Effectiveness of pulmonary rehabilitation in different COPD stages

Abstract

Rationale: Pulmonary rehabilitation can improve exercise tolerance, symptoms, muscle function and lung mechanics.

Aims: The Aim of the study was to investigate what is the effectiveness of pulmonary rehabilitation in different stages of COPD.

Materials and methods: 201 patients with COPD (GOLD stage I, n=21, FEV₁: 86±13 %pred; stage II, n=41, FEV₁: 61±7 %pred; stage III, n=78, FEV₁: 40±7 %pred; stage IV, n=61, FEV₁: 23±4 %pred) participated in this study. Patients performed a complex pulmonary rehabilitation program with chest wall-stretching, controlled breathing techniques and training, and personalized exercise training 2-3 times for 20-30 minutes per day by cycling and treadmill for 4 weeks. 6 minutes walking distance (6MWD), Modified Medical Research Dyspnea Scale (mMRC), COPD Assessment test (CAT), lung function, chest wall expansion (CE), maximal inspiratory pressure (MIP) and breath holding time were measured.

Results: Rehabilitation resulted improvement in 6MWD (stage I: 423±94 vs. 485±85m*, stage II: 357±85 vs. 413±85*; stage III: 361±88 vs. 416±85; stage IV: 314±91 vs. 373±97m*, *p<0,05), CAT (stage I: 14±6 vs. 8±6*, stage II: 16±6 vs. 8±6*, stage III: 17±7 vs. 10±7*, stage IV: 20±6 vs 14±6*, *p<0,05) and CE (stage I: 5,00±1,81 vs. 6,98±1,91cm*; stage II: 3,92±1,82 vs. 5,73±199*, stage III: 3,89±1,94 vs. 5,53±1,96*; stage IV: 3,48±1,61 vs. 5,0±1,71*, * p<0,05). Lung function, mMRC, MIP and breath holding time did not change significantly in the different stages.

Conclusion: PR was effective in improvement of exercise tolerance, lung mechanics and quality of life in all stages, except 6MWD in stage III. A longer rehabilitation time may need to achieve significant changes in the other markers.