Chest
Volume 117, Issue 4, April 2000, Pages 976-983
Journal home page for Chest

Clinical Investigations
COPD
Long-term Effects of Outpatient Rehabilitation of COPD: A Randomized Trial

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Objective

To examine the short- and long-term effects of an outpatient pulmonary rehabilitation program for COPD patients on dyspnea, exercise, health-related quality of life, and hospitalization rate.

Setting

Secondary-care respiratory clinic in Barcelona.

Methods

We conducted a randomized controlled trial with blinding of outcome assessment and follow-up at 3, 6, 9, 12, 18, and 24 months. Sixty patients with moderate to severe COPD (age 65 ± 7 years; FEV1 35 ± 14%) were recruited. Thirty patients randomized to rehabilitation received 3 months of outpatient breathing retraining and chest physiotherapy, 3 months of daily supervised exercise, and 6 months of weekly supervised breathing exercises. Thirty patients randomized to the control group received standard care.

Results

We found significant differences between groups in perception of dyspnea (p < 0.0001), in 6-min walking test distance (p < 0.0001), and in day-to-day dyspnea, fatigue, and emotional function measured by the Chronic Respiratory Questionnaire (p < 0.01). The improvements were evident at the third month and continued with somewhat diminished magnitude in the second year of follow-up. The PR group experienced a significant (p < 0.0001) reduction in exacerbations, but not the number of hospitalizations. The number of patients needed to treat to achieve significant benefit in health-related quality of life for a 2-year period was approximately three.

Conclusion

Outpatient rehabilitation programs can achieve worthwhile benefits that persist for a period of 2 years.

Section snippets

Patients

We enrolled 60 COPD patients5 from among those presenting to our hospital's outpatient clinic. Participants were age≤ 75 years and had an FEV1 < 70% of reference values, FEV1/FVC < 65%, and Pao2 > 55 mm Hg at rest with no indication for prescribing home oxygen therapy. None had experienced an exacerbation or been hospitalized in the previous month; all were free of clinically apparent heart disease or relevant bone or joint disease. We enrolled consecutive eligible patients interested in

Patient Demographics, Enrollment, and Compliance

We randomly assigned 30 patients to the control group and 30 to rehabilitation. All 60 patients were men whose mean age was 65 ± 7 years (range, 46 to 74 years) and mean lung function values were FVC, 63 ± 15% of reference value (33 to 94%); FEV1, 35 ± 14% of reference value (15 to 68%); FEV1/FVC, 40 ± 11% (23 to 64%); RV, 179 ± 45% of reference value (87 to 278%); total lung capacity, 112 ± 20% of reference value (82 to 190%); Pao2, 70 ± 9 mm Hg (56 to 89 mm Hg); and Paco2, 44 ± 5 mm Hg (34 to

Discussion

This study is consistent with previous reports,1, 23 showing that a PR program for COPD patients encompassing education, breathing retraining, and chest physiotherapy followed by exercise training leads to improvement in dyspnea, functional exercise capacity, and HRQL. The strengths of our study include the randomized design, the blinding of supervisors and technicians who measured outcome variables, and our maintenance of long-term follow-up in a population likely to have many reasons for

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