Pulmonary rehabilitation for moderate COPD (GOLD 2)--does it have an effect?

Although pulmonary rehabilitation is an integrated part of standard care in patients with severe COPD, it is uncertain whether those with less severe COPD benefit from such treatment. The aim of the present survey was to evaluate the effect of rehabilitation in patients with moderate COPD and to determine their willingness to participate in rehabilitation.

In a single-centre, randomized, placebo-controlled, unblinded clinical trial, participants comprised 61 of 133 referred subjects with moderate COPD. Of the 61 participants, 35 were randomized to receive rehabilitation and 26 subjects to receive standard COPD care from their GP. After randomization 19 subjects dropped out.

Effects of physical training were seen during the period of intervention. Compared with those receiving standard GP care, those receiving rehabilitation showed improvements in walking distance and leg strength as well as improvements in quality of life; however, the effect was temporary, and at 18 months' follow-up there was no significant difference between the groups. Only 61 subjects of the referred group of 133 with moderate COPD accepted the offer of rehabilitation.

Although an effect was found of pulmonary rehabilitation in subjects with moderate COPD, it disappeared over 18 months. Only a minority of patients with moderate COPD referred for rehabilitation accepted and completed the treatment offer.