Cough in pulmonary rehabilitation: a retrospective analysis of responders and nonresponders

Pulmonary rehabilitation (PR) is essential for people with chronic respiratory diseases (CRDs), yet its impact on cough-related quality of life (CR-QoL) remains unexplored. We assessed the effects of PR on CR-QoL, described the characteristics of responders and nonresponders to PR, and explored determinants of responsiveness in this health domain in individuals with CRDs.

A retrospective study was conducted. We assessed CR-QoL using the Leicester Cough Questionnaire (LCQ) and the impact of the disease with the COPD Assessment Test (CAT), before and after PR. Cut-offs of <17.05 in LCQ total score and ≥10 in CAT were used to detect low CR-QoL and medium impact of the disease. Responders were defined as achieving a minimal clinically important difference (MCID) of ≥1.3 on the LCQ total score. Pre- versus post-PR analysis involved the t-test, Wilcoxon test or McNemar test and comparisons between groups included the independent t-test, Mann-Whitney U-test or Fisher's exact test. Logistic regression was employed to investigate factors influencing MCID achievement.

135 participants with CRDs (39% females; age 68±10 years; 61% COPD; forced expiratory volume in 1 s (FEV₁) % pred 62.6±23.0%) were included. After PR, significant improvements were observed in all LCQ domains and CAT. 31% of participants were identified as responders in the LCQ (36% females; age 66±10 years; 62% COPD; FEV₁ % pred 60.0±22.3%), showcasing significant differences in the LCQ and CAT compared to nonresponders. People with low CR-QoL and medium/high impact of the disease at baseline were 11 and 4 times more likely to respond to PR in CR-QoL, respectively.

PR enhances CR-QoL. Identification of CR-QoL and disease impact traits at baseline offers insights to optimise this outcome responsiveness to PR.