Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease - A quasi-experimental pilot study

A Machado; A Oliveira; C Valente; C Burtin; A Marques

doi:10.1016/j.pulmoe.2019.05.004

Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease - A quasi-experimental pilot study

Pulmonology. 2020 Jan-Feb;26(1):27-38. doi: 10.1016/j.pulmoe.2019.05.004. Epub 2019 Jun 1.

Authors

A Machado¹, A Oliveira¹, C Valente², C Burtin³, A Marques⁴

Affiliations

¹ Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
² Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
³ Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
⁴ Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal. Electronic address: amarques@ua.pt.

PMID: 31164288
DOI: 10.1016/j.pulmoe.2019.05.004

Abstract

Background: Pulmonary rehabilitation (PR) is a cornerstone intervention for the management of patients with stable chronic obstructive pulmonary disease (COPD). However, its role during acute exacerbations (AECOPD) is controversial since most studies have been conducted in hospitalised patients, when more than 80% of AECOPD are managed on an outpatient basis. This quasi-experimental pilot study assessed the effects of a community-based PR programme during mild-to-moderate AECOPD.

Methods: Outpatients were recruited from hospitals and allocated to experimental (EG) or control (CG) groups. EG received standard medication plus 3-weeks of PR. The CG received standard medication. Dyspnoea (mMRC), quadriceps muscle strength (QMS), functionality (5-repetition sit-to-stand test) and impact of the disease (COPD assessment test (CAT)) were assessed within 48h of the AECOPD onset and after PR. Symptoms of dyspnoea and fatigue (mBorg), heart and respiratory (RR) rates and peripheral oxygen saturation (SpO₂) were assessed at rest and monitored in all PR sessions. Need for hospitalisation was monitored during the 3-weeks.

Results: Twelve patients (69±7 years, FEV₁ 52±27 pp) in the EG and eleven in the CG (66±9 years, FEV₁ 55±22 pp) were enrolled. The EG presented significant improvements on QMS (Pre 21.0 vs. Post 25.0, p=0.012), CAT (Pre 23.0 vs. Post 14.5, p=0.008), symptoms of dyspnoea at rest (Pre 3.0 vs. Post 1.0, p=0.008), SpO₂ (Pre 94.0 vs. Post 96.0, p=0.031) and RR (Pre 24.0 vs. Post 20.5, p=0.004). No significant improvements were found in the CG.

Conclusion: Adding PR to the management of mild-to-moderate AECOPD seems to result in improvements on parameters usually associated with an increased risk of re-exacerbation and poor prognosis. Randomised studies with larger samples are needed to confirm these results.

Keywords: Chronic obstructive; Community health services; Disease progression; Pulmonary disease; Rehabilitation.

MeSH terms

Aged
Community Health Services / methods*
Disease Progression
Female
Follow-Up Studies
Humans
Male
Muscle Strength / physiology*
Outpatients*
Pilot Projects
Prognosis
Pulmonary Disease, Chronic Obstructive / physiopathology
Pulmonary Disease, Chronic Obstructive / rehabilitation*
Quality of Life
Retrospective Studies
Surveys and Questionnaires