[Benefits of a home-based pulmonary rehabilitation program for patients with severe chronic obstructive pulmonary disease].
OBJECTIVE
The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease (COPD) are uncertain. We aimed to assess the short- and medium-term efficacy of such a program in this clinical setting.


METHODS
Patients with severe COPD (stages III-IV, classification of the Global Initiative for Chronic Obstructive Lung Disease) and incapacitating dyspnea (scores 3-5, Medical Research Council [MRC] scale) were randomized to a control or domiciliary rehabilitation group. The 9-week supervised pulmonary rehabilitation program included educational sessions, respiratory physiotherapy, and muscle training in weekly sessions in the patient's home. We assessed the following variables at baseline, 9 weeks, and 6 months: lung function, exercise tolerance (3-minute walk test), dyspnea (MRC score), and health-related quality of life with the Chronic Respiratory Questionnaire (CRQ).


RESULTS
Thirty-eight patients with a mean (SD) age of 68 (6) years were enrolled. The mean MRC score was 4 (0.8) and mean forced expiratory volume in 1 second was 29% of reference. Twenty-nine patients completed the study (6 months). Distance covered on the walk test increased significantly in the rehabilitation group (P=.001) and the difference was maintained at 6 months. Dyspnea also improved significantly with rehabilitation (P<.05), but the reduction was not evident at 6 months. Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks: dyspnea (3.1 [0.8] vs 3.6 [0.7]; P=.02) and fatigue (3.7 [0.8] vs 4.2 [0.9]; P=.002). A clinically relevant but not statistically significant change in mastery over disease was detected (from 4.3 to 4.9). All improvements were maintained at 6 months.


CONCLUSIONS
Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months.
Regiane Resqueti
Vanessa
V
Hospital de la Santa Creu i de Sant Pau, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
Gorostiza
Amaia
A
Gáldiz
Juan B
JB
López de Santa María
Elena
E
Casan Clarà
Pere
P
Güell Rous
Rosa
R
D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D000886:Anthropometry; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000534:rehabilitation*; D000068299:Salmeterol Xinafoate; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000420:Albuterol; D011241:Prednisone