Clinical predictors of the efficacy of a pulmonary rehabilitation programme in patients with COPD.

Cardio-Thoracic and Vascular Department, University of Pisa, Italy.
Respiratory medicine (Impact Factor: 2.33). 04/2009; 103(8):1224-30. DOI:10.1016/j.rmed.2009.01.023
Source: PubMed

ABSTRACT To identify predictors of success for an 8week pulmonary rehabilitation programme (PRP) in patients with chronic obstructive pulmonary disease (COPD).
Sixty patients were stratified in subgroups according to baseline findings: airway obstruction (FEV(1) >/= or <50% pred), pulmonary hyperinflation (TLC > or <or=120% pred), BMI value (BMI > or <or=25), cardiovascular (CV) comorbidity, and resting PaO(2) (PaO(2) >/= or <60mmHg). Outcome measurements of PRP were: >54m increase in 6min walking test (6MWT), or >4points reduction in total score of S. George Respiratory Questionnaire (SGRQ). Logistic regression analysis was used.
After PRP there was a significant improvement in exercise tolerance and quality of life, which correlated with baseline FEV(1)/VC, PaO(2), SpO(2), 6MWT and SGRQ. SGRQ significantly decreased and 6MWT significantly increased after PRP in all subgroups, except for patients with CV comorbidities. Both univariate and multivariate logistic regression analyses showed that BMI>25 and resting PaO(2)<60mmHg were independent predictors of PRP efficacy in terms of improvement of 6MWT, but not of SGRQ scores.
Clinical and functional baseline findings do not predict the response to PRP in COPD. The greater efficacy in patients with BMI>25 or with PaO(2)<60mmHg may be due to a greater deconditioning in overweight patients, and to a larger room for improvement in hypoxemic patients.

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    ABSTRACT: Introduction. Conflicting results have been so far reported about baseline lung function, as predicting factor of pulmonary rehabilitation (PR) efficacy. Aim. To ascertain whether or not baseline lung function could predict a benefit in terms of a significant change in 6-min walk test (6MWT) after PR. Methods. Seventy-five stable moderate-to-severe COPD inpatients with comorbidities (complex COPD), allocated to a three-week PR program, were retrospectively evaluated. Pulmonary function, 6MWT, dyspnea (BDI/TDI), and quality of life (EQ-VAS) were assessed before and after PR program. The patients were divided into two groups depending on the change in 6MWT (responders > 30 m and nonresponders ≤ 30 m). Logistic regression analysis was used. Results. After PR, 6MWT performance all outcome measures significantly improved (P < 0.01). Compared to nonresponders (N = 38), the responders (N = 37) had lower values in baseline lung function (P < 0.01). Logistic regression analysis showed that FEV1 < 50% pred and TL, CO < 50% pred were independent predictors of PR efficacy. Conclusions. Our study shows that in stable moderate-to-severe complex COPD inpatients, baseline lung function may predict the response to PR in terms of 6MWT. We also found that complex COPD patients with poor lung function get more benefit from PR.
    BioMed research international. 01/2013; 2013:483162.
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    Pulmonary medicine. 01/2014; 2014:782702.


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