Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (Review)
Puhan, MA and Gimeno-Santos, E and Scharplatz, M and Troosters, T and Walters, EH and Steurer, J, Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (Review), Cochrane Database of Systematic Reviews, 2011, (10) Article CD005305. ISSN 1469-493X (2011) [Refereed Article]
Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease
(COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. However,
in unstable COPD patients who have recently suffered an exacerbation, the effects of pulmonary rehabilitation are less established.
To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other
patient-important outcomes (mortality, health-related quality of life and exercise capacity).
Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO and the Cochrane Airways Group Register of
Trials. Searches were current as of March 2010.
Randomized controlled trials comparing pulmonary rehabilitation of any duration after exacerbation of COPD with conventional care.
Pulmonary rehabilitation programmes needed to include at least physical exercise. Control groups received conventional community
care without rehabilitation.
Data collection and analysis
We calculated pooled odds ratios and weighted mean differences (MD) using random-effects models. We requested missing data from
the authors of the primary studies.
We identified nine trials involving 432 patients. Pulmonary rehabilitation significantly reduced hospital admissions (pooled odds ratio
0.22 [95% CI 0.08 to 0.58], number needed to treat (NNT) 4 [95% CI 3 to 8], over 25 weeks) and mortality (OR 0.28; 95% CI
0.10 to 0.84), NNT 6 [95% CI 5 to 30] over 107 weeks). Effects of pulmonary rehabilitation on health-related quality of life were
well above the minimal important difference when measured by the Chronic Respiratory Questionnaire (MD for dyspnea, fatigue,
emotional function and mastery domains between 0.81 (fatigue; 95% CI 0.16 to 1.45) and 0.97 (dyspnea; 95% CI 0.35 to 1.58)) and
the St. Georges Respiratory Questionnaire total score (MD -9.88; 95% CI -14.40 to -5.37); impacts domain (MD -13.94; 95% CI -
20.37 to -7.51) and for activity limitation domain (MD -9.94; 95% CI -15.98 to -3.89)). The symptoms domain of the St. Georges
Respiratory Questionnaire showed no significant improvement. Pulmonary rehabilitation significantly improved exercise capacity and
the improvement was above the minimally important difference (six-minute walk test (MD 77.70 meters; 95% CI 12.21 to 143.20)
and shuttle walk test (MD 64.35; 95% CI 41.28 to 87.43)). No adverse events were reported in three studies.
Evidence from nine small studies of moderate methodological quality, suggests that pulmonary rehabilitation is a highly effective and
safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients who have
recently suffered an exacerbation of COPD.