Outpatient pulmonary rehabilitation following acute exacerbations of COPD

Abstract

Background Exacerbations of chronic obstructive pulmonary disease (COPD) are characterised by increased dyspnoea, reduced quality of life and muscle weakness. Re-exacerbation and hospital admission are common. Pulmonary rehabilitation (PR) administered after hospital admission for an exacerbation can improve quality of life and exercise capacity. Objective To determine whether outpatient postexacerbation PR (PEPR) could reduce subsequent hospital admission episodes. Methods Patients admitted to hospital for an exacerbation of COPD were randomised to receive either usual follow-up care (UC) or PEPR after discharge. Hospital admission and emergency department attendances for COPD exacerbations were recorded over a 3-month period and analysed on an intention-to-treat basis. Secondary outcomes included exercise capacity and quadriceps strength. Results 60 patients underwent concealed randomisation at the time of their hospital discharge (UC: n¼30, mean (SD) age 65 (10) years, forced expiratory volume in 1 s (FEV 1 ) 52 (22)% predicted; PEPR: n¼30, 67(10) years, 52 (20)% predicted). The proportion of patients readmitted to hospital with an exacerbation was 33% in the UC group compared with 7% in those receiving PEPR (OR 0.15, 95% CI 0.03 to 0.72, p¼0.02). The proportion of patients that experienced an exacerbation resulting in an unplanned hospital attendance (either admission or review and discharge from the emergency department) was 57% in the UC group and 27% in those receiving PEPR (OR 0.28, 95% CI 0.10 to 0.82, p¼0.02). Conclusions Post-exacerbation rehabilitation in COPD can reduce re-exacerbation events that require admission or hospital attendance over a 3-month period. Clinical Trials Registration Number NCT00557115.

Twice versus three-times weekly pulmonary rehabilitation in a real-life clinical setting

“…Our patient outcomes are similar to others (that came mainly from more established academic units) 6,8,14,15,18 and this helps to validate our PRP by confirming benefits within an everyday clinical setting. This indicates that PRPs should be offered in a non-teaching group of hospitals.…”

“…), intensity and type of exercises, educational, psychological and behavioural components, oxygen supplementation, what outcomes to measure and total duration [3][4][5][6][7] . However, there still remain unanswered questions including what are the best sites for delivery of a PRP, whether nutritional supplementation should be offered during PRP, what are optimal target populations and what post-rehabilitation maintenance strategies reduce the declines seen in nearly all settings [7][8][9] .…”

Chronic obstructive pulmonary disease: consequences beyond the lung

“…13 Recent data show that provision of pulmonary rehabilitation early after an exacerbation can restore function, with a number needed to treat of only four to prevent one readmission. [14][15][16] Reduced inspiratory muscle pressures are also common in COPD. These occur largely as a consequence of hyperinflation which flattens and shortens the diaphragm, placing it at a mechanical disadvantage, rather than because of intrinsic muscle problems.…”

Lung transplantation for chronic obstructive pulmonary disease

“…Pulmonary rehabilitation in COPD improves exercise capacity, 43 reduces hospitalization days, 44 reduces readmissions for acute exacerbation, 45 reduces dyspnea, 46 and improves health related quality of life. 44,46 Among patients referred for lung transplantation, a short-term pulmonary rehabilitation program utilizing Nordic walking improved dyspnea, 6 minute walk, and quality of life.…”