Functional Status and Survival Following Pulmonary Rehabilitation

doi:10.1378/chest.118.3.697

Chest

Volume 118, Issue 3, September 2000, Pages 697-703

https://doi.org/10.1378/chest.118.3.697 Get rights and content

Background

Functional exercise capacity has been shownto be a strong predictor of survival following pulmonaryrehabilitation. This study evaluated whether questionnaire-ratedfunctional status is also predictive of survival.

Patientsand methods

Following pulmonary rehabilitation, patients withadvanced chronic lung disease were evaluated for survival, 6-min walkdistance, and questionnaire-rated functional status. The latter wasmeasured using the pulmonary functional status scale, which hassubscores of functional activities, psychological status, and dyspnea. Information on survival was available on 149 patients.

Results

The mean age was 69 years, and 45% of patientswere male. Eighty-nine percent had a diagnosis of COPD, and their, FEV₁ was 37 ± 18% of predicted. Ninety-one (61%) weremarried. The 3-year survival for the group was 85%. Age, gender, bodymass index, and primary diagnosis were not related to survival. Variables strongly associated with increased survival followingpulmonary rehabilitation included a higher postrehabilitation, Functional Activities score, a longer postrehabilitation 6-min walkdistance, and being married (vs widowed, single, or divorced). Diseaseseverity variables associated with survival included an initialreferral to outpatient pulmonary rehabilitation, no supplemental oxygenrequirement, and a higher percent-predicted FEV₁.

Conclusion

Indicators of functional status are strongpredictors of survival in patients with advanced lungdisease.

Section snippets

Patients

Survival following pulmonary rehabilitation was studied inpatients with symptomatic lung disease who were referred to aparticipating Connecticut Pulmonary Rehabilitation Consortium programfrom 1993 to 1994. Ten programs in the consortium gave outpatientpulmonary rehabilitation; 1 program also gave inpatient pulmonaryrehabilitation. One hundred sixty-four patients had been included in ashort-term study evaluating the effect of pulmonary rehabilitation onquestionnaire-measured functional status.⁸

Patients

Of the 164 patients originally evaluated in the Connecticut Pulmonary Rehabilitation Consortium study from 1993 to 1994, follow-upinformation on survival status was obtainable in 149 patients (91%).Primary respiratory diagnoses on referral to pulmonary rehabilitationincluded COPD (133 patients, 89%), chronic asthma (12 patients),chest-wall disease (3 patients), and pulmonary fibrosis (1 patient).One hundred thirteen patients (76%) were given outpatient pulmonaryrehabilitation, and 36 patients

Discussion

The purpose of this study was to evaluate the relationship offunctional status to subsequent survival following pulmonaryrehabilitation. Survival data from 10 centers in the Connecticut Pulmonary Rehabilitation Consortium were analyzed. Although theseprograms varied in their approaches to rehabilitation, they allstandardized their outcome assessment, which consisted of the 6-minwalk test and the PFSS. The variability in the pulmonary rehabilitationprograms and in their patient populations

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We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work. Enrico Clini, Jose Jardim, Linda Nici, Jonathan Raskin, Richard ZuWallack (editors).
Multidimensional indices in the assessment of chronic obstructive pulmonary disease
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Citation Excerpt :
Characteristically, subjective self-evaluation of their condition or exercise capacity by patients may significantly differ to an objective evaluation [27]. The test is widely used in chronic diseases, like COPD, because it is more sensitive than other traditional markers of disease severity to changes in the functional status, whether present or absent [28,29]. It may change independently of FEV1% and as a consequence may be used to assess the clinical status of patients with severe COPD in whom FEV1% is already rigid to modifications [30].
Chronic obstructive pulmonary disease (COPD), a very common disease, is the third leading cause of death worldwide. Due to the significant heterogeneity of clinical phenotypes of COPD there is no single method suitable for predicting patients’ health status and outcomes, and therefore multidimensional indices, assessing different components of the disease, were developed and are recommended for clinical practice by international guidelines. Several indices have been widely accepted: BODE and its modifications, ADO, DOSE, CODEX, COTE. They differ in their composition and aim, while they are more accurate and better validated in specific settings and populations. We review the characteristics, strengths and limitations of these indices, and we discuss their role in routine management of patients with COPD, as well as in specific clinical scenarios, such as resuscitation and ceiling of care, or decisions to offer more invasive treatments. This analysis may help clinicians to use those indexes in a more practical and appropriate way.
Self-reported exercise capacity among current smokers eligible for lung cancer screening: Distribution and association with key comorbidities
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Citation Excerpt :
This is important as COPD is significantly under-diagnosed in the lung cancer screening population. Various measures of functional and exercise capacity have been found to be independently predictive of death among patients with heart failure [31], lung cancer [32], COPD [33], and overall [34]. Unlike medical diagnoses, EC, whether measured by self-report or formal testing, is not routinely recorded in medical settings.
as lung cancer screening (LCS) is implemented is that patients will be screened who are too ill to benefit. Poor exercise capacity (EC) predicts adverse outcomes following lung resection.
Describe the distribution of EC among smokers eligible for LCS and examine associations with comorbidities.
Cross-sectional analysis of baseline data from a randomized controlled trial of tobacco treatment in the context of LCS. Participants responded regarding limitations in moderate activities, ability to climb stairs, and frequency of dyspnea on a scale from never/almost never to all or most of the time. Responses were assigned a numeric score and summed to categorize exercise limitation. Associations between poor EC and key comorbidities were examined using adjusted logistic regression.
660 participants completed a survey with the following characteristics: 64.4% male, 89.5% white, mean age 64.5. Overall EC categories were: good 39.0%, intermediate 41.6%, and poor 19.4%. Prevalence of poor EC was higher among patients with COPD (OR 4.62 95%CI 3.05–7.02), heart failure (OR 3.07 95%CI 1.62–5.82) and cardiovascular disease (OR 2.24, 95%CI 1.45–3.47), and was highest among patients with multimorbidity. Among patients with COPD and heart failure, 57% had poor and 0% had good EC. In adjusted logistic regression, only COPD and Charlson comorbidity index remained significantly associated with poor EC.
Many patients eligible for LCS reported poor EC, with increased odds of poor EC among patients with comorbidities. More research is needed to determine how to best integrate EC and comorbidity into eligibility and shared decision-making conversations.
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: This work was supported by funds from each author’s respectiveinstitution.

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Chest

Clinical InvestigationsCopdFunctional Status and Survival Following Pulmonary Rehabilitation

Background

Patientsand methods

Results

Conclusion

Section snippets

Patients

Patients

Discussion

Chest

Chest

J Urol

Am J Cardiol

Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease

Ann Intern Med

Variables related to increased mortality following out-patient pulmonary rehabilitation

Eur Respir J

Prognosis in chronic obstructive pulmonary disease

Am Rev Respir Dis

Predictors of mortality in chronic obstructive pulmonary disease: a 15-year follow-up study

Am Rev Respir Dis

The Medical Research Council Working Party (Stuart-Harris C, chairman). Long term domiciliary oxygen therapy in chronic hypoxemic cor pulmonale complicating chronic bronchitis and emphysema

Lancet

Clinical Investigations
Copd
Functional Status and Survival Following Pulmonary Rehabilitation