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Vol. 42. Issue 9.
Pages 434-439 (September 2006)
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Vol. 42. Issue 9.
Pages 434-439 (September 2006)
Original Articles
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Functional Status and Survival in Patients With Chronic Obstructive Pulmonary Disease Following Pulmonary Rehabilitation
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María Victorina López Varelaa,
Corresponding author
mlopez@chasque.net

Correspondence: Dra. M.V. López Varela. 21 deSetiembre, 2353/301. 11200 Montevideo. Uruguay
, Turquesa Anidoa, María Larrosab
a Departamento de Neumología. Centro de Asistencia del Sindicato Médico del Uruguay (CASMU), Montevideo. Uruguay, Member of Latin American Thoracic Society (ALAT)
b Departamento de Fisiatría, CASMU, Montevideo, Uruguay, Member of ALAT
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Objectives

To study functional status and survival in patients with chronic obstructive pulmonary disease (COPD) following a pulmonary rehabilitation program.

Patients and methods

We assessed lung function, 6-minute walk distance, Borg score for dyspnea upon completion of the 6-minute walk, workload in watts on a cycle ergometer, quality of life using the St George's Respiratory Questionnaire (SGRQ); the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; and survival.

Results

One hundred five patients participated in the pulmonary rehabilitation program. The patients had a mean (SD) age of 63.9 (9.3) years, body mass index of 24.5 (4.56) kg/m2, and forced expiratory volume in 1 second (FEV1) of 0.91 (0.46) L. The mean distances walked in 6 minutes were 412.8 (79.4) m before the pulmonary rehabilitation program and 443.46 (81.57) m after rehabilitation. The mean workloads on the cycle ergometer before and after rehabilitation, respectively, were 47.9 (29.6) W and 77.76 (20.88) W. The mean Borg scores were 2.2 (1.37) before and 1.47 (1.37) after rehabilitation, and the SGRQ scores at the same times were 27.63 (16.02) and 25.45 (15.12). Mortality due to respiratory disease (105 months) was 19%. Cumulative survival rates at 1 year, 3 years, and 6 years were 91%, 86.7%, and 6.75%, respectively. Survival was related to an FEV1 greater than 1.02 L (P=.05), a 6-minute walk distance over 448 m before rehabilitation (P=.04) and 454 m after rehabilitation (P=.05), and a workload on the cycle ergometer of over 54 W before rehabilitation (P=.01) and 72 W (P=.02) afterwards. The correlations between survival and both SGRQ and BODE scores were weaker.

Conclusions

We observed improved exercise capacity, dyspnea ratings, and, to a lesser extent, better SGRQ scores in our COPD patients following pulmonary rehabilitation. The best predictors of survival were FEV1, the 6-minute walk distance, and the cycle ergometer workloads.

Key words:
Pulmonary rehabilitation
COPD
Survival predictors
Objetivos

Mostrar los resultados funcionales y la supervivencia de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) tras un programa de rehabilitación respiratoria (RR).

Pacientes y métodos

Se evaluaron la función pulmonar, la distancia recorrida en 6 min y la disnea según la escala de Borg en la prueba de la marcha de 6 min, carga en vatios sobre cicloergómetro y calidad de vida por el St. George's Respiratory Questionnaire (SGRQ), puntuación en el índice BODE y supervivencia.

Resultados

Ingresaron en el programa de RR 105 pacientes, con una edad media ± desviación estándar de 63,9 ± 9,3 años, índice de masa corporal de 24,5 ± 4,56 y volumen espiratorio forzado en el primer segundo (FEV1) de 0,91 ± 0,46 l/s. La distancia recorrida en 6 min antes de RR fue de 412,8 ± 79,4 m, y tras RR de 443,46 ± 81,57 m. La carga en cicloergómetro fue de 47,9 ± 29,6 W pre-RR y de 77,76 ± 20,88 W post-RR. La puntuación en la escala de Borg fue de 2,2 ± 1,37 pre-RR y de 1,47 ± 1,37 post-RR, y el SGRQ de 27,63 ± 16,02 y 25,45 ± 15,12, respectivamente. La mortalidad respiratoria (105 meses) fue del 19%. La supervivencia acumulada a 1, 3 y 6 años fue del 91, el 86,7 y el 67,5%, respectivamente, y se relacionó con un valor de FEV1 mayor de 1,02 l/s (p = 0,05), distancia recorrida en la prueba de la marcha de 6 min mayor de 448 m pre-RR (p = 0,04) y de 454 m post-RR (p = 0,05) y carga en cicloergómetro mayor de 54 W pre-RR (p = 0,01) y de 72 W post-RR (p = 0,02). La relación de la supervivencia con el SGRQ y el índice BODE fue menor.

Conclusiones

La capacidad de ejercicio, la disnea y, en menor grado, la calidad de vida mejoraron con la RR en los pacientes con EPOC. Los mejores predictores de supervivencia fueron el FEV1, la distancia recorrida en 6 min y los vatios alcanzados en el cicloergómetro.

Palabras clave:
Rehabilitación respiratoria
EPOC
Predictores de supervivencia
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