The Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial

Abstract

Background

Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months.

Methods

This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA).

Results

A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV ₁) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEV _1%predicted (0.98, 95% CI 0.96 to 0.99).

Conclusion

Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): copd

Journal ID (pmc): copd

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date (Electronic): 31 December 2020

Publication date Collection: 2020

Volume: 15

Pages: 3423-3431

Affiliations

[1 ]La Trobe University , Melbourne, Australia

[2 ]Monash University , Melbourne, Australia

[3 ]Institute for Breathing and Sleep , Melbourne, Australia

[4 ]Department of Respiratory and Sleep Medicine, Austin Health , Melbourne, Australia

[5 ]Department of Medicine, The University of Melbourne , Melbourne, Australia

[6 ]Department of Physiotherapy, Alfred Health , Melbourne, Australia

[7 ]The Nossal Institute of Global Health, The University of Melbourne , Melbourne, Australia

[8 ]Department of Physiotherapy, Austin Health , Melbourne, Australia

[9 ]Department of Pulmonary Hypertension, Alfred Health , Melbourne, Australia

[10 ]Physiotherapy Department, Monash University , Melbourne, Australia

[11 ]Department of Public Health, La Trobe University , Melbourne, Australia

Author notes

Correspondence: Anne E Holland Monash University , Central Clinical School, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC3004, AustraliaTel [phone] Email [e-mail]

Article

Publisher ID: 271094

DOI: 10.2147/COPD.S271094

PMC ID: 7781036

Copyright statement: © 2020 Wageck et al.

License:

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Page count

Figures: 0, Tables: 12, References: 32, Pages: 9

Funding

Funded by: B Wageck is the recipient of a full fee research scholarship (LTUFFRs);

Funded by: postgraduate research scholarships (LTUPRS) from La Trobe University, Melbourne, Australia;

B Wageck is the recipient of a full fee research scholarship (LTUFFRs) and postgraduate research scholarships (LTUPRS) from La Trobe University, Melbourne, Australia.

Categories

Subject: Clinical Trial Report