto et al, it has been shown that the individual comorbidities have no relation to the PR results and PR has equal efficacy in young and elderly patients with COPD. 24 In contrast to our results, Crisafulli concluded that exercise tolerance and quality of life in COPD patients might be reduced due to comorbidity, and the CCI score was negatively correlated with the 6-MWD increase.…”

Section: Discussionmentioning

confidence: 99%

“…4 In many studies examining the effect of comorbidity on PR outcomes in COPD patients, they grouped patient according to the number of comorbidities as with no comorbidity, with only one comorbidity and with two or more comorbidities. 3,4,13,23 Unlike other studies, we examined the effect of comorbidity severity on PR outcomes. For this aim, we used the CCI that is a reliable, valid, and well correlated with mortality.…”

Section: Discussionmentioning

confidence: 99%

The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients

Naz

Şahin²,

Varol³

et al. 2018

Chron Respir Dis

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Chronic obstructive pulmonary disease (COPD) is not only associated with respiratory system involvement but also with systemic consequences leading to chronic comorbidities. In this study, we aimed to investigate the effect of comorbidity severity on pulmonary rehabilitation (PR) outcomes in COPD patients. We conducted a retrospective cohort study to compare the effectiveness of PR in COPD patients who completed an 8-week PR program. There were at least one comorbid in 120 of 211 patients and we divided them into the groups according to Charlson Comorbidity Index (CCI) scores (1 points, group 1 (n = 54); 2 points, group 2 (n = 41); 3 points, group 3 (n = 25)). We compared 6-minute walk distance (MWD), dyspnea perception, pulmonary function tests, blood gases analysis, quality of life, anxiety, and depression scores which were recorded before and after PR between the groups. Before PR 6-MWD distance was significantly lower in group 2 (p = 0.033). Improvements in 6-MWD, blood gas values, dyspnea perception, quality of life, and anxiety were determined in all groups after PR (p < 0.05). When the gains after PR were compared, there were no significant differences between groups (p > 0.05). COPD patients benefit from PR independent from their comorbidity severity. Comorbidity severity has no effect on PR gains. Therefore, patients with comorbidities should not be excluded from PR programs and encouraged to participate.Clinical Trial Number:NCT03319108.

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Effect of comorbidities on response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Cited by 7 publications

References 28 publications

The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

Exercise-based rehabilitation for major non-communicable diseases in low-resource settings: a scoping review

The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients

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