Seven-year time course of lung function, symptoms, health-related quality of life, and exercise tolerance in COPD patients undergoing pulmonary rehabilitation programs

Aim: To evaluate the long-term course of outcome indexes in patients with chronic obstructive pulmonary disease (COPD) undergoing repeated pulmonary rehabilitation programs (PRP). Design: Prospective, observational study. Setting: Pulmonary Rehabilitation Center. Patients: Forty-eight COPD patients (M 33, age 59.6 +/- 8.9 years, forced expiratory volume in 1s (FEV1) 58 +/- 16% predicted, DLCO 71 +/- 17% predicted.) undergoing 5 Day-Hospital based PRPs in a period of 7.2 +/- 0.8 years. Measurements: Lung function, exercise capacity (incremental cycloergometry, test-6-minute walking test (6MWD)), dyspnoea (Baseline-BDI and Transitional-TDI Dyspnoea Index and Medical Research Council score-MRC), health-related quality of life (HRQL) (St. George Respiratory Questionnaire (SGRQ), and the derived BODE index were assessed pre and post each PRP. Results: During follow-up, patients showed a 18 22 (mean +/- SEM) ml/year FEV1 decline (95%CI: -24.4 to 11.6; p < 0.001). Exercise tolerance and BDI remained stable over time whereas SGRQ improved (Delta SGRQ total score: -9.6 +/- 14%, p < 0.001). BODE index significantly worsened (from 1.27 +/- 1.14 to 1.98 +/- 1.64; p < 0.001), being this change mainly attributable to worsening in FEV1. Each PRP elicited significant improvement in exercise capacity, dyspnoea, SGRQ and BODE score. Post-PRP improvements in 6MWD, MRC and TDI were higher after the first three than after the last two PRPs (p < 0.001), whereas the greatest gain in SGRQ was observed after PRP1 and then it was lower (p < 0.03) but stable in the following periods of observation. Conclusion: Despite progressive lost in effectiveness of repeated PRP, COPD patients undergoing those programs do not show any significant worsening in exercise tolerance, dyspnoea and HRQL along a period of 7 years. (c) 2007 Elsevier Ltd. All rights reserved.