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Abstract
To assess the clinical effectiveness of pulmonary rehabilitation (PR) after 10 or 20 consecutive sessions in outpatients with chronic airway obstruction (CAO). Observational prospective cohort trial. Outpatient clinic of a rehabilitation center. Twenty-five outpatients (mean age, 65 +/- 9 years [+/- SD]; FEV1, 64 +/- 12% predicted) admitted to a comprehensive PR program, including exercise training. The load reached on a cycloergometer (maximal achieved load [W-max]), the maximal and isoload dyspnea and leg fatigue on a Borg scale, 6-min walk distance (6MWD), and the health-related quality of life as assessed using the St. George's Respiratory Questionnaire (SGRQ) [total and components score] have been recorded as outcome measures at baseline, after 10 sessions (T10), and after 20 sessions (T20). The predefined criteria of the clinically significant improvement were as follows: + 15% W-max, + 54 m at 6MWD, - 1 point at isoload dyspnea and leg fatigue, and - 4% at SGRQ scores. There was a mean significant difference between changes at T20 and T10 for 6MWD (- 42.96 m; 95% confidence interval [CI], - 57.79 to - 28.12 m; p = 0.001), total SGRQ (4.80; 95% CI, 2.29 to 7.31; p = 0.001), activity SGRQ (3.60; 95% CI, 0.48 to 6.71; p = 0.025), and symptoms SGRQ (5.96; 95% CI, 2.72 to 9.2; p = 0.001). The percentage of patients who improved was different at T20 as compared with T10 for W-max (68% and 48%, respectively; p = 0.025), 6MWD (76% and 20%, p = 0.001), and total SGRQ (64% and 36%, p = 0.008). A 10-session course of PR provides only limited clinically significant changes of outcome measures when compared with a 20-session course in outpatients with CAO of mild-to-moderate severity.
Highlights
Study objective: To assess the clinical effectiveness of pulmonary rehabilitation (PR) after 10 or 20 consecutive sessions in outpatients with chronic airway obstruction (CAO)
A 10-session course of PR provides only limited clinically significant changes of outcome measures when compared with a 20-session course in outpatients with CAO of mild-to-moderate severity. (CHEST 2005; 127:105–109)
Significant changes of outcome measures after PR have been reported in patients with CAO of variable severity[5,6] and in different settings.[7]
Summary
The studied patients were consecutively admitted to our outpatient rehabilitation ambulatory unit. CAO was diagnosed, and the cases were classified as mild-to-moderate degree CAO; diagnosis of COPD was defined according to Global Initiative for Obstructive Lung Disease (GOLD) staging and definition,[1] whereas chronic asthma was characterized by variable airflow limitation with reversible obstruction (range, 14 to 35%) and bronchial hyperresponsiveness,[11] in absence of smoking history. All the included COPD patients had history of smoking (Ͼ 20 pack-years); four of them were current smokers. All the admitted patients complained of breathlessness (score Ն 2 on the 5-point Medical Research Council [MRC] scale).[12] No change in the treatment with inhaled bronchodilators and/or inhaled steroids (if applied) was made in the 2 weeks preceding admission to our hospital. Patients with any severe concomitant disease (ie, severe left ventricular dysfunction, cancer), or inability or refusal to cooperate were excluded from the study
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