Internal and Emergency Medicine

, Volume 9, Issue 1, pp 23–31

Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation

  • Ernesto Crisafulli
  • Elena Venturelli
  • Gianluca Biscione
  • Guido Vagheggini
  • Andrea Iattoni
  • Sasha Lucic
  • Nicolino Ambrosino
  • Franco Pasqua
  • Alfredo Cesario
  • Enrico Maria Clini
IM - ORIGINAL

DOI: 10.1007/s11739-011-0727-z

Cite this article as:
Crisafulli, E., Venturelli, E., Biscione, G. et al. Intern Emerg Med (2014) 9: 23. doi:10.1007/s11739-011-0727-z

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.

Keywords

Exercise Rehabilitation COPD Lung hyperinflation 

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

Copyright information

© SIMI 2011

Authors and Affiliations

  • Ernesto Crisafulli
    • 1
  • Elena Venturelli
    • 2
  • Gianluca Biscione
    • 3
  • Guido Vagheggini
    • 4
  • Andrea Iattoni
    • 2
  • Sasha Lucic
    • 1
  • Nicolino Ambrosino
    • 4
  • Franco Pasqua
    • 3
  • Alfredo Cesario
    • 3
  • Enrico Maria Clini
    • 1
    • 2
  1. 1.Pulmonary RehabilitationVilla Pineta HospitalPavullo (MO)Italy
  2. 2.DAI Oncology, Haematology and Respiratory DiseasesUniversity of Modena-Reggio EmiliaModenaItaly
  3. 3.Division of Pulmonary RehabilitationSan Raffaele HospitalVelletri (Rome)Italy
  4. 4.Auxilium Vitae Rehabilitation CenterVolterra (Pisa)Italy