title: Impact of comorbidities in pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic Obstructive Pulmonary Disease (COPD) represents an increasing burden worldwide. COPD can no longer be considered a disease which only involves the lungs, its systemic consequences make it an important risk factor for other chronic comorbidities.
  
  
  OBJECTIVE
  To determine the frequency of comorbidities in patients with COPD undergoing a pulmonary rehabilitation program (PRP) and to evaluate the influence of baseline characteristics as well as comorbidities on the outcomes of PRP.
  
  
  METHODS
  The present study included all COPD patients that were admitted to a PRP in our unit. The response to PR was measured by the improvement in exercise tolerance (6 minute walk test), dyspnea (Mahler's Dyspnea Index) and health status (St. George's Respiratory Questionnaire).
  
  
  RESULTS
  114 patients with COPD were included. Most patients (96,5%) had at least one comorbidity. Metabolic diseases (71.1%), cardiovascular diseases (67.5%), other respiratory conditions (57.9%) and anxiety/depression (21.1%) were the most prevalent ones. 64.9%, 64.9% and 51.1% of the patients improved in terms of exercise tolerance, quality of life and dyspnea, respectively. The overall results were similar in all levels of the disease and in all comorbid subgroups. Logistic regression analysis showed that respiratory failure and ischemic heart disease negatively influenced improvement in health status and anxiety/depression predicted lower improvement in dyspnea.
  
  
  CONCLUSIONS
  PR was associated with improvements in all comorbid subgroups of patients, underlining the important role of exercise training in rehabilitation of those chronic diseases associated with COPD. On the other hand, the presence of comorbidities in COPD patients, if clinically controlled, should not preclude access to PR.
authors.affiliation: Serviço de Pneumologia, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal. alexandracarreiro@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Carreiro
authors.forename: J
authors.initials: J
authors.lastname: Santos
authors.forename: F
authors.initials: F
authors.lastname: Rodrigues
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000534:rehabilitation*; D012189:Retrospective Studies; D016896:Treatment Outcome