RANDOMIZED CONTROLLED TRIAL OF PULMONARY REHABILITATION IN SEVERE CHRONIC OBSTRUCTIVE PULMONARY-DISEASE PATIENTS, STRATIFIED WITH THE MRC DYSPNEA SCALE

This study tested the hypothesis that severity of respiratory disabili ty may affect the outcome of pulmonary rehabilitation. In this randomi zed, controlled study, 126 patients with chronic obstructive pulmonary disease (COPD) were stratified for dyspnoea using the Medical Researc h Council (MRC) dyspnoea score into MRC3/4 (Moderate) (n=66) and MRC 5 (Severe) dyspnoeic (n=60) groups. The patients were randomly assigned to an eight week programme of either exercise plus education (Exercis e group) or education (Control group). Education and exercise programm es for the moderately dyspnoeic patients were carried out in a hospita l outpatient setting. Severely dyspnoeic patients were all treated at home. Those in the Exercise group received an individualized training programme. There was a significant improvement in shuttle walking dist ance in the moderate dyspnoeic group, who received exercise training; baseline (mean+/-SEM) 191+/-22 m, post-rehabilitation 279+/-22 m (p<0. 001). There was no improvement in exercise performance in the severely dyspnoeic patients receiving exercise. Neither group of control patie nts improved. Health status, assessed by the Total Chronic Respiratory Disease Questionnaire score, increased in the moderately dyspnoeic pa tients receiving exercise from 80+/-18 to 95+/-17 (p<0.0001) after reh abilitation. Much smaller changes were seen in the other three groups. Improvement in exercise performance and health status in patients wit h chronic obstructive pulmonary disease after an exercise programme de pends on the initial degree of dyspnoea.