Chest
Volume 105, Issue 4, April 1994, Pages 1046-1052
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The Effect of Comprehensive Outpatient Pulmonary Rehabilitation on Dyspnea

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To evaluate the effect of outpatient pulmonary rehabilitation (OPR) on dyspnea, we measured this symptom using a visual analogue scale during graded treadmill exercise testing and with baseline and transitional dyspnea indices (TDI). The latter measure overall dyspnea in three spheres: functional impairment, magnitude of task, and magnitude of effort. Twenty patients with COPD referred for OPR were randomly assigned to either a treatment group (T, n=10), with dyspnea evaluated at baseline then shortly following a 6-week OPR program, or a control group (C, n=10), with dyspnea evaluated at baseline then following a 6-week waiting period. No significant change in maximal exercise performance from baseline to repeated testing was observed in either group. Dyspnea at maximum treadmill workload (Dmax), which did not significantly change in C, decreased from 74.4 ± 18.9 percent at baseline to 50.5 ± 23.2 percent post-OPR in T (p=0.006). The Dmax related to minute ventilation (Dmax/VEmax) and oxygen consumption (Dmax/Vo2max) also significantly decreased following OPR. The reduction in exertional dyspnea was apparent by the second minute of exercise. Additionally, TDI focal scores were significantly higher in T than C (2.3 ± 1.06 vs 0.2 ± 1.75 units, p=0.006), indicating decreased overall dyspnea following OPR. These results point to significant improvements in both exertional and clinically assessed dyspnea following OPR.

Section snippets

Patients

Patients referred to our OPR program were considered for the study. Inclusion criteria included the following: (1) a clinical diagnosis of moderately severe to severe COPD; (2) a significant exertional dyspnea despite conventional medical therapy; (3) an FEV1 equal to or less than 1.4 L; and (4) the absence of significant, associated medical problems that might interfere with the patient's ability to undergo OPR. Because our oxygen analyzer for treadmill exercise testing was not accurate at

Patients

Age, sex, FEV1, 12-min walking distance, and BDI focal scores of the 20 study patients are given in Table 1. As indicated, all had moderately severe to severe airways obstruction. Although baseline FEV1 tended to be somewhat lower in C than T patients (0.79 ± 0.18 L vs 0.94 ± 0.32 L), this difference was not statistically significant. Both groups were similar with respect to exercise endurance, as measured by the 12-min walk distance, and overall dyspnea, as measured by the BDI focal score.

Baseline Exercise Testing—Pre-exercise and Maximal Workload Values

DISCUSSION

The purpose of this investigation was to evaluate the effect of OPR on dyspnea in advanced COPD. One group of patients was studied before and after OPR while a control group was studied before and after a waiting period. Exertional dyspnea during graded treadmill exercise testing was measured with a visual analogue scale, while overall impairment from dyspnea was measured with the baseline and transitional dyspnea indices. A decrease in dyspnea at maximal workload was observed only in the group

ACKNOWLEDGMENT

The writers thank Bartolome Celli, M.D., Chief, Pulmonary Section, Boston VA Medical Center, for valuable assistance during the planning of this study.

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    Manuscript received March 26, 1993; revision accepted August 31

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