The impact of pulmonary rehabilitation on people with mild chronic obstructive pulmonary disease: A randomised controlled trial.

Abstract

Introduction: People with mild chronic obstructive pulmonary disease (COPD) experience exercise intolerance, dyspnoea and poor health-related quality of life. However, the role of pulmonary rehabilitation in this group is unclear. Objective(s): This randomised controlled trial aimed to explore effects of home-based pulmonary rehabilitation (PR) in people with mild COPD. Method(s): People with mild COPD (FEV1/FVC<70%; FEV1>80%predicted) with a smoking history of >= 10 packet years were randomised to either 8-weeks of home-based PR (one home visit and seven once-weekly telephone calls) or attention control (weekly social telephone calls). Sixminute walk distance (6MWD), modified Medical Research Council (mMRC) dyspnoea score and Chronic Respiratory Questionnaire (CRQ) scores were compared between groups post intervention and at 6-months. Result(s): A total of 58 participants (34 females, mean age 68 (SD 9) years, FEV1 90 (7) %predicted, 6MWD 496 (105) metres) were included with 29 participants randomised to home-based PR. Participants attended an average of 6.8 of the eight scheduled sessions, ranging from three to eight sessions. Both groups showed improvements in exercise capacity, symptoms and health-related quality of life over time, however there was no betweengroup differences in the primary outcome of 6MWD at end-intervention (mean difference 1.4 metres, 95% confidence interval (CI) -28.7 to 31.4 metres) or six months (9.8 metres, 95% CI - 30.5 to 50.2 metres). At 6-months follow-up home-based PR participants were more likely to have clinically important improvements in CRQ emotional function (50% of home PR vs 0% control, p<0.001) and CRQ total score (45% vs 17%, p=0.05), however there were no other differences in symptoms or other aspects of health-related quality of life. Conclusion(s): For people with mild COPD, home-based pulmonary rehabilitation did not improve exercise capacity or health-related quality of life more than weekly social telephone calls.