Seven-year time course of lung function, symptoms, health-related quality of life, and exercise tolerance in COPD patients undergoing pulmonary rehabilitation programs

Katia Foglio, Luca Bianchi, Gisella Bruletti, Roberto Porta, Michele Vitacca, Bruno Balbi, Nicolino Ambrosino
Respiratory Medicine 2007, 101 (9): 1961-70

AIM: To evaluate the long-term course of outcome indexes in patients with chronic obstructive pulmonary disease (COPD) undergoing repeated pulmonary rehabilitation programs (PRP).

DESIGN: Prospective, observational study.

SETTING: Pulmonary Rehabilitation Center.

PATIENTS: Forty-eight COPD patients (M 33, age 59.6+/-8.9 years, forced expiratory volume in 1s (FEV(1)) 58+/-16% predicted, DLCO 71+/-17% predicted.) undergoing 5 Day-Hospital based PRPs in a period of 7.2+/-0.8 years.

MEASUREMENTS: Lung function, exercise capacity (incremental cycloergometry, test-6-minute walking test (6MWD)), dyspnoea (Baseline-BDI and Transitional-TDI Dyspnoea Index and Medical Research Council score-MRC), health-related quality of life (HRQL) (St. George Respiratory Questionnaire (SGRQ), and the derived BODE index were assessed pre and post each PRP.

RESULTS: During follow-up, patients showed a 18+/-22 (mean+/-SEM)ml/year FEV(1) decline (95%CI: -24.4 to 11.6; p<0.001). Exercise tolerance and BDI remained stable over time whereas SGRQ improved (DeltaSGRQ total score: -9.6+/-14%, p<0.001). BODE index significantly worsened (from 1.27+/-1.14 to 1.98+/-1.64; p<0.001), being this change mainly attributable to worsening in FEV(1). Each PRP elicited significant improvement in exercise capacity, dyspnoea, SGRQ and BODE score. Post-PRP improvements in 6MWD, MRC and TDI were higher after the first three than after the last two PRPs (p<0.001), whereas the greatest gain in SGRQ was observed after PRP1 and then it was lower (p<0.03) but stable in the following periods of observation.

CONCLUSION: Despite progressive lost in effectiveness of repeated PRP, COPD patients undergoing those programs do not show any significant worsening in exercise tolerance, dyspnoea and HRQL along a period of 7 years.

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