La Trobe University, Melbourne, Australia.
Monash University, Melbourne, Australia.
Int J Chron Obstruct Pulmon Dis. 2020 Dec 31;15:3423-3431. doi: 10.2147/COPD.S271094. eCollection 2020.
Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months.
This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA).
A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEVpredicted (0.98, 95% CI 0.96 to 0.99).
Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management.
肺康复是治疗慢性阻塞性肺疾病（COPD）患者的有效方法，但疗效维持不佳。本研究旨在评估肺康复后 1 年内 COPD 加重对 12 个月时结局的影响。
这是一项 COPD 家庭与医院康复治疗的试验的二次分析，随访时间为 12 个月。采用行政数据（处方）和住院记录（入院）分别确定中度和重度加重。评估肺康复后 12 个月时加重对生活质量（慢性呼吸问卷，CRQ）、呼吸困难（改良医学研究委员会，mMRC）、运动能力（6 分钟步行距离，6MWD）和客观测量的体力活动（中到剧烈体力活动，MVPA）的影响。
共纳入 166 名参与者，平均年龄（标准差）为 69（9）岁，用力呼气量占预计值的百分比（FEV）为 49（19）%。68%的参与者发生中度加重，34%的参与者发生重度加重。发生重度加重是 CRQ（总分、疲劳和情绪功能领域）、mMRC、6MWD 和 MVPA 12 个月时预后较差的独立预测因素（均 p<0.05）。完成肺康复的患者发生重度加重的可能性较小（29%比 48%，p=0.02）。基线 CRQ 总分（比值比 0.97，95%置信区间 0.95 至 0.99）和 FEV 预测值（0.98，95%置信区间 0.96 至 0.99）较差者发生重度加重的可能性更大。
肺康复后常发生重度加重，并预测 12 个月时预后较差。维持肺康复疗效的策略应针对预防和管理加重。
