Pulmonology

Pulmonology

Volume 25, Issue 2, March–April 2019, Pages 71-78
Pulmonology

Original article
Physiological and clinical characteristics of patients with COPD admitted to an inpatient pulmonary rehabilitation program: A real-life study

https://doi.org/10.1016/j.pulmoe.2018.07.001Get rights and content
Under a Creative Commons license
open access

Abstract

Background and objective

Patient selection criteria and experimental interventions of randomized controlled trials may not reflect how things work in practice. The aim of this study was to describe the characteristics of chronic obstructive pulmonary disease (COPD) patients undergoing an inpatient pulmonary rehabilitation program (PRP) and the correlates of success.

Methods

Retrospective database review of 975 consecutive patients transferred from acute care hospitals after an acute exacerbation (group A: 14.6%) or admitted from home (group B: 75.4%), from 2010 to 2017. Patients were also divided according to the associated registered main diagnosis: COPD (group 1: 30.6%); COPD and respiratory failure (group 2: 51.7%); COPD and obstructive sleep apnea (group 3: 17.6%). Baseline correlates of post-PRP changes in six minute walking test (6MWT) were also evaluated.

Results

Global Initiative for Chronic Obstructive Lung Disease stages 3 and 4 were the most commonly represented in group 2 (p = 0.0001). Comorbidity Index of all patients was 3.9 ± 1.8. The overall in-hospital mortality rate was 1.3% (5.6% vs 0.6%, in groups A and B, respectively; p = 0.0001). Hypertension, cardiac diseases and obesity were observed in 65.2, 52.2 and 29.6% of patients, respectively. Post-PRP 6MWT increased in all groups. Age, male gender, airway obstruction and baseline 6MWT were correlated with a post-PRP 30 meter increase in 6MWT.

Conclusion

Confirming data of literature, this real-life study shows the characteristics of COPD patients undergoing an inpatient PRP with significant improvement in exercise capacity, independent of whether in stable state or after a recent exacerbation or of the associated main diagnosis.

Abbreviations

6MWT
six minute walking test
AECOPD
acute exacerbation of COPD
ANOVA
analysis of variance
ATS
American Thoracic Society
BMI
body mass index
CIRS
Cumulative Illness Rating Scale
CI
Comorbidity Index
COPD
chronic obstructive pulmonary disease
FEV1
forced expiratory volume at 1 second
FVC
forced vital capacity
GOLD
Global Initiative for Chronic Obstructive Lung Disease
Hb
haemoglobin
HRQL
health-related quality of life
LoS
length of stay
LTOT
long-term oxygen therapy
MCID
minimal clinically important difference
OSAS
obstructive sleep apnoea syndrome
PaCO2
arterial carbon dioxide tension
PaO2
arterial oxygen tension
PRP
pulmonary rehabilitation program
RCT
randomized controlled trial
SI
Severity Index
SpO2
pulse oximetric oxygen saturation.

Keywords

Exercise training
COPD
Comorbidities
Exercise capacity
Respiratory failure
OSAS

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