[A randomized controlled trial study of pulmonary rehabilitation with respiratory physiology as the guide on prognosis in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To observe the effect of pulmonary rehabilitation with respiratory physiology as guide in patients with chronic obstructive pulmonary disease (COPD).

METHODS: Sixty patients of severe and very severe COPD as categorized by global proposed diagnostic criteria for COPD (GOLD, 2006) were enrolled for study. They were randomly divided into three groups, and with 20 patients in each group. The patients in group A were given pulmonary rehabilitation guided by respiratory physiology thrice a day, 15 minutes each time for 8 weeks. The patients in group B were given pulmonary rehabilitation with pursed lip respiration thrice a day, 15 minutes per time for 8 weeks. The patients in group C were given no pulmonary rehabilitation. Six minute-walk-distance (6MWD), medical research council (MRC) dyspnea scale, activities of daily living (ADL), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and quality of life (QOL) were determined before and after respective pulmonary rehabilitation course.

RESULTS: (1) There were 3, 5, 5 patients in group A, group B, group C dropped off in the course of rehabilitation respectively. (2) The patients' MRC grade after pulmonary rehabilitation in group A and group B decreased compared with that before pulmonary rehabilitation (both P<0.01), but the difference was not significant between two groups (P>0.05). (3) 6MWD, ADL, MEP, MIP of patients in group A and group B increased after pulmonary rehabilitation compared with that before pulmonary rehabilitation, and 6MWD, ADL, MEP, MIP of patients in group A were increased after pulmonary rehabilitation more than those in group B (P<0.05 or P<0.01). (4)The patients' body status, shortness of breath, social activity, home chores in group A and group B, and uneasiness in group A after pulmonary rehabilitation were improved more than those before pulmonary rehabilitation (P<0.05 or P<0.01), but the difference in state of mind, headache, appetite was not markedly different before and after pulmonary rehabilitation in two groups (all P>0.05). The difference in QOL was not marked between group A and group B after pulmonary rehabilitation (all P>0.05).

CONCLUSION: (1) The pulmonary rehabilitation with pursed lip respiration and the pulmonary rehabilitation with the guide of respiratory physiology ameliorates dyspnea, improves ADL, QOL, exercise tolerance, function of respiratory muscle in the severe and very severe COPD patients remarkably. (2) The effect of the pulmonary rehabilitation with the guide of respiratory physiology is better than that of the pulmonary rehabilitation with pursed lip respiration, and it can be considered as a more effective pulmonary rehabilitation method for the patients with severe and very severe COPD.