Source: Annual Congress 2010 - Exercise training and pulmonary rehabilitation
Disease area: Airway diseases

Abstract

Aim: To identify predictors of response to community based pulmonary rehabilitation for COPD patients.
Methods: Of 158 COPD patients (FEV1 % pred 60(15)%) 77 completed 24 month rehabilitation and 81 completed usual care. Response was defined as a score of ²much improved² or ²slightly improved² on a 5-point self-perceived effectiveness scale that was completed at month 24. Results were compared with previously used criteria of response (improvement in St. George´s Respiratory Questionnaire (SGRQ) ≥ 4 points and improvement in cycle endurance time (CET) ≥105 seconds).
Results: Based on self-perceived effectiveness, 65% of patients in the intervention group classified as responder compared with 31% in the usual care group (p<0.001). Change from baseline in disease specific (p<0.001) and generic quality of life (p<0.001), dyspnea (p<0.05), CET (p<0.05), 6 min walking distance (p<0.001) and severe exacerbations (p<0.05) was significantly better in responders than in non-responders after 12 and 24 months, but not after 4 months. Total costs were significantly lower in responders (p<0.05). In multivariate logistic regression ²fatigue after CET at baseline² was a strong predictor of long-term poorly perceived effectiveness (p<0.05). For each centimetre increase in visual analogue scale of fatigue, the odds of being a responder decreased with 0.795.
Conclusion: Our community based pulmonary rehabilitation program that specifically focused on less advanced COPD patients appeared more effective for participants with a low level of perceived fatigue after CET. Moreover, a positive treatment response at month 24 was not associated with significantly better effects after 4 months of treatment.

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C. van Wetering, M. Rutten-van Mölken, M. Hoogendoorn, J. Janssen, A. Schols (Veldhoven, Rotterdam, Netherlands). Determinants of 2-year response to a community based pulmonary rehabilitation program. Eur Respir J 2010; 36: Suppl. 54, 1935

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