Outcome of pulmonary rehabilitation in patients with COPD: Comparison between patients receiving exercise training and those receiving exercise training and CPAP

Abstract

BackgroundPulmonary rehabilitation (PR) using exercise training has been useful to increase the exercise capacity and life quality in patients with chronic obstructive pulmonary disease (COPD). However, airflow limitation which characterizes COPD usually worsens during exercise due to the lack of flow reserve and dyspnea hinders exercise maintenance. Non-invasive ventilation (NIV) has been a beneficial therapeutic tool for COPD patients to ameliorate their dyspnea and intensify their exercise. Thus, using NIV during exercise training program might have a synergistic effect in managing patients with COPD by increasing their physical activity, exercise intensity and capacity and their quality of life. ObjectiveTo study the effect of using NIV during PR by exercise training on dyspnea, exercise tolerance and quality of life as compared to effect of exercise alone in patients of COPD. Subjects and methodsThe present study was conducted on 24 stable male patients with COPD who were ex-smokers. Patients were divided into 2 groups; group 1 (Exercise gp) included 12 patients who had undergone exercise training only and group 2 (EX/CPAP gp) which included also 12 patients who had undergone exercise in addition to NIV using continuous positive airway pressure (CPAP). Baseline and after 1 month assessment of patients' pulmonary functions, arterial blood gases, dyspnea scale assessed with the Modified Medical Research Council (MRC), 6 minute walking test (6MWT), BODE index and COPD Assessment Test (CAT) score was done. ResultsGroup 2 (Ex/CPAP gp) showed a statistically significant improvement in 6MWD, BODE index, SaO2, PaCO2, Pimax, mMRC, and CAT score (p<.05). Group 1 (exercise group) showed a statistically significant improvement in 6MWD, Pimax, BODE index, mMRC and CAT score (p<.05). As regards comparison of group 1 to group 2, the % of improvement in 6MWD and BODE index was significantly more in group 2 than group 1 (p= .010 and <.001, respectively). No significant differences were found between both groups as regards blood gases, mMRC and CAT score. ConclusionAdding non-invasive ventilation to an exercise rehabilitation program in patients with stable COPD has shown to augment improvement in exercise performance.