title: Extra-pulmonary features in COPD patients entering rehabilitation after stratification for MRC dyspnea grade.
abstract: Experts have stated that referral for rehabilitation of patients with chronic obstructive pulmonary disease (COPD) becomes appropriate when these patients become aware of their disability (e.g. usually grade 3 to 5 on the Medical Research Council (MRC) dyspnea scale). However, patients with MRC dyspnea grade 1/2 may also suffer from extra-pulmonary features, such as abnormal body composition, exercise intolerance and reduced disease-specific health status. In the present study, we have studied whether and to what extent chronic obstructive pulmonary disease (COPD) patients with MRC dyspnea grade 1/2 have extra-pulmonary features compared to patients with grade 3, 4 or 5? Pulmonary function, body composition, 6-min walking distance, peak exercise capacity, anxiety, depression and disease-specific health status have been assessed in 333 outpatients who had been referred for pulmonary rehabilitation. On average, patients with MRC dyspnea grade 1/2 had a better exercise tolerance and disease-specific health status compared to patients with grade 4 or 5. Nevertheless, grade 1/2 patients had a higher prevalence of muscle mass depletion. In addition, these patients did still have aberrant values in one or more of the aforementioned outcomes. On average, patients with MRC dyspnea grade 1/2 may clearly suffer from extra-pulmonary features, indicating the necessity to refer these patients for rehabilitation. Therefore, MRC dyspnea scale alone does not appear to be a suitable measure to identify most patients with COPD who have to be referred for rehabilitation.
authors.affiliation: Department of Research, Development & Education, Centre for Integrated Rehabilitation of Organ Failure (CIRO), Horn, The Netherlands. martijnspruit@proteion.nl
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.forename: Herman-Jan
authors.initials: HJ
authors.lastname: Pennings
authors.forename: Paul P
authors.initials: PP
authors.lastname: Janssen
authors.forename: Joan D
authors.initials: JD
authors.lastname: Does
authors.forename: Sigrid
authors.initials: S
authors.lastname: Scroyen
authors.forename: Marco A
authors.initials: MA
authors.lastname: Akkermans
authors.forename: Rob
authors.initials: R
authors.lastname: Mostert
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
mesh_terms: D000339:Affect; D000368:Aged; D001784:Blood Gas Analysis; D001823:Body Composition; D015992:Body Mass Index; D004417:Dyspnea / Q000145:classification* / Q000503:physiopathology / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006305:Health Status Indicators; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D014797:Vital Capacity