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Chronic obstructive pulmonary disease
Outpatient pulmonary rehabilitation following acute exacerbations of COPD
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  1. John M Seymour1,
  2. Lauren Moore2,
  3. Caroline J Jolley1,
  4. Katie Ward1,
  5. Jackie Creasey3,
  6. Joerg S Steier1,
  7. Bernard Yung3,
  8. William D-C Man4,
  9. Nicholas Hart2,
  10. Michael I Polkey4,
  11. John Moxham1
  1. 1King's College London School of Medicine, London, UK
  2. 2Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3Basildon and Thurrock NHS Foundation Trust, Essex, UK
  4. 4Royal Brompton and Harefield NHS Trust, London, UK
  1. Correspondence to Dr John Seymour, Department of Respiratory Medicine, King's College Hospital, London SE5 9RJ, UK; john.seymour{at}kcl.ac.uk

Abstract

Background Exacerbations of chronic obstructive pulmonary disease (COPD) are characterised by increased dyspnoea, reduced quality of life and muscle weakness. Re-exacerbation and hospital admission are common. Pulmonary rehabilitation (PR) administered after hospital admission for an exacerbation can improve quality of life and exercise capacity.

Objective To determine whether outpatient post-exacerbation PR (PEPR) could reduce subsequent hospital admission episodes.

Methods Patients admitted to hospital for an exacerbation of COPD were randomised to receive either usual follow-up care (UC) or PEPR after discharge. Hospital admission and emergency department attendances for COPD exacerbations were recorded over a 3-month period and analysed on an intention-to-treat basis. Secondary outcomes included exercise capacity and quadriceps strength.

Results 60 patients underwent concealed randomisation at the time of their hospital discharge (UC: n=30, mean (SD) age 65 (10) years, forced expiratory volume in 1 s (FEV1) 52 (22)% predicted; PEPR: n=30, 67(10) years, 52 (20)% predicted). The proportion of patients re-admitted to hospital with an exacerbation was 33% in the UC group compared with 7% in those receiving PEPR (OR 0.15, 95% CI 0.03 to 0.72, p=0.02). The proportion of patients that experienced an exacerbation resulting in an unplanned hospital attendance (either admission or review and discharge from the emergency department) was 57% in the UC group and 27% in those receiving PEPR (OR 0.28, 95% CI 0.10 to 0.82, p=0.02).

Conclusions Post-exacerbation rehabilitation in COPD can reduce re-exacerbation events that require admission or hospital attendance over a 3-month period.

Clinical Trials Registration Number NCT00557115.

  • COPD
  • rehabilitation
  • exacerbation
  • quadriceps
  • pulmonary rehabilitation

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

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    Footnotes

    • Funding JMS was funded by a British Lung Foundation Project Grant (P04/8). CJJ was funded by the Medical Research Council UK. JSS was funded by the European Respiratory Society. WDCM was funded by the Medical Research Council UK and the National Institute for Health. Study design, conduct, analysis and reporting were independent of the project sponsor (King's College London) and funder (British Lung Foundation). MIP's salary is part funded by the Respiratory Biomedical Research Unit of the Royal Brompton Hospital and Imperial College.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the King's College Hospital REC, Basildon and Thurrock University Hospitals REC (SSA), St Thomas' Hospitals REC (SSA).

    • Provenance and peer review Not commissioned; externally peer reviewed.