BMJ, doi: 10.1136/bmj.38258.662720.3A, (Published 25 October 2004)

PAPERS

Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study

William D-C Man 1, Michael I Polkey 2, Nora Donaldson 3, Barry J Gray 3, John Moxham 1

1 Respiratory Muscle Laboratory, Guy's, King's, and St Thomas' School of Medicine, King's College Hospital, London SE5 9PJ
2 Royal Brompton Hospital, London SW3 6NP
3 King's College Hospital, London SE5 9RS

Objective To evaluate the effects of an early community based pulmonary rehabilitation programme after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease (COPD).

Design A single centre, randomised controlled trial.

Setting An inner city, secondary and tertiary care hospital in London.

Participants 42 patients admitted with an acute exacerbation of COPD.

Intervention An eight week, pulmonary rehabilitation programme for outpatients, started within 10 days of hospital discharge, or usual care.

Main outcome measures Incremental shuttle walk distance, disease specific health status (St George's respiratory questionnaire, SGRQ; chronic respiratory questionnaire, CRQ) and generic health status (medical outcomes short form 36 questionnaire, SF-36) at three months after hospital discharge.

Results Early pulmonary rehabilitation, compared with usual care, led to significant improvements in median incremental shuttle walk distance (60 metres, 95% confidence interval 26.6 metres to 93.4 metres, P=0.0002), mean SGRQ total score (-12.7, -5.0 to -20.3, P=0.002), all four domains of the CRQ (dyspnoea 5.5, 2.0 to 9.0, P=0.003; fatigue 5.3, 1.9 to 8.8, P=0.004; emotion 8.7, 2.4 to 15.0, P=0.008; and mastery 7.5, 4.2 to 10.7, P<0.001) and the mental component score of the SF-36 (20.1, 3.3 to 36.8, P=0.02). Improvements in the physical component score of the SF-36 did not reach significance (10.6, -0.3 to 21.6, P=0.057).

Conclusion Early pulmonary rehabilitation after admission to hospital for acute exacerbations of COPD is safe and leads to statistically and clinically significant improvements in exercise capacity and health status at three months.

(Accepted 7 September 2004)
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Non-pharmacological management
Graeme P Currie and J Graham Douglas
BMJ 2006 332: 1379-1381. [Extract] [Full Text] [PDF]

Pulmonary rehabilitation and readmissions in COPD: Hospital readmissions did not fall
Daniel K C Lee
BMJ 2005 330: 480. [Extract] [Full Text]

Multidisciplinary rehabilitation improves COPD
BMJ 2004 329: 0. [Full Text] [PDF]

This article has been cited by other articles:

  • Bott, J, Blumenthal, S, Buxton, M, Ellum, S, Falconer, C, Garrod, R, Harvey, A, Hughes, T, Lincoln, M, Mikelsons, C, Potter, C, Pryor, J, Rimington, L, Sinfield, F, Thompson, C, Vaughn, P, White, J, on behalf of the British Thoracic Society Physioth, (2009). Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 64: i1-i52 [Full text]  
  • Black, P N, McDonald, C F (2009). Interventions to reduce the frequency of exacerbations of chronic obstructive pulmonary disease. Postgrad. Med. J. 85: 141-147 [Abstract] [Full text]  
  • Polkey, M. I., Rabe, K. F. (2009). Chicken or egg: physical activity in COPD revisited. Eur Respir J 33: 227-229 [Full text]  
  • Diggines, E. (2008). Can practice-based commissioning improve the provision of pulmonary rehabilitation in the community? Plan for a new service. InnovAiT 1: 656-660 [Abstract] [Full text]  
  • Ringbaek, T, Brondum, E, Martinez, G, Lange, P, and Pulmonary Rehabilitation Research Group, (2008). Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program. Chronic Respiratory Disease 5: 75-80 [Abstract]  
  • Cazzola, M., MacNee, W., Martinez, F. J., Rabe, K. F., Franciosi, L. G., Barnes, P. J., Brusasco, V., Burge, P. S., Calverley, P. M. A., Celli, B. R., Jones, P. W., Mahler, D. A., Make, B., Miravitlles, M., Page, C. P., Palange, P., Parr, D., Pistolesi, M., Rennard, S. I., Rutten-van Molken, M. P., Stockley, R., Sullivan, S. D., Wedzicha, J. A., Wouters, E. F., on behalf of the American Thoracic Society/Europea, (2008). Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 31: 416-469 [Abstract] [Full text]  
  • Wilt, T. J., Niewoehner, D., MacDonald, R., Kane, R. L. (2007). Management of Stable Chronic Obstructive Pulmonary Disease: A Systematic Review for a Clinical Practice Guideline. ANN INTERN MED 147: 639-653 [Abstract] [Full text]  
  • Jones, Dr. R. (2007). Too little, too late the patients' perspective on education for COPD. Chronic Respiratory Disease 4: 189-190  
  • Carr, S. J., Goldstein, R. S., Brooks, D. (2007). Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation. Chest 132: 127-134 [Abstract] [Full text]  
  • Ries, A. L., Bauldoff, G. S., Carlin, B. W., Casaburi, R., Emery, C. F., Mahler, D. A., Make, B., Rochester, C. L., ZuWallack, R., Herrerias, C. (2007). Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 131: 4S-42S [Abstract] [Full text]  
  • British Thoracic Society Guideline Development Gro, (2007). Intermediate care--Hospital-at-Home in chronic obstructive pulmonary disease: British Thoracic Society guideline. Thorax 62: 200-210 [Full text]  
  • Steiner, M. C (2007). Sarcopaenia in chronic obstructive pulmonary disease. Thorax 62: 101-103 [Full text]  
  • Swallow, E. B, Reyes, D., Hopkinson, N. S, Man, W. D-C, Porcher, R., Cetti, E. J, Moore, A. J, Moxham, J., Polkey, M. I (2007). Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax 62: 115-120 [Abstract] [Full text]  
  • (2006). Poster presentations. Thorax 61: ii57-ii133 [Full text]  
  • Calverley, P M A (2006). Caring for the burden of COPD.. Thorax 61: 831-832 [Full text]  
  • Nici, L., Donner, C., Wouters, E., Zuwallack, R., Ambrosino, N., Bourbeau, J., Carone, M., Celli, B., Engelen, M., Fahy, B., Garvey, C., Goldstein, R., Gosselink, R., Lareau, S., MacIntyre, N., Maltais, F., Morgan, M., O'Donnell, D., Prefault, C., Reardon, J., Rochester, C., Schols, A., Singh, S., Troosters, T., on behalf of the ATS/ERS Pulmonary Rehabilitation, (2006). American thoracic society/european respiratory society statement on pulmonary rehabilitation.. Am. J. Respir. Crit. Care Med. 173: 1390-1413 [Full text]  
  • Currie, G. P, Douglas, J G. (2006). Non-pharmacological management.. BMJ 332: 1379-1381 [Full text]  
  • Rodriguez-Roisin, R (2006). COPD exacerbations {middle dot} 5: Management.. Thorax 61: 535-544 [Abstract] [Full text]  
  • Wedzicha, J. A., Wilkinson, T. (2006). Impact of Chronic Obstructive Pulmonary Disease Exacerbations on Patients and Payers. Proc Am Thorac Soc 3: 218-221 [Abstract] [Full text]  
  • Pitta, F., Troosters, T., Probst, V. S., Spruit, M. A., Decramer, M., Gosselink, R. (2006). Physical Activity and Hospitalization for Exacerbation of COPD. Chest 129: 536-544 [Abstract] [Full text]  
  • Hill, N. S. (2006). Pulmonary rehabilitation.. Proc Am Thorac Soc 3: 66-74 [Abstract] [Full text]  
  • Rochester, C. L. (2005). Clinical Year in Review IV: Asthma, Chronic Obstructive Pulmonary Disease, Exercise and Rehabilitation, and Critical Care Medicine. Proc Am Thorac Soc 2: 461-465 [Full text]  
  • Rodriguez-Roisin, R. (2005). Is this the beginning of unravelling the puzzle of COPD exacerbations?. Eur Respir J 26: 376-378 [Full text]  
  • Man, W D-C, Hopkinson, N S, Harraf, F, Nikoletou, D, Polkey, M I, Moxham, J (2005). Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease. Thorax 60: 718-722 [Abstract] [Full text]  
  • Spruit, M. A (2005). Enhanced physiotherapy management of acute exacerbations of chronic obstructive pulmonary disease. Chronic Respiratory Disease 2: 117-119  
  • (2005). Other articles noted. Evid. Based Med. 10: 95-96 [Full text]  
  • (2005). Evidence based journal watch. Br. J. Sports. Med. 39: 371-372 [Full text]  
  • Jain, A (2005). Benefits of early pulmonary rehabilitation following acute exacerbation of COPD. Thorax 60: 233-233 [Full text]  
  • Lee, D. K C (2005). Pulmonary rehabilitation and readmissions in COPD: Hospital readmissions did not fall. BMJ 330: 480-480 [Full text]  
  • (2004). Pulmonary Rehabilitation in Acute Exacerbations of COPD. JWatch General 2004: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Focusing on Rehabilitation
Angela Koutsokera, et al.
bmj.com, 14 Nov 2004 [Full text]
When to do it?
M Thirumaran, et al.
bmj.com, 21 Nov 2004 [Full text]
Pulmonary rehabilitation and hospital readmissions in chronic obstructive pulmonary disease
Daniel K C Lee
bmj.com, 25 Nov 2004 [Full text]
Education, exercise or environment?
Trevor T Nicholson
bmj.com, 2 Dec 2004 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ