Turkish journal of medical sciences | 2021
Maintenance of Pulmonary Rehabilitation Benefits in Patients with COPD: Is a Structured 5-year Follow-up Program Helpful?
Abstract
BACKGROUND\nPulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD),but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program.\n\n\nMETHOD\nCOPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George?s Respiratory Questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1s (FEV1), the forced vital capacity (FVC), the forced mid-expiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study.\n\n\nRESULTS\nThirty-three COPD patients with a mean age of 58±8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47±16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p<0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p=0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p=0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p<0.001) and year 3 (p=0.005/ 0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years.\n\n\nCONCLUSION\nStructured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Long-term randomized controlled studies are needed to verify these results.