title: Comprehensive out-patient pulmonary rehabilitation: Treatment outcomes in early and late stages of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) and to establish whether in early disease stage PR is as effective as in late stages of disease.
  
  
  METHODS
  A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To eluciate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council (MRC)], body composition [body mass index (BMI), fat free mass (FFM), fat free mass index (FFMI)], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life (HRQoL) with St. George Respiratory Disease Questionnaire, psycohological status (Hospital anxiety-depression (HAD) scale) were evaluated before and after PR.
  
  
  RESULTS
  At the end of PR in the early disease stage group, the improvement in forced vital capacity (FVC) reached a statistically significant level (P < 0.05). In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements (P < 0.001). HRQoL and exercise capacity were significantly improved for the two groups (P < 0.001). Psychological status evaluated with the HAD scale improved after PR (P < 0.001) both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages.
  
  
  CONCLUSIONS
  These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program.
authors.affiliation: Division of Pulmonary Rehabilitation and Home Care Center, Ankara, Turkey.
authors.forename: Pinar
authors.initials: P
authors.lastname: Ergün
authors.forename: Dicle
authors.initials: D
authors.lastname: Kaymaz
authors.forename: Ersin
authors.initials: E
authors.lastname: Günay
authors.forename: Yurdanur
authors.initials: Y
authors.lastname: Erdoğan
authors.forename: Ulkü Yilmaz
authors.initials: UY
authors.lastname: Turay
authors.forename: Neşe
authors.initials: N
authors.lastname: Demir
authors.forename: Ebru
authors.initials: E
authors.lastname: Canak
authors.forename: Fatma
authors.initials: F
authors.lastname: Sengül
authors.forename: Nurcan
authors.initials: N
authors.lastname: Egesel
authors.forename: Serdal Kenan
authors.initials: SK
authors.lastname: Köse