Effects of Pulmonary Rehabilitation in Patients with Mild-to-moderate Chronic Obstructive Pulmonary Disease: Bottom of an Iceberg

Overview

Journal Turk J Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2019 Aug 28

PMID 31453507

Authors

Pervin Korkmaz Ekren

Alev Gurgun

Funda Elmas Uysal

Senay Tuncel

Sami Deniz

Hale Karapolat

Feza Bacakoglu

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aims to compare the effects of pulmonary rehabilitation (PR) in patients with mild-to-moderate and severe-to-very severe chronic obstructive pulmonary disease (COPD).

Patients And Methods: Between January 2005 and December 2010, a total of 76 patients with mild-to-moderate (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stages I+II, n=33, mean age 66.0±8.6 years) and severe-to-very severe (GOLD Stages III+IV, n=43, mean age 63.5±8.8 years) COPD completed an eight-week outpatient PR program. Incremental and endurance shuttle walk tests (ISWT, ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression Scale were assessed before and after PR. Changes after the intervention were compared between two groups.

Results: There were significant improvements in the ISWT and median 60 m [(-150)-(400)] in mild-to-moderate group and 70 m [(0)-(270)] in severe-to-very severe group (both, p<0.001). The ESWT time improved in both groups, 122s [(-279)-(665)] (p=0.002) and 61s [(-180)- (878)] (p<0.001), respectively. Significant effects were observed in all domains of the SGRQ except the impact score in mild-to-moderate patients. There were significant improvements in all domains except the symptoms score in severe-to-very severe patients. Using the CRQ, a significant improvement was shown in all domains of CRQ except the dyspnea score of mild-to-moderate patients. Anxiety and depression scores decreased after PR in both groups (p<0.05). According to changes in outcomes, there was no difference in any parameters between two groups.

Conclusion: This study demonstrates that patients with mild-to-moderate COPD benefit from PR comparably to patients with severe-to- very-severe COPD. Although patients with mild-to-moderate COPD are not usually symptomatic, our findings suggest that they should be included in PR.

References

Tselebis A, Bratis D, Pachi A, Moussas G, Ilias I, Harikiopoulou M . A pulmonary rehabilitation program reduces levels of anxiety and depression in COPD patients. Multidiscip Respir Med. 2013; 8(1):41. PMC: 3693865. DOI: 10.1186/2049-6958-8-41. View

Cooper C . The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med. 2006; 119(10 Suppl 1):21-31. DOI: 10.1016/j.amjmed.2006.08.004. View

Singh S, Morgan M, Scott S, Walters D, Hardman A . Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992; 47(12):1019-24. PMC: 1021093. DOI: 10.1136/thx.47.12.1019. View

Revill S, Morgan M, Singh S, Williams J, Hardman A . The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax. 1999; 54(3):213-22. PMC: 1745445. DOI: 10.1136/thx.54.3.213. View

Janson C, Marks G, Buist S, Gnatiuc L, Gislason T, McBurnie M . The impact of COPD on health status: findings from the BOLD study. Eur Respir J. 2013; 42(6):1472-83. PMC: 3844139. DOI: 10.1183/09031936.00153712. View

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

Bratas O, Espnes G, Rannestad T, Walstad R . Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients--especially in patients with mild or moderate disease. Chron Respir Dis. 2010; 7(4):229-37. DOI: 10.1177/1479972310374343. View

Martinez F, Donohue J, Rennard S . The future of chronic obstructive pulmonary disease treatment--difficulties of and barriers to drug development. Lancet. 2011; 378(9795):1027-37. DOI: 10.1016/S0140-6736(11)61047-7. View

Elbehairy A, Ciavaglia C, Webb K, Guenette J, Jensen D, Mourad S . Pulmonary Gas Exchange Abnormalities in Mild Chronic Obstructive Pulmonary Disease. Implications for Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med. 2015; 191(12):1384-94. DOI: 10.1164/rccm.201501-0157OC. View

10.

Vagaggini B, Costa F, Antonelli S, Simone C, De Cusatis G, Martino F . Clinical predictors of the efficacy of a pulmonary rehabilitation programme in patients with COPD. Respir Med. 2009; 103(8):1224-30. DOI: 10.1016/j.rmed.2009.01.023. View

11.

Miranda E, Malaguti C, Dal Corso S . Peripheral muscle dysfunction in COPD: lower limbs versus upper limbs. J Bras Pneumol. 2011; 37(3):380-8. DOI: 10.1590/s1806-37132011000300016. View

12.

ZuWallack R . How are you doing? What are you doing? Differing perspectives in the assessment of individuals with COPD. COPD. 2007; 4(3):293-7. DOI: 10.1080/15412550701480620. View

13.

ODonnell D, Maltais F, Porszasz J, Webb K, Albers F, Deng Q . The continuum of physiological impairment during treadmill walking in patients with mild-to-moderate COPD: patient characterization phase of a randomized clinical trial. PLoS One. 2014; 9(5):e96574. PMC: 4006871. DOI: 10.1371/journal.pone.0096574. View

14.

Buist A, McBurnie M, Vollmer W, Gillespie S, Burney P, Mannino D . International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370(9589):741-50. DOI: 10.1016/S0140-6736(07)61377-4. View

15.

Diaz A, Morales A, Diaz J, Ramos C, Klaassen J, Saldias F . CT and physiologic determinants of dyspnea and exercise capacity during the six-minute walk test in mild COPD. Respir Med. 2013; 107(4):570-9. DOI: 10.1016/j.rmed.2012.12.011. View

16.

Jacome C, Marques A . Short- and Long-term Effects of Pulmonary Rehabilitation in Patients With Mild COPD: A COMPARISON WITH PATIENTS WITH MODERATE TO SEVERE COPD. J Cardiopulm Rehabil Prev. 2016; 36(6):445-453. DOI: 10.1097/HCR.0000000000000219. View

17.

Decramer M, Rennard S, Troosters T, Mapel D, Giardino N, Mannino D . COPD as a lung disease with systemic consequences--clinical impact, mechanisms, and potential for early intervention. COPD. 2008; 5(4):235-56. DOI: 10.1080/15412550802237531. View

18.

Golmohammadi K, Jacobs P, Sin D . Economic evaluation of a community-based pulmonary rehabilitation program for chronic obstructive pulmonary disease. Lung. 2004; 182(3):187-96. DOI: 10.1007/s00408-004-3110-2. View

19.

Ofir D, Laveneziana P, Webb K, Lam Y, ODonnell D . Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007; 177(6):622-9. DOI: 10.1164/rccm.200707-1064OC. View

20.

Guenette J, Jensen D, Webb K, Ofir D, Raghavan N, ODonnell D . Sex differences in exertional dyspnea in patients with mild COPD: physiological mechanisms. Respir Physiol Neurobiol. 2011; 177(3):218-27. DOI: 10.1016/j.resp.2011.04.011. View