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The Impact of Chronic Obstructive Pulmonary Disease Exacerbation on Pulmonary Rehabilitation Participation and Functional Outcomes

Steele, Bonnie G. PhD, ARNP; Belza, Basia PhD, RN; Cain, Kevin PhD; Coppersmith, Jeff MS, PT; Howard, JoEllen BS, PT; Lakshminarayan, Sambasiva MD; Haselkorn, Jodi MD

Journal of Cardiopulmonary Rehabilitation & Prevention:
doi: 10.1097/HCR.0b013e3181c85845
Pulmonary Rehabilitation
Abstract

PURPOSE: The purpose of this study was to determine the impact of chronic obstructive pulmonary disease exacerbation (COPDE) on pulmonary rehabilitation (PR) participation and completion and on PR outcomes of daily activity, self-reported daily exercise, and functional capacity.

METHODS: Participants in an 8-week outpatient PR program were studied pre- and post-PR. Variables included COPDE occurrence (computerized patient record system), self-reported exercise (daily activity diary), daily activity (accelerometer), exercise capacity (6-minute walk distance), dyspnea today and over the past 30 days (Lareau's Functional Status and Dyspnea Questionnaire), health status (The Medical Outcomes Study 36-Item Short-Form Health Survey adapted for Veterans), and quality of life (Seattle Obstructive Lung Disease Questionnaire).

RESULTS: Outpatients with COPD (N = 146, 140 men) started PR; 112 completed the program and were studied. Of the 30 participants who had at least 1 COPDE during the program, 10 quit the program. Subjects who exacerbated had a lower body mass index than did patients without COPDE (28.4 compared with 30.8, respectively, P < .05), more severe COPD (percent-predicted forced expiratory volume in the first second of expiration, FEV1% predicted, 32%, compared with 40%, respectively, P< .05), and required supplemental oxygen (70% compared with 36%, respectively, P< .05). Exacerbators who completed PR were more likely to be nonsmokers, on oxygen, and have a higher FEV1% predicted than were exacerbators who quit. It was found that postprogram exercise capacity improved overall, with exacerbators performing better than nonexacerbators on the 6-minute walk test (P = .044). There were no significant differences in other outcomes.

CONCLUSIONS: Findings suggest that COPD exacerbators who completed PR had similar outcomes as did nonexacerbators and should be encouraged to return to PR after COPDE.

In Brief

Pulmonary rehabilitation (PR) participants with chronic obstructive pulmonary disease who exacerbated during PR had better 6-minute walk distance values (P = .04) and comparable life quality and health status outcomes (P = NS) as did those who did not exacerbate. PR patients who exacerbate should be encouraged to reenter and complete PR whenever possible.

Author Information

Primary Care and Specialty Medicine Service, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington (Drs Steele and Lakshminarayan); University of Washington School of Nursing, Seattle, Washington (Drs Belza and Cain); VA Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington (Mr Coppersmith and Ms Howard); Rehabilitation Care Service, Department of Veterans Affairs Puget Sound Health Care System and Rehabilitation Medicine and Epidemiology, University of Washington School of Medicine, Seattle, Washington (Dr Haselkorn).

Corresponding Author: Bonnie G. Steele, PhD, ARNP, Primary Care and Specialty Medicine Service, Department of Veterans Affairs Puget Sound Health Care System (S-111-B), 1660 South Columbian Way, Seattle, WA 98108 (bonnie.steele@va.gov).

© 2010 Lippincott Williams & Wilkins, Inc.