Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
Projeto de Reabilitação Pulmonar, Universidade Feevale, Novo Hamburgo, RS, Brasil.
J Bras Pneumol. 2020;46(6):e20190309. doi: 10.36416/1806-3756/e20190309. Epub 2020 Jul 15.
Objective To verify if there are differences in Chronic Obstructive Pulmonary Disease (COPD) patient exacerbator and non-exacerbator phenotypes undergoing a Pulmonary Rehabilitation Program (PRP). Methods A real life retrospective study included outpatients with COPD from public primary care who completed a 12-weeks PRP, three times a week. All were assessed before and after PRP using the six-minute walk test (6MWT), the modified Medical Research Council (mMRC) dyspnea index, quality of life and Body-mass Index, airflow Obstruction, Dyspnea and Exercise (BODE index). Results A total of 151 patients were analyzed and mean age was 65.0 ± 8.1 years and mean Forced Expiratory Volume (FEV) 1% of predicted was 39.8 ± 15.9. The predominant gender was male (66.9%). Of these patients 31 (20.5%) were exacerbator phenotype There was a significant improvement in the mean distance in the 6MWT in both groups, with the largest change observed in the exacerbator group [mΔ (95% CI): 84.9 (57.1-112.6) vs. 48.6 (37-60.2) p= 0.018]. Significant reduction in dyspnea on the mMRC scale occurred in both groups, with the highest intensity in the exacerbator group [mΔ (95% CI): - 0.8 (-1.11 to 0.51) vs. -1.6 (-2.20 to -1.13) p = 0.006]. Improvement in the BODE index occurred in both groups, but the mean variation was also significantly greater in the exacerbator group [mΔ (95% CI): -1.44 (-2.17 to -0.70) p= 0.045]. Conclusion Patients with COPD exacerbator phenotype had a greater magnitude of response to PRP (36 meters) when compared to non-exacerbator phenotype regardless the severity of airflow obstruction, also showing improvement in prognosis measured by the BODE index.
验证慢性阻塞性肺疾病（COPD）患者在进行肺康复计划（PRP）时，是否存在加重者和非加重者表型的差异。方法：这是一项真实的回顾性研究，纳入了来自公立基层医疗的 COPD 门诊患者，他们完成了为期 12 周、每周 3 次的 PRP。所有患者在 PRP 前后均接受了 6 分钟步行测试（6MWT）、改良的医学研究委员会（mMRC）呼吸困难指数、生活质量和身体质量指数、气流阻塞、呼吸困难和运动（BODE 指数）评估。结果：共分析了 151 例患者，平均年龄为 65.0 ± 8.1 岁，预计用力呼气量（FEV）1%为 39.8 ± 15.9。主要性别为男性（66.9%）。其中 31 例（20.5%）为加重者表型。两组患者 6MWT 平均距离均显著改善，加重者组变化最大[平均差值（95%置信区间）：84.9（57.1-112.6）比 48.6（37-60.2），p=0.018]。两组 mMRC 呼吸困难量表评分均显著降低，加重者组降低幅度最大[mΔ（95%置信区间）：-0.8（-1.11 至 0.51）比-1.6（-2.20 至-1.13），p=0.006]。两组 BODE 指数均有所改善，但加重者组的平均变化也显著更大[mΔ（95%置信区间）：-1.44（-2.17 至-0.70），p=0.045]。结论：与非加重者表型相比，COPD 加重者表型患者对 PRP 的反应幅度更大（增加 36 米），无论气流阻塞的严重程度如何，而且 BODE 指数也显示出预后改善。
