Abstract
Hospitalisations for severe exacerbations of chronic obstructive pulmonary disease are associated with significant physical and psychological consequences including an increase in symptom severity, severe reductions in physical activity, a deleterious effect on skeletal muscle, impaired exercise tolerance/ability to self-care, decline in quality of life, and increased anxiety and depression. As these consequences are potentially amenable to exercise training, there is a clear rationale for pulmonary rehabilitation in the peri/post-exacerbation setting. Although a 2011 Cochrane review was overwhelmingly positive, subsequent trials have shown less benefit and real-life observational studies have revealed poor acceptability. Qualitative studies have demonstrated that the patient experience is a determining factor while the presence of comorbidities may influence referral, adherence and response to pulmonary rehabilitation. Systematic reviews of less supervised interventions, such as self-management, have shown limited benefits in the post-exacerbation setting. The recent update of the Cochrane review of peri-exacerbation pulmonary rehabilitation showed that benefits were associated with the “comprehensive” nature of the intervention (the number of sessions received, the intensity of exercise training and education delivered, and the degree of supervision) but implementation is demanding. The challenge is to develop interventions that are deliverable and acceptable around the time of an acute exacerbation but also deliver the desired clinical impact.
Abstract
Pulmonary rehabilitation after severe exacerbation of #COPD is effective but implementation is challenging http://ow.ly/QOmyg
Footnotes
Support statement: W.D-C. Man was supported by a National Institute for Health Research (NIHR) Clinician Scientist award (CS/7/007), a UK Medical Research Council (MRC) New Investigator Research Grant (G1002113) and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London. R.E. Jordan was funded by a NIHR post-doctoral fellowship (pdf/01/2008/023) and the lead investigator of a systematic review of self-management funded by the NIHR Health Technology Assessment programme (10/44/01). J.K. Quint was funded by a MRC Population Health Scientist Fellowship (G0902135). S.J. Singh was supported by the NIHR CLAHRC for East Midlands. This project was part undertaken at the NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Conflict of interest: Disclosures can be found alongside this article at openres.ersjournals.com
- Received August 3, 2015.
- Accepted August 6, 2015.
- Copyright ©ERS 2015
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