Abstract
The role of pulmonary rehabilitation (PR) in COPD patients with lung hyperinflation has not yet been fully investigated. We retrospectively evaluated the effect of a standard PR course on exercise tolerance and symptoms according to the presence or absence of associated lung hyperinflation, as defined by lung function parameters in three Italian rehabilitation centres. In a cohort of 823 COPD patients (age 71 ± 8 years, FEV1 56 ± 18% pred.) we have systematically recorded: changes (∆) in 6-minute walking test (6MWD) as the primary outcome; dyspnoea (D); muscle fatigue (F); SO2nadir during effort; perceived breathlessness score (MRC); and specific health-related quality of life (SGRQ). Outcomes were compared between patients with lung hyperinflation (n = 283, LH) or without (n = 540 No-LH). Groups were comparable for age, body mass index, baseline exercise tolerance, and breathlessness. ∆-6MWD (+72 ± 47 vs. +62 ± 42 m, p < 0.05); ∆-D (−2.3 ± 1.7 vs. −1.9 ± 1.3 point, p < 0.05) and ∆-SO2nadir (+1.4 ± 3.0 and +0.5 ± 3.3 point, p < 0.05) were greater in LH than in No-LH. Using a multivariate linear regression model, ∆-6MWD in the LH group significantly correlated with lower functional residual capacity (p = 0.021) and baseline 6MWD (p = 0.004). Tolerance, gas exchange and perceived symptoms during effort are the parameters that gain a significant benefit from standard rehabilitation in COPD patients with a lung hyperinflation condition.
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Abbreviations
- Δ:
-
Pre-to-post changes in rehabilitation outcomes
- 6MWD:
-
6-Minute walking distance
- BMI:
-
Body mass index
- BODE:
-
Global functional index obtained by measure of BMI, FEV1, MRC and 6MWD
- COPD:
-
Chronic obstructive pulmonary disease
- D:
-
Borg dyspnoea
- SD:
-
Standard deviation
- LH:
-
COPD patients with associated lung hyperinflation
- F:
-
Borg muscle fatigue
- FEV1/FVC:
-
Forced expiratory volume in the first second on forced vital capacity ratio
- FEV1 :
-
Forced expiratory volume in the first second
- FiO2 :
-
Inspiratory fraction of oxygen
- FRC:
-
Functional residual capacity
- FVC:
-
Forced vital capacity
- GOLD:
-
Global initiative for chronic obstructive lung disease
- HRQL:
-
Health-related quality of life
- LTOT:
-
Long-term oxygen therapy
- LVRS:
-
Lung volume reduction surgery
- MCID:
-
Minimal clinically important difference
- MRC:
-
Medical Research Council dyspnoea scale
- NETT:
-
National Emphysema Treatment Trial
- No-LH:
-
Patients without a lung hyperinflation
- PaCO2 :
-
Arterial partial pressure of carbon dioxide
- PaO2/FiO2 :
-
Arterial pressure on specific oxygen flow
- PaO2 :
-
Arterial partial pressure of oxygen
- PR:
-
Pulmonary rehabilitation
- RV/TLC:
-
Residue volume on total lung capacity ratio
- RV:
-
Residual volume
- SGRQ:
-
St. George’s respiratory questionnaire on perceived quality of life
- SO2nadir:
-
Minimum value of pulse oxygen saturation recorded during 6MWD
- TLC:
-
Total lung capacity
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Crisafulli, E., Venturelli, E., Biscione, G. et al. Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation. Intern Emerg Med 9, 23–31 (2014). https://doi.org/10.1007/s11739-011-0727-z
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DOI: https://doi.org/10.1007/s11739-011-0727-z