Is it really useful to repeat outpatient pulmonary rehabilitation programsin patients with chronic airway obstruction? A 2-year controlled study

Study objectives: To answer the following questions: in patients with chron ic airway obstruction (CAO), (1) can pulmonary rehabilitation lead to simil ar short-term gains at successive,yearly interventions, and (2) is there an y real clinical or physiologic long-term benefit by yearly repetition of pu lmonary rehabilitation programs (PRPs)? Design: Randomized, controlled clinical study. Setting: Pulmonary rehabilitation center. Patients: Sixty-one CAO patients studied 1 year after completing an initial 8-week outpatient PRP (PRP1). Intervention: Patients were randomly classified into two groups. A second P RP (PRP2) was completed by the first group (group 1) but not by the second group (group 2). One year later, a third PRP (PRP3) was performed by both g roups. Measurements: Lung function, cycloergometry, walking test, dyspnea, and hea lth-related quality of life (HRQL) were assessed before and after PRP2, and before and after PRP3. The numbers of hospitalizations and exacerbations o ver the year were also recorded. Results: Complete data sets were obtained from 36 patients (17 patients in group 1 and 19 patients in group 2). The two groups did not differ in any p arameter either before PRP1, after PRP1, or at randomization. There was no significant change over time for airway obstruction in either group. After PRP2, exercise tolerance, dyspnea, and HRQL improved in group 1. Neverthele ss, 1 year later, patients of group 1 did not differ from patients of group 2 in any outcome parameter, such that in comparison to before PRP1, only H RQL was still better in both groups 24 months after PRP1. Yearly hospitaliz ations and exacerbations per patient significantly decreased in both groups in the 2 years following PRP1, when compared to the 2 years prior. Neverth eless, at the 24-month follow-up visit, a further reduction in yearly exace rbations was observed only in group 1 but not in group 2 in comparison to w hat was observed at the le-month follow-up visit. The PRP3 resulted in impr ovement in exercise tolerance in both groups. Conclusion: In patients with CAO, an outpatient PRP can achieve benefits in HRQL and a decreased number of hospitalizations, which persist for a perio d of 2 years. Successive, yearly interventions lead to similar short-term g ains but do not result in additive long-term physiologic benefits. Further reduction in yearly exacerbations seems to he the main benefit of an additi onal PRP.