Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled studyBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38258.662720.3A (Published 18 November 2004) Cite this as: BMJ 2004;329:1209
- William D-C Man (), MRC clinical research fellow1,
- Michael I Polkey, consultant physician in respiratory medicine3,
- Nora Donaldson, senior lecturer in statistics2,
- Barry J Gray, consultant physician in respiratory medicine2,
- John Moxham, professor of respiratory medicine1
- 1 Respiratory Muscle Laboratory, Guy's, King's, and St Thomas' School of Medicine, King's College Hospital, London SE5 9PJ
- 2 King's College Hospital, London SE5 9RS
- 3 Royal Brompton Hospital, London SW3 6NP
- Correspondence to: W D-C Man
- Accepted 7 September 2004
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.
The CONSORT checklist of items to include when reporting a randomised controlled trial is on bmj.com
We thank the Southwark and Lambeth pulmonary rehabilitation team for running and supervising the rehabilitation programme described in this work.
Contributors WD-CM conceived the idea of the study, obtained grant funding, designed the protocol, recruited subjects, collected and analysed data and wrote the first and final drafts of the manuscript. MIP helped design the protocol of the study, interpreted data, and helped write the first and final drafts of the manuscript. ND helped design the study, performed statistical analysis of the data and helped write the first and final drafts of the manuscript. BJG helped design the study, recruited patients, interpreted data and helped write the first and final drafts of the manuscript. JM was the senior investigator, and will act as guarantor. He helped conceive the idea and design of the study, obtained grant funding, interpreted data, and helped write the first and final drafts of the manuscript. Christine Jones and Caroline Mooney helped in the recruitment of subjects. Renata Morello, Sheena Radford, Julie Backley, Lynda Haggis, Claire Bradley, Lauren Moore, and Debbie James were involved in data collection and were members of the multidisciplinary team that provided the active intervention.
Funding This study was supported by a British Lung Foundation Trevor Clay Memorial Grant. WD-CM is a clinical research training fellow of the Medical Research Council (UK). The Southwark and Lambeth pulmonary rehabilitation team is in part funded by “Pursuing Perfection,” coordinated by the NHS Modernisation Agency
Competing interests None declared.
Ethical approval The local research ethics committee approved the study.