Repeated Pulmonary Rehabilitation in Severe and Disabled COPD Patients

Abstract

Background: The optimal frequency of delivering a pulmonary rehabilitation program (PR) is not yet a well established issue. It is still unclear whether repeated PR at established intervals will result in effective maintenance or further improvement in the patient’s health status. Objectives: To investigate whether more frequently repeated PR in patients with COPD (1) leads to similar short and long-term physiological gains, and (2) decreases the burden due to hospitalization. Methods: Thirty-five disabled COPD patients (FEV₁ below 50% predicted, MRC score 3) in a stable state were studied in a randomized controlled trial. After completing an initial inpatient PR program, they were randomly assigned to either group 1 (performing a second and a third PR after 6 and 12 months) or group 2 (performing only a second PR after 12 months). Results: Lung functions, exercise capacity (by means of a timed walk test – 6MWT), peak-effort dyspnea (D) and leg fatigue (F), and health-related quality of life by means of SGRQ were assessed prior to (T1, T3, T5) and after (T2, T4, T6) each PR program: the same measures were taken on an outpatient basis at T3 in group 2. The number of hospital admissions (HA) and days spent in the hospital (DH) were also recorded over the year. The two groups did not differ in any parameter at baseline. 6MWD, D, F and SGRQ improved to the same level (p = 0.05) after each PR in both groups. However, the baseline level of D, F and SGRQ symptoms and impact scores progressively improved over time in group 1 but not in group 2. After 12 months, a larger amount of patients in Group 1, as compared to Group 2, reported H10 DH/year (p < 0.0001). Conclusions: In severe and disabled COPD, a more frequently repeated inpatient PR may lead to some additional physiological and clinical benefits over 1 year.

Predictive Significance of the Six-Minute Walk Distance for Long-Term Survival in Chronic Hypercapnic Respiratory Failure

“…In line with this, 6-MWD in COPD is known to be valuable for clinical assessment, monitoring and prediction of survival [10,11,12,13,14,43,44,45]. Recent data even suggest that 6-MWD can indicate clinical changes not detectable in the sequential evaluation of pulmonary impairments alone [44].…”

“…Most of the evidence favoring 6-MWD in the evaluation of treatment effects [9,10,11,12] and prediction of survival has been obtained in COPD [8, 13, 14], consistent with the fact that COPD exhibits multiple systemic manifestations beyond the respiratory impairment itself [14,15,16,17,18], e.g. reductions in body mass index (BMI) and fat-free mass [4, 18], which affect 6-MWD [19].…”

Estimation of Minimal Clinically Important Difference in EQ-5D Visual Analog Scale Score After Pulmonary Rehabilitation in Subjects With COPD

“…15 Similarly, in a previous 2-y controlled study, Foglio et al 40 showed that successive, annual interventions lead to similar short-term gains but do not result in additive long-term physiologic benefits, except for the further reduction in the number of exacerbations. On the other hand, some additional physiological and clinical benefits were observed by Romagnoli et al 41 in a study in which subjects repeated PR programs more frequently, that is, every 6 months. However, we did not observe a significant difference in EQ-VAS change between subjects with COPD that had undergone a single PR program Shown are the results of Pearson's correlation coefficient (r) when all subjects are considered.…”

Home-Based Pulmonary Rehabilitation in Very Severe COPD

“…[10][11][12][13][14][15][16]19,36,37 Nevertheless, we are unaware of reports of home-based pulmonary rehabilitation programs that have included only patients receiving long-term oxygen treatment. The majority of previous studies have excluded such patients [10][11][12]14,15,17,18 programs where vital signs may be better monitored during exercise and better results may be achieved, 15,38,39 the reality is that this is not always possible. As Boxall et al 19 suggest and as our data support, severe COPD sufferers are frequently those who have the most difficulty in accessing hospital programs.…”