Efficacy of amultidisciplinary pulmonary rehabilitation outpatient program on exacerbations in overweight and obese patients with asthma.

Abstract

Even though many studies have investigated the effectiveness of weight loss interventions, the efficacy of pulmonary rehabilitation (PR) has not yet been proven in obese patients with asthma. The aims of this study were to investigate the efficacy of PR on asthma exacerbations in the first year after PR and to evaluate the efficacy of PR in exercise capacity, quality of life, psychosocial symptoms and control of asthma in overweight patients. The exercise capacity, health-related quality of life scores, psychosocial symptoms, asthma control test (ACT) data, number of emergency admissions and hospitalizations of 35overweight patients with asthma who completed a1-year multidisciplinary PR program were recorded and analyzed. Of the participants 30 were female, the mean age was 45± 9years, 13 (37%) patients were overweight and 22 (63%) were obese. The average number of emergency admissions (from 1.2± 1.1 to 0.3± 0.8) and hospitalizations (from 0.6± 0.9 to 0.0± 0.1) decreased significantly 1 year after PR (both p<0.001). After PR, statistically significant improvements in exercise capacity as measured by the incremental shuttle walking test (ISWT) from 281± 104m to 339± 95m (p< 0.001), the endurance shuttle walking test (ESWT) from 13.3± 7.4min to 17.5± 4.5min (p= 0.005), quality of life measured by the St. George's respiratory questionnaire (SGRQ total from 64± 14 to 28± 10, p< 0.001), dyspnea sensation with the Medical Research Council (MRC) scale (from 2.6± 0.6 to 2.1± 0.4, p<0.001) and hospital anxiety depression scores (HADS, anxiety score from 9.9± 1.6 to 7.1± 2.1, depression score from 9.4± 1.9 to 7.2± 2.3, both p< 0.001) were found. A reduction in body mass index (BMI) was found in obese patients only, but the fat-free mass index (FFMI) improved in both overweight and obese patients (from 19.00± 1.90 to 19.45± 2.04, p= 0.01). The mean ACT score increased significantly (from 18 to 21points, p< 0.001). The number of patients with poorly controlled asthma decreased from 21 (60%) to 10 (28%). This study showed that comprehensive multidisciplinary PR was associated with adecreased number of emergency admissions and hospitalizations for asthma exacerbations in 1 year, and improvements of dyspnea sensation, quality of life, exercise capacity, and psychosocial status in overweight and obese patients.