Are COPD patients with chronic dyspnea and attending pulmonary rehabilitation treated with dual bronchodilatation or not?

Abstract

Introduction: COPD patients with chronic dyspnea have impaired exercise tolerance. In Denmark, participation in pulmonary rehabilitation (PR) needs referred from general practitioner (GP) or pulmonologist. We wanted to ascertain whether COPD patients with chronic dyspnea (MRC breathlessness scale ≥ 3) and participating in PR program are treated with inhaled long acting beta2 agonist AND anticholinergics (LABA+LAMA). Does PR patients whom are not treated with LABA+LAMA have a higher drop-out rate? Method: Prospective, consecutive study of COPD patients referred attending PR in Region Zealand (Denmark): community-based or hospital-based. Spirometry data, symptoms scores including MRC, and exacerbation frequency was obtained by a single investigator (MT). Results: Totally 47 patients completed PR, and 35 patients had pre-PR MRC≥3. Of these, 54% received LABA+LAMA. 13 of the 22 drop-out patients had pre-PR MRC ≥ 3. Of these 62% received LABA+LAMA. Patients on LABA+LAMA had a 69% chance of finishing the PR program whereas 77% if the patients recieved other/no treatment. But patients treated with LABA and LAMA who finished the program had an almost 3 times higher exacerbation rate and worse pulmonary function (FEV1, Forced Expiratory Volume in the first second), especially in the LABA+LAMA group who did not finish PR. Conclusion: In both groups only little over half of the patients with chronic dyspnea receive LABA+LAMA and 9% does not receive any treatment. Patients on LABA+LAMA have a much lower FEV1 and more exacerbations compared to the other treatment/no treatment group. This could have an effect on the probabilities for completing PR.