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Veterans With Chronic Obstructive Pulmonary Disease Achieve Clinically Relevant Improvements in Respiratory Health After Pulmonary Rehabilitation

Major, Stephen MD; Moreno, Marcella RN; Shelton, John RRT; Panos, Ralph J. MD

Journal of Cardiopulmonary Rehabilitation and Prevention: November/December 2014 - Volume 34 - Issue 6 - p 420–429
doi: 10.1097/HCR.0000000000000079
Pulmonary Rehabilitation

PURPOSE: To measure respiratory health and respiratory-related (RR) health care utilization in veterans with chronic obstructive pulmonary disease referred to pulmonary rehabilitation (PR) at the Cincinnati Veterans Administration (VA) Medical Center.

METHODS: We reviewed the records of 430 patients referred for PR from 2008 to 2010: 78 met inclusion criteria and completed PR (PR group); 92 qualified for PR but declined participation (referral group). All PR participants completed the St. George's Respiratory Questionnaire (SGRQ), BODE index, 6-minute walk test (6MWT), UCSD Shortness of Breath Questionnaire (UCSDSOBQ), Pulmonary Disease Knowledge Test, and self-reported use of short-acting bronchodilators before and after PR. All VA health care encounters during the 12 months before and after PR (PR group) or referral (referral group) were reviewed.

RESULTS: Respiratory health improved after PR: SGRQ (60.6 ± 15.1, 51.1 ± 16.7), BODE (4.65 ± 1.93, 3.41 ± 1.84), 6MWT (497 ± 367 m, 572 ± 397 m), UCSDSOBQ (68.3 ± 21.1, 61.0 ± 20.9), Pulmonary Disease Knowledge Test (75.9 ± 12.4%, 85.9 ± 11.1%), short-acting bronchodilator (22.5 ± 25.3, 12.8 ± 15.6 inhalations per week) (before, after PR; P < .001 for all comparisons). The RR emergency department (ED) visits (0.71 ± 1.44, 0.44 ± 0.86; P = .04) and RR hospitalizations (0.41 ± 0.73, 0.23 ± 0.51; P = .03) (visits/patient/year; pre-PR, post-PR) decreased following PR. RR ED visits and hospitalizations were the same for the PR and referral groups prior to PR but declined post-PR (0.44 ± 0.86, 0.78 ± 1.36 ED visits/patient/year; P = .05) and (0.23 ± 0.51, 0.59 ± 1.20 hospitalizations/patient/year; P = .01). Ninety-four percent of PR participants achieved the minimal clinically important difference in at least 1 univariate scale (Modified Medical Research Council, UCSDSOBQ, SGRQ, and 6MWT); 82%, 2 scales; 59%, 3 scales; and 24%, all 4 scales.

CONCLUSIONS: Pulmonary rehabilitation improves respiratory health in veterans with chronic obstructive pulmonary disease and decreases RR health care utilization.

After pulmonary rehabilitation, veterans with chronic obstructive pulmonary disease walked further, reduced their rescue inhaler use, enjoyed better quality of life, and had fewer respiratory-related emergency department visits and hospitalizations. Their respiratory health and health care utilization were better than those of patients who were referred to but did not participate in pulmonary rehabilitation.

Pulmonary, Critical Care, and Sleep Medicine Division, Cincinnati Veterans Affairs Medical Center (Drs Major and Panos), Pulmonary, Critical Care, and Sleep Medicine Division, University of Cincinnati College of Medicine (Drs Major and Panos), and Pulmonary Rehabilitation Program, Cincinnati Veterans Affairs Medical Center (Ms Moreno, Mr Shelton, and Dr Panos), Cincinnati, Ohio.

Correspondence: Ralph J. Panos, MD, Pulmonary, Critical Care, and Sleep Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220 (

Conflicts of interest: none declared.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins