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Am Fam Physician. 2004;69(3):711-715

An integral part of the comprehensive care recommended for patients with chronic obstructive pulmonary disease (COPD) is a pulmonary rehabilitation program. Various studies have demonstrated that these programs are effective in reducing symptoms of dyspnea, and improving exercise capacity and quality of life in patients with COPD. The current recommendation for these programs is that they take a multidisciplinary approach to the care of these patients. Such programs require a significant amount of resources and money. Hui and Hewitt developed a simple outpatient pulmonary rehabilitation program that consisted of incremental exercise endurance training, upper- and lower-limb weight training, and endurance activities. The team involved in this program included a physiotherapist supervised by a respiratory physician. Hui and Hewitt hypothesized that this simple pulmonary rehabilitation program could improve health outcomes and reduce hospital use in patients with COPD.

Patients with a diagnosis of COPD and a forced expiratory volume in one second of less than 60 percent predicted or exertional limitations secondary to dyspnea were enrolled in this prospective, longitudinal trial. The program consisted of endurance training that started with walking, progressed to bicycle ergometer and, if appropriate, to steps and jogging on a mini-trampoline. Upper- and lower-limb weight training started at week 3 of the program. No other formal support was provided, and no other allied health professional was involved in the program.

Baseline evaluation of the patients included spirometry, a six-minute walking distance assessment, Borg dyspnea scale after the six-minute walk, and a quality-of-life assessment using the chronic respiratory disease questionnaire. These evaluations were repeated one week after completion of the program. Hospitalization and length of stay for the participants were assessed for one year before the study and for one year after the program was completed. The researchers included only hospital stays that were directly related to exacerbation of COPD.

Thirty-six patients completed the study. Those who participated had a significant improvement in exercise endurance, with the average six-minute walking distance improving from 333 m at the start of the program to 423 m at the completion of the program. They also had a significant reduction in dyspnea scores and improvement in quality-of-life scores. There was no change in lung function at the end of the study compared with baseline readings. The number of hospital admissions was reduced significantly when the year before the study was compared with the year after completion of the study. In addition, the average length of hospital stay was reduced significantly from 7.4 days before the program to 3.3 days after the program was completed.

The authors conclude that a simple, low-cost, outpatient pulmonary rehabilitation program can improve health outcomes in patients with COPD. They add that this program was shown to improve health outcomes and reduce hospitalizations and average length of stays. The program also could help reduce the cost of caring for patients with COPD.

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