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Early pulmonary rehabilitation after acute exacerbation of COPD: a randomised controlled trial

Jakob L. Kjærgaard, Carsten B. Juhl, Peter Lange, Jon T. Wilcke
ERJ Open Research 2020 6: 00173-2019; DOI: 10.1183/23120541.00173-2019
Jakob L. Kjærgaard
1Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
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  • For correspondence: jakob@naj.dk
Carsten B. Juhl
2Dept of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
3Research Unit for Musculoskeletal Function and Physiotherapy, Dept of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Peter Lange
1Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
4Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Jon T. Wilcke
1Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
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  • Article
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  • FIGURE 1
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    FIGURE 1

    Flowchart of the study design. COPD: chronic obstructive pulmonary disease; PR: pulmonary rehabilitation; AECOPD: acute exacerbation of COPD; GOLD: Global Initiative for Chronic Obstructive Lung Disease; PFT: pulmonary function test; MRC: medical research council dyspnoea scale; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walk test; CAT: COPD assessment test.

  • FIGURE 2
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    FIGURE 2

    Screening, randomisation and study completion. AECOPD: acute exacerbation of chronic obstructive pulmonary disease; PR: pulmonary rehabilitation; PFT: pulmonary function test. #: excluded (n=547): declined to participate (n=125); death in hospital (n=30); life expectancy <6 months (n=134); other rehabilitation programme (n=126); living in nursing home (n=29); not COPD (n=30); residence outside Gentofte Hospital's admission area (n=73).

  • FIGURE 3
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    FIGURE 3

    Cumulative incidence of hospital readmissions and mortality. Competing risk analysis (Fine and Gray) of hospital readmission with death as competing risk. Adjusted for age, sex, forced expiratory volume in 1 s and COPD Assessment Test. Hazard ratio 0.79 (95% CI 0.47–1.23), p=0.33. Arrows show the start of pulmonary rehabilitation (PR).

  • FIGURE 4
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    FIGURE 4

    Mortality. Kaplan–Meier plot showing survival. Log-rank test p=0.59. Arrows show the start of pulmonary rehabilitation (PR).

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    FIGURE 5

    Exercise capacity and quality of life. Functional measures in a) incremental shuttle walk test and b) endurance shuttle walk test, and c) quality of life in COPD Assessment Test at baseline, 2 months and 6 months follow-up. PR: pulmonary rehabilitation. *: p<0.05.

Tables

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  • TABLE 1

    Baseline characteristics

    CharacteristicsEarly PR group (n=70)Stable PR group (n=61)
    Age years72.7±9.474.4±7.8
    Male n (%)29 (41)25 (41)
    FEV1 L1.0±0.41.0±0.4
    FEV1 % predicted40.2±1544.1±17
    MRC dyspnoea score3.4±0.93.1±0.8
    CAT score16.8±6.014.7±5.3
    LTOT n (%)3 (5)5 (8)
    BMI kg·m−223.5±4.624.2±4.1
    Smoking n (%)
     Current22 (31)15 (25)
     Former45 (64)43 (70)
     Never3 (4)3 (5)
     Exposure pack-years40.6±16.543.5±19.5
    GOLD assessment
     Group C n (%)4 (6)5 (8)
     Group D n (%)66 (94)56 (92)
    ISWT distance m186±117188±110
    ESWT time s216±199263±210
    ESWT level6.0±3.66.3±3.6

    Data are presented as mean±sd unless otherwise stated. PR: pulmonary rehabilitation; FEV1: forced expiratory volume in 1 s; MRC: Medical Research Council; CAT: COPD Assessment Test; LTOT: long-term oxygen therapy; BMI: body mass index; GOLD: Global Initiative for Chronic Obstructive Lung Disease; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walk test.

    • TABLE 2

      Physical performance and quality of life

      Early PR group change from baselineStable PR group change from baselineDifference between groups (95% CI)p-value
      Incremental shuttle walk test m
       Baseline193.3±8.8192.7±9.0
       2 months72.4±9.5***38.5±9.5***33.9 (4.2–63.7)0.02
       6 months68.1±10.0***50.4±10.0***17.7 (−13.3–48.7)0.26
      Endurance shuttle walk test s
       Baseline239±42.4253±44.1
       2 months399±45.5***259±45.6***140 (−2.0–282.8)0.05
       6 months332±47.8***307±47.6***25 (−123.4–171.9)0.75
      COPD Assessment Test score
       Baseline15.8±0.515.2±0.6
       2 months−3.5±0.6**−2.1±0.6**−1.4 (−3.4–0.6)0.17
       6 months−3.6±0.6**−2.2±0.6**−1.4 (−3.5–0.6)0.18

      Data are presented as change from baseline±se unless otherwise stated. PR: pulmonary rehabilitation. **: p<0.01; ***: p<0.001.

      Supplementary Materials

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      • Supplementary Material

        Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

        Supplementary material 00173-2019.SUPPLEMENT

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      Early pulmonary rehabilitation after acute exacerbation of COPD: a randomised controlled trial
      Jakob L. Kjærgaard, Carsten B. Juhl, Peter Lange, Jon T. Wilcke
      ERJ Open Research Jan 2020, 6 (1) 00173-2019; DOI: 10.1183/23120541.00173-2019

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      Early pulmonary rehabilitation after acute exacerbation of COPD: a randomised controlled trial
      Jakob L. Kjærgaard, Carsten B. Juhl, Peter Lange, Jon T. Wilcke
      ERJ Open Research Jan 2020, 6 (1) 00173-2019; DOI: 10.1183/23120541.00173-2019
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