Long-term pulmonary rehabilitation (PR) maintenance programs can benefit people with chronic obstructive pulmonary disease (COPD) in a real-life setting, a retrospective study indicates.
In fact, PR maintenance programs lasting three years or more were associated with favorable survival indicators among patients, particularly those with less severe disease, the study data demonstrated.
The study, “Efficacy of a long-term pulmonary rehabilitation maintenance program for COPD patients in a real-life setting: a 5-year cohort study,” was published in the journal Respiratory Research.
Although there is no cure for COPD, lifestyle changes and treatments can be effective at managing its symptoms. One option is PR, a program that incorporates exercise training, health education classes, and psychological support.
PR has been shown to ease shortness of breath (dyspnea) and improve exercise capacity and quality of life among COPD patients. Although these benefits can be further sustained with the aid of specialized PR maintenance programs for one to two years, the potential long-term benefits of such regimens have not been explored.
To fill this knowledge gap, researchers at the University of Montpellier, in France, examined data from the French Air+R network database. Their goal: to assess changes in the outcomes and survival probability of 144 COPD patients who were on a multidisciplinary PR maintenance program for one to five years after being discharged from a pulmonary rehabilitation program.
The patients had a mean age of 66.26 and a majority (56.9%) were male. On average, the patients had at least two additional health conditions (comorbidities), the most common being cardiovascular (59.7%), pulmonary (45.8%), or metabolic (32.6%) disorders.
Every year, patients following the PR maintenance program completed the six-minute walk test (6MWT), which measures physical endurance. Assessments also were done to evaluate their health-related quality of life — using the VQ11 questionnaire — and shortness of breath, for which the investigators used the Medical Research Council (MRC) dyspnea scale. Their five-year survival probability was compared with that of a control group, which included patients who completed a PR program without following through with a maintenance intervention.
Most patients (73%) had complete follow-up data. A total of 39 withdrew from the study at some point and 10 died. The reasons for withdrawal included clinical worsening (10 cases), motivation (seven cases), logistics (six cases), relationships within the network (six cases), or others (10 cases). The adherence rate to the maintenance program was 53%. Oe adverse event, that of knee swelling, was reported.
The results showed that patients following the maintenance program had significant PR benefits at four years for 6MWD and VQ11 and at five years for MRC assessments. In this group of patients, an average of 0.26 unprogrammed medical consultations and 0.86 hospitalization days per year were recorded during follow-up.
When analyzing multiple variables at the same time — a process called a multivariate analysis — the researchers found the risk of death (mortality) among patients on long-term pulmonary rehabilitation maintenance was 3.1-times lower than in those who did not follow such a program. Moreover, the five-year survival probability was significantly higher for patients on PR maintenance.
The investigators also identified two clusters of response to long-term PR: one of responder patients and one of non-responders. The non-responder cluster included 30 patients on the PR maintenance program (21%), while the responder cluster included those with less severe disease.
The study had several limitations, the researchers noted, including its non-randomized design, potential biases of the survival analysis, and a lack of complete initial PR data.
Nonetheless, the researchers said the study’s results showed that long-term programs were effective.
“Although complementary research studies with other designs are warranted, this study adds valuable information regarding the indications and decisions for pulmonary rehabilitation,” the researchers wrote.
“This study provides evidence of the efficacy of a pragmatic PR maintenance program in a real-life setting for more than 3 years,” the team concluded. “In contrast to short-term PR, long-term PR maintenance appeared more beneficial in less severe COPD patients.”
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