Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.

Milo A. Puhan, Elena Gimeno-Santos, Madlaina Scharplatz, Thierry Troosters, E. Haydn Walters, Johann Steurer

Research output: Contribution to journalArticle

Abstract

Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. However, in unstable COPD patients who have recently suffered an exacerbation, the effects of pulmonary rehabilitation are less established. To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other patient-important outcomes (mortality, health-related quality of life and exercise capacity). Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO and the Cochrane Airways Group Register of Trials. Searches were current as of March 2010. Randomized controlled trials comparing pulmonary rehabilitation of any duration after exacerbation of COPD with conventional care. Pulmonary rehabilitation programmes needed to include at least physical exercise. Control groups received conventional community care without rehabilitation. We calculated pooled odds ratios and weighted mean differences (MD) using random-effects models. We requested missing data from the authors of the primary studies. We identified nine trials involving 432 patients. Pulmonary rehabilitation significantly reduced hospital admissions (pooled odds ratio 0.22 [95% CI 0.08 to 0.58], number needed to treat (NNT) 4 [95% CI 3 to 8], over 25 weeks) and mortality (OR 0.28; 95% CI 0.10 to 0.84), NNT 6 [95% CI 5 to 30] over 107 weeks). Effects of pulmonary rehabilitation on health-related quality of life were well above the minimal important difference when measured by the Chronic Respiratory Questionnaire (MD for dyspnea, fatigue, emotional function and mastery domains between 0.81 (fatigue; 95% CI 0.16 to 1.45) and 0.97 (dyspnea; 95% CI 0.35 to 1.58)) and the St. Georges Respiratory Questionnaire total score (MD -9.88; 95% CI -14.40 to -5.37); impacts domain (MD -13.94; 95% CI -20.37 to -7.51) and for activity limitation domain (MD -9.94; 95% CI -15.98 to -3.89)). The symptoms domain of the St. Georges Respiratory Questionnaire showed no significant improvement. Pulmonary rehabilitation significantly improved exercise capacity and the improvement was above the minimally important difference (six-minute walk test (MD 77.70 meters; 95% CI 12.21 to 143.20) and shuttle walk test (MD 64.35; 95% CI 41.28 to 87.43)). No adverse events were reported in three studies. Evidence from nine small studies of moderate methodological quality, suggests that pulmonary rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients who have recently suffered an exacerbation of COPD.

Original languageEnglish (US)
JournalThe Cochrane database of systematic reviews
Issue number10
StatePublished - 2011

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Chronic Obstructive Pulmonary Disease
Rehabilitation
Lung
Numbers Needed To Treat
Quality of Life
Exercise
Dyspnea
Fatigue
Odds Ratio
Mortality
Hospital Mortality
MEDLINE
Disease Progression
Randomized Controlled Trials
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Puhan, M. A., Gimeno-Santos, E., Scharplatz, M., Troosters, T., Walters, E. H., & Steurer, J. (2011). Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. The Cochrane database of systematic reviews, (10).

Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. / Puhan, Milo A.; Gimeno-Santos, Elena; Scharplatz, Madlaina; Troosters, Thierry; Walters, E. Haydn; Steurer, Johann.

In: The Cochrane database of systematic reviews, No. 10, 2011.

Research output: Contribution to journalArticle

Puhan, MA, Gimeno-Santos, E, Scharplatz, M, Troosters, T, Walters, EH & Steurer, J 2011, 'Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.', The Cochrane database of systematic reviews, no. 10.
Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. The Cochrane database of systematic reviews. 2011;(10).
Puhan, Milo A. ; Gimeno-Santos, Elena ; Scharplatz, Madlaina ; Troosters, Thierry ; Walters, E. Haydn ; Steurer, Johann. / Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. In: The Cochrane database of systematic reviews. 2011 ; No. 10.
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abstract = "Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. However, in unstable COPD patients who have recently suffered an exacerbation, the effects of pulmonary rehabilitation are less established. To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other patient-important outcomes (mortality, health-related quality of life and exercise capacity). Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO and the Cochrane Airways Group Register of Trials. Searches were current as of March 2010. Randomized controlled trials comparing pulmonary rehabilitation of any duration after exacerbation of COPD with conventional care. Pulmonary rehabilitation programmes needed to include at least physical exercise. Control groups received conventional community care without rehabilitation. We calculated pooled odds ratios and weighted mean differences (MD) using random-effects models. We requested missing data from the authors of the primary studies. We identified nine trials involving 432 patients. Pulmonary rehabilitation significantly reduced hospital admissions (pooled odds ratio 0.22 [95{\%} CI 0.08 to 0.58], number needed to treat (NNT) 4 [95{\%} CI 3 to 8], over 25 weeks) and mortality (OR 0.28; 95{\%} CI 0.10 to 0.84), NNT 6 [95{\%} CI 5 to 30] over 107 weeks). Effects of pulmonary rehabilitation on health-related quality of life were well above the minimal important difference when measured by the Chronic Respiratory Questionnaire (MD for dyspnea, fatigue, emotional function and mastery domains between 0.81 (fatigue; 95{\%} CI 0.16 to 1.45) and 0.97 (dyspnea; 95{\%} CI 0.35 to 1.58)) and the St. Georges Respiratory Questionnaire total score (MD -9.88; 95{\%} CI -14.40 to -5.37); impacts domain (MD -13.94; 95{\%} CI -20.37 to -7.51) and for activity limitation domain (MD -9.94; 95{\%} CI -15.98 to -3.89)). The symptoms domain of the St. Georges Respiratory Questionnaire showed no significant improvement. Pulmonary rehabilitation significantly improved exercise capacity and the improvement was above the minimally important difference (six-minute walk test (MD 77.70 meters; 95{\%} CI 12.21 to 143.20) and shuttle walk test (MD 64.35; 95{\%} CI 41.28 to 87.43)). No adverse events were reported in three studies. Evidence from nine small studies of moderate methodological quality, suggests that pulmonary rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients who have recently suffered an exacerbation of COPD.",
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AU - Steurer, Johann

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