Background: The optimal frequency of delivering a pulmonary rehabilitation program (PR) is not yet a well established issue. It is still unclear whether repeated PR at established intervals will result in effective maintenance or further improvement in the patient’s health status. Objectives: To investigate whether more frequently repeated PR in patients with COPD (1) leads to similar short and long-term physiological gains, and (2) decreases the burden due to hospitalization. Methods: Thirty-five disabled COPD patients (FEV1 below 50% predicted, MRC score 3) in a stable state were studied in a randomized controlled trial. After completing an initial inpatient PR program, they were randomly assigned to either group 1 (performing a second and a third PR after 6 and 12 months) or group 2 (performing only a second PR after 12 months). Results: Lung functions, exercise capacity (by means of a timed walk test – 6MWT), peak-effort dyspnea (D) and leg fatigue (F), and health-related quality of life by means of SGRQ were assessed prior to (T1, T3, T5) and after (T2, T4, T6) each PR program: the same measures were taken on an outpatient basis at T3 in group 2. The number of hospital admissions (HA) and days spent in the hospital (DH) were also recorded over the year. The two groups did not differ in any parameter at baseline. 6MWD, D, F and SGRQ improved to the same level (p = 0.05) after each PR in both groups. However, the baseline level of D, F and SGRQ symptoms and impact scores progressively improved over time in group 1 but not in group 2. After 12 months, a larger amount of patients in Group 1, as compared to Group 2, reported H10 DH/year (p < 0.0001). Conclusions: In severe and disabled COPD, a more frequently repeated inpatient PR may lead to some additional physiological and clinical benefits over 1 year.

Keywords:
Exercise training, Quality of life, Pulmonary rehabilitation program
1.
Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD): Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease:NHLBI/WHO workshop report, NIH Publ. 2701. Bethesda, US Department of Health and Human Services, 2001.
2.
Lacasse Y, Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, Goldstein RS: Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002;CD003793.
3.
Salman GF, Mosier MC, Beasley BW, Calkins DR: Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials. J Gen Intern Med 2003;18:213–221.
4.
Goldstein RS, Gort EH, Stubbing D, Avendano MA, Guyatt GH: Randomised controlled trial of respiratory rehabilitation. Lancet 1994:344:1394–1397.
5.
Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, Sanchis J: Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest 2000;117:976–983.
6.
Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K,Turner-Lawlor PJ, Payne N, Newcombe RG, Ionescu AA, Thomas J, Tunbridge J: Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000;355:362–368.
7.
Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N: Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Eur Respir J 1999;13:125–132.
8.
Strijbos JH, Postma DS, van Altena R, Gimeno F, Koeter GH: A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD: a follow-up of 18 months. Chest 1996;109:366–372.
9.
Cockcroft AE, Saunders MJ, Berry G: Randomised controlled trial of rehabilitation in chronic respiratory disability. Thorax 1981;36:200–203.
10.
Clini EM, Romagnoli M: Inpatient pulmonary rehabilitation: does it make sense? Chron Resp Dis 2005;2:43–46.
11.
Nava S: Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil 1998;79:849–854.
12.
Foglio KL, Bianchi L, Ambrosino N: Is it really useful to repeat outpatient pulmonary rehabilitation programs in patients with chronic airway obstruction? A 2-year controlled study. Chest 2001;119:1696–1704.
13.
Cilione C, Lorenzi C, Dell’Orso D, Garuti G, Rossi G, Totaro L, Clini E: Predictors of change in exercise capacity after comprehensive COPD inpatient rehabilitation. Med Sci Monit 2002;8:CR740–CR745.
14.
Tramacere A, Rizzardi R, Cilione C, Serri B, Florini F, Lorenzi MC, Clini E: Effects of respiratory therapist-directed protocol on prescription and outcomes of pulmonary rehabilitation in COPD inpatients. Respiration 2004;71:60–65.
15.
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 1993;16(suppl 16):5–40.
16.
Bruschi C, Cerveri I, Zoia MC, Fanfulla F, Fiorentini M, Casali L, Grassi M, Grassi C: Reference values of maximal respiratory mouth pressures: a population-based study. Am Rev Respir Dis 1992;146:790–793.
17.
ATS Statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:11–17.
18.
Borg G: Psychophysical basis of perceived exertion. Med Sci Sports Exerc 1992;14:377–381.
19.
Carone M, Bertolotti G, Anchisi F, Zotti AM: The St. George’s Respiratory Questionnaire (SGRQ): Italian version. Rassegna Patol App Respir 1999;14:31–37.
20.
Troosters T, Gosselink R, Decramer M: Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med 2000:109:207–212.
21.
Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA: Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002;57:847–852.
22.
Ries AL, Kaplan RM, Limberg TM, Prewitt LM: Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med 1995:122:823–832.
23.
Celli BR, MacNee W: Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932–946.
24.
Swerts PMJ, Kretzers LM, Terpstra-Lindeman E, Verstappen FT, Wouters EF: Exercise reconditioning in the rehabilitation of patients with chronic obstructive pulmonary disease: a short- and long-term analysis. Arch Phys Med Rehab 1990;71:570–573.
25.
Grosbois JM, Lamblin C, Lemaire B, Chekroud H, Dernis JM, Douay B, Fortin F: Long-term benefits of exercise maintenance after outpatient rehabilitation program in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil 1999;19:216–225.
26.
British Thoracic Society: Pulmonary rehabilitation. Thorax 2001;56:827–834.
27.
Garcia-Aymerich J, Farrero E, Felez MA, Izquierdo J, Marrades RM, Anto JM: Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax 2003;58:100–105.
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2006
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