Physical and affective components of dyspnoea are improved by pulmonary rehabilitation in COPD

Abstract

BackgroundDyspnoea is a multidimensional experience of breathing discomfort, but its affective dimension is unfrequently assessed in people with chronic obstructive pulmonary disease (COPD). We evaluated the effectiveness of a home-based pulmonary rehabilitation (PR) programme on the physical and affective components of dyspnoea assessed by the Dyspnoea-12 (D-12) questionnaire. We also determined the baseline characteristics that contributed to the change in D-12 scores.MethodsIn this retrospective study, 225 people with COPD (age, 65±11 years; forced expiratory volume in 1 s (FEV1), 35±15% of predicted value) were enrolled into a person-centric home-based PR, consisting of a weekly supervised 90 min home session during 8 weeks. D-12 questionnaire, health status, anxiety and depressive symptoms, exercise tolerance and general fatigue were assessed at baseline (M0), at the end of PR programme (M2), and 8 (M8) and 14 months (M14) after M0. Multivariable analysis of covariance (ANCOVA) models were performed to identify the baseline characteristics that contributed to the change in D-12 scores.ResultsBoth physical and affective components of dyspnoea and all the other outcome measures were improved at M2, M8 and M14 compared with baseline (p<0.05). Baseline body mass index was the only significant independent predictor of the changes in physical dyspnoea score, while the change in the affective dimension of dyspnoea after PR was associated with FEV1, anxiety symptoms and exercise tolerance (6 min stepper test). However, since these variables had only a small impact on the changes in D-12 questionnaire scores, results from the ANCOVA analysis should be taken cautiously.ConclusionBoth physical and affective components of dyspnoea were improved, at short term and long term, by 8 weeks of individualised home-based PR. The present results support the importance of assessing dyspnoea as a multidimensional experience during PR, warranting replication by robustly designed randomised and controlled studies.

Effectiveness of endurance training rehabilitation after hospitalisation in intensive care for COVID-19-related acute respiratory distress syndrome on dyspnoea (RECOVER): a randomised controlled, open-label multicentre trial

“…A concomitant improvement of the physical component of the SF-12 quality of life scale was observed, without significant modification neither of mental component nor of the global quality of life. Whereas physiotherapy has been used for a long time, little data exists concerning the procedure's implementation, leading to an important variability from one physiotherapist to another for a given patient [25][26][27]. Management of patients with chronic respiratory insufficiency and dyspnoea in ETR is however based on the standardisation of the procedure, allowing accurate evaluation of the treatment effectiveness on breathlessness and quality of life.…”

“…Another explanation could be a lack of power. Using a more sensitive evaluation tool, such as the Short Form-36, might have been able to detect a difference, as previously demonstrated in COPD or in COVID-19 [25][26][27]. The SF-36 was actually our first choice for assessing QOL but, for practical and temporal reasons during the pandemic, we ultimately opted for the more time-efficient SF-12.…”

“…A large combination of organ dysfunctions, not affected by physiotherapy, such as ageusia, headaches, hair loss, intestinal disorders may play a major part in global quality of life, especially in a young population with few comorbidities [14]. Another explanation suggested by Grosbois et al would be that anxiety and depression (mental component of SF-12) seem to have a greater impact on dyspnoea compared than the physical component [27]. Therefore, an improvement in dyspnoea could have a greater effect on the physical rather than on the mental part of QOL.…”

Improving the wellbeing of caregivers of patients with COPD using a home-based pulmonary rehabilitation programme

“…Data was collected from January 2018 to December 2019. Details regarding the referral and criteria selection of the patients with COPD, and the home-based PR programme can be found elsewhere [22,23].…”

Effectiveness of a home-based pulmonary rehabilitation programme in people recovering from a severe and critically COVID-19 infection

“…The home-based PR was offered by a private company ( FormAction Santé ) that has been offering this model of intervention for people with chronic respiratory disease for over a decade [ 8 , 9 ]. Details regarding the ethical approval (CEPRO 2021-054), informed consent of participants, and PR programme can be found elsewhere.…”