Effects of pulmonary rehabilitation in COPD patients treated with different pharmacological associations

Abstract

Background: In a multidimensional approach the association of Pulmonary Rehabilitation (PR) with a drug-induced bronchodilation and reduction of lung hyperinflation, should maximize the improvement in exercise tolerance and pulmonary function achievable in COPD patients. Aims: This observational study evaluated the response to PR in COPD treated with different therapy. Methods: A population of COPD patients treated with fluticasone 500mcg+formoterol 20mcg bid (group A) or beclomethasone 400mcg+salbutamol 1250mcg bid (group B) underwent a 3-week PR protocol following guidelines. Lung function, gas exchange, 6-minute walk distance, BORG and St. George's Respiratory Questionnaire (SGRQ) scores were collected at admission (T0), at discharge (T1=21 days) and at a 1-month follow up (T2=51 days). Repeated-measures ANOVA models for testing groups differences over time were fitted using Stata/SE 12.1. Results: 30 COPD patients aged 72.63(8.34) years, and including 56.67% females were enrolled. FEV1 significantly improved at T1 and T2 both in group A (1.37(0.77) lt, 1.14(0.46) lt, 1.01(0.41) lt at T2, T1 and T0 evaluation), and in group B (1.30(0.41) lt vs 1.23(0.62) lt vs 1.12(0.48) lt). A 2-fold increase in FEV1 was observed in group A (+0.36) vs group B (+0.18) (p<0.05). Other borderline significant differences were observed for secondary endpoints, especially BORG scale and SGRQ. Conclusions: PR effectiveness on exercise tolerance in COPD is beyond dispute, regardless the specific pharmacological treatment. Despite this, further studies are needed investigating the hypothesis that an adequate bronchodilation associated with long-acting β2-agonists could enhance the results of PR.