Improvements in outcomes for chronic obstructive pulmonary disease (COPD) attributable to a hospital-based...

To determine whether the benefits of pulmonary rehabilitation, demonstrated in selected subjects in randomised controlled studies, can be achieved by a hospital-based respiratory rehabilitation programme conducted as part of routine clinical management.

A prospective longitudinal study of patients with severe chronic obstructive pulmonary disease (COPD) enrolled in a hospital based, non-medically supervised, outpatient, respiratory rehabilitation programme was undertaken. The rehabilitation programme was of pragmatic design and content, supervised by respiratory physiotherapists and comprised seven two hour sessions over one month for groups of six to eight patients. It included education on disease management, practical instruction in coping skills, as well as a progressive aerobic exercise programme for specific muscle training related to functional activities. Subjects were assessed prior to the programme but after optimisation of pharmacologic therapy, at the completion of the programme and at three months and six months post-programme. Principal outcome parameters were exercise capacity (as assessed by a six minute walk distance [MWD] test), degree of perceived breathlessness and quality of life (QOL) (assessed by the Chronic Respiratory Disease Questionnaire [CRDQ]).

Fifty-one subjects with severe COPD (Fev1 = 0.9 +/- 0.4 1) completed the programme. There was a significant improvement in exercise capacity (a six MWD test improved from 375 +/- 126 m at baseline to 440 +/- 109 m at three months, p < 0.005). There were significant improvements in QOL (in the total CRDQ score as well as in the domains of dyspnoea, fatigue and mastery). There was a reduction in the level of perceived dyspnoea (modified Borg Scale). Most improvements were maintained for three and six months following completion of the programme. Compared with the six months preceding the programme there was a reduction in hospital admissions and reduction in courses of oral steroids.

An outpatient, hospital-based respiratory rehabilitation programme pragmatically adapted for clinical utility produces substantial and clinically significant improvements in exercise tolerance and QOL, similar in type and magnitude to those obtained in controlled clinical trials. There was an associated reduction in COPD-related morbidity. Such gains were mostly maintained for six months after completion of the programme. Thus respiratory rehabilitation must be regarded as an essential component of a comprehensive clinical programme for the management of COPD.