Predictors of response to pulmonary rehabilitation in stable chronic obstructive pulmonary disease patients: A prospective cohort study

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Date: April-June 2019
From: Journal of Postgraduate Medicine(Vol. 65, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 3,450 words
Lexile Measure: 1580L

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Byline: S. Ragaselvi, A. Janmeja, D. Aggarwal, A. Sidana, P. Sood

Context: Pulmonary rehabilitation (PR) has become a standard of care in the management of chronic obstructive pulmonary disease (COPD). However, a significant proportion of the patients do not show benefit after the PR program. Aims: The study was planned to find different patient- and/or disease-related factors that may predict response to PR in stable COPD. Subjects and Methods: A total of 102 stable COPD patients were prospectively enrolled. Baseline evaluation and investigations, including spirometry, arterial blood gas analysis, and bone mineral density assessment, were done. Thereafter, all patients underwent an 8-week comprehensive outpatient PR program that consisted of exercise training, education, nutritional, and psychological counseling. The response to PR was dichotomously (yes/no) defined by the combined improvement in exercise tolerance (6-min walk distance [6MWD] +54 m) and quality of life (St. George's Respiratory Questionnaire [SGRQ] score - 4 points) measured before and after the program. Thereafter, different predefined factors were analyzed for their possible association with the PR response. Results: A total of 80 patients (78.4%) completed the PR program and were subjected for analysis. Out of them, 42 (52.5%) showed improvement in both 6MWD and SGRQ score (46 in 6MWD and 54 in SGRQ score). After application of multivariate logistic regression analysis, forced expiratory volume in 1 s <50% predicted (odds ratio [OR]: 2.9; 95% confidence interval [CI]: 1.1-8.3; P = 0.04) and osteoporosis (OR: 0.26; 95% CI: 0.13-0.53; P < 0.001) were found as independent factors predicting PR efficacy. Conclusions: Poor baseline lung function predicts a short-term improvement in exercise capacity and quality of life in COPD patients, whereas osteoporosis is a negative predictor of PR response. Active search for these factors may help in better patient selection, thus leading to improved outcome after PR.

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive airway disease affecting 8.4%-15% of the adult population worldwide.[1] India too carries a high burden of the disease with prevalence estimates ranging from 2% to 22% in men and 1.2%-19% in women.[2] Being an irreversible disease, the primary goal of COPD treatment is the improvement in symptoms and prevent/manage exacerbations.

Pulmonary rehabilitation (PR) is a nonpharmacological intervention that has been shown to improve dyspnea, exercise capacity, and quality of life in COPD patients.[3],[4] It involves patient assessment-guided therapies that include exercise training, education, and behavior change. With a strong favorable evidence, PR is now the standard of care in COPD patients.[5] However, in spite of a well-organized PR program, a significant proportion of patients who complete the program do not attain expected benefits in terms of health-related quality of life (HRQoL) and/or exercise capacity.[6],[7],[8] Hence, it becomes crucial to identify the patients who are likely to achieve maximum benefit out of the PR program.

Previous studies have tried to evaluate different clinical-, physiological-, and disease-related factors that could predict PR efficacy. However, these have yielded inconsistent results with a variety of factors such as age,[6] dyspnea grade,[9] partial pressure of oxygen (PaO[sub]2) in...

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Gale Document Number: GALE|A584164885