Effectiveness of pulmonary rehabilitation in individuals with Chronic Obstructive Pulmonary Disease according to inhaled therapy: The Maugeri study

Effect of Pulmonary Rehabilitation on COPD Assessment Test Items in Individuals Classified as GOLD Group E

“…Three out of eight items (breathlessness, activities at home, and energy) showed baseline mean values ≥3, indicating a high level of severity. Total CAT significantly improved (from 20.8 ± 7.8 to 12.4 ± 6.9 or 22 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) to 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), p < 0.001), 1,911 participants (86.3%) reaching the MCID. At baseline, 1,985 individuals (89.7%) had a total CAT score ≥10, while at the end of program, the number significantly decreased to 1,437 (64.9%) (p < 0.001).…”

“…However, analyzing data according to gender, age, or presence of CRF, some items showed a significantly greater improvement than others. This can be explained by (1) the different severity of baseline scores (e.g., item scores of individuals with CRF were higher than those of individuals without, Table 2), confirming that individuals with a worse baseline status are good responders to PR [8]; and/or (2) limited responsiveness of respective items. Indeed, as shown in Figure 4, only the presence of CRF was significantly associated with an improvement in total CAT higher than the MCID.…”

“…We analyzed data of individuals with: (i) diagnosis of COPD as defined by DRG 49120 and 49121; (ii) use of inhaled therapy according to COPD guidelines: long-acting muscarinic antagonist and/or long-acting beta2-agonist, with or without inhaled corticosteroids [1, 8]; (iii) classified into GOLD group E; (iv) history of ECOPD within 30 days prior to admission; availability of paired data of pre- and post-PR CAT.…”

“…Exclusion criteria were data of individuals dead or transferred to acute hospitals, included in GOLD groups A or B; missing data of CAT score at admission and/or discharge; data of individuals with oncological, neurological, heart failure, ischemic cardiovascular diseases. Part of the data from the database has been published elsewhere [7, 8].…”

“…The ICS Maugeri network hospitals share a PR program supervised by a multidisciplinary team consisting of chest physicians, nurses, physical therapists, dieticians, and psychologists, as previously described [7, 8, 12]. The standard in-hospital program includes the optimization of drug therapy, education [20], nutritional programs, and psychosocial counseling when appropriate, and at least 22 sessions over a period of 3–4 weeks of supervised and incremental cycle exercise training according to Maltais et al [21] until performing 30-min continuous cycling at 50–70% of the maximal load calculated on the baseline 6MWT according to Luxton et al [22] Peripheral limb muscle activities are also performed.…”