Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD, using St.George's Respiratory questionnaire (SGRQ), the 6-minutes walking test (6-MWT) and BODE index as the primary outcome measures. METHODS: A prospective, parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD (67 men and 13 women; mean age 64.8 +/- 10.6 years; FEV1, 42.8% +/- 7.6% of the predicted value. The active group (n = 40) took part in a 14-week rehabilitation program [3 h/wk, 1.5 h of education and exercise and 1.5 h of cycling]. The control group (n = 40) was reviewed routinely as medical outpatients. The following evaluations were carried out at study entry and afterl4 weeks: (1) pulmonary function studies; (2) 6-minutes walking test 6MWT; (3) quality of life; and (4) BODE index. RESULTS: The following patients completed the study: 35 patients (87.5%) from the active group (mean age, 63.7 +/- 11.9 years; mean forced expiratory volume in one second (FEV1), 41.9 +/- 2.6% of the predicted value); and 36 patients (88%) from the control group (mean age, 65.9 +/- 10.3 years; mean FEV1, 43.33 +/- 3.6% of the predicted value). We found no changes in pulmonary function parameters in the active group and the control one at 14weeks. On the other hand, there were significant changes within the components of the SGRQ (12.3 for the score total) for the patients of the active group but not for the patients of the control one (only 1.5 for the score total), we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one, and finally a decrease of two points (from 6 to 4) was noted in the score of the active group's BODE index without any change in the control group's one. CONCLUSION: An outpatient-based of 14-week rehabilitation program significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD, and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index.

Effect of a noninvasive ventilatory support during exercise of a program in pulmonary rehabilitation in patients with COPD.

BACKGROUND: Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity of exercise being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from reaching higher levels of intensity. STUDY OBJECTIVE: This study was to determine whether inspiratory pressure support (IPS) applied during sub maximal exercise could enable individuals with severe but stable COPD to increase their exercise tolerance. PARTICIPANTS: Twelve subjects with severe stable COPD (mean (SD): age = 63(8.2) years; FEV1 = 0.89(0.42) L (34)% predicted; FEV1/FVC = 0.31(0.07) only nine subjects completed the study. INTERVENTION: Each subject completed ten sessions of cycling at 25%-50% of their maximum power without NIVS and another ten sessions using NIVS. MEASUREMENTS AND RESULTS: Dyspnea was measured using Borg scale. Subjects reached high levels of dyspnea 4.7 (1.81) during the sessions without NIVS vs low levels of dyspnea during the sessions using NIVS 1.3 (0.6). Exercise time during the sessions without NIVS and with NIVS was 19.37 (3.4) and 33.75 (9.5) min, respectively. Maximal workload during the sessions without NIVS and with NIVS was 27 (3.7) and 50 (10.5) watt, respectively. CONCLUSION: We conclude that IPS delivered by nasal mask can improve exercise tolerance and dyspnea in stable severe COPD patients and hence this mode of ventilatory support may be useful in respiratory rehabilitation programs.