Home-based pulmonary rehabilitation in very severe COPD: is it safe and useful?

OBJECTIVE: To determine the safety and usefulness of a home-based pulmonary rehabilitation program for patients with very severe chronic obstructive pulmonary disease (COPD) who receive long-term treatment with oxygen.

METHODS: A randomized prospective study that included 50 patients with very severe COPD undergoing long-term treatment with oxygen. At the start of the program and after 12 months, the following evaluations were performed: pulmonary function tests, submaximal exercise capability, and quality of life. The rehabilitation program lasted for 1 year, with periodic home visits by a physiotherapist and included respiratory reeducation training of the respiratory muscles and muscular training.

RESULTS: Forty-two patients completed the study (27 in the rehabilitation group and 15 in the control group). There were no initial differences between the 2 groups. No complications arising from the performance of the exercises were observed. The rehabilitation group showed a clinically significant increase in the distance covered in the 6-minute walk test (313 +/- 72 m vs 392 +/- 82 m, P = .0001) and a clinically significant reduction in the St George's Respiratory Questionnaire score (55.3 +/- 15.0 vs 40.5 +/- 13.8, P = .0001). No significant changes were found in any of the parameters studied in the control group.

CONCLUSION: A home-based pulmonary rehabilitation program for patients with very severe COPD under long-term oxygen treatment is safe and useful, as it achieves an improvement in exercise tolerance, reduces dyspnea after effort, and improves quality of life without causing any complication arising from the performance of the exercises.