Department of Research and Education, CIRO, Horn, The Netherlands.
Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Respirology. 2017 Jul;22(5):942-949. doi: 10.1111/resp.12987. Epub 2017 Jan 31.
Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess differences in dropout and outcomes of PR between COPD with and without AEs.
Clinically stable patients with moderate-to-very severe COPD (age: 64.1 ± 9.1 years, 55.6% males, forced expiratory volume in 1 s (FEV ): 48.6 ± 20.0% predicted) were assessed during PR (inpatient and outpatient). Mild-to-moderate AEs were defined as 'the prescription of systemic glucocorticosteroids and/or antibiotics, following an acute increase in respiratory symptoms'. Severe AEs were defined as 'a hospital admission due to an AE'. Health status was measured by COPD Assessment Test (CAT), COPD-specific version of the St George's Respiratory Questionnaire (SGRQ-C) and Clinical COPD Questionnaire (CCQ). Symptoms of anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS). Exercise capacity was measured with the 6-min walking test (6MWT) and constant work rate test (CWRT).
A total of 518 patients were assessed during a pre-rehabilitation assessment. Four hundred and seventy-six patients started PR, of whom 419 (88.0%) completed it. A larger proportion of patients who dropped out had a severe AE during PR (20.0% vs 3.5%, P < 0.001). Completers with severe AE showed a deterioration in 6MWT, while completers without AE and with mild-to-moderate AE improved (-24.8 (95% CI: -94.0 to 44.5) vs 24.2 (95% CI: 16.0 to 32.5) vs 25.1 (95% CI: 14.0 to 36.3) metres, P = 0.042). No other significant differences were observed in outcomes comparing completers with and without AE during PR.
Mild-to-moderate AEs do not affect dropout or response of PR, although severe AEs are associated with dropout. AEs should not lead to discontinuation of PR, as response is in general not affected.
脱落或无应答是肺康复（PR）中的一个重要问题，这凸显了识别脱落和应答预测因子的必要性。COPD 的急性加重（AE）可能会影响脱落率和 PR 的反应。我们旨在评估 COPD 合并和不合并 AE 患者在 PR 中脱落和结局的差异。
在 PR（住院和门诊）期间评估了患有中重度至非常严重 COPD 的临床稳定患者（年龄：64.1±9.1 岁，55.6%为男性，1 秒用力呼气量（FEV ）：48.6±20.0%预计值）。轻度至中度 AE 定义为“急性呼吸症状加重后，开具全身糖皮质激素和/或抗生素”。重度 AE 定义为“因 AE 住院”。健康状况通过 COPD 评估测试（CAT）、圣乔治呼吸问卷（SGRQ-C）COPD 特定版本和临床 COPD 问卷（CCQ）进行测量。焦虑和抑郁症状通过医院焦虑和抑郁量表（HADS）进行测量。运动能力通过 6 分钟步行测试（6MWT）和恒功率测试（CWRT）进行测量。
共有 518 名患者在康复前评估中接受了评估。476 名患者开始接受 PR，其中 419 名（88.0%）完成了 PR。在 PR 期间脱落的患者中，有更大比例的患者患有严重 AE（20.0% vs 3.5%，P<0.001）。患有严重 AE 的完成者的 6MWT 恶化，而没有 AE 和患有轻度至中度 AE 的完成者则有所改善（-24.8（95%CI：-94.0 至 44.5）vs 24.2（95%CI：16.0 至 32.5）vs 25.1（95%CI：14.0 至 36.3）米，P=0.042）。在 PR 期间，没有观察到完成者与 AE 之间的其他显著差异。
轻度至中度 AE 不影响 PR 的脱落或反应，尽管重度 AE 与脱落有关。AE 不应导致 PR 的中断，因为反应通常不受影响。
