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Title: The Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial.
Austin Authors: Wageck, Bruna;Cox, Narelle S ;McDonald, Christine F ;Burge, Angela T ;Mahal, Ajay;Hill, Catherine J ;Lee, Annemarie L;Moore, Rosemary P ;Nicolson, Caroline;O'Halloran, Paul;Lahham, Aroub;Gillies, Rebecca;Holland, Anne E 
Affiliation: The Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia
Respiratory and Sleep Medicine
Department of Medicine, The University of Melbourne, Melbourne, Australia
Department of Physiotherapy, Alfred Health, Melbourne, Australia
Department of Pulmonary Hypertension, Alfred Health, Melbourne, Australia
Physiotherapy Department, Monash University, Melbourne, Australia
Department of Public Health, La Trobe University, Melbourne, Australia
La Trobe University, Melbourne, Australia
Monash University, Melbourne, Australia
Institute for Breathing and Sleep
Issue Date: 31-Dec-2020 2020-12-31
Publication information: International Journal of Chronic Obstructive Pulmonary Disease 2020; 15: 3423-3431
Abstract: 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. 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). A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV1) 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 FEV1%predicted (0.98, 95% CI 0.96 to 0.99). 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.
DOI: 10.2147/COPD.S271094
ORCID: 0000-0001-8956-8767
PubMed URL: 33408472
Type: Journal Article
Subjects: COPD
long term maintenance
pulmonary rehabilitation
Appears in Collections:Journal articles

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