title: A pilot study on domiciliary pulmonary rehabilitation programme in the management of severe chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Pulmonary rehabilitation is now an accepted modality of care in the management of chronic obstructive pulmonary disease (COPD) patients. However, in resource-limited settings, conventional pulmonary rehabilitation may not be feasible due to the high cost involved and the extensive infrastructure requirement. In view of these constraints, we designed a domiciliary pulmonary rehabilitation programme and evaluated its usefulness in the management of severe COPD.
  
  
  METHODS
  A total of 20 patients suffering from severe COPD (ten patients each in the experimental and control groups) were enrolled in the study. The experimental group was subjected to domiciliary pulmonary rehabilitation along with medical management, while the control group underwent only conventional medical management. During the six-month study period, both groups were assessed for quality of life (clinical COPD questionnaire), exercise capacity (six-minute walk distance) and spirometry values (forced expiratory volume in one second and forced vital capacity).
  
  
  RESULTS
  Statistically significant differences were observed in clinical COPD questionnaire scores in both groups from the fourth month (p-value is 0.002 and 0.001 at the end of four and six months, respectively). The results of the six-minute walk distance showed a similar trend (p-value is 0.009 and 0.001 at the end of four and six months, respectively). No significant difference was observed in either of the spirometry values.
  
  
  CONCLUSIONS
  The domiciliary pulmonary rehabilitation programme improves the quality of life and exercise endurance of patients with severe COPD, and thereby acts as a substitute for conventional pulmonary rehabilitation programmes in resource-limited situations.
authors.affiliation: Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun 248140, Uttarakhand, India. girish_sindhwani@rediffmail.com
authors.forename: G
authors.initials: G
authors.lastname: Sindhwani
authors.forename: A
authors.initials: A
authors.lastname: Verma
authors.forename: D
authors.initials: D
authors.lastname: Biswas
authors.forename: M
authors.initials: M
authors.lastname: Srivastava
authors.forename: J
authors.initials: J
authors.lastname: Rawat
mesh_terms: D000368:Aged; D015444:Exercise; D005541:Forced Expiratory Volume; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation* / Q000628:therapy*; D011788:Quality of Life; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome