Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial

Abstract

Background: The effectiveness of pulmonary rehabilitation in advanced COPD is well established, but few data are available in less advanced disease. Methods: In a 2 year randomised controlled trial, 199 patients with an average moderate airflow obstruction but impaired exercise capacity (mean (SD) forced expiratory volume in 1 s (FEV 1 ) 60 (16)%, peak work load (Wmax) ,70%) were randomised to the INTERdisciplinary COMmunity-based COPD management programme (INTERCOM) or usual care. Intervention consisted of 4 months multidisciplinary rehabilitation followed by a 20-month maintenance phase. Outcomes (4, 12, 24 months): health-related quality of life (St George's Respiratory Questionnaire (SGRQ)), exacerbation frequency, MRC dyspnoea score, cycle endurance time (CET), 6-minute walking distance (6MWD), skeletal muscle strength and patients' and caregivers' perceived effectiveness. Conclusions: This study shows that a multidisciplinary community-based disease management programme is also effective in patients with COPD with exercise impairment but less advanced airflow obstruction. Trial registration number: NCT00840892In patients with advanced chronic obstructive pulmonary disease (COPD), beneficial effects of pulmonary rehabilitation programmes on exercise capacity, dyspnoea and quality of life are well established.

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…Of these, 58 were considered potentially relevant and 23 studies 17,18,19,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50 met the eligibility criteria and were included in this review. One of the selected studies appeared in two distinct publications 49,50 in which the same intervention was applied to the same patients but describing different outcomes.…”

“…Thirteen studies were done in Europe 17,19,21,31,33,38,42,43,45,46,48,49,50 , six in Asia 30,36,39,40,44,47 , two in Australasia 34,35 , one in North America 41 , and one in South America 32 . Among the studies included in the review, 19 17,18,19,30,31,32,33,34,36,38,39,40,42,43,44,46,47,48,49,50 compared HCPR to control group (n = total 893; n HCPR = 485), while four 35,37,41,45 compared HCPR to OPR (n total = 375; n HCPR = 178). No studies reported harmful effects related to HCPR during interventions.…”

“…Four studies 19,38,43,48 (n = 280) evaluated dyspnea using the MRC. The meta-analysis indicated significant improvement in the 6MWT (33.79 meters, 95%CI: 6.03 to 61.54, I 2 = 76%), but due to the high heterogeneity, a subgroup analysis was done on studies including patients with FEV 1 above and below 50% of predicted.…”

“…• Analysis 1: HCPR vs. control group (a) Functional Capacity and Dyspnea: Ten studies 30,31,33,36,40,44,46,47,48,50 (n = 461) assessed functional capacity with the 6MWT and seven used the ISWT 18,32,34,38,39,42,43 (n = 321). Four studies 19,38,43,48 (n = 280) evaluated dyspnea using the MRC.…”

COPD in primary care: from episodic to continual management

“…[2][3][4] Clinical trials have shown that inhaled bronchodilators and to a lesser extent corticosteroids improve symptoms and reduce exacerbations. 2,5,6 Notably, recent studies suggest that lung function decline is fastest in early instead of advanced COPD, and that maintenance treatment with inhaled medication is also beneficial in moderate, and not only in severe, obstruction.…”