title: Veterans with chronic obstructive pulmonary disease achieve clinically relevant improvements in respiratory health after pulmonary rehabilitation.
abstract: OBJECTIVE
  To measure respiratory health and respiratory-related (RR) health care utilization in veterans with chronic obstructive pulmonary disease referred to pulmonary rehabilitation (PR) at the Cincinnati Veterans Administration (VA) Medical Center.
  
  
  METHODS
  We reviewed the records of 430 patients referred for PR from 2008 to 2010: 78 met inclusion criteria and completed PR (PR group); 92 qualified for PR but declined participation (referral group). All PR participants completed the St. George's Respiratory Questionnaire (SGRQ), BODE index, 6-minute walk test (6MWT), UCSD Shortness of Breath Questionnaire (UCSDSOBQ), Pulmonary Disease Knowledge Test, and self-reported use of short-acting bronchodilators before and after PR. All VA health care encounters during the 12 months before and after PR (PR group) or referral (referral group) were reviewed.
  
  
  RESULTS
  Respiratory health improved after PR: SGRQ (60.6 ± 15.1, 51.1 ± 16.7), BODE (4.65 ± 1.93, 3.41 ± 1.84), 6MWT (497 ± 367 m, 572 ± 397 m), UCSDSOBQ (68.3 ± 21.1, 61.0 ± 20.9), Pulmonary Disease Knowledge Test (75.9 ± 12.4%, 85.9 ± 11.1%), short-acting bronchodilator (22.5 ± 25.3, 12.8 ± 15.6 inhalations per week) (before, after PR; P < .001 for all comparisons). The RR emergency department (ED) visits (0.71 ± 1.44, 0.44 ± 0.86; P = .04) and RR hospitalizations (0.41 ± 0.73, 0.23 ± 0.51; P = .03) (visits/patient/year; pre-PR, post-PR) decreased following PR. RR ED visits and hospitalizations were the same for the PR and referral groups prior to PR but declined post-PR (0.44 ± 0.86, 0.78 ± 1.36 ED visits/patient/year; P = .05) and (0.23 ± 0.51, 0.59 ± 1.20 hospitalizations/patient/year; P = .01). Ninety-four percent of PR participants achieved the minimal clinically important difference in at least 1 univariate scale (Modified Medical Research Council, UCSDSOBQ, SGRQ, and 6MWT); 82%, 2 scales; 59%, 3 scales; and 24%, all 4 scales.
  
  
  CONCLUSIONS
  Pulmonary rehabilitation improves respiratory health in veterans with chronic obstructive pulmonary disease and decreases RR health care utilization.
authors.affiliation: Pulmonary, Critical Care, and Sleep Medicine Division, Cincinnati Veterans Affairs Medical Center (Drs Major and Panos), Pulmonary, Critical Care, and Sleep Medicine Division, University of Cincinnati College of Medicine (Drs Major and Panos), and Pulmonary Rehabilitation Program, Cincinnati Veterans Affairs Medical Center (Ms Moreno, Mr Shelton, and Dr Panos), Cincinnati, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Major
authors.forename: Marcella
authors.initials: M
authors.lastname: Moreno
authors.forename: John
authors.initials: J
authors.lastname: Shelton
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Panos
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009820:Ohio; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D001993:Bronchodilator Agents