Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study.
OBJECTIVE
To evaluate the effects of an early community based pulmonary rehabilitation programme after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease (COPD).


METHODS
A single centre, randomised controlled trial.


METHODS
An inner city, secondary and tertiary care hospital in London.


METHODS
42 patients admitted with an acute exacerbation of COPD.


METHODS
An eight week, pulmonary rehabilitation programme for outpatients, started within 10 days of hospital discharge, or usual care.


METHODS
Incremental shuttle walk distance, disease specific health status (St George's respiratory questionnaire, SGRQ; chronic respiratory questionnaire, CRQ) and generic health status (medical outcomes short form 36 questionnaire, SF-36) at three months after hospital discharge.


RESULTS
Early pulmonary rehabilitation, compared with usual care, led to significant improvements in median incremental shuttle walk distance (60 metres, 95% confidence interval 26.6 metres to 93.4 metres, P = 0.0002), mean SGRQ total score (-12.7, -5.0 to -20.3, P = 0.002), all four domains of the CRQ (dyspnoea 5.5, 2.0 to 9.0, P = 0.003; fatigue 5.3, 1.9 to 8.8, P = 0.004; emotion 8.7, 2.4 to 15.0, P = 0.008; and mastery 7.5, 4.2 to 10.7, P < 0.001) and the mental component score of the SF-36 (20.1, 3.3 to 36.8, P = 0.02). Improvements in the physical component score of the SF-36 did not reach significance (10.6, -0.3 to 21.6, P = 0.057).


CONCLUSIONS
Early pulmonary rehabilitation after admission to hospital for acute exacerbations of COPD is safe and leads to statistically and clinically significant improvements in exercise capacity and health status at three months.
Man
William D-C
WD
Respiratory Muscle Laboratory, Guy's, King's, and St Thomas' School of Medicine, King's College Hospital, London SE5 9PJ. william.man@kcl.ac.uk
Polkey
Michael I
MI
Donaldson
Nora
N
Gray
Barry J
BJ
Moxham
John
J
D000208:Acute Disease; D000368:Aged; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008131:London; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D016896:Treatment Outcome