title: The impact of chronic obstructive pulmonary disease exacerbation on pulmonary rehabilitation participation and functional outcomes.
abstract: OBJECTIVE
  The purpose of this study was to determine the impact of chronic obstructive pulmonary disease exacerbation (COPDE) on pulmonary rehabilitation (PR) participation and completion and on PR outcomes of daily activity, self-reported daily exercise, and functional capacity.
  
  
  METHODS
  Participants in an 8-week outpatient PR program were studied pre- and post-PR. Variables included COPDE occurrence (computerized patient record system), self-reported exercise (daily activity diary), daily activity (accelerometer), exercise capacity (6-minute walk distance), dyspnea today and over the past 30 days (Lareau's Functional Status and Dyspnea Questionnaire), health status (The Medical Outcomes Study 36-Item Short-Form Health Survey adapted for Veterans), and quality of life (Seattle Obstructive Lung Disease Questionnaire).
  
  
  RESULTS
  Outpatients with COPD (N = 146, 140 men) started PR; 112 completed the program and were studied. Of the 30 participants who had at least 1 COPDE during the program, 10 quit the program. Subjects who exacerbated had a lower body mass index than did patients without COPDE (28.4 compared with 30.8, respectively, P < .05), more severe COPD (percent-predicted forced expiratory volume in the first second of expiration, FEV1% predicted, 32%, compared with 40%, respectively, P< .05), and required supplemental oxygen (70% compared with 36%, respectively, P< .05). Exacerbators who completed PR were more likely to be nonsmokers, on oxygen, and have a higher FEV1% predicted than were exacerbators who quit. It was found that postprogram exercise capacity improved overall, with exacerbators performing better than nonexacerbators on the 6-minute walk test (P = .044). There were no significant differences in other outcomes.
  
  
  CONCLUSIONS
  Findings suggest that COPD exacerbators who completed PR had similar outcomes as did nonexacerbators and should be encouraged to return to PR after COPDE.
authors.affiliation: Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA. bonnie.steele@va.gov
authors.forename: Bonnie G
authors.initials: BG
authors.lastname: Steele
authors.forename: Basia
authors.initials: B
authors.lastname: Belza
authors.forename: Kevin
authors.initials: K
authors.lastname: Cain
authors.forename: Jeff
authors.initials: J
authors.lastname: Coppersmith
authors.forename: JoEllen
authors.initials: J
authors.lastname: Howard
authors.forename: Sambasiva
authors.initials: S
authors.lastname: Lakshminarayan
authors.forename: Jodi
authors.initials: J
authors.lastname: Haselkorn
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015992:Body Mass Index; D015897:Comorbidity; D018450:Disease Progression; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D016896:Treatment Outcome