Vitacca Michele, Ambrosino Nicolino, Belli Stefano, Vigna Matteo, Zampogna Elisabetta, Aliani Maria, Piaggi Giancarlo, Paneroni Mara
Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Italy.
Respir Med. 2021 Aug;184:106465. doi: 10.1016/j.rmed.2021.106465. Epub 2021 May 14.
Pulmonary rehabilitation is effective also in patients recovering from acute exacerbations of COPD (AECOPD). We aimed to evaluate whether levels of dyspnoea affect the outcome of pulmonary rehabilitation in patients recovering from AECOPD requiring different levels of care.
Retrospective data analysis of 1057 patients recovering from AECOPD requiring either hospital (Hospital group: 291) or home management (Home group: 766), undergone post AECOPD in-patient pulmonary rehabilitation. The 6-min walking distance (6MWD) test was the primary outcome, stratified by the Barthel index Dyspnoea (Bid). Data of modified Medical Research Council scale, Short Physical Performance Battery, COPD Assessment Test were also analysed, when available.
In overall population 6MWD improved significantly from 278 (129) to 335 (139) meters (p < 0.001). As compared to Home, 6MWD improved more in Hospital group [by 81.9 (79.6) vs 48.9 (94.4) meters respectively, p < 0.001] also when stratified by Bid levels (all: p < 0.01). In Hospital group, 6MWD improved significantly more in patients with Bid level 3 than levels 4 and 5 (p < 0.05). Hospital group showed a greater proportion of patients reaching the Minimal Clinically Important Difference for 6MWD (75.9 vs 56.7% in Hospital and Home group respectively p < 0.001). All other available outcome measures significantly (p < 0.01) improved independent of the Bid levels. There was no significant correlation between baseline severity of airflow obstruction and effect of the program.
In-patient pulmonary rehabilitation results in clinically meaningful improvement in patients recovering from AECOPD, independent of severity of dyspnoea. However, the levels of dyspnoea severity and the care required by AECOPD influenced the magnitude of success.
肺康复对慢性阻塞性肺疾病急性加重（AECOPD）恢复期患者也有效。我们旨在评估呼吸困难程度是否会影响需要不同护理水平的AECOPD恢复期患者的肺康复效果。
对1057例从AECOPD恢复且需要住院（住院组：291例）或居家管理（居家组：766例）的患者进行回顾性数据分析，这些患者在AECOPD后接受了住院肺康复。6分钟步行距离（6MWD）测试是主要结局指标，按巴塞尔指数呼吸困难（Bid）分层。如有可用数据，还分析了改良医学研究委员会量表、简短体能状况量表、慢性阻塞性肺疾病评估测试的数据。
在总体人群中，6MWD从278（129）米显著提高到335（139）米（p<0.001）。与居家组相比，住院组的MWD改善更大[分别为81.9（79.6）米和48.9（94.4）米，p<0.001]，按Bid水平分层时也是如此（所有p<0.01）。在住院组中，Bid水平为3的患者6MWD改善明显大于水平4和5的患者（p<0.05）。住院组达到6MWD最小临床重要差异的患者比例更高（住院组和居家组分别为75.9%和56.7%，p<0.001）。所有其他可用结局指标均显著（p<0.01）改善，与Bid水平无关。气流阻塞的基线严重程度与该项目的效果之间无显著相关性。
住院肺康复可使AECOPD恢复期患者在临床上获得有意义的改善，与呼吸困难严重程度无关。然而，呼吸困难严重程度和AECOPD所需的护理水平影响了成功的程度。
