Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA.
J Cardiopulm Rehabil Prev. 2010 Jan-Feb;30(1):53-60. doi: 10.1097/HCR.0b013e3181c85845.
The purpose of this study was to determine the impact of chronic obstructive pulmonary disease exacerbation (COPDE) on pulmonary rehabilitation (PR) participation and completion and on PR outcomes of daily activity, self-reported daily exercise, and functional capacity.
Participants in an 8-week outpatient PR program were studied pre- and post-PR. Variables included COPDE occurrence (computerized patient record system), self-reported exercise (daily activity diary), daily activity (accelerometer), exercise capacity (6-minute walk distance), dyspnea today and over the past 30 days (Lareau's Functional Status and Dyspnea Questionnaire), health status (The Medical Outcomes Study 36-Item Short-Form Health Survey adapted for Veterans), and quality of life (Seattle Obstructive Lung Disease Questionnaire).
Outpatients with COPD (N = 146, 140 men) started PR; 112 completed the program and were studied. Of the 30 participants who had at least 1 COPDE during the program, 10 quit the program. Subjects who exacerbated had a lower body mass index than did patients without COPDE (28.4 compared with 30.8, respectively, P < .05), more severe COPD (percent-predicted forced expiratory volume in the first second of expiration, FEV1% predicted, 32%, compared with 40%, respectively, P< .05), and required supplemental oxygen (70% compared with 36%, respectively, P< .05). Exacerbators who completed PR were more likely to be nonsmokers, on oxygen, and have a higher FEV1% predicted than were exacerbators who quit. It was found that postprogram exercise capacity improved overall, with exacerbators performing better than nonexacerbators on the 6-minute walk test (P = .044). There were no significant differences in other outcomes.
Findings suggest that COPD exacerbators who completed PR had similar outcomes as did nonexacerbators and should be encouraged to return to PR after COPDE.
本研究旨在确定慢性阻塞性肺疾病加重（COPDE）对肺康复（PR）参与和完成情况以及对日常活动、自我报告的日常运动和功能能力的 PR 结果的影响。
研究了参加 8 周门诊 PR 计划的参与者在 PR 前后的情况。变量包括 COPDE 发生情况（计算机患者记录系统）、自我报告的运动（日常活动日记）、日常活动（加速度计）、运动能力（6 分钟步行距离）、今天和过去 30 天的呼吸困难（Lareau 的功能状态和呼吸困难问卷）、健康状况（适应退伍军人的医疗结果研究 36 项简短健康调查问卷）和生活质量（西雅图阻塞性肺病问卷）。
146 名门诊 COPD 患者（140 名男性）开始进行 PR；112 名完成了该计划并进行了研究。在该计划期间至少发生 1 次 COPDE 的 30 名参与者中，有 10 名退出了该计划。加重的患者体重指数低于未发生 COPDE 的患者（分别为 28.4 和 30.8，P<0.05），COPD 更严重（预计第一秒用力呼气量百分比，FEV1%预测，分别为 32%和 40%，P<0.05），需要补充氧气（分别为 70%和 36%，P<0.05）。完成 PR 的加重者更有可能不吸烟、吸氧和 FEV1%预测值较高，而退出 PR 的加重者则相反。研究发现，整体而言，运动能力在 PR 后有所提高，在 6 分钟步行测试中，加重者的表现优于非加重者（P=0.044）。其他结果没有显著差异。
研究结果表明，完成 PR 的 COPD 加重者的结果与非加重者相似，应鼓励他们在 COPDE 后返回 PR。
