Pulmonary Rehabilitation After Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients Who Previously Completed a Pulmonary Rehabilitation Program

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PURPOSEAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) impair health-related quality of life (HRQL). We evaluated the effect of an abbreviated repeat pulmonary rehabilitation (PR) program on HRQL after an AECOPD.METHODSPatients who had completed PR were followed for up to 12 months to identify an AECOPD and then placed in randomized groups to receive a 3-week repeat-PR intervention or usual care. Measures of HRQL (Chronic Respiratory Disease Questionnaire, CRQ) and functional exercise capacity (6-minute walk distance, 6MWD) were collected at 2 (T1), 5 (T2), and 12 weeks (T3) post-AECOPD. The repeat-PR program was undertaken between T1 and T2. Between-group differences were examined using repeated- measures analysis of variance or covariance.RESULTSOf the 60 patients (30 men, age 69±8 years, forced expiratory volume in 1 second 0.86±0.40 L, 6MWD 367±99 m) followed, 41 experienced an AECOPD 14 ± 11 weeks after completion of the initial PR program and 33 completed the study. Of these, 16 and 17 were randomized to the intervention and control groups, respectively. No between-group differences were demonstrated at T2 or T3. With the exclusion of 5 subjects who experienced a second AECOPD between T1 and T3, the participants in the intervention group demonstrated greater reduction in dyspnea when compared to those in the control group at T3 (0.8±1.6 vs −0.4±1.3 points per item, P = .04).CONCLUSIONSThe reduction in dyspnea in those who did not experience a second AECOPD provides preliminary evidence for the role of repeat programs. The application of repeat PR should be refined in larger trials.

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