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Evidence summaries

Pulmonary Rehabilitation Following Exacerbations of Chronic Obstructive Pulmonary Disease

Pulmonary rehabilitation including exercise therapy after a recent exacerbation of chronic obstructive pulmonary disease is effective in improving health-related quality of life and exercise capacity, and appears to reduce hospital admissions compared to usual care. Level of evidence: "A"

A Cochrane review [Abstract] 1 including 20 studies with a total of 1 477 subjects considered the effects of pulmonary rehabilitation after acute exacerbations of chronic obstructive pulmonary disease (COPD). Rehabilitation programmes showed great diversity (number of completed exercise sessions; type, intensity and supervision), patient education (from none to extensive self-management programmes) and how they were organised. Rehabilitation significantly reduced hospital admissions (table T1). Intervention improved health-related quality of life measured by St. Georges Respiratory Questionnaire total score (SGRQ) and exercise capacity (six-minute walk test) (table T1). Rehabilitation did not show an effect on mortality, but trials were underpowered to detect an effect and none used mortality as a primary outcome.

Pulmonary rehabilitation versus usual care for patients with COPD

OutcomeRelative effect(95% CI)Risk with controlRisk with intervention - Rehabilitation (95% CI)No of participants(studies), Quality of the evidence
Hospital readmission (follow-up, median 9 months)OR 0.44(0.21 to 0.91)500 / 1000306 / 1000(174 to 476)810 (8), Moderate
Mortality (follow-up, median 12 months)OR 0.68(0.28 to 1.67)150 / 1000107 / 1000(47 to 228)670(6), Low
Health-related quality of life: SGRQ: total score (follow-up, median 5 months), a lower score indicates better quality of life-Score at beginning of rehabilitation around 65Mean change from baseline in score 7.80 units lower (95% CI -12.12 to -3.47)1003 (8), High
Change from baseline in 6-minute walking test (follow-up, median 3 months)-Distance at beginning around 300 mMean change from baseline 62.38 metres more (95% CI 38.45 to 86.31)819 (13), High

References

  • Puhan MA, Gimeno-Santos E, Cates CJ et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016;(12):CD005305. [PubMed]

Primary/Secondary Keywords