Abstract
The degree of lung function is frequently used as referral criterion for pulmonary rehabilitation. The efficacy of pulmonary rehabilitation was assessed in 518 chronic obstructive pulmonary disease (COPD) patients, after clustering based on a comprehensive pre-rehabilitation lung function assessment. Mean improvements in dyspnea, exercise performance, health status, mood status and problematic activities of daily life after pulmonary rehabilitation were mostly comparable between the seven clusters, despite significant differences in the degree of lung function. The current study demonstrates no significant relationship between the seven lung-function-based clusters and response to pulmonary rehabilitation. Therefore, baseline lung function cannot be used to identify those who will respond well to pulmonary rehabilitation, and moreover, cannot be used as a criterion for referral to pulmonary rehabilitation in patients with COPD.
Highlights
Pulmonary rehabilitation, defined as a comprehensive non-pharmacological intervention, is generally very effective in patients with chronic obstructive pulmonary disease (COPD) [1]
A proportion of COPD patients with mild to moderate airflow limitation may suffer from severe dyspnea and experience everyday limitations [3]
It has been shown that, mean improvements following exercise-based pulmonary rehabilitation are comparable after stratification for baseline airflow limitation [8,9]
Summary
Pulmonary rehabilitation, defined as a comprehensive non-pharmacological intervention, is generally very effective in patients with chronic obstructive pulmonary disease (COPD) [1]. Statistically significant and clinically relevant improvements can be obtained for dyspnea, exercise capacity and health status compared to standard care [2,3,4]. In daily practice and in clinical trials, the degree of airflow limitation is frequently used as an indicator for referral for pulmonary rehabilitation [2]. Not all patients with COPD with severe to very severe airflow limitation are symptomatic or limited in their daily functioning [5]. The degree of airflow limitation, is a poor determinant of the physical and psychological status of a patient with COPD [6,7]. It has been shown that, mean improvements following exercise-based pulmonary rehabilitation are comparable after stratification for baseline airflow limitation [8,9]. There is no difference in baseline forced expiratory volume in 1 s (FEV1) between very good and poor responders to pulmonary
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