Trajectories of COPD patients' response to repeated pulmonary rehabilitation programs

Pulmonary rehabilitation (PR) is essential in the management of chronic obstructive pulmonary disease (COPD), but the long-term effects and the outcomes of repeated programs especially in non-responders remain to be clarified. The aim of this study is to evaluate the long-term effect of PR 12 months after and the effect of repeated PR depending on the patient's response to the first PR.

This is a single center retrospective analysis of COPD patients admitted to two or three PR programs between January 2012 and December 2017, using the 6-min walking distance (6MWD) to determine the functional response to PR.

One hundred ninety patients completed PR twice and 62 completed PR three times with 10-14 months delay between programs. The effect of the first PR program (PR1) on 6MWD was mostly lost after one year. The 6MWD change after the second PR program (PR2) was smaller than after PR1 (+65 ± 30 m post-PR1, +44 ± 20 m post-PR2; p = 0.001). Out of the 149 responders post-PR1, 44 (30%) became non-responders post-PR2. Out of the 41 non-responders post-PR1, 23 (56%) became responders post-PR2. Patients with long term oxygen therapy and severe exercise dyspnea were most likely to remain non-responders to repeated PR.

This study showed that most of the 6MWD improvement following PR disappears over 12 months and emphasized the clinical relevance of repeating PR including for non-responders to initial PR. However, some patients did not respond systematically to PR and may require specific PR modalities to improve their functional status.