Abstract
BackgroundPulmonary rehabilitation improves exercise capacity and reduces risk of future exacerbation in COPD when performed after an exacerbation. There have been no previous studies of post-exacerbation rehabilitation in bronchiectasis.MethodsParallel group randomized controlled trial compared pulmonary rehabilitation (PR) to standard care (SC) in patients followed an antibiotic treated exacerbation of bronchiectasis. Patients were randomized following a 14 day course of antibiotics was completed. The primary outcome was 6-min walk distance (6 MW) at 8 weeks. Secondary outcomes were time to the next exacerbation, St.Georges Respiratory Questionnaire, COPD CAT score, Leicester cough questionnaire (LCQ) and FEV1 at 8 and 12 weeks post exacerbation.ResultsForty eight patients were enrolled but only 27 had exacerbations within 12 months of enrolment. Nine patients received pulmonary rehabilitation and 18 received standard care. The 6 MW improved significantly from post-exacerbation to 8 weeks in both groups, with no significant difference between PR and SC- mean difference of 11 m (95% CI -34.3 to 56.3,p = 0.6). Time to the next exacerbation was not significantly different hazard ratio 0.83 (0.31–2.19, p = 0.7). No significant differences were seen between groups in terms of LCQ, CAT, FEV1 or SGRQ between groups. An analysis of probability based on the patients enrolled suggested > 1000 subjects are likely be required to have an > 80% probability of observing a statistically significant difference between PR and SC and any such differences would be likely to be too small to be clinically relevant.ConclusionsThis pilot study identified no significant benefits associated with pulmonary rehabilitation after exacerbations of bronchiectasis.Trial registrationNCT02179983, registered on Clinicaltrials.gov 29th June 2014.
Highlights
Pulmonary rehabilitation improves exercise capacity and reduces risk of future exacerbation in Chronic obstructive pulmonary disease (COPD) when performed after an exacerbation
Disease progression in bronchiectasis is associated with a reduction in exercise capacity. 6-min walk distance is correlated with lung function and extent of bronchiectasis on Computed tomograph (CT) scan and was found by McDonnell et al to reflect disease severity measured by the Chalmers et al BMC Pulmonary Medicine (2019) 19:85 bronchiectasis severity index [7]
Maximising exercise capacity following exacerbations of bronchiectasis can be seen as preventing an important element of the disease progression associated with exacerbations [10,11,12]
Summary
Pulmonary rehabilitation improves exercise capacity and reduces risk of future exacerbation in COPD when performed after an exacerbation. Patients with frequent exacerbations experience a high risk of hospitalization, have significantly worse quality of life and an increase in mortality of 86% for patients experiencing 3 or more exacerbations per year [2, 3]. Exacerbation symptoms last for a median of 16 days and Disease progression in bronchiectasis is associated with a reduction in exercise capacity. Maximising exercise capacity following exacerbations of bronchiectasis can be seen as preventing an important element of the disease progression associated with exacerbations [10,11,12]
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