Effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease with different degrees of static lung hyperinflation

Publication date: Available online 12 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michiel J.E.G.W. Vanfleteren, Maud Koopman, Martijn A. Spruit, Herman-Jan Pennings, Frank Smeenk, Willem Pieters, Jan J.A.M. van den Bergh, Arent-Jan Michels, Emiel F.M. Wouters, Miriam T.J. Groenen, Frits M.E. Franssen, Lowie E.G.W. Vanfleteren
ObjectiveTo evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).DesignRetrospective cohort study.SettingPulmonary Rehabilitation Network.ParticipantsA cohort of 1981 patients with COPD (55% males; age: 66.8 ± 9.3y; FEV1%: 50.7 ± 19.5; RV%: 163.0 ± 49.7).InterventionAn interdisciplinary PR program for patients with COPD consisting of 40 sessions.Main outcome measuresParticipants were stratified into five quintiles according to baseline RV and were evaluated on the basis of pre and post PR 6 minute walk distance (6MWD), constant work rate test (CWRT) and Saint George's Respiratory Questionnaire (SGRQ), among other clinical parameters.ResultsWith increasing RV quintile, patients were younger, more frequently female, had lower FEV1%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT and worse SGRQ scores (p<0.01). All RV strata improved following PR in all three outcomes (p<0.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (p<0.01) but similar Δ6MWD (p=0.948) and ΔSGRQ (p=0.086) after PR.ConclusionsLH in COPD is related to younger age, female gender, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH however influences walking and cycling response following PR differently.



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