Der Effekt von einem Jahr ambulanter pneumologischer Rehabilitation auf Patienten mit COPD

摘要

BACKGROUND: The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation. RESULTS: 100 patients (42 female/58 male) with COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), a mean age of 60.5 ± 9.6 years, BMI 25.8 ± 6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO₂max from 1.1 to 1.3 l/min, P < 0.05), modified Bruce Test (from 13 ± 7 Min to 18 ± 9 Min; P < 0.001), upper limb (from 39.9 ± 3 to 52.9 ± 8 kg; P < 0.001) and lower limb strength increased significantly (from 85.3 ± 45 to 131.5 ± 57 kg; P < 0.001). The maximal inspiratory pressure rose from 81,1 mbar to 108,8 mbar (p < 0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2 ± 3.6 to 26.5 ± 2.8; P < 0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P = 0.006) and the number of hospitalization days (from 27.3 to 3.3, P < 0.001). CONCLUSIONS: One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.