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Is It Really Useful To Repeat Outpatient Pulmonary Rehabilitation Programs in Patients With Chronic Airway Obstruction?^*

A 2-Year Controlled Study

^* From the Fondazione S. Maugeri IRCCS, Pulmonary Rehabilitation and Lung Function Unit, Scientific Institute of Gussago, Gussago, Italy.

Correspondence to: Nicolino Ambrosino MD, FCCP, Fisiopatologia Respiratoria, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Gussago I-25064 Gussago (BS), Italy; e-mail: nambrosino{at}fsm.it

Study objectives: To answer the following questions: in patients with chronic airway obstruction (CAO), (1) can pulmonary rehabilitation lead to similar short-term gains at successive, yearly interventions, and (2) is there any real clinical or physiologic long-term benefit by yearly repetition of pulmonary rehabilitation programs (PRPs)?

Design: Randomized, controlled clinical study.

Setting: Pulmonary rehabilitation center.

Patients: Sixty-one CAO patients studied 1 year after completing an initial 8-week outpatient PRP (PRP1).

Intervention: Patients were randomly classified into two groups. A second PRP (PRP2) was completed by the first group (group 1) but not by the second group (group 2). One year later, a third PRP (PRP3) was performed by both groups.

Measurements: Lung function, cycloergometry, walking test, dyspnea, and health-related quality of life (HRQL) were assessed before and after PRP2, and before and after PRP3. The numbers of hospitalizations and exacerbations over the year were also recorded.

Results: Complete data sets were obtained from 36 patients (17 patients in group 1 and 19 patients in group 2). The two groups did not differ in any parameter either before PRP1, after PRP1, or at randomization. There was no significant change over time for airway obstruction in either group. After PRP2, exercise tolerance, dyspnea, and HRQL improved in group 1. Nevertheless, 1 year later, patients of group 1 did not differ from patients of group 2 in any outcome parameter, such that in comparison to before PRP1, only HRQL was still better in both groups 24 months after PRP1. Yearly hospitalizations and exacerbations per patient significantly decreased in both groups in the 2 years following PRP1, when compared to the 2 years prior. Nevertheless, at the 24-month follow-up visit, a further reduction in yearly exacerbations was observed only in group 1 but not in group 2 in comparison to what was observed at the 12-month follow-up visit. The PRP3 resulted in improvement in exercise tolerance in both groups.

Conclusion: In patients with CAO, an outpatient PRP can achieve benefits in HRQL and a decreased number of hospitalizations, which persist for a period of 2 years. Successive, yearly interventions lead to similar short-term gains but do not result in additive long-term physiologic benefits. Further reduction in yearly exacerbations seems to be the main benefit of an additional PRP.

Key Words: bronchial asthma • COPD • dyspnea • exercise tolerance • health-related quality of life

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