The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia (original) (raw)
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International journal of chronic obstructive pulmonary disease, 2014
Pulmonary rehabilitation (PR) is an important treatment option for chronic obstructive pulmonary disease (COPD) patients and might contribute to a reduction in exacerbation and exacerbation-related hospitalization rate. In this prospective study, all COPD patients that completed a comprehensive pulmonary rehabilitation program (PRP) between June 2006 and December 2012 were included. Self-reported exacerbation and hospitalization frequency 1 year before PR was retrospectively recorded. During the year following PR, exacerbation and hospitalization frequency was recorded with questionnaires. For 343 patients, complete information on exacerbation and hospitalization rate was obtained. The mean number of exacerbations decreased significantly after participating in a PRP by 1.37 exacerbations/year (95% confidence interval 1.029 to 1.717) from 4.56±3.26 exacerbations in the year preceding PR to 3.18±2.53 in the year following PR (P<0.0005). The number of hospitalizations due to exacerb...
Respiratory Care, 2016
BACKGROUND: Pulmonary rehabilitation (PR) programs are a mainstay for treatment in COPD. Lung function impairment alone does not predict beneficial effects of PR. The new COPD categories take into account assessment of symptoms, such as dyspnea and exacerbations, which may be important indications for PR. This study evaluates the effect of PR on exercise capacity, symptoms, and health status in different COPD categories. METHODS: Subjects with COPD referred for PR were classified into COPD categories A, B, C, and D. Exercise capacity (6-min walk distance [6MWD] and constant work rate at 80% of peak work rate), symptoms (Mahler's index), and health status (St George Respiratory Questionnaire) were compared before and after PR programs for each COPD category. Changes were analyzed using generalized estimating equations and logistic regression models. RESULTS: One hundred sixty-seven subjects were included (COPD categories A [16%], B [12%], C [31%], and D [41%]). Groups were homogeneous in age, body mass index, smoking pack-years, and comorbidities. Significant improvements in all outcomes were found after adjusting for COPD categories, age, sex, body mass index, and COPD-specific comorbidity index. All COPD categories improved exercise capacity (6MWD and constant work rate). Categories A and C had more pronounced improvements in 6MWD than categories B and D. Symptoms (Mahler's index) also improved significantly in categories A and C, whereas change was not significant in categories B and D. Global health status (St George Respiratory Questionnaire) improved significantly in all COPD categories. Despite these differences, the odds of achieving a minimum clinically important difference in each outcome were similar and without statistical significance for the A, B, and C categories when compared with D. CONCLUSIONS: This study demonstrates that patients in all COPD categories may improve exercise capacity, symptoms, and health status with PR programs, and COPD categories alone may not be sufficient to discriminate which patients may benefit most from them.
International Journal of Chronic Obstructive Pulmonary Disease, 2017
Aims: To study the short-and long-term results of pulmonary rehabilitation (PR) given in the Helsinki University Heart and Lung Center and to understand the hospital resources used to treat severe COPD exacerbations in the city of Helsinki. Materials and methods: Seventy-eight inactive patients with severe COPD were recruited for a PR course; three of them did not finish the course. The course took 6-8 weeks and included 11-16 supervised exercise sessions. Using electronic medical records, we studied all COPD patients with hospital admission in the city of Helsinki in 2014, including COPD diagnosis, criteria for exacerbation, and potential exclusion/inclusion criteria for PR. Results: Seventy-five of the patients finished the PR course and 92% of those patients showed clinically significant improvement. Their hospital days were reduced by 54% when compared to the year before. At 1 year after the course, 53% of the patients reported that they have continued with regular exercise training. In the city of Helsinki, 437 COPD patients were treated in a hospital due to exacerbation during 2014. On the basis of their electronic medical records, 57% of them would be suitable for PR. According to a rough estimate, 10%-20% hospital days could be saved annually if PR was available to all, assuming that the PR results would be as good as those shown here. Conclusions: The study showed that in a real-world setting, PR is efficient when measured by saved hospital days in severe COPD. Half of the patients could be motivated to continue exercising on their own.
Impact of pulmonary rehabilitation programs in improving health status in COPD patients
Balneo Research Journal, 2019
Pulmonary rehabilitation programme (PRP) have a positive impact on multiple outcomes of COPD, such as decreasing symptoms, increasing exercise tolerance and improving general health status. The aim of this study is to evaluate exercise tolerance impairment and to assess the impact of PRP in improving health status in patients diagnosed with COPD. It was conducted a prospective parallel group study in the Pulmonary Rehabilitation Department of the Clinical Hospital "V. Babes”, Timisoara, from 2007 to 2010. The subjects included in the study were patients diagnosed with COPD stages I-IV GOLD, initially evaluated and started a PRP, then re-evaluated after 3 weeks and 6 months. The study group included 168 patients, 158 men, mean age 61.73 years. The initial evaluation revealed higher values of dyspnea scores using mMRC scale in advanced COPD stages (3.69±0.77 in patients with COPD stage IV, vs 0.88±0.5 in patients with COPD stage, p<0.05), decreased Forced expiratory volume in ...
Egyptian Journal of Bronchology, 2018
Context Chronic obstructive pulmonary disease (COPD) is a very disabling disorder that is accompanied by some extrapulmonary manifestations. Pulmonary rehabilitation (PR) is outlined to enhance both physical and psychological condition of patients with chronic chest diseases. Aims We aimed at evaluating the effectiveness of 8 weeks of outpatient PR on improving breathlessness, quality of life, exercise tolerance, and functional ability in patients with stable COPD. Settings and design A randomized controlled clinical study was conducted. Patients and methods The current study was carried out on 80 patients with stable COPD who were classified into group 1, where 40 patients were subjected to usual pharmacological therapy for COPD and PR for 8 weeks, and group 2, where 40 patients were subjected to usual pharmacological therapy only. Both groups were assessed regarding spirometric pulmonary function, arterial blood gases, 6 min walk test, dyspnea score (modified-Medical Research Council), and health-related quality of life [Saint George respiratory questionnaire (SGRQ)]. SPSS 20.0 for windows and MedCalc 13 for windows were used for statistical analysis. Results Approximately 50% of patients in group 1 showed improvement in dyspnea, whereas only 25% of patients were improved in group 2. Moreover, there was a statistical significance difference between both patient groups regarding the post-treatment improvement in 6 min walk distance (6MWD) and the post-treatment improvement in the three components of SGRQ score and also in the total SGRQ score (P<0.001). The improvement in 6MWD showed significantly inverse correlation with the baseline age, modified-Medical Research Council, and SGRQ scores, whereas the improvement in 6MWD was significantly directly correlated with the baseline forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, PaO 2 , and baseline 6MWD. Conclusion PR for patients with stable COPD is an effective tool for improving quality of life, exercise capacity, and dyspnea score.
Srpski arhiv za celokupno lekarstvo, 2021
Introduction/Objective. Chronic obstructive pulmonary disease (COPD) is a primary lung disease. Today, pulmonary rehabilitation (PR) is the basis for non-pharmacological treatment of these patients, with numerous confirmed effects on the most significant symptoms of the disease and the quality of life (QoL). The aim of this study was to determine the relationship between certain risk factors and the outcome of PR, as well as to determine the percentage of respondents who had a positive outcome of PR. Methods. The study included 500 patients with COPD, determined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines, all stages (I?IV), in the stable phase of the disease, who completed the outpatient PR program. Disease stage, comorbidities, forced expiratory volume in the first second, six-minute walk test (6MWT), COPD Assessment Test (CAT), and Medical Research Council dyspnea scale, body mass index, airflow obstruction, dyspnea and exercise capacity (BO...
Respiratory care, 2016
COPD is a high-mortality disease and projected to become the third leading cause of death worldwide by 2030. Our aim was to evaluate predictors of 3-y mortality and factors associated with early (1 y) and late (second and third year) mortality in subjects with severe COPD who completed a pulmonary rehabilitation program. A historical cohort study was performed with subjects with COPD who were admitted to a day-hospital for chronic respiratory failure for a pulmonary rehabilitation program, from January 2008 to December 2010. The population was characterized based on sociodemographic factors, body mass index, smoking habits, lung function tests, respiratory failure, comorbidities, bacterial colonization, Modified Medical Research Council dyspnea index, 6-min walk test, mechanical ventilation, noninvasive ventilation, long-term oxygen therapy, hospital admissions, and mortality. From 183 patients who completed a pulmonary rehabilitation program, 93 had COPD. Our cohort had 78 male and...
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, 2006
To assess the efficacy of a pulmonary rehabilitation programme lasting 24 months and carried out at primary care health centres in improving the quality of life of patients with moderate COPD, compared with a programme of 12 weeks pulmonary rehabilitation with the usual care. Secondary aims include the assessment of the effects of the programme on dyspnoea, exercise capacity, reduction of crises, hospital admissions and length of time in hospital. Randomised clinical trial, with 3 groups in parallel and with blind evaluation. The control group will continue with the customary care. Patients attended at primary health care centres with a diagnosis, based on GOLD criteria, of moderate COPD. Patients will be recruited from 5 health centres. 56 patients per group are needed (allowing for 20% drop-outs) to detect the minimum clinically meaningful differences between treatments, with an alpha error of 0.005 and statistical power of 80%. All eligible patients with signed informed consent w...
Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study
Respiratory Research
Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. Methods This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was ...