Pulmonary rehabilitation after exacerbation of bronchiectasis: a pilot randomized controlled trial

摘要

Pulmonary rehabilitation improves exercise capacity and reduces risk of future exacerbation in COPD when performed after an exacerbation. There have been no previous studies of post-exacerbation rehabilitation in bronchiectasis. Parallel group randomized controlled trial compared pulmonary rehabilitation (PR) to standard care (SC) in patients followed an antibiotic treated exacerbation of bronchiectasis. Patients were randomized following a 14?day course of antibiotics was completed. The primary outcome was 6-min walk distance (6?MW) at 8?weeks. Secondary outcomes were time to the next exacerbation, St.Georges Respiratory Questionnaire, COPD CAT score, Leicester cough questionnaire (LCQ) and FEV1 at 8 and 12?weeks post exacerbation. Forty eight patients were enrolled but only 27 had exacerbations within 12?months of enrolment. Nine patients received pulmonary rehabilitation and 18 received standard care. The 6?MW improved significantly from post-exacerbation to 8?weeks in both groups, with no significant difference between PR and SC- mean difference of 11?m (95% CI -34.3 to 56.3,p?=?0.6). Time to the next exacerbation was not significantly different hazard ratio 0.83 (0.31–2.19, p?=?0.7). No significant differences were seen between groups in terms of LCQ, CAT, FEV1 or SGRQ between groups. An analysis of probability based on the patients enrolled suggested ?1000 subjects are likely be required to have an ?80% probability of observing a statistically significant difference between PR and SC and any such differences would be likely to be too small to be clinically relevant. This pilot study identified no significant benefits associated with pulmonary rehabilitation after exacerbations of bronchiectasis. NCT02179983, registered on Clinicaltrials.gov 29th June 2014.