Journal Information
Vol. 42. Issue 9.
Pages 434-439 (September 2006)
Share
Share
Download PDF
More article options
Vol. 42. Issue 9.
Pages 434-439 (September 2006)
Original Articles
Full text access
Functional Status and Survival in Patients With Chronic Obstructive Pulmonary Disease Following Pulmonary Rehabilitation
Visits
4591
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
This item has received
Article information
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
Full text is only aviable in PDF
References
[1]
Pauwels RA, Buist AS, Carverley PH, Jenkins CR, Hurd SS.
Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive. Lung Disease (GOLD) Workshop Summary.
Am J Respir Crit Care Med., 163 (2001), pp. 1256-1276
[2]
Mannino DM, Gagnon RC, Petty TL, Lydick E.
Obstructive lung disease and low lung function in adults in the United States. Data from the National Health and Nutrition Examination Survey, 1988–1994.
Arch Intern Med., 160 (2001), pp. 1683-1689
[3]
Sobradillo V, Miratvilles M, Gabriel R, Jiménez Ruiz CA, Villasante C, Mase JF, et al.
Geographic variations in prevalence and underdiagnosis of COPD. Results of the Ibercorp Multicentre Epidemiological Study.
Chest, 118 (2000), pp. 981-989
[4]
Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO).
[5]
Celli B, MacNee W, committee members.
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS-ERS position paper.
Eur Respir J., 23 (2004), pp. 932-946
[6]
Killian KJ, Leblanc P, Martin H, Summers E, Jones HL, Campbell EJM.
Exercise capacity and ventilatory, circulatory and symptom limitation in patients with chronic airflow limitation.
Am Rev Respir Dis., 146 (1992), pp. 935-940
[7]
American Thoracic Society.
European Respiratory Society. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease.
Am J Respir Crit Care Med., 159 (1999), pp. S1-S28
[8]
Montes de Oca M, Torres S, Hernández Y, Romero E, Talamo C.
Peripheral skeletal muscles in COPD patients: correlation with pulmonary function and quality of life.
Eur Respir J., 20 (2002), pp. 497S
[9]
Decramer M, Gosselink R, Troosterst T, Verschueren M, Evers G.
Muscle weakness is related to utilization of health care resources in COPD patients.
Eur Respir J., 10 (1997), pp. 417-423
[10]
Marquis K, Debigaré R, Lacasse Y, Leblanc P, Jobin Y, Carrier G, et al.
Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med., 166 (2002), pp. 809-813
[11]
ERS Task Force Position Paper. Selection criteria and programmes of pulmonary rehabilitation and chronic care scientific group of the European Respiratory Society.
Eur Respir J., 10 (1997), pp. 744-757
[12]
American Thoracic Society.
Pulmonary rehabilitation 1999.
Am J Respir Crit Care Med., 159 (1999), pp. 1666-1682
[13]
Chronic obstructive pulmonary disease: national clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care.
Thorax, 59 (2004), pp. 1232
[14]
Normativa SEPAR. Normativa sobre la rehabilitación respiratoria. Grupo de Trabajo de la SEPAR.
Arch Bronconeumol, 26 (2000), pp. 257
[15]
Ries A, Kaplan R, Limberg T, Prewitt L.
Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.
Ann Intern Med., 122 (1995), pp. 823-832
[16]
Gosselink R.
Respiratory rehabilitation: improvement of short and long-term outcome.
Eur Respir J., 20 (2002), pp. 4-5
[17]
Salman GF, Mosier MC, Beasley BW, Calkins DR.
Rehabilitation for patients with chronic obstructive pulmonary disease. Meta analysis of randomized controlled trials.
J Gen Intern Med., 18 (2003), pp. 213-221
[18]
Montes de Oca M, Torres S, González Y, Romero E, Hernández N, Tálamo C.
Cambios en la tolerancia al ejercicio, calidad de vida relacionada con la salud y características de los músculos periféricos después de 6 semanas de entrenamiento en pacientes con enfermedad obstructiva crónica.
Arch Bronconeumol, 41 (2005), pp. 413-418
[19]
Hui KP, Hewitt AB.
A simple pulmonary rehabilitation program improves health outcomes and reduces hospital utilization in patients with COPD.
Chest, 124 (2003), pp. 94-97
[20]
ATS Statement. Lung function testing: selection of reference values and interpretative strategies.
Am Rev Respir Dis., 144 (1991), pp. 1202
[21]
ATS Statement. Guidelines for six-minute walk test.
Am J Respir Crit Care Med., 166 (2002), pp. 111
[22]
Mahler D, Wells C.
Evaluation of clinical methods for rating dyspnea.
Chest, 93 (1988), pp. 580
[23]
Ferrer M, Alonso J, Prieto L, Plaza V, Manso E, Marrades R, et al.
Validity and reliability of the St. George's Respiratory Questionnaire after adaption to a different language and culture: the Spanish example.
Eur Respir J., 9 (1996), pp. 1160
[24]
Celli B, Cote C, Marín S, Casanova C, Montes de Oca M, Méndez R, et al.
The body-mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med., 350 (2004), pp. 1005-1012
[25]
Jones PW, Quirk FII, 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., 145 (1992), pp. 1321-1327
[26]
López Varela MV, Jiménez F, Tempone A, Fagúndez K.
Disease severity in COPD patients.
Eur Respir J., 22 (2003), pp. 5775
[27]
Wijkstra PJ, van Altena R, Kraan J, Otten V, Postma DS, Koëler GH.
Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home.
Eur Respir J., 7 (1994), pp. 269-273
[28]
Ambach W, Chadwick-Straver VM, Wagenaar RC, von Keimpema ARJ, Kemper MCG.
The effects of a community based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial.
Eur Respir J., 10 (1997), pp. 104-113
[29]
Zu Wallack R.
Clinical interpretation of health related quality of life outcomes in COPD: application to critical care.
Eur Respir Rev., 12 (2002), pp. 92-97
[30]
Gerardi DA, Lovett L, Benoit-Connors ML, Reardon JZ, Zu Wallack RL.
Variables related to increased mortality following outpatient pulmonary rehabilitation.
Eur Respir J., 9 (1996), pp. 431-435
[31]
Bowen JB, Volto JJ, Thrall RS, Campbell Haggerty MC, Stockdale-Wooley R, Bandyopadhyay T, et al.
Functional status and survival following pulmonary rehabilitation.
Chest, 118 (2000), pp. 697-703
[32]
Oga T, Nishimura K, Tsukiro M, Soto S, Hajiro T.
Analysis of the factors related to mortality in chronic obstructive pulmonary disease. Role of exercise capacity and health status.
Am J Respir Crit Care Med., 167 (2003), pp. 544-549
[33]
The IPPB Trial Group.
Intermittent positive pressure breathing therapy of chronic obstructive pulmonary disease: a clinical trial.
Ann Intern Med., 99 (1983), pp. 612-620
[34]
Pinto-Plata VM, Cote C, Cabral H, Taylor J, Celli B.
The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.
Eur Respir J., 23 (2004), pp. 28-33
[35]
Domingo Salvaney A, Lamarca R, Ferrer M, García Aymerich J, Alonso J, Félez M, et al.
Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med., 166 (2002), pp. 680-685
[36]
Landbo C, Prescott E, Lange P, Vestbo J, Almdal T.
Prognostic value of nutritional status in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med., 160 (1999), pp. 1856
Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?