A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients

Altenburg, Wytske A.; Greef, M.H.G. de; Hacken, Nick H. T. ten; Wempe, Johan B.

doi:10.1016/j.rmed.2011.11.008

Cited by 41 publications

(42 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar evidence has been reported in patients with COPD [24,31,32] . As well as for patients with COPD, it is conceivable that even patients with non-CF bronchiectasis and a poor baseline lung function are at risk of entering a downward spiral of dyspnea, sedentariness, demotivation, and, finally, deconditioning [33] .…”

Section: Discussionsupporting

confidence: 87%

Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis Bronchiectasis: A Retrospective Analysis of Clinical and Functional Predictors of Efficacy

et al. 2015

View full text Add to dashboard Cite

sures after PR was assessed. Both univariate and multiple logistic analyses were performed to evaluate the presence of independent predictors of the efficacy of PR. Results: One hundred and eight patients [49 males, mean age 71 years, mean forced expiratory volume in 1 s (FEV 1 ) 76% predicted] were included. After PR, there was a significant improvement in 6MWD, TDI, and EQ-VAS score (p < 0.001). Changes in 6MWD and EQ-VAS score correlated with baseline FEV 1 , FEV 1 /vital capacity (VC), residual volume, transfer factor of the lung for carbon monoxide, and the number of exacerbations in the previous year. Both univariate and multivariate logistic regression analyses showed that male gender, baseline FEV 1 /VC <70%, and >2 exacerbations in the previous year were independent predictors of PR efficacy in terms of an improvement in 6MWD. Conclusions: Our study supports the inclusion of patients with bronchiectasis in PR programs. Clinical and functional baseline findings partially predict the response to PR in terms of exercise tolerance. Further prospective, randomized, controlled trials are needed. © 2015 S. Karger AG, Basel Key Words Bronchiectasis · Pulmonary rehabilitation · Predictors of efficacy Abstract Background:International guidelines recommend the inclusion of patients with bronchiectasis in pulmonary rehabilitation (PR) to improve exercise capacity and health-related quality of life (HRQoL). At present, the effect of PR in these patients has been poorly investigated. Objective: The aim of our retrospective analysis was to evaluate the effects and predictors of success for a PR program in patients with bronchiectasis not related to cystic fibrosis (non-CF bronchiectasis). Methods: One hundred and thirty-five non-CF bronchiectasis inpatients, allocated to a 3-week PR program, were retrospectively evaluated. Exercise capacity (6-min walk distance, 6MWD), dyspnea (Baseline/Transition Dyspnea Index, BDI/TDI), and HRQoL [EuroQol visual analogue scale (EQ-VAS)] were assessed before and after PR. The relationship between baseline parameters and changes in outcome mea-

show abstract

Section: Discussionsupporting

confidence: 87%

Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis Bronchiectasis: A Retrospective Analysis of Clinical and Functional Predictors of Efficacy

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Moreover, the PR program improved static and dynamic lung volumes, exercise tolerance and dyspnea perception regardless of the severity of airflow limitation. Despite the many clinical trials conducted in severe patients with COPD and the contrasting results [21,23,24,25,26,27], our data support the idea that no patients, neither those with moderate disease nor the more severely hyperinflated [28], should be excluded from a PR workout. Our data are in line with recent reports that describe an increase in FEV 1 of 99 ml paralleled by a reduction in RV of 240 ml after a 3-week PR program in severe COPD patients [21], while a recent physiological study in 22 severe COPD patients by de Albuquerque et al [29] has reported important improvements in static lung volumes after 8 weeks of exercise training, although the difference was not significant.…”

Section: Discussioncontrasting

confidence: 47%

“…Predicted values for lung function variables are from Quanjer [22]. As the literature on the effect of PR on D LCO is scarce, the study was powered considering previous reports that investigated lung volume changes following PR in COPD [23]. Considering a 10% dropout rate and the need for a subgroup analysis, we set the minimum target number for the study population to be around 200 patients.…”

Section: Methodsmentioning

confidence: 99%

Improvements in Lung Diffusion Capacity following Pulmonary Rehabilitation in COPD with and without Ventilation Inhomogeneity

et al. 2016

View full text Add to dashboard Cite

Background: Lung diffusing capacity (DLCO) and lung volume distribution predict exercise performance and are altered in COPD patients. If pulmonary rehabilitation (PR) can modify DLCO parameters is unknown. Objectives: To investigate changes in DLCO and ventilation inhomogeneity following a PR program and their relation with functional outcomes in patients with COPD. Methods: This was a prospective, observational, multicentric study. Patients were evaluated before and after a standardized 3-week PR program. Functional assessment included body plethysmography, DLCO, transfer factor (KCO) and alveolar volume (VA), gas exchange, the 6-min walking test (6MWT) and exercise-related dyspnea. Patients were categorized according to the severity of airflow limitation and presence of ventilation inhomogeneity, identified by a VA/TLC <0.8. Results: Two hundred and fifty patients completed the study. Baseline forced expiratory volume in 1 s (FEV₁) % predicted (mean ± SD) was 50.5 ± 20.1 (76% males); 137 patients had a severe disease. General study population showed improvements in 6MWT (38 ± 55 m; p < 0.01), DLCO (0.12 ± 0.63 mmol × min^-1 kPa^-1; p < 0.01), lung function and dyspnea. Comparable improvements in DLCO were observed regardless of the severity of disease and the presence of ventilation inhomogeneity. While patients with VA/TLC <0.8 improved the DLCO increasing their VA (177 ± 69 ml; p < 0.01), patients with VA/TLC >0.8 improved their KCO (8.1 ± 2.8%; p = 0.019). The latter had also better baseline lung function and higher improvements in 6MWT (14.6 ± 6.7 vs. 9.0 ± 1.8%; p = 0.015). Lower DLCO at baseline was associated with lower improvements in 6MWT, the greatest difference being between subjects with very severe and mild DLCO impairment (2.7 ± 7.4 vs. 14 ± 2%; p = 0.049). Conclusions: In COPD patients undergoing a PR program, different pathophysiological mechanisms may drive improvements in DLCO, while ventilation inhomogeneity may limit improvements in exercise tolerance.

show abstract

“…In a randomized controlled trial of a home-based 12-week training program involving 58 severe or very severe COPD patients, a significant increase could be demonstrated (p < 0.008) [10]. In another, nonrandomized observational study of 102 COPD patients who followed a 7-week program of pulmonary rehabilitation, the authors came to the conclusion that patients with worse disease status (combination of lower FEV 1 , more hyperinflation, lower exercise capacity, and worse quadriceps force) improved most in endurance exercise capacity [18]. …”

Section: Discussionmentioning

confidence: 99%

Effect of a Three-Week Inpatient Rehabilitation Program on 544 Consecutive Patients with Very Severe COPD: A Retrospective Analysis

et al. 2015

View full text Add to dashboard Cite

Background: Pulmonary rehabilitation improves exercise capacity, symptoms, and quality of life in chronic obstructive pulmonary disease (COPD) patients, and is therefore recommended in all stages of the disease. However, there are insufficient data on patients with very severe disease. Objective: To describe the effect of an in-house multidisciplinary pulmonary rehabilitation program on patients with very severe COPD. Methods: We performed a retrospective analysis of 544 consecutive patients with very severe COPD (FEV₁ 0.97 ± 0.26 l) that underwent an in-house pulmonary rehabilitation program (23.44 ± 4.97 days). The studied outcome parameters were the 6-min walk test (6-MWT), health-related quality of life as analyzed by the COPD Assessment Test (CAT) and a dyspnea score [modified Medical Research Council (mMRC) scale], and lung function [forced expiratory volume in 1 s (FEV₁) and residual volume (RV)]. Results: We found significant improvements regarding 6-MWT scores (from 321.93 ± 115.67 to 365.82 ± 111.79 m; p < 0.001), CAT scores (from 23.21 ± 6.75 to 19.57 ± 7.35; p < 0.001), mMRC scale scores (from 3.17 ± 1.14 to 2.81 ± 1.22; p < 0.001), and FEV₁ (from 0.97 ± 0.26 to 1.08 ± 0.33 l; p < 0.001). A number of baseline variables were significantly correlated with the improvements that occurred during the program (Δ): baseline 6-MWT with Δ6-MWT (r = -0.316; p < 0.001), baseline CAT with ΔCAT (r = -0.302; p < 0.001), baseline mMRC with ΔmMRC (r = -0.444; p < 0.001), and baseline RV with ΔRV (r = -0.284; p < 0.001), demonstrating that improvements were more pronounced in patients with worse baseline characteristics. Patients on long-term oxygen therapy (LTOT) exhibited significantly greater improvements regarding CAT than patients not on LTOT. Conclusion: Patients with very severe COPD exhibit clinically meaningful improvements when undergoing pulmonary rehabilitation.

show abstract

A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients

Cited by 41 publications

References 35 publications

Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis Bronchiectasis: A Retrospective Analysis of Clinical and Functional Predictors of Efficacy

Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis Bronchiectasis: A Retrospective Analysis of Clinical and Functional Predictors of Efficacy

Improvements in Lung Diffusion Capacity following Pulmonary Rehabilitation in COPD with and without Ventilation Inhomogeneity

Effect of a Three-Week Inpatient Rehabilitation Program on 544 Consecutive Patients with Very Severe COPD: A Retrospective Analysis

Contact Info

Product

Resources

About