Timing of Pulmonary Rehabilitation in Readmitted Patients with Severe Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial

Abstract

Early pulmonary rehabilitation (PR), started during hospitalization or within the first month after discharge, has been shown to reduce exacerbations and improve health-related-quality of life (HRQoL) and exercise capacity. However, no randomized clinical trials (RCT) have compared the efficacy of PR started during hospitalization (DHPR) to PR initiated one month post-hospitalization (PHPR). We conducted an RCT to compare DHPR to PHPR in severe patients with COPD readmitted for exacerbations in a tertiary hospital setting. Patients were randomized to receive three months of DHPR or PHPR. Outcomes were assessed at completion of the PR programme and at months 3 and 9. A total of 53 patients (26 DHPR and 27 PHPR) were included. There were no between-group differences in the number of exacerbations (mean, 3.62 vs. 3.04 in the DHPR and PHPR groups, respectively; p = 0.403). Dyspnea in activities of daily living, exercise capacity, and all HRQoL parameters improved in the PHPR group. In the DHPR group, improvement was observed only for some HRQoL parameters. All gains in both groups were lost during follow-up. More adverse events were observed in the DHPR group (20 vs 5, p = 0.023), although none of these were clinically significant. In this sample of patients with severe COPD readmitted to the hospital for exacerbations, both approaches to PR were safe, but PHPR yielded better outcomes overall. These findings suggest that, PR should be initiated in patients with severe COPD only after hospital discharge when the patients’ clinical condition has stabilized.

Keywords:

• Severe COPD patients
• hospital pulmonary rehabilitation
• home pulmonary rehabilitation
• exacerbations

Acknowledgments

The authors wish to thank the physiotherapist and occupational therapist who participated in this study for their excellent work in implementing the rehabilitation programme. We also thank the patients who agreed to participate in the study. Finally, we thank Ana Alonso and Meritxell Peiro for their assistance in data collection, and Bradley Londres for professional English language editing.

Conflicts of interest

The authors certify that there are no conflicts of interests.

Author contributions

All authors played a role in the clinical investigation and in writing the manuscript. MRG was the principal investigator and developed the original idea for the study. GFF and LPDR applied the PR programme and evaluated the outcomes together with FMV. All authors contributed to data collection. IBR and DOV analyzed the data.

Additional information

Funding

Sources of funding and other support: partially funded by a grant from the Spanish Society of Pneumology and Thoracic Surgery (2012).