Source: Annual Congress 2011 - Exacerbations and severe chronic respiratory disease: oxygen, rehabilitation, admission to hospital and palliative care
Disease area: Airway diseases

Abstract

Introduction
Exacerbations are a key feature of COPD and are known to impact lung function, daily physical activity level, quality of life, survival, and health resource usage. Pulmonary rehabilitation (PR) is an effective treatment for disability in COPD, with previous research identifying improved outcome for patients reporting no exacerbations (NE) when compared with patients suffering exacerbations (Riario-Sforza et al., 2005). A frequent susceptibility exacerbation phenotype (>2 exacerbations in previous year) has been identified (Hurst et al., 2010) which may have implications for response to PR. We hypothesised that patients with frequent exacerbations (FE) would gain less benefit from an 8-week outpatient PR program.
Method
In 93 COPD patients reporting NE (n=28), one exacerbation (OE) (n=28) or FE (n =37) in the previous year, the following assessments were made before (T0) and after (T1) PR: fat free mass (FFM), incremental shuttle walk (ISW), self-report Chronic Respiratory Disease Questionnaire (CRDQ-SR).Median (IQR) change in ISW, FFM, and CRDQ-SR total score from T0 to T1 was compared between groups using Kruskal-Wallis tests.
Results
ISW distance and CRDQ-SR increased in NE (80 (13-148)m, 13.5 (1.5-23.8)) OE (50 (0-110)m, 19.0 (2.0-32.0)) and FE (60 (20-270)m, 21.0 (8.0-28.0)) groups.FFM increased in NE (0.36 (-1.32-1.26)kg) and OE (0.51 (-0.85-1.33)kg) but not FE (-0.07 (-1.38-2.29)kg).No significant differences were found between groups for any variables (ISW: p = 0.46, CRDQ total p = 0.35, FFM: p = 0.94).
Conclusion
The "susceptibility to exacerbation" phenotype does not appear to affect improvements in exercise capacity, or health related quality of life gained during PR.


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J. L. Canavan, K. A. Ingram, R. P. Fowler, P. Marns, K. Dobson, A. L. Clark, C. M. Nolan, M. I. Polkey, W. D. C. Man (London, United Kingdom). The "susceptibility to exacerbation" phenotype in COPD and response to pulmonary rehabilitation. Eur Respir J 2011; 38: Suppl. 55, 1250

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