Division of Pulmonary Rehabilitation and Home Care Center, Ankara, Turkey.
Ann Thorac Med. 2011 Apr;6(2):70-6. doi: 10.4103/1817-1737.78420.
The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) and to establish whether in early disease stage PR is as effective as in late stages of disease.
A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To eluciate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council (MRC)], body composition [body mass index (BMI), fat free mass (FFM), fat free mass index (FFMI)], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life (HRQoL) with St. George Respiratory Disease Questionnaire, psycohological status (Hospital anxiety-depression (HAD) scale) were evaluated before and after PR.
At the end of PR in the early disease stage group, the improvement in forced vital capacity (FVC) reached a statistically significant level (P < 0.05). In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements (P < 0.001). HRQoL and exercise capacity were significantly improved for the two groups (P < 0.001). Psychological status evaluated with the HAD scale improved after PR (P < 0.001) both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages.
These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program.
本研究旨在评估慢性阻塞性肺疾病（COPD）综合肺康复（PR）的疗效，并确定 PR 在疾病早期阶段是否与晚期阶段同样有效。
共纳入 55 例稳定期 COPD 患者，其中 28 例为早期疾病阶段，27 例为晚期疾病阶段。所有患者均接受了为期 8 周的综合门诊 PR 方案。为阐明 PR 的效果并比较改善程度，我们评估了肺功能、呼吸困难感觉[医学研究委员会（MRC）量表]、身体成分[体重指数（BMI）、去脂体重（FFM）、去脂体重指数（FFMI）]、运动能力[递增式穿梭步行试验、耐力式穿梭步行试验]、健康相关生活质量（St. George 呼吸疾病问卷）、心理状态（医院焦虑抑郁量表），并于 PR 前后进行比较。
在早期疾病阶段组，PR 结束时用力肺活量（FVC）的改善具有统计学意义（P<0.05）。在两个疾病阶段，BMI、FFM 和 FFMI 均无显著差异。两组患者的改良 BORG 量表评估的运动性呼吸困难减轻程度虽无统计学差异，但 MRC 量表评估的呼吸困难评分有显著改善（P<0.001）。两组患者的生活质量和运动能力均有显著改善（P<0.001）。PR 后，两组患者的心理状态（HAD 量表）均有改善（P<0.001），且在早期和晚期阶段均有改善。研究参数的改善在早期和晚期疾病阶段没有差异。
这些结果表明，COPD 患者从门诊综合 PR 方案中获益，无论疾病严重程度如何。即使是处于早期疾病阶段的患者也应被推荐并鼓励参与 PR 方案。
