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Pulmonary Rehabilitation in Acute Exacerbations of COPD

Results from a small trial suggest that pulmonary rehabilitation can be started soon after hospital discharge, with beneficial effects.

Pulmonary rehabilitation has been shown to be an effective nonpharmacologic means of managing stable chronic obstructive pulmonary disease (COPD). In this randomized trial, investigators from the U.K. show that rehabilitation can help as an early intervention after hospitalization for acute exacerbations of COPD as well.

Forty-two patients were enrolled in the trial within 10 days of discharge from the hospital for an acute flare of COPD and were allocated to receive usual care or 8 weeks of pulmonary rehabilitation. Rehabilitation consisted of two 2-hour classes per week: 1 hour of exercise and 1 hour of educational activities, with emphasis on self-care, nutrition, and lifestyle. Three-month follow-up data were available for 34 patients.

Compared with the usual-care group, the rehabilitation group showed significant improvements in median distance on a walking test, mean score on a standardized respiratory questionnaire, all four domains (dyspnea, fatigue, emotion, and mastery) of a chronic respiratory disease questionnaire, and the mental component of the SF-36 health status survey. The rehab group also had a significantly lower rate of emergency-room visits (10% vs. 43%), and there was a nonsignificant trend toward fewer hospital days.

Comment: The results of this small trial suggest that pulmonary rehabilitation can be started soon after hospital discharge, with beneficial effects. Whether these effects persist with longer follow-up remains to be seen. Unfortunately, the authors don't discuss whether pharmacologic treatment -- a potential confounding variable -- was similar in the intervention and control groups during the follow-up period. At the time of publication, the full text of the original article was available free of charge.

— Keith I. Marton, MD

Published in Journal Watch General Medicine December 28, 2004

Citation(s):

Man WD-C et al. Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: Randomised controlled study. BMJ 2004 Nov 20; 329:1209-11.

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