Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction

Abstract

The aim of this study was to evaluate the long-term outcome of an outpatient pulmonary rehabilitation programme (PRP) in patients with chronic airway obstruction (CAO).In 61 CAO patients (35 asthmatics and 26 chronic obstructive pulmonary disease (COPD)) lung and respiratory muscle function, exercise tolerance (by symptom limited cycloergometer and walking tests), dyspnoea (Borg scale, visual analogue scale (VAS), baseline and transitional dyspnoea index (BDI and TDI, respectively)) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were assessed at baseline (t0), at discharge (t1) and 12 months postdischarge (t2). Preprogramme and postprogramme hospital admissions and exacerbations of disease were also recorded.In comparison with baseline, no significant change was observed in lung function tests in either diagnostic group, either at t1 or at t2. In both groups improvements in respiratory muscle strength, exercise tolerance, Borg scale and VAS reported at t1 were partially reduced at t2. Analysis of variance showed that these changes over time were similar in the two groups. Mean values of SGRQ and BDI/TDI improved at t1, and, unlike exercise tolerance, did not worsen at t2. However, a clinically relevant difference in SGRQ between t2 and t0 was reported only in 56% of asthmatics and 52% of COPD patients. Compared with the preceding 2 yrs, in the year following PRP, hospital admissions and disease exacerbations decreased significantly in both diagnostic groups.Regardless of diagnosis, patients with chronic airway obstruction who underwent an outpatient pulmonary rehabilitation programme maintained an improved quality of life 12 months postdischarge despite a partial loss of the improvement in exercise tolerance. Eur Respir J 1999; 13: 125±132.

The Feasibility of Recording Speech Breathing Patterns before and after Pulmonary Rehabilitation in an Out-Patient Environment

“…However, despite the improvement in walking distance, in our study modified Borg scores did not significantly change between the first and last PR assessment. Most studies that have observed significant improvements in modified Borg Scores following PR have reported higher breathlessness scores at baseline (>5) [14,[22][23][24]. In contrast, the average resting modified Borg Score in this study was found to be very low at baseline (equating to 'very mild shortness of breath'), and remained low after the six week PR programme.…”

Pulmonary rehabilitation and the BODE index in COPD

“…This confirms the results of previous studies [20,21] that showed a significant improvement in hospitalisation rate and hospital stay after pulmonary rehabilitation. Prior studies assessing the long-term effects of PR have reported that gains in health-related quality of life and HCRU, persist for up to 2 yrs following PR, and that other outcomes, such as improvements in dyspnoea and functional capacity, are lost if patients fail to remain active [26,27,36]. In the current study, 29% of PR graduates joined a supervised maintenance exercise programme and continued to exercise (three times per week) throughout their observational period, and as many as 49% of graduates reported that they continued to exercise on a regular basis for at least 1 yr following PR.…”

Maintenance of inspiratory muscle training in COPD patients: one year follow-up

“…While it is well documented that the benefits of multidisciplinary pulmonary rehabilitation gradually decline over 1 or 2 yrs [10][11], the long-term effects of IMT were investigated to a much lesser extent in COPD.…”