Ragaselvi S, Janmeja A K, Aggarwal D, Sidana A, Sood P
Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India.
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India.
J Postgrad Med. 2019 Apr-Jun;65(2):101-106. doi: 10.4103/jpgm.JPGM_433_18.
Pulmonary rehabilitation (PR) has become a standard of care in the management of chronic obstructive pulmonary disease (COPD). However, a significant proportion of the patients do not show benefit after the PR program.
The study was planned to find different patient- and/or disease-related factors that may predict response to PR in stable COPD.
A total of 102 stable COPD patients were prospectively enrolled. Baseline evaluation and investigations, including spirometry, arterial blood gas analysis, and bone mineral density assessment, were done. Thereafter, all patients underwent an 8-week comprehensive outpatient PR program that consisted of exercise training, education, nutritional, and psychological counseling. The response to PR was dichotomously (yes/no) defined by the combined improvement in exercise tolerance (6-min walk distance [6MWD] +54 m) and quality of life (St. George's Respiratory Questionnaire [SGRQ] score - 4 points) measured before and after the program. Thereafter, different predefined factors were analyzed for their possible association with the PR response.
A total of 80 patients (78.4%) completed the PR program and were subjected for analysis. Out of them, 42 (52.5%) showed improvement in both 6MWD and SGRQ score (46 in 6MWD and 54 in SGRQ score). After application of multivariate logistic regression analysis, forced expiratory volume in 1 s <50% predicted (odds ratio [OR]: 2.9; 95% confidence interval [CI]: 1.1-8.3; P = 0.04) and osteoporosis (OR: 0.26; 95% CI: 0.13-0.53; P < 0.001) were found as independent factors predicting PR efficacy.
Poor baseline lung function predicts a short-term improvement in exercise capacity and quality of life in COPD patients, whereas osteoporosis is a negative predictor of PR response. Active search for these factors may help in better patient selection, thus leading to improved outcome after PR.
肺康复（PR）已成为慢性阻塞性肺疾病（COPD）管理中的一项标准治疗措施。然而，相当一部分患者在接受肺康复计划后并未显示出获益。
本研究旨在找出不同的患者和/或疾病相关因素，这些因素可能预测稳定期COPD患者对肺康复的反应。
前瞻性纳入了102例稳定期COPD患者。进行了包括肺功能测定、动脉血气分析和骨密度评估在内的基线评估和检查。此后，所有患者接受了为期8周的综合门诊肺康复计划，该计划包括运动训练、教育、营养和心理咨询。肺康复的反应通过该计划前后测量的运动耐量（6分钟步行距离[6MWD]+54米）和生活质量（圣乔治呼吸问卷[SGRQ]评分-4分）的综合改善进行二分法（是/否）定义。此后，分析了不同的预定义因素与肺康复反应的可能关联。
共有80例患者（78.4%）完成了肺康复计划并接受分析。其中，42例（52.5%）在6MWD和SGRQ评分方面均有改善（6MWD改善46分，SGRQ评分改善54分）。应用多因素逻辑回归分析后，发现1秒用力呼气容积<50%（比值比[OR]：2.9；95%置信区间[CI]：1.1-8.3；P=0.04）和骨质疏松症（OR：0.26；95%CI：0.13-0.53；P<0.001）是预测肺康复疗效的独立因素。
基线肺功能差预示着COPD患者运动能力和生活质量的短期改善，而骨质疏松症是肺康复反应的负性预测因素。积极寻找这些因素可能有助于更好地选择患者，从而改善肺康复后的结局。
