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Keywords

6-minute walk test, COPD exacerbation, health-related quality of life, pulmonary rehabilitation

 

Authors

  1. Carr, S. J. MSc
  2. Hill, K. PhD
  3. Brooks, D. PhD
  4. Goldstein, R. S. MBChB

Abstract

PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impair health-related quality of life (HRQL). We evaluated the effect of an abbreviated repeat pulmonary rehabilitation (PR) program on HRQL after an AECOPD.

 

METHODS: Patients who had completed PR were followed for up to 12 months to identify an AECOPD and then placed in randomized groups to receive a 3-week repeat-PR intervention or usual care. Measures of HRQL (Chronic Respiratory Disease Questionnaire, CRQ) and functional exercise capacity (6-minute walk distance, 6MWD) were collected at 2 (T1), 5 (T2), and 12 weeks (T3) post-AECOPD. The repeat-PR program was undertaken between T1 and T2. Between-group differences were examined using repeated- measures analysis of variance or covariance.

 

RESULTS: Of the 60 patients (30 men, age 69+/-8 years, forced expiratory volume in 1 second 0.86+/-0.40 L, 6MWD 367+/-99 m) followed, 41 experienced an AECOPD 14 +/- 11 weeks after completion of the initial PR program and 33 completed the study. Of these, 16 and 17 were randomized to the intervention and control groups, respectively. No between-group differences were demonstrated at T2 or T3. With the exclusion of 5 subjects who experienced a second AECOPD between T1 and T3, the participants in the intervention group demonstrated greater reduction in dyspnea when compared to those in the control group at T3 (0.8+/-1.6 vs -0.4+/-1.3 points per item, P = .04).

 

CONCLUSIONS: The reduction in dyspnea in those who did not experience a second AECOPD provides preliminary evidence for the role of repeat programs. The application of repeat PR should be refined in larger trials.