Effect of Pulmonary Rehabilitation in Patients with Asthma COPD Overlap Syndrome: A Randomized Control Trial

Abstract

Objectives We sought to evaluate the effectiveness of six weeks pulmonary rehabilitation (PR) in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). Methods We enrolled 28 patients with ACOS. Fourteen patients were randomly allocated to the PR group, which comprised of supervised endurance training, supervised resistance training, breathing exercises, self management, and education. The other 14 patients were allocated to the control group, who were asked to continue their usual routine strategies for six weeks. All patients were assessed at baseline and after six weeks using the six minute walk test (6MWT), St George Respiratory Questionnaire (SGRQ), pulmonary function test (PFT), and Bode index (BI). Results We saw a significant improvement in 6MWT ( p = 0.001), SGRQ ( p = 0.007), and BI ( p < 0.001) in the PR group after six weeks compared to the control group. There was no significant difference between the groups for PFT ( p = 0.182) after six weeks. Conclusions Use of a short-term PR program in ACOS patients results in favorable changes in functional capacity, health-related quality of life, and BI. However, short-term PR was not sufficient to register changes in pulmonary function in these patients.

A Promising Intervention for Comprehensive Pulmonary Rehabilitation for Asthma COPD Overlap Syndrome

“…We read with great interest the article by Orooj et al, entitled: "Effect of Pulmonary Rehabilitation in Patients with Asthma COPD Overlap Syndrome: A Randomized Control Trial" published in the May 2020 issue of the Oman Medical Journal . 1 Firstly, we would like to congratulate the authors for sharing the first randomized control trial that assessed the effectiveness of a comprehensive six-week pulmonary rehabilitation (PR) program in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). The PR program was an institution-based, which is highly recommended considering the high possibility of cardiopulmonary adverse events in an intervention that has not been investigated among the ACOS population.…”

Letter in Reply: A Promising Intervention for Comprehensive Pulmonary Rehabilitation for Asthma COPD Overlap Syndrome

“…We acknowledge the inclination of the authors for the investigation conducted by us. 1 We appreciate their scrutiny of our investigation 2 and would like to address the issues raised by them with a holistic approach.…”

“…As per the American Thoracic Society/European Respiratory Society, 3 pulmonary rehabilitation (PR) is a comprehensive approach in which structured program educating on self-management is considered one of the key components of comprehensive PR. Our randomized control trial aimed to assess the effect of a comprehensive PR program in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) 2 ; therefore, it became imperative that the control group should be excluded from receiving any form of intervention (either exercise/education) that is a part of comprehensive PR. 3 This is also in accordance with a previously conducted investigation 4 else this inclusion might have made the study design less rigorous and could have affected the outcomes of the investigation.…”

“…As per the ethical principle of ‘risk-benefit balance’, the rule of thumb is that a control intervention should commensurate to the best available treatment or provided with the best usual care. 7 Keeping this balance into consideration, none of the participants in our study 2 were deprived of receiving the standard medical care along with usual strategies similar to previously conducted studies. 4 , 5 The control group was further enrolled in the PR-program after completion of the investigation.…”

“…The authors are right to point out that within-group comparisons can be incorporated as our investigation aimed to elucidate the effect between the groups, so we were less inclined regarding within-group significance, but we have depicted mean and standard deviation for both the groups at baseline as well as after six-weeks in Table 2 . 2 …”