Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

Moore, Elizabeth; Newson, Roger; Joshi, Miland; Palmer, Tom; Rothnie, Kieran J; Singh, Sally; Majeed, Azeem; Soljak, Michael; Quint, Jennifer K

doi:10.1016/j.chest.2017.05.006

Cited by 33 publications

(28 citation statements)

References 34 publications

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“…Despite the evidence-base, as well as universal inclusion of PR in management guidelines for COPD (34), there is global underutilization of PR both in stable outpatients and patients hospitalized with AECOPD (35,36). Recent data have shown there are multiple barriers at all levels of the post-AECOPD PR patient pathway.…”

Section: Challenges In Delivering Pr Following An Aecopdmentioning

confidence: 99%

Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease

Jones¹,

Barker²,

Nolan³

et al. 2018

J. Thorac. Dis.

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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are one of the most common causes of emergency hospital admission and place great burden upon healthcare systems. Furthermore, AECOPD represent an important life event for patients, and are associated with significant reductions in physical activity, skeletal muscle function, exercise tolerance and health-related quality of life. Pulmonary rehabilitation, an intervention comprising supervised exercise-training and education, may counteract these negative consequences and target modifiable risk factors for hospital readmission. A recent Cochrane systematic review included 20 randomized controlled trials comparing pulmonary rehabilitation after exacerbation of COPD versus conventional care. Overall, the evidence supports moderate to large effects on health-related quality of life and exercise capacity. However, there is substantial heterogeneity across studies, and more recent studies have been more equivocal, including around hospital readmissions, particularly when rehabilitation is started in the inpatient setting. In this narrative review, we examine the rationale for pulmonary rehabilitation following AECOPD with a particular focus on skeletal muscle function, review the current evidence for pulmonary rehabilitation in the AECOPD setting, and identify areas that require future research, including the structure and nature of the intervention, improving uptake and adherence, and the role of alternative rehabilitation strategies for patients with AECOPD.

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Section: Challenges In Delivering Pr Following An Aecopdmentioning

confidence: 99%

Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease

Jones¹,

Barker²,

Nolan³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Interestingly, the GOLD document recommends the addition of a second bronchodilator as the logical step‐up to single‐agent bronchodilation . However, respiratory rehabilitation has been shown to yield relevant clinical benefits to patients with a good efficacy/safety profile . These findings have led clinicians to debate whether an increase to a second LABD or implementation of a respiratory rehabilitation programme would be the best strategy for a patient with persistent symptoms.…”

Section: Step Up From Single To Double Bronchodilationmentioning

confidence: 99%

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

et al. 2018

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The implementation of potential new step-up or step-down treatment recommendations in response to current guidelines is one of the main challenges currently faced in actual daily practice settings. In the present narrative review, we aim to discuss the relevance of these step-up and step-down proposals at the patient level in daily clinical practice. In particular, we aim to review the challenges associated with inhaled maintenance therapy for chronic obstructive pulmonary disease (COPD) in four clinical scenarios. First, we discuss the step up from single to double bronchodilation, including current controversies regarding the addition of a second bronchodilator versus initial treatment with two bronchodilators. Second, we discuss the step up from double bronchodilation to triple therapy while challenging current indications for inhaled steroid therapy and discussing triple therapy designs. Third, we discuss the step down from triple therapy to double bronchodilation while evaluating the effect of this downshift in risk categories on the patient according to the new classifications. Finally, we discuss the step down from double to single bronchodilation, with a special focus on safety. We believe this review will help to highlight the most relevant discussion points regarding the treatment of COPD in a manner that will stimulate and guide related clinical research.

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“…However, the availability of repeat recordings and multiple types of data (including examination findings, pathology results and onwards referrals) over a long period of time can be used to improve and validate the classification of diagnoses and other important exposures and outcomes. Many disease definitions have been validated already -for example, definitions of COPD and asthma in the GOLD-CPRD database -and EXCEED will contribute further to this important area of study [53][54][55][56][57][58][59]. In addition to disease status validation, combining records of drug prescriptions, diagnostic and symptom codes can be used define complex phenotypes that have not been possible to study previously.…”

Section: What Are the Main Strengths And Weaknesses?mentioning

confidence: 99%

Cohort Profile: Extended Cohort for E-health, Environment and DNA (EXCEED)

John

Reeve

Free

et al. 2018

Preprint

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EXCEED is a longitudinal population-based cohort which facilitates investigation of genetic, environmental and lifestyle-related determinants of a broad range of diseases and of multiple morbidity through data collected at baseline and via electronic healthcare record linkage. Recruitment has taken place in Leicester, Leicestershire and Rutland since 2013 and is ongoing, with 10 156 participants aged 30-69 to date. The population of Leicester is diverse and additional recruitment from the local South Asian community is ongoing. Participants have consented to follow-up for up to 25 years through electronic health records (EHR). Data available includes baseline demographics, anthropometry, spirometry, lifestyle factors (smoking and alcohol use) and longitudinal health information from primary care records, with additional linkage to other EHR datasets planned. Patients have consented to be contacted for recall-by-genotype and recall-by-phenotype sub-studies, providing an important resource for precision medicine research. We welcome requests for collaboration and data access by contacting the study management team via exceed@le.ac.uk.

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Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

Cited by 33 publications

References 34 publications

Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease

Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

Cohort Profile: Extended Cohort for E-health, Environment and DNA (EXCEED)

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