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Pulmonary rehabilitation (PR) results in significant improvements to quality of life and both functional and maximum exercise capacity in patients with stable COPD. In this study the benefits of an early outpatient PR programme were compared with usual care at 3 months following hospital admission for acute exacerbation of COPD.
42 patients with acute exacerbation of COPD admitted to hospital were recruited into the study. All the patients received standard treatment including bronchodilators, oral steroids, antibiotics, oxygen, and (if required) non-invasive ventilation. At discharge, patients were randomised to either an early PR programme or usual care, with 21 patients in each group. Baseline assessments 24 hours before discharge were made by measuring exercise capacity with an incremental shuttle walk test. The St George’s Respiratory Questionnaire (SGRQ) and Chronic Respiratory Disease Questionnaire (CRQ) were used to measure disease specific health status, with the SF-36 questionnaire employed for generic health status. The PR programme was run by a multidisciplinary team and consisted of twice weekly classes for 8 weeks, each session lasting 2 hours with 1 hour of exercise and 1 hour of educational activity.
After 3 months the results showed significant improvements in exercise capacity, SGRQ, CRQ, and generic health status in the PR group, with fewer visits to A&E and a trend to a reduced hospital readmission rate. Possible mechanisms to explain the effects of PR include improvements in skeletal muscle function, reduced sensitivity to breathlessness, and life style changes. Early PR thus significantly improves functional capacity and quality of life after discharge following acute exacerbation of COPD.
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