Background: International guidelines recommend the inclusion of patients with bronchiectasis in pulmonary rehabilitation (PR) to improve exercise capacity and health-related quality of life (HRQoL). At present, the effect of PR in these patients has been poorly investigated. Objective: The aim of our retrospective analysis was to evaluate the effects and predictors of success for a PR program in patients with bronchiectasis not related to cystic fibrosis (non-CF bronchiectasis). Methods: One hundred and thirty-five non-CF bronchiectasis inpatients, allocated to a 3-week PR program, were retrospectively evaluated. Exercise capacity (6-min walk distance, 6MWD), dyspnea (Baseline/Transition Dyspnea Index, BDI/TDI), and HRQoL [EuroQol visual analogue scale (EQ-VAS)] were assessed before and after PR. The relationship between baseline parameters and changes in outcome measures after PR was assessed. Both univariate and multiple logistic analyses were performed to evaluate the presence of independent predictors of the efficacy of PR. Results: One hundred and eight patients [49 males, mean age 71 years, mean forced expiratory volume in 1 s (FEV1) 76% predicted] were included. After PR, there was a significant improvement in 6MWD, TDI, and EQ-VAS score (p < 0.001). Changes in 6MWD and EQ-VAS score correlated with baseline FEV1, FEV1/vital capacity (VC), residual volume, transfer factor of the lung for carbon monoxide, and the number of exacerbations in the previous year. Both univariate and multivariate logistic regression analyses showed that male gender, baseline FEV1/VC <70%, and >2 exacerbations in the previous year were independent predictors of PR efficacy in terms of an improvement in 6MWD. Conclusions: Our study supports the inclusion of patients with bronchiectasis in PR programs. Clinical and functional baseline findings partially predict the response to PR in terms of exercise tolerance. Further prospective, randomized, controlled trials are needed.

Keywords:
Bronchiectasis, Pulmonary rehabilitation, Predictors of efficacy
1.
McShane PJ, Naureckas ET, Tino G, Strek ME: Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2013;188:647-656.
2.
Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis (Non-CF) Guideline Group: British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65:i1-i58.
3.
Martínez-García MA, Soler-Cataluña JJ, Perpiñá-Tordera M, Román-Sánchez P, Soriano J: Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007;132:1565-1572.
4.
Ten Hacket NH, Wijstra PJ, Kerstjens HA: Treatment of bronchiectasis in adults. BMJ 2007;335:1089-1093.
5.
Martínez-García MA, Perpiñà-Tordera M, Román-Sánchez P, Soler-Cataluña JJ: Quality-of-life determinants in patients with clinically stable bronchiectasis. Chest 2005;128:739-745.
6.
Gokdemir Y, Hamzah A, Erdem E, Cimsit C, Ersu R, Karakoc F, Karadag B: Quality of life in children with non-cystic-fibrosis bronchiectasis. Respiration 2014;88:46-51.
7.
Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al; ATS/ERS Task Force on Pulmonary Rehabilitation: An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-e64.
8.
Holland AE, Wadell K, Spruit MA: How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD. Eur Respir Rev 2013;22:577-586.
9.
Lee AL, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Rautela L, Stirling RG, Thompson PJ, Holland AE: The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis - a randomised controlled trial. Respir Res 2014,15:44.
10.
Martínez-García MA, Perpiñá-Tordera M, Soler-Cataluña JJ, Román-Sánchez P, Lloris-Bayo A, González-Molina A: Dissociation of lung function, dyspnea ratings and pulmonary extension in bronchiectasis. Respir Med 2007;101:2248-2253.
11.
Lee AL, Button BM, Ellis S, Stirling R, Wilson JW, Holland AE, Denehy L: Clinical determinants of the 6-minute walk test in bronchiectasis. Respir Med 2009;101:2248-2253.
12.
Newall C, Stockley RA, Hill SL: Exercise training and inspiratory muscle training in patients with bronchiectasis. Thorax 2005;60:943-948.
13.
Mandal P, Sidhu MK, Kope L, Pollock W, Stevenson LM, Pentland JL, Turnbull K, Mac Quarrie S, Hill AT: A pilot study of pulmonary rehabilitation and chest physiotherapy versus chest physiotherapy alone in bronchiectasis. Respir Med 2012;106:1647-1654.
14.
Ong HK, Lee AL, Hill CJ, Holland AE, Denehy L: Effects of pulmonary rehabilitation in bronchiectasis: a retrospective study. Chron Respir Dis 2011;8:21-30.
15.
van Zeller M, Mota PC, Amorim A, Viana P, Martins P, Gaspar L, Hespanhol V, Gomes I: Pulmonary rehabilitation in patients with bronchiectasis: pulmonary function, arterial blood gases, and the 6-minute walk test. J Cardiopulm Rehabil Prev 2012;32:278-283.
16.
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 Suppl 1993;16:5-40.
17.
Cotes JE, Chinn DJ, Quanjer PH, Roca J, Yernault JC: Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993;16:41-52.
18.
Mahler DA, Guyatt GH, Jones PW: Clinical measurements of dyspnoea; in Mahler DA (ed): Dyspnea. New York, Marcel Dekker, 1998, pp 149-198.
19.
Brooks R, Rabin R, De Charro F: The Measurement and Validation of Health Status Using EQ-5D: A European Perspective; Evidence from the EuroQol BIOMED Research Programme, ed 1. Dordrecht, Kluwer Academic Publishers, 2003.
20.
ATS statement: guidelines for the six-minute walk test. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. Am J Respir Crit Care Med 2002;166:111-117.
21.
Mahler DA, Horowitz MB: Perception of breathlessness during exercise in patients with respiratory disease. Med Sci Sports Exerc 1994;26:1078-1081.
22.
Polkey MI, Spruit MA, Edwards LD, Watkins ML, Pinto-Plata V, Vestbo J, Calverley PMA, Tal-Singer R, Agusti A, Bakke PS, Coxson HO, Lomas DA, MacNee W, Rennard S, Silverman EK, Miller BE, Crim C, Yates J, Wouters EFM, Celli B: Six-minute-walk test in chronic obstructive pulmonary diseases: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med 2013;187:382-386.
23.
Witek TJ Jr, Mahler DA: Minimal important difference of the transition dyspnoea index in a multinational clinical trial. Eur Respir J 2003;21:267-272.
24.
Zanini A, Aiello M, Adamo D, Casale S, Cherubino F, Della Patrona S, Raimondi E, Zampogna E, Chetta A, Spanevello A: Estimation of minimal clinically important difference in EQ-VAS score after pulmonary rehabilitation in patients with COPD. Respir Care 2015;60:88-95.
25.
Ringbaek T, Brøndum E, Martínez G, Lange P: EuroQol in assessment of the effect of pulmonary rehabilitation COPD patients. Respir Med 2008;102:1563-1567.
26.
Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T; ATS/ERS Pulmonary Rehabilitation Writing Committee: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006;173:1490-1513.
27.
Fuchs-Climent D, Le Gallais D, Varray A, Desplan J, Cadopi M, Préfaut C: Quality of life and exercise tolerance in chronic obstructive pulmonary disease: effects of a short and intensive inpatient rehabilitation program. Am J Phys Med Rehabil 1999;78:330-335.
28.
Clini E, Foglio K, Bianchi L, Porta R, Vitacca M, Ambrosino N: In-hospital short-term training program for patients with chronic airway obstruction. Chest 2001;120:1500-1505.
29.
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.
30.
Carone M, Patessio A, Ambrosino N, Baiardi P, Balbi B, Balzano G, et al: Efficacy of pulmonary rehabilitation in chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD): the Maugeri Study. Respir Med 2007;101:2447-2453.
31.
Altenburg WA, de Greef MHG, ten Hacken NHT, Wempe JB: A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients. Respir Med 2012;106:694-700.
32.
Zanini A, Chetta A, Gumiero F, Della Patrona S, Casale S, Zampogna E, et al: Six-minute walking distance improvement after pulmonary rehabilitation is associated with baseline lung function in clinically complex COPD patients. A retrospective study. Biomed Res Int 2013;2013:483162.
33.
MacIntyre NR: Mechanisms of functional loss in patients with chronic lung disease. Respir Care 2008;53:1177-1184.
34.
Foy CG, Rejeski WJ, Berry MJ, Zaccaro D, Woodard CM: Gender moderates the effects of exercise therapy on health-related quality of life among COPD patients. Chest 2001;119:70-76.
35.
Robles PG, Brooks D, Goldstein R, Salbach N, Mathur S: Gender-associated differences in pulmonary rehabilitation outcomes in people with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 2014;34:87-97.
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2015
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