Early comprehensive pulmonary rehabilitation for hospitalized patients with acute ex-acerbation of chronic obstructive pulmonary disease: a randomized controlled trial

Authors

  • Yuqin Zeng Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
  • Qian Wu Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
  • Yan Chen Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
  • Shan Cai Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China

DOI:

https://doi.org/10.2340/jrm.v56.39953

Keywords:

Pulmonary rehabilitation, AECOPD, randomized control trial, acute exacerbation of chronic obstructive pulmonary disease

Abstract

Objective: To investigate whether an early comprehensive pulmonary rehabilitation intervention initiated during hospital admission is safe and effective for patients with acute exacerbation of chronic obstructive pulmonary disease.

Design: Prospective randomized controlled study.

Subjects/Patients: Patients with acute exacerbation of chronic obstructive pulmonary disease.

Methods: In total, 108 patients were randomized to the early comprehensive pulmonary rehabilitation and usual care groups within 48 hours. The 6-min walking distance, quality of life, breathlessness, and inspiratory muscle strength were measured on admission and discharge. Any adverse events of pulmonary rehabilitation were recorded.

Results: On discharge, the patients in the early comprehensive pulmonary rehabilitation group had a more significant improvement in the 6-min walking distance (47.5 vs 23.0, p = 0.04). There was no significant difference in quality of life and breathlessness between the 2 groups. In the early comprehensive pulmonary rehabilitation group, inspiratory muscle strength and peak inspiratory flow were significantly improved, and the changes were much more pronounced than in the usual care group. There were no adverse events.

Conclusion: Early comprehensive pulmonary rehabilitation is safe and effective for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease, and should be performed during the early stage of hospitalization.

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References

Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease 2017. Available from: http: //goldcopd.org/ (accessed December 23, 2016).

Chen X, Wang N, Chen Y, Xiao T, Fu C, Xu B. Costs of chronic obstructive pulmonary dis-ease in urban areas of China: a cross-sectional study in four cities. Int J Chron Obstruct Pulmon Dis 2016; 11: 2625-2632.

https://doi.org/10.2147/COPD.S118523 DOI: https://doi.org/10.2147/COPD.S118523

Dransfield MT, Kunisaki KM, Strand MJ, Anzueto A, Bhatt SP, Bowler RP, et al. Acute exacer-bations and lung function loss in smokers with and without chronic obstructive pulmo-nary disease. Am J Respir Crit Care Med 2017; 195: 324-330.

https://doi.org/10.1164/rccm.201605-1014OC DOI: https://doi.org/10.1164/rccm.201605-1014OC

Kessler R, Ståhl E, Vogelmeier C, Haughney J, Trudeau E, Löfdahl CG, et al. Patient under-standing, detection, and experience of COPD exacerbations: an observational, interview-based study. Chest 2006; 130: 133-142.

https://doi.org/10.1378/chest.130.1.133 DOI: https://doi.org/10.1378/chest.130.1.133

Martinez FJ, Han MK, Flaherty K, Curtis J. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease. Expert Rev Anti Infect Ther 2006; 4: 101-124.

https://doi.org/10.1586/14787210.4.1.101 DOI: https://doi.org/10.1586/14787210.4.1.101

Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188: e13-64.

McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015: CD003793.

https://doi.org/10.1002/14651858.CD003793.pub3 DOI: https://doi.org/10.1002/14651858.CD003793.pub3

Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; 12: CD005305.

https://doi.org/10.1002/14651858.CD005305.pub4 DOI: https://doi.org/10.1002/14651858.CD005305.pub4

Ryrsø CK, Godtfredsen NS, Kofod LM, Lavesen M, Mogensen L, Tobberup R, et al. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med 2018; 18: 154.

https://doi.org/10.1186/s12890-018-0718-1 DOI: https://doi.org/10.1186/s12890-018-0718-1

Greening NJ, Williams JE, Hussain SF, Harvey-Dunstan TC, Bankart MJ, Chaplin EJ, et al. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomized controlled trial. BMJ 2014; 349: g4315.

https://doi.org/10.1136/bmj.g4315 DOI: https://doi.org/10.1136/bmj.g4315

Wedzicha JA Ers Co-Chair, Miravitlles M, Hurst JR, Calverley PM, Albert RK, Anzueto A, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017; 49: 1600791.

https://doi.org/10.1183/13993003.00791-2016 DOI: https://doi.org/10.1183/13993003.00791-2016

Alison JA, McKeough ZJ, Johnston K, McNamara RJ, Spencer LM, Jenkins SC, et al. Austra-lian and New Zealand Pulmonary Rehabilitation Guidelines. Respirology 2017; 22: 800-819.

https://doi.org/10.1111/resp.13025 DOI: https://doi.org/10.1111/resp.13025

Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier JS, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax 2010; 65: 423-428.

https://doi.org/10.1136/thx.2009.124164 DOI: https://doi.org/10.1136/thx.2009.124164

Helen J. Hislop JM. Daniels and Worthingham's muscle testing: techniques of manual examination, 8th ed. St Louis, MO: Saunders Elsevier; 2007. p. 2-11.

Costi S, Crisafulli E, Degli Antoni F, Beneventi C, Fabbri LM, Clini EM. Effects of unsuppor-ted upper extremity exercise training in patients with COPD: a randomized clinical trial. Chest 2009; 136: 387-395.

https://doi.org/10.1378/chest.09-0165 DOI: https://doi.org/10.1378/chest.09-0165

Rydwik E, Karlsson C, Frändin K, Akner G. Muscle strength testing with one repetition maximum in the arm/shoulder for people aged 75+: test-retest reliability. Clin Rehabil 2007; 21: 258-265.

https://doi.org/10.1177/0269215506072088 DOI: https://doi.org/10.1177/0269215506072088

Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377-381.

https://doi.org/10.1249/00005768-198205000-00012 DOI: https://doi.org/10.1249/00005768-198205000-00012

Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest 2005; 128: 3177-3182.

https://doi.org/10.1378/chest.128.5.3177 DOI: https://doi.org/10.1378/chest.128.5.3177

Gimeno-Santos E, Rodriguez DA, Barberan-Garcia A, Blanco I, Vilaró J, Torralba Y, et al. Endurance exercise training improves heart rate recovery in patients with COPD. COPD 2014; 11: 190-196.

https://doi.org/10.3109/15412555.2013.831401 DOI: https://doi.org/10.3109/15412555.2013.831401

Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2008; 89: 1782-1787.

https://doi.org/10.1016/j.apmr.2008.01.020 DOI: https://doi.org/10.1016/j.apmr.2008.01.020

ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111-117.

https://doi.org/10.1164/ajrccm.166.1.at1102 DOI: https://doi.org/10.1164/ajrccm.166.1.at1102

Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34: 648-654.

https://doi.org/10.1183/09031936.00102509 DOI: https://doi.org/10.1183/09031936.00102509

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-338.

https://doi.org/10.1183/09031936.05.00034805 DOI: https://doi.org/10.1183/09031936.05.00034805

Polkey MI, Spruit MA, Edwards LD, Watkins ML, Pinto-Plata V, Vestbo J, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important diffe-rence for death or hospitalization. Am J Respir Crit Care Med 2013; 187: 382-386.

https://doi.org/10.1164/rccm.201209-1596OC DOI: https://doi.org/10.1164/rccm.201209-1596OC

Machado A, Matos Silva P, Afreixo V, Caneiras C, Burtin C, Marques A. Design of pulmo-nary rehabilitation programmes during acute exacerbations of COPD: a systematic re-view and network meta-analysis. Eur Respir Rev 2020; 159: 200039.

https://doi.org/10.1183/16000617.0039-2020 DOI: https://doi.org/10.1183/16000617.0039-2020

He M, Yu S, Wang L, Lv H, Qiu Z. Efficiency and safety of pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease. Med Sci Monit 2015; 21: 806-812.

https://doi.org/10.12659/MSM.892769 DOI: https://doi.org/10.12659/MSM.892769

Deepak TH, Mohapatra PR, Janmeja AK, Sood P, Gupta M. Outcome of pulmonary rehabili-tation in patients after acute exacerbation of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2014; 56: 7-12.

https://doi.org/10.5005/ijcdas-56-1-7 DOI: https://doi.org/10.5005/ijcdas-56-1-7

Ko FW, Cheung NK, Rainer TH, Lum C, Wong I, Hui DS. Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomized controlled trial. Thorax 2017; 72: 122-128.

https://doi.org/10.1136/thoraxjnl-2016-208396 DOI: https://doi.org/10.1136/thoraxjnl-2016-208396

Georgiopoulou VV, Dimopoulos S, Sakellariou D, Papazachou O, Gerovasili V, Tasoulis A, et al. Cardiopulmonary rehabilitation enhances heart rate recovery in patients with COPD. Respir Care 2012; 57: 2095-2103.

https://doi.org/10.4187/respcare.01485 DOI: https://doi.org/10.4187/respcare.01485

Mo R, Zeng Y, Cai S, Chen Y, Chen P, Wu Q, et al. Correlation between inspiratory muscle strength and pulmonary ventilation function in patients with chronic obstructive pul-monary disease. J Chinese Physician 2018; 20: 1771-1774.

Gosselink R, De Vos J, van den Heuvel SP, Segers J, Decramer M, Kwakkel G. Impact of in-spiratory muscle training in patients with COPD: what is the evidence? Eur Respir J 2011; 37: 416-425.

https://doi.org/10.1183/09031936.00031810 DOI: https://doi.org/10.1183/09031936.00031810

Abedi Yekta AH, Poursaeid Esfahani M, Salehi S, Hassabi M, Khosravi S, Kharabian S, et al. Assessment of the effects of inspiratory muscle training (IMT) and aerobic training on the quality of life of patients with chronic obstructive pulmonary disease. Tanaffos 2019; 18: 223-229.

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Published

2024-08-22

How to Cite

Zeng, Y., Wu, Q., Chen, Y., & Cai, S. (2024). Early comprehensive pulmonary rehabilitation for hospitalized patients with acute ex-acerbation of chronic obstructive pulmonary disease: a randomized controlled trial. Journal of Rehabilitation Medicine, 56, jrm39953. https://doi.org/10.2340/jrm.v56.39953

Issue

Vol. 56 (2024)

Section

Original Report

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Copyright (c) 2024 Yuqin Zeng, Qian Wu, Yan Chen, Shan Cai

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From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.

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