Efficiency and Safety of Pulmonary Rehabilitation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background Pulmonary rehabilitation (PR) is able to improve dyspnea, endurance capacity, and health-related quality of life in chronic obstructive pulmonary disease (COPD) patients, but it is rarely used in China. This study aimed to assess the effectiveness and safety of PR after exacerbation of COPD. Material/Methods Patients admitted to hospital due to an exacerbation of COPD were randomized to receive either PR or routine care (control group). The PR program was performed from the second day of admission until discharge. The pre-post changes in 6-minute walk distance (6MWD), self-reported quality of life (QOL) assessed by CAT score and CRQ-SAS score, and activity of daily life assessed by ADL-D score were determined. The perceived end-effort dyspnea (Borg scale) was measured throughout the study. Results A total of 101 patients were enrolled, of whom 7 withdrew after randomization, and 94 completed this study. There were 66 patients in the PR group and 28 in the control group. The 6MWD, resting SpO2, and exercise Borg dyspnea score were significantly improved in the PR group. In addition, the PR group had greater improvement in the total CRQ-SAS score and had a lower CAT score. Significant improvements were also found in the ADL-D and BODE index in the PR group. No adverse events were recorded during exercise. Conclusions Our study provides evidence that it is safe and feasible to apply an early PR in patients with acute exacerbation of COPD.

[1]  J. Meijer,et al.  Reduction of exacerbation frequency in patients with COPD after participation in a comprehensive pulmonary rehabilitation program , 2014, International journal of chronic obstructive pulmonary disease.

[2]  D. Brooks,et al.  Pulmonary rehabilitation at the time of the COPD exacerbation. , 2014, Clinics in chest medicine.

[3]  Pulmonary rehabilitation: overwhelming evidence but lost in translation? , 2010, Physiotherapy Canada. Physiotherapie Canada.

[4]  J. Steurer,et al.  Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. , 2009, The Cochrane database of systematic reviews.

[5]  H. T. Moriya,et al.  Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. , 2012, Archives of physical medicine and rehabilitation.

[6]  Thierry Troosters,et al.  American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. , 2006, American journal of respiratory and critical care medicine.

[7]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[8]  J. Hankinson,et al.  Standardisation of the single-breath determination of carbon monoxide uptake in the lung , 2005, European Respiratory Journal.

[9]  S. Spencer,et al.  Time course of recovery of health status following an infective exacerbation of chronic bronchitis , 2003, Thorax.

[10]  G. Guyatt,et al.  A randomised trial to evaluate the self-administered standardised chronic respiratory questionnaire , 2005, European Respiratory Journal.

[11]  Sibel Naycı,et al.  The View of the Turkish Thoracic Society on the Report of the GOLD 2017 Global Strategy for the Diagnosis, Management, and Prevention of COPD. , 2017, Turkish thoracic journal.

[12]  J. Maurer.  Effects of Home-Based Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Trial , 2010 .

[13]  P. Jones,et al.  Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease , 1999, Thorax.

[14]  J. Bourbeau,et al.  The COPD assessment test: a systematic review , 2014, European Respiratory Journal.

[15]  Hubertus Jm Vrijhoef,et al.  Acute exacerbations of COPD: recommendations for integrated care , 2008, Expert review of respiratory medicine.

[16]  I. Homma,et al.  Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory muscle training. , 2002, Internal medicine.

[17]  I. Homma,et al.  [Clinical effects of four weeks of respiratory muscle stretch gymnastics in patients with chronic obstructive pulmonary disease]. , 1996, Nihon Kyobu Shikkan Gakkai zasshi.

[18]  T. Seemungal,et al.  Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. , 2000, American journal of respiratory and critical care medicine.

[19]  P. Poole,et al.  Does early pulmonary rehabilitation reduce acute health‐care utilization in COPD patients admitted with an exacerbation? A randomized controlled study , 2009, Respirology.

[20]  E. Clini,et al.  Early rehabilitation: much better than nothing. , 2010, American journal of respiratory and critical care medicine.

[21]  R. Zuwallack,et al.  Pulmonary rehabilitation for management of chronic obstructive pulmonary disease. , 2009, The New England journal of medicine.

[22]  R. Kozu,et al.  Differences in Response to Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and Chronic Obstructive Pulmonary Disease , 2010, Respiration.

[23]  Richard Casaburi,et al.  Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. , 2007, Chest.

[24]  ATS statement: guidelines for the six-minute walk test. , 2002, American journal of respiratory and critical care medicine.

[25]  M. Decramer,et al.  Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. , 2010, American journal of respiratory and critical care medicine.

[26]  K. Ariyoshi,et al.  Development of an activity of daily living scale for patients with COPD: The Activity of Daily Living Dyspnoea scale , 2009, Respirology.

[27]  S. Kalra,et al.  ARE PATIENTS WITH COPD MORE ACTIVE AFTER PULMONARY REHABILITATION , 2008 .

[28]  N. Ambrosino,et al.  Effects of early inpatient rehabilitation after acute exacerbation of COPD. , 2009, Respiratory medicine.

[29]  F. Blackstock,et al.  Early Rehabilitation Exercise Program for Inpatients During an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED TRIAL , 2012, Journal of cardiopulmonary rehabilitation and prevention.

[30]  Alice Y.M. Jones,et al.  Breathing exercises for chronic obstructive pulmonary disease. , 2012, The Cochrane database of systematic reviews.

[31]  Pamela Berry,et al.  Tests of the responsiveness of the COPD assessment test following acute exacerbation and pulmonary rehabilitation. , 2012, Chest.

[32]  W. Yao,et al.  Time course of inflammation resolution in patients with frequent exacerbations of chronic obstructive pulmonary disease , 2014, Medical science monitor : international medical journal of experimental and clinical research.

[33]  Ciro Casanova,et al.  The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. , 2004, The New England journal of medicine.

[34]  B. Harrison,et al.  An investigation into the effects of exercise tolerance training on patients with chronic airways obstruction. , 1984, Physiotherapy.