Abstract
Introduction: Although PR is considered an integral component in COPD management, short term benefits of PR in patients with severe airflow obstruction in an Indian setting is unclear.
Aim: To study the effects of a hospital-based structured PR on EC and QOL in Indian outpatients with severe COPD
Methods: Clinically stable severe COPD patients (FEV1<50% predicted) on optimized medical therapy were randomly assigned to rehabilitation (RG) and control group (CG). The RG attended thrice weekly (24 sessions) of supervised PR program whereas CG received usual outpatient care. Both groups were reassessed at eight weeks. Changes in Six Minute Walk Distance (Δ6MWD) and Saint George’s Respiratory Questionnaire (ΔSGRQ) from the baseline were assessed at eight weeks. Secondary outcomes included changes in spirometry and BODE index. Maximum oxygen uptake (VO2max) was also noted in patients who were able to undergo cardiopulmonary exercise test.
Results: Eighty patients were randomized, 40 in each group; 28 patients (70%) in RG and 30 (75%) in CG completed the study. After eight weeks, RG showed significant improvement in 6MWD and all domains of SGRQ as compared to CG [Δ6MWD: effect size 38.1 meters, 95% CI (21.3-54.8), p=0.001 and SGRQtotal: effect size 11.5, 95% CI (6.9-16.0), p=0.001]. The dyspnea level (mMRC scale) and BODE index decreased only in RG whereas spirometry and VO2max remained unchanged in both groups.
Conclusion: PR improves functional EC, QOL and dyspnea in severe COPD independent of change in peak EC and spirometry, suggesting non-ventilatory benefits of PR. A successful structured hospital-based outpatient PR is feasible in an Indian setting as well.
- Copyright ©the authors 2017
