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Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation

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Abstract

The role of pulmonary rehabilitation (PR) in COPD patients with lung hyperinflation has not yet been fully investigated. We retrospectively evaluated the effect of a standard PR course on exercise tolerance and symptoms according to the presence or absence of associated lung hyperinflation, as defined by lung function parameters in three Italian rehabilitation centres. In a cohort of 823 COPD patients (age 71 ± 8 years, FEV1 56 ± 18% pred.) we have systematically recorded: changes (∆) in 6-minute walking test (6MWD) as the primary outcome; dyspnoea (D); muscle fatigue (F); SO2nadir during effort; perceived breathlessness score (MRC); and specific health-related quality of life (SGRQ). Outcomes were compared between patients with lung hyperinflation (n = 283, LH) or without (n = 540 No-LH). Groups were comparable for age, body mass index, baseline exercise tolerance, and breathlessness. ∆-6MWD (+72 ± 47 vs. +62 ± 42 m, p < 0.05); ∆-D (−2.3 ± 1.7 vs. −1.9 ± 1.3 point, p < 0.05) and ∆-SO2nadir (+1.4 ± 3.0 and +0.5 ± 3.3 point, p < 0.05) were greater in LH than in No-LH. Using a multivariate linear regression model, ∆-6MWD in the LH group significantly correlated with lower functional residual capacity (p = 0.021) and baseline 6MWD (p = 0.004). Tolerance, gas exchange and perceived symptoms during effort are the parameters that gain a significant benefit from standard rehabilitation in COPD patients with a lung hyperinflation condition.

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Abbreviations

Δ:

Pre-to-post changes in rehabilitation outcomes

6MWD:

6-Minute walking distance

BMI:

Body mass index

BODE:

Global functional index obtained by measure of BMI, FEV1, MRC and 6MWD

COPD:

Chronic obstructive pulmonary disease

D:

Borg dyspnoea

SD:

Standard deviation

LH:

COPD patients with associated lung hyperinflation

F:

Borg muscle fatigue

FEV1/FVC:

Forced expiratory volume in the first second on forced vital capacity ratio

FEV1 :

Forced expiratory volume in the first second

FiO2 :

Inspiratory fraction of oxygen

FRC:

Functional residual capacity

FVC:

Forced vital capacity

GOLD:

Global initiative for chronic obstructive lung disease

HRQL:

Health-related quality of life

LTOT:

Long-term oxygen therapy

LVRS:

Lung volume reduction surgery

MCID:

Minimal clinically important difference

MRC:

Medical Research Council dyspnoea scale

NETT:

National Emphysema Treatment Trial

No-LH:

Patients without a lung hyperinflation

PaCO2 :

Arterial partial pressure of carbon dioxide

PaO2/FiO2 :

Arterial pressure on specific oxygen flow

PaO2 :

Arterial partial pressure of oxygen

PR:

Pulmonary rehabilitation

RV/TLC:

Residue volume on total lung capacity ratio

RV:

Residual volume

SGRQ:

St. George’s respiratory questionnaire on perceived quality of life

SO2nadir:

Minimum value of pulse oxygen saturation recorded during 6MWD

TLC:

Total lung capacity

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Authors and Affiliations

  1. Pulmonary Rehabilitation, Villa Pineta Hospital, 41026, Pavullo (MO), Italy

    Ernesto Crisafulli, Sasha Lucic & Enrico Maria Clini

  2. DAI Oncology, Haematology and Respiratory Diseases, University of Modena-Reggio Emilia, Modena, Italy

    Elena Venturelli, Andrea Iattoni & Enrico Maria Clini

  3. Division of Pulmonary Rehabilitation, San Raffaele Hospital, Velletri (Rome), Italy

    Gianluca Biscione, Franco Pasqua & Alfredo Cesario

  4. Auxilium Vitae Rehabilitation Center, Volterra (Pisa), Italy

    Guido Vagheggini & Nicolino Ambrosino

Authors
  1. Ernesto Crisafulli
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  2. Elena Venturelli
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  3. Gianluca Biscione
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  4. Guido Vagheggini
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  6. Sasha Lucic
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  8. Franco Pasqua
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  9. Alfredo Cesario
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  10. Enrico Maria Clini
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Correspondence to Ernesto Crisafulli.

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Crisafulli, E., Venturelli, E., Biscione, G. et al. Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation. Intern Emerg Med 9, 23–31 (2014). https://doi.org/10.1007/s11739-011-0727-z

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  • DOI: https://doi.org/10.1007/s11739-011-0727-z

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