Eerreira G, Eeuerman M, Spiegler P
J Cardiopulm Rehabil. 2006;26:54-60.
Purpose:
To determine whether there is any difference in the effect of pulmonary rehabilitation (PR) on outcomes inpatients with and without chronic obstructive pulmonary disease (COPD).
Methods:
Retrospective analysis of medical records of all patients enrolling in PR over a 5-year period.
Results:
A total of 422 patients enrolled in a multidisciplinary PR program from August 1999 to April 2004. Three hundred nine patients had COPD and 113 patients had diagnoses other than COPD. Three hundred seventy-nine patients completed the program. Pulmonary rehabilitation was conducted according to currently accepted guideline. Measurements included the 6-minute walk distance (6MWD) performed at the beginning and end of the program and the quality of life as determined by the Chronic Respiratory Questionnaire at the beginning and end of the program. Both groups had significant improvements in the 6MWD and all domains of the Chronic Respiratory Questionnaire after PR. There was no significant difference in any of these outcomes between the 2 groups. The base line forced expiratory volume in 1 second was not correlated with improvement in the 6MWD in either group.
Conclusions:
There is no significant difference in improvement in exercise tolerance or quality of life after PR in COPD versus non-COPD patients. Baseline lung function does not predict improvement in exercise tolerance. Pulmonary rehabilitation is effective for patients with disability due to any chronic respiratory disease and not just COPD.
Commentary:
Most studies assessing outcomes of PR have been conducted among patients with COPD. The existing base of medical literature assessing efficacy of PR among patients with disorders other than COPD is much smaller and, to date, is based largely on observational studies and small case series. A few randomized controlled trials have also emerged recently. Importantly, where studied, patients with many respiratory disorders other than COPD including asthma, cystic fibrosis, restrictive chest wall disease, pulmonary fibrosis, obesity-related respiratory disturbances, lung cancer, and some neuromuscular diseases have all been found consistently to benefit from exercise training and rehabilitative interventions. This is not surprising, given that the comorbidities associated with COPD (such as skeletal muscle I dysfunction, systemic inflammation, impaired nutrition, dyspnea, cardiocirculatory limitation, as exchange disturbances) that collectively contribute significantly to functional impairment and disability are also common among patients with respiratory diseases other than COPD and, unlike fixed impairments in lung function, are often responsive to the PR intervention, However, although referral of patients with disorders other than COPD to PR programs is increasingly common, insurance coverage for PR participation may be declined due to relative lack of clinical trials assessing outcomes of PR for any given disease other than COPD. Moreover, many trials conducted among patients with disorders other than COPD have focused primarily on exercise training and some education, without the full complement of components included traditionally in comprehensive PR programs. Therefore, additional studies are needed that address this topic. In this study by Femeira and colleagues, outcomes of an 8-week outpatient PR program for a 5-year period were retrospectively analyzed, and data from patients with COPD who had completed the program (n = 309) were compared with those from patients with disorders other than COPD who had participated in the same program (n= l13). In this study, the non-COPD patient group included persons with asthma, pulmonary fibrosis, restrictive chest wall disease, bronchiectasis, sarcoidosis, diaphragm paralysis, tracheomalacia, pulmonary artery hypertension, postlung resection, and postacute respiratory distress syndrome, and a variety of other interstitial lung diseases. Consistent with findings of other smaller studies, patients with the non-COPD diagnoses had comparable gains in both exercise endurance (6MWD) and health status (Chronic Respiratory Disease Questionnaire) to those made by the patients with COPD. Baseline lung function did not predict the extent of gain in 6MWD after PR. Moreover, both the patients with non-COPD airway disease and those with restrictive lung disease achieved comparable gains in exercise tolerance and health status after PR. Additional work is needed to determine how to best adapt PR programs to the needs of diverse patient groups, to enable optimal gains to be made after PR by individual patients with different disorders.
CR