The impact of home-based pulmonary rehabilitation on people with mild chronic obstructive pulmonary disease: a randomised controlled trial.

Abstract

People with mild chronic obstructive pulmonary disease (COPD) experience exercise intolerance, dyspnoea and poor quality of life. However, the role of pulmonary rehabilitation (PR) in this group is unclear. This randomised controlled trial aimed to explore the effects of home-based PR in people with mild COPD. People with mild COPD (FEV1/FVC<70%; FEV1>80%predicted) with a smoking history of ≥ 10 packet years were randomised to either eight weeks of home-based PR (one home visit and seven once-weekly telephone calls) or standard care (weekly social telephone calls). Six-minute walk distance (6MWD), and modified Medical Research Council (mMRC) and Chronic Respiratory Questionnaire (CRQ) scores were compared. A total of 58 participants (34 males, mean age 68 (SD 9) years, FEV1%predicted 90 (7), 6MWD 496 (105) meters) were included with 31 participants randomised to home-based PR. Participants attended an average of 6.8 of the 8 scheduled sessions, ranging from 3 to 8 sessions. Both groups showed improvements in exercise capacity, symptoms and health-related quality of life over time, however there was no difference in 6MWD at end-intervention (mean difference -3 metres, 95% confidence interval (CI) -64 to 58) or six months (7 metres, 95% CI -59 to 72). At six months home-based PR participants were more likely to have clinically important improvements in CRQ emotional function (50% of home PR vs 0% control, p<0.001) and CRQ total score (45% vs 17%, p=0.05). For people with mild COPD, home-based pulmonary rehabilitation did not improve exercise capacity more than standard care.