The impact on health status in short- and long-terms of a novel and non-orthodox real-world COPD rehabilitation effort in rural India: an appraisal

Abstract

Background

Rehabilitation has been an integral part of management of COPD. Since the implementation of the standard rehabilitation protocol is hardly possible in the rural developing world, aiming to make a feasible alternate effort may be worthwhile.

Methods

COPD patients diagnosed through spirometry were first stabilized with 6 weeks of uniform pharmacotherapy. Subsequently, they were subjected to a curriculum-based intensive single-session intervention with education, bronchial hygiene, and exercise training. The latter involved whole body exercise, pursed lip breathing, and diaphragmatic exercise. The participants continued to practice the exercises under real-world encouragement and supervision from trained volunteers. The impact was appraised in terms of change in health status through COPD assessment test (CAT) score measurements at stabilization, and after 6 weeks and 1 year of the intensive training and education.

Results

At stabilization, 70 out of 96 selected COPD subjects (73%) turned up (with mean age 62±9 years and mean FEV₁ as 1.16±0.39 L) showing improvement as per CAT score (p=0.0001) from pharmacotherapy. After practicing the imparted education and training for 6 weeks, all these 70 participants had further significant improvement in the health status (n=70, p=0.00001). This improvement, been reinforced and supervised, continued to last even at 1 year (n=54, p=0.0001).

Conclusion

The self-managed practice of a single-session education and training under real-world supervision can bring forth significant long-term improvement in the health status of COPD sufferers. Such simple and feasible intervention may substitute formal COPD rehabilitation programs in resource constraint situations.

Keywords:

• rural COPD
• extensive training
• single point intensive education and training
• quality of life
• respiratory function tests

Acknowledgments

We would like to thank the following people for their support in the study: Rana Dey, Institute of Pulmocare & Research, New Town Kolkata, India; Ratna Dey, Institute of Pulmocare & Research, New Town Kolkata, India; Jayanta Das, Rural volunteer, Rajnagar, Birbhum, India; Moloy Bhattacharya, Rural volunteer, Rajnagar, Birbhum, India; Pintu Bagdi, Rural volunteer, Rajnagar, Birbhum, India; Kumar Chakarborty, Consultant Physician, Kolkata, India; Ratan Lal Manna, Rural volunteer, Birbhum, India; MD. Nizamuddin, Rural volunteer, Birbhum, India; Dharam Sutradhar, Rural volunteer, Birbhum, India; Sanjoy Mondal, Rural volunteer, Birbhum, India; and Akal Mal, Rural volunteer, Birbhum, India. The Department of Science and Technology of the Government of West Bengal funded the study.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no other conflicts of interest in this work.