title: Efficacy of standard rehabilitation in COPD outpatients with comorbidities.
abstract: A prospective study was performed to confirm the prevalence pattern of the most frequent co-morbidities and to evaluate whether characteristics of patients, specific comorbidities and increasing number of comorbidities are independently associated with poorer outcomes in a population with complex chronic obstructive pulmonary disease (COPD) submitted for pulmonary rehabilitation (PR). 316 outpatients (mean ± SD age 68 ± 7 yrs) were studied. The outcomes recorded were comorbidities and proportion of patients with a pre-defined minimally significant change in exercise tolerance (6-min walk distance (6MWD) +54 m), breathlessness (Medical Research Council (MRC) score -1 point) and quality of life (St George's Respiratory Questionnaire -4 points). 62% of patients reported comorbidities; systemic hypertension (35%), dyslipidaemia (13%), diabetes (12%) and coronary disease (11%) were the most frequent. Of these patients, >45% improved over the minimum clinically important difference in all the outcomes. In a logistic regression model, baseline 6MWD (OR 0.99, 95% CI 0.98-0.99; p = 0.001), MRC score (OR 12.88, 95% CI 6.89-24.00; p = 0.001) and arterial carbon dioxide tension (OR 1.08, 95% CI 1.00-1.15; p = 0.034) correlated with the proportion of patients who improved 6MWD and MRC, respectively. Presence of osteoporosis reduced the success rate in 6MWD (OR 0.28, 95% CI 0.11-0.70; p = 0.006). A substantial prevalence of comorbidities in COPD outpatients referred for PR was confirmed. Only the individual's disability and the presence of osteoporosis were independently associated with poorer rehabilitation outcomes.
authors.affiliation: Dept Oncology, University of Modena, Villa Pineta Hospital, Pavullo, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Crisafulli
authors.forename: P
authors.initials: P
authors.lastname: Gorgone
authors.forename: B
authors.initials: B
authors.lastname: Vagaggini
authors.forename: M
authors.initials: M
authors.lastname: Pagani
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: F
authors.initials: F
authors.lastname: Costa
authors.forename: V
authors.initials: V
authors.lastname: Guarriello
authors.forename: P
authors.initials: P
authors.lastname: Paggiaro
authors.forename: A
authors.initials: A
authors.lastname: Chetta
authors.forename: F
authors.initials: F
authors.lastname: de Blasio
authors.forename: D
authors.initials: D
authors.lastname: Olivieri
authors.forename: L M
authors.initials: LM
authors.lastname: Fabbri
authors.forename: E M
authors.initials: EM
authors.lastname: Clini
mesh_terms: D000368:Aged; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000534:rehabilitation*; D012189:Retrospective Studies; D012959:Socioeconomic Factors