title: Outpatient pulmonary rehabilitation following acute exacerbations of COPD.
abstract: BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are characterised by increased dyspnoea, reduced quality of life and muscle weakness. Re-exacerbation and hospital admission are common. Pulmonary rehabilitation (PR) administered after hospital admission for an exacerbation can improve quality of life and exercise capacity. OBJECTIVE To determine whether outpatient post-exacerbation PR (PEPR) could reduce subsequent hospital admission episodes. METHODS Patients admitted to hospital for an exacerbation of COPD were randomised to receive either usual follow-up care (UC) or PEPR after discharge. Hospital admission and emergency department attendances for COPD exacerbations were recorded over a 3-month period and analysed on an intention-to-treat basis. Secondary outcomes included exercise capacity and quadriceps strength. RESULTS 60 patients underwent concealed randomisation at the time of their hospital discharge (UC: n=30, mean (SD) age 65 (10) years, forced expiratory volume in 1 s (FEV(1)) 52 (22)% predicted; PEPR: n=30, 67(10) years, 52 (20)% predicted). The proportion of patients re-admitted to hospital with an exacerbation was 33% in the UC group compared with 7% in those receiving PEPR (OR 0.15, 95% CI 0.03 to 0.72, p=0.02). The proportion of patients that experienced an exacerbation resulting in an unplanned hospital attendance (either admission or review and discharge from the emergency department) was 57% in the UC group and 27% in those receiving PEPR (OR 0.28, 95% CI 0.10 to 0.82, p=0.02). CONCLUSIONS Post-exacerbation rehabilitation in COPD can reduce re-exacerbation events that require admission or hospital attendance over a 3-month period. Clinical Trials Registration Number NCT00557115.
authors.affiliation: Department of Respiratory Medicine, King's College Hospital, London SE5 9RJ, UK. john.seymour@kcl.ac.uk
authors.forename: John M
authors.initials: JM
authors.lastname: Seymour
authors.forename: Lauren
authors.initials: L
authors.lastname: Moore
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Jolley
authors.forename: Katie
authors.initials: K
authors.lastname: Ward
authors.forename: Jackie
authors.initials: J
authors.lastname: Creasey
authors.forename: Joerg S
authors.initials: JS
authors.lastname: Steier
authors.forename: Bernard
authors.initials: B
authors.lastname: Yung
authors.forename: William D-C
authors.initials: WD
authors.lastname: Man
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.forename: Michael I
authors.initials: MI
authors.lastname: Polkey
authors.forename: John
authors.initials: J
authors.lastname: Moxham
mesh_terms: D000208:Acute Disease; D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D008131:London; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010044:Outpatient Clinics, Hospital; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D052097:Quadriceps Muscle / Q000503:physiopathology; D011788:Quality of Life