Pulmonary rehabilitation after acute exacerbation of chronic obstructive pulmonary disease in patients who previously completed a pulmonary rehabilitation program

Abstract

Purpose: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impair health-related quality of life (HRQL). We evaluated the effect of an abbreviated repeat pulmonary rehabilitation (PR) program on HRQL after an AECOPD.

Methods: Patients who had completed PR were followed for up to 12 months to identify an AECOPD and then placed in randomized groups to receive a 3-week repeat-PR intervention or usual care. Measures of HRQL (Chronic Respiratory Disease Questionnaire, CRQ) and functional exercise capacity (6-minute walk distance, 6MWD) were collected at 2 (T(1)), 5 (T(2)), and 12 weeks (T(3)) post-AECOPD. The repeat-PR program was undertaken between T(1) and T(2). Between-group differences were examined using repeated- measures analysis of variance or covariance.

Results: Of the 60 patients (30 men, age 69+/-8 years, forced expiratory volume in 1 second 0.86+/-0.40 L, 6MWD 367+/-99 m) followed, 41 experienced an AECOPD 14 +/- 11 weeks after completion of the initial PR program and 33 completed the study. Of these, 16 and 17 were randomized to the intervention and control groups, respectively. No between-group differences were demonstrated at T(2) or T(3). With the exclusion of 5 subjects who experienced a second AECOPD between T(1) and T(3), the participants in the intervention group demonstrated greater reduction in dyspnea when compared to those in the control group at T(3) (0.8+/-1.6 vs -0.4+/-1.3 points per item, P = .04).

Conclusions: The reduction in dyspnea in those who did not experience a second AECOPD provides preliminary evidence for the role of repeat programs. The application of repeat PR should be refined in larger trials.