Improvements in outcomes for chronic obstructive pulmonary disease (COPD) attributable to a hospital-based respiratory rehabilitation programme

Aim: To determine whether the benefits of pulmonary rehabilitation, demonst rated in selected subjects in randomised controlled studies, can be achieve d by a hospital-based respiratory rehabilitation programme conducted as par t of routine clinical management. Methods: Design: A prospective longitudinal study of patients with severe c hronic obstructive pulmonary disease (COPD) enrolled in a hospital based, n on-medically supervised, outpatient, respiratory rehabilitation programme w as undertaken. The rehabilitation programme was of pragmatic design and content, supervise d by respiratory physiotherapists and comprised seven two hour sessions ove r one month for groups of six to eight patients. It included education on d isease management, practical instruction in coping skills, as well as a pro gressive aerobic exercise programme for specific muscle training related to functional activities. Subjects were assessed prior to the programme but after optimisation of pha rmacologic therapy, at the completion of the programme and at three months and six months post-programme. Principal outcome parameters were exercise c apacity (as assessed by a six minute walk distance [MWD] test), degree of p erceived breathlessness and quality of life (QOL) (assessed by the Chronic Respiratory Disease Questionnaire [CRDQ]). Results: Fifty-one subjects with severe COPD (Fev(1)=0.9+/-0.4 l) completed the programme. There was a significant improvement in exercise capacity (a six MWD test improved from 375+/-126 m at baseline to 440+/-109 m at three months, p<0.005). There were significant improvements in QOL (in the total CRDQ score as well as in the domains of dyspnoea, fatigue and mastery). Th ere was a reduction in the level of perceived dyspnoea (modified Borg Scale ). Most improvements were maintained for three and six months following com pletion of the programme. Compared with the six months preceding the progra mme there was a reduction in hospital admissions and reduction in courses o f oral steroids. Conclusions: An outpatient, hospital-based respiratory rehabilitation progr amme pragmatically adapted for clinical utility produces substantial and cl inically significant improvements in exercise tolerance and QOL, similar in type and magnitude to those obtained in controlled clinical trials. There was an associated reduction in COPD-related morbidity. Such gains were most ly maintained for six months after completion of the programme. Thus respir atory rehabilitation must be regarded as an essential component of a compre hensive clinical programme for the management of COPD.