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

Abstract

Introduction/Aim: 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. 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 onceweekly telephone calls) or attention control (weekly social telephone calls). Six-minute 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 between-group differences in the primary outcome of 6MWD at endintervention (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.