Chest

Chest

Volume 119, Issue 6, June 2001, Pages 1696-1704
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Clinical Investigations
COPD
Is It Really Useful To Repeat Outpatient Pulmonary Rehabilitation Programs in Patients With Chronic Airway Obstruction?: A 2-Year Controlled Study

https://doi.org/10.1378/chest.119.6.1696Get rights and content

Study objectives

To answer the following questions: in patients with chronic airway obstruction (CAO), (1) can pulmonary rehabilitation lead to similar short-term gains at successive, yearly interventions, and (2) is there any real clinical or physiologic long-term benefit by yearly repetition of pulmonary rehabilitation programs (PRPs)?

Design

Randomized, controlled clinical study.

Setting

Pulmonary rehabilitation center.

Patients

Sixty-one CAO patients studied 1 year after completing an initial 8-week outpatient PRP (PRP1).

Intervention

Patients were randomly classified into two groups. A second PRP (PRP2) was completed by the first group (group 1) but not by the second group (group 2). One year later, a third PRP (PRP3) was performed by both groups.

Measurements

Lung function, cycloergometry, walking test, dyspnea, and health-related quality of life (HRQL) were assessed before and after PRP2, and before and after PRP3. The numbers of hospitalizations and exacerbations over the year were also recorded.

Results

Complete data sets were obtained from 36 patients (17 patients in group 1 and 19 patients in group 2). The two groups did not differ in any parameter either before PRP1, after PRP1, or at randomization. There was no significant change over time for airway obstruction in either group. After PRP2, exercise tolerance, dyspnea, and HRQL improved in group 1. Nevertheless, 1 year later, patients of group 1 did not differ from patients of group 2 in any outcome parameter, such that in comparison to before PRP1, only HRQL was still better in both groups 24 months after PRP1. Yearly hospitalizations and exacerbations per patient significantly decreased in both groups in the 2 years following PRP1, when compared to the 2 years prior. Nevertheless, at the 24-month follow-up visit, a further reduction in yearly exacerbations was observed only in group 1 but not in group 2 in comparison to what was observed at the 12-month follow-up visit. The PRP3 resulted in improvement in exercise tolerance in both groups.

Conclusion

In patients with CAO, an outpatient PRP can achieve benefits in HRQL and a decreased number of hospitalizations, which persist for a period of 2 years. Successive, yearly interventions lead to similar short-term gains but do not result in additive long-term physiologic benefits. Further reduction in yearly exacerbations seems to be the main benefit of an additional PRP.

Section snippets

Materials and Methods

Patients gave their informed consent to participate in the study, which was approved by the Ethical Committee of Salvatore Maugeri Foundation, and was conducted according to the Declaration of Helsinki.

Results

Figure 1 shows the profile of number of patients at each phase of the study. The short-term and 12-month results of PRP1 in 61 patients have been reported previously.5 No patient died during the study. All 30 patients of group 1 completed PRP2.

Discussion

This study shows that successive, yearly interventions of pulmonary rehabilitation lead to similar short-term gains but do not result in additive long-term benefits in dyspnea, exercise tolerance, or HRQL. Nevertheless, additional PRP is associated with reduction in exacerbations not requiring hospitalizations.

Our study is consistent with previous reports2,3,5,6,7 confirming that an outpatient (day hospital-based) PRP for CAO patients, including lower-limb and upper-limb exercise training and

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    Copyright © 2001 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.