Pulmonary Rehabilitation Information

Community pulmonary rehabilitation after hospitalization for acute exacerbations of chronic obstructive pulmonary disease:  A randomized controlled study.

Man WD, Polkey MI, Donaldson N, Gray BJ, Moxham J.
BMJ. 2004;329(7476):1209.

Respiratory Muscle Laboratory, Guy's, King's, and St Thomas' School of Medicine, King's College Hospital, London SE5 9PJ.

This study's objective was to evaluate the effects of an early community based pulmonary rehabilitation program after hospitalization for an acute exacerbation of COPD. This was a single center, randomized controlled trial in an inner city, secondary and tertiary care hospital in London.  Participants were 42 patients admitted with an acute exacerbation of COPD.  Participants were randomized to an eight week, outpatient pulmonary rehabilitation program, started within 10 days of hospital discharge, or to usual care.  Principal outcome measures were incremental shuttle walk distance, disease specific health status (St George's respiratory questionnaire, SGRQ; chronic respiratory questionnaire, CRQ) and generic health status (medial outcomes short form 36 questionnaire, SF-36) at three months after hospital discharge.

Early pulmonary rehabilitation, compared with usual care, led to significant improvements in median incremental shuttle walk distance (60 meters, P=0.0002), mean SGRQ total score (-12.7, P = 0.002), all four domains of the CRQ (dyspnoea 5.5, P = 0.003; fatigue 5.3, P = 0.004; emotion 8.7, P = 0.008; and mastery 7.5, P < 0.001) and the mental component score of the SF-36 (20.1, P = 0.02).  Improvements in the physical component score of the SF-36 did not reach significance (10.6, P = 0.057).

Early pulmonary rehabilitation after admission to hospital for acute exacerbations of COPD is safe and leads to statustically and clinically significant improvements in exercise capacity and health status at three months.

Comments  
At least as important as the ability to restore these patients' exercise capacity and quality of life is the ability of early rehabilitation to revent further exacerbations.  In the three months after discharge from hospitalization, the group participating in early rehabilitation experienced 39% fewer hospital readmissions, 30% fewer hospital days and 70% fewer emergency room visits.

Additional information:

American Thoracic Society Annual Meeting 2005
The role of physical therapies in preventing exacerbation in COPD

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Last modified: 11/01/09