The Feasibility and Effect of Early Pulmonary Rehabilitation in Patients after Acute Exacerbation of Chronic Obstructive Pulmonary Disease in A District Hospital_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 WuZhendong , ZengRuijun , DengZhibing

Department of Internal Medicine, The People's Hospital of Nanhai Economic Development Zone, Foshan, Guangdong, 528327, China;

Corresponding author：

WuZhendong, Email: hificash282778@126.com

Keywords：

Chronic obstructive pulmonary disease; Pulmonary rehabilitation; Medical research council scale; St. George's respiratory questionnaire; Six-minute walk test

DOI：

10.7507/1671-6205.2015084

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Objective To investigate the feasibility and effect of early pulmonary rehabilitation (PR) in patients after acute exacerbation of chronic obstructive pulmonary disease (COPD) in a district hospital. Methods A single-centre prospective study was conducted. The COPD patients after an episode of acute exacerbation and referred to the outpatient department were recruited from January 2013 to December 2014. They were randomized to a group with PR (PR group) and a group without PR (wPR group). The following data were recorded and evaluated including age, gender, forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and FEV₁ as a percentage of the predicted value (FEV₁% pred).The baseline and the post-PR medical research council scale (MRC), St. George's respiratory questionnaire (SGRQ), and six-minute walk distance (6MWD) were also compared. Results A total of 91 cases were enrolled with 46 cases in the PR group and 45 cases in the wPR group. The age, gender, the severity of COPD were similar in two groups (P > 0.05). The MRC score and SGRQ score of the PR group were significantly improved 3 months later compare with the baseline (P < 0.05), and did not changed significantly in the wPR group (P > 0.05). There were 26 patients whose SGRQ scores decreased > 4 in the PR group (26/46, 56.5%), which was significantly higher than the wPR group (7/45, 15.6%) (P < 0.05). The 6MWD of the PR group was significantly increased 3 months later compare with the baseline (P < 0.05), and did not changed significantly in the wPR group (P > 0.05). There were 22 patients whose 6MWD increased > 54 meters in the PR group (22/46, 47.8%), which was significantly higher than the wPR group (9/45, 20.0%) (P < 0.05). Conclusions It is feasible and safety to perform early PR in patients after acute exacerbation of COPD in the district hospital. The early PR can improve the MRC score, SGQR score, and 6MWD in COPD patients.

Citation： WuZhendong, ZengRuijun, DengZhibing. The Feasibility and Effect of Early Pulmonary Rehabilitation in Patients after Acute Exacerbation of Chronic Obstructive Pulmonary Disease in A District Hospital. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(4): 337-340. doi: 10.7507/1671-6205.2015084 Copy

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2.	Mathers CD, Boerma T, Ma Fat D.Global and regional causes of death.Br Med Bull, 2009, 92:7-32.
3.	Hamilton AL, Killian KJ, Summers E, et al.Symptom intensity and subjective limitation to exercise in patients with cardiorespiratory disorders.Chest, 1996, 110:1255-1263.
4.	Gosselink R, Troosters T, Decramer M.Peripheral muscle weakness contributes to exercise limitation in COPD.Am J Respir Crit Care Med, 1996, 16:976-980.
5.	Vestbo J, Hurd SS, Agustí AG, et al.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:GOLD executive summary.Am J Respir Crit Care Med, 2013, 187:347-365.
6.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华内科杂志, 2007, 46:254-261.
7.	Donner CF, Muir JF, Rehabilitation and Chronic Care Scientific Group of the European Respiratory Society.Selection criteria and programmes for pulmonary rehabilitation in COPD patients.Eur Respir J, 1997, 10:744-757.
8.	文红, 郑劲平.慢性阻塞性肺疾病患者肺康复下肢运动处方的制订.中国康复医学杂志, 2006, 21:860-863.
9.	Jones PW, Quirk FH, Baveystock CM, et al.A self-complete measure of health status for chronic airflow limitation:the St George's Respiratory Questionnaire.Am Rev Respir Dis, 1992, 145:1321-1327.
10.	Redelmeier DA, Bayoumi AM, Goldstein RS, et al.Interpreting small differences in functional status:the six minute walk test in chronic lung disease patients.Am J Respir Crit Care Med, 1997, 18:1278-1282.
11.	Kortebein P, Ferrando A, Lombeida J, et al.Effect of 10 days of bed rest on skeletal muscle in healthy older adults.JAMA, 2007, 297:1772-1774.
12.	张锋英, 俞烽, 杭晶卿, 等.社区呼吸康复对稳定期慢性阻塞性肺疾病患者疗效的影响.中华物理医学与康复杂志, 2014, 36:47-51.
13.	Troosters T, Probst VS, Crul T, et al.Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 2010, 181:1072-1077.
14.	Giavedoni S, Deans A, McCaughey P, et al.Neuromuscular electrical stimulation prevents muscle function deterioration in exacerbated COPD:a pilot study.Respir Med, 2012, 106:1429-1434.
15.	Greening NJ, Williams JEA, Hussain SF, et al.An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease:randomised controlled trial.BMJ, 2014, 349:4315.
16.	Barakat S, Michele G, George P, et al.Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis, 2008, 3:155-162.
17.	Griffiths TL, Burr ML, Campbell IA, et al.Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation:a randomized controlled trial.Lancet, 2000, 355:362-368.
18.	Riario-Sforza GG, Incorvaia C, Paterniti F, et al.Effects of pulmonary rehabilitation on exercise capacity in patients with COPD:a number needed to treat study.Int J Chron Obstruct Pulmon Dis, 2009, 4:315-319.
19.	Lacasse Y, Martin S, Lasserson TJ, et al.Meta analysis of respiratory rehabilitation in chronic obstructive pulmonary disease:a Cochrane systematic review.Eura Medicophys, 2007, 4:475-485.

1. Mannino DM, Buist AS.Global burden of COPD:risk factors, prevalence, and future trends.Lancet, 2007, 370:765-773.
2. Mathers CD, Boerma T, Ma Fat D.Global and regional causes of death.Br Med Bull, 2009, 92:7-32.
3. Hamilton AL, Killian KJ, Summers E, et al.Symptom intensity and subjective limitation to exercise in patients with cardiorespiratory disorders.Chest, 1996, 110:1255-1263.
4. Gosselink R, Troosters T, Decramer M.Peripheral muscle weakness contributes to exercise limitation in COPD.Am J Respir Crit Care Med, 1996, 16:976-980.
5. Vestbo J, Hurd SS, Agustí AG, et al.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:GOLD executive summary.Am J Respir Crit Care Med, 2013, 187:347-365.
6. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华内科杂志, 2007, 46:254-261.
7. Donner CF, Muir JF, Rehabilitation and Chronic Care Scientific Group of the European Respiratory Society.Selection criteria and programmes for pulmonary rehabilitation in COPD patients.Eur Respir J, 1997, 10:744-757.
8. 文红, 郑劲平.慢性阻塞性肺疾病患者肺康复下肢运动处方的制订.中国康复医学杂志, 2006, 21:860-863.
9. Jones PW, Quirk FH, Baveystock CM, et al.A self-complete measure of health status for chronic airflow limitation:the St George's Respiratory Questionnaire.Am Rev Respir Dis, 1992, 145:1321-1327.
10. Redelmeier DA, Bayoumi AM, Goldstein RS, et al.Interpreting small differences in functional status:the six minute walk test in chronic lung disease patients.Am J Respir Crit Care Med, 1997, 18:1278-1282.
11. Kortebein P, Ferrando A, Lombeida J, et al.Effect of 10 days of bed rest on skeletal muscle in healthy older adults.JAMA, 2007, 297:1772-1774.
12. 张锋英, 俞烽, 杭晶卿, 等.社区呼吸康复对稳定期慢性阻塞性肺疾病患者疗效的影响.中华物理医学与康复杂志, 2014, 36:47-51.
13. Troosters T, Probst VS, Crul T, et al.Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 2010, 181:1072-1077.
14. Giavedoni S, Deans A, McCaughey P, et al.Neuromuscular electrical stimulation prevents muscle function deterioration in exacerbated COPD:a pilot study.Respir Med, 2012, 106:1429-1434.
15. Greening NJ, Williams JEA, Hussain SF, et al.An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease:randomised controlled trial.BMJ, 2014, 349:4315.
16. Barakat S, Michele G, George P, et al.Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis, 2008, 3:155-162.
17. Griffiths TL, Burr ML, Campbell IA, et al.Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation:a randomized controlled trial.Lancet, 2000, 355:362-368.
18. Riario-Sforza GG, Incorvaia C, Paterniti F, et al.Effects of pulmonary rehabilitation on exercise capacity in patients with COPD:a number needed to treat study.Int J Chron Obstruct Pulmon Dis, 2009, 4:315-319.
19. Lacasse Y, Martin S, Lasserson TJ, et al.Meta analysis of respiratory rehabilitation in chronic obstructive pulmonary disease:a Cochrane systematic review.Eura Medicophys, 2007, 4:475-485.

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The Feasibility and Effect of Early Pulmonary Rehabilitation in Patients after Acute Exacerbation of Chronic Obstructive Pulmonary Disease in A District Hospital

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