Kjærgaard Jakob L, Juhl Carsten B, Lange Peter, Wilcke Jon T
Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark.
Dept of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark.
ERJ Open Res. 2020 Feb 17;6(1). doi: 10.1183/23120541.00173-2019. eCollection 2020 Jan.
The aim of this study was to establish whether early pulmonary rehabilitation after severe exacerbation of chronic obstructive pulmonary disease (COPD) reduces mortality and hospital admissions, and increases physical performance and quality of life compared to rehabilitation initiated later in the stable phase of COPD.
In a randomised controlled trial of 150 patients hospitalised with an exacerbation of COPD, participants were allocated to pulmonary rehabilitation either within 2 weeks after discharge or the same rehabilitation programme but initiated 2 months after discharge.
Early pulmonary rehabilitation did not prolong time to first hospital admission or time to death (hazard ratio 0.79, 95% CI 0.47-1.23, p=0.33) compared to rehabilitation in stable phase. However, 2 months after inclusion, pulmonary rehabilitation resulted in a significantly better improvement in the incremental shuttle walk test (33.9 m, 95% CI 4.18-63.7, p=0.02) compared to that in the stable phase. The difference in the endurance shuttle walk test was of borderline significance (140 s, 95% CI -2.03-282.76, p=0.05), but there was no significant difference concerning the COPD assessment test (-1.43 points, 95% CI -3.44-0.59, p=0.17).
Early pulmonary rehabilitation after acute exacerbation of COPD led to a faster improvement in physical performance compared to rehabilitation initiated later in the stable phase, but did not improve survival or prolong time to hospital readmission.
本研究旨在确定慢性阻塞性肺疾病（COPD）严重加重后早期进行肺康复与在COPD稳定期后期开始康复相比，是否能降低死亡率和住院率，并提高身体机能和生活质量。
在一项针对150例因COPD加重而住院的患者的随机对照试验中，参与者被分配接受出院后2周内的肺康复治疗，或相同的康复计划，但在出院后2个月开始。
与稳定期康复相比，早期肺康复并未延长首次住院时间或死亡时间（风险比0.79，95%可信区间0.47 - 1.23，p = 0.33）。然而，纳入研究2个月后，与稳定期相比，肺康复在递增往返步行试验中的改善明显更好（33.9米，95%可信区间4.18 - 63.7，p = 0.02）。耐力往返步行试验的差异具有临界显著性（140秒，95%可信区间 - 2.03 - 282.76，p = 0.05），但在慢性阻塞性肺疾病评估测试方面无显著差异（-1.43分，95%可信区间 - 3.44 - 0.59，p = 0.17）。
与在稳定期后期开始的康复相比，COPD急性加重后早期进行肺康复可使身体机能更快改善，但并未提高生存率或延长再次入院时间。
