Download PDF
Semin Respir Crit Care Med 2009; 30(6): 649-655
DOI: 10.1055/s-0029-1242634
© Thieme Medical Publishers

Pulmonary Rehabilitation and the COPD Exacerbation

Christine Mikelsons1 , Wisia Wedzicha2 , 3
  • 1Physiotherapy Department, Royal Free Hospital, London, United Kingdom
  • 2Department of Academic Respiratory Medicine, University College London
  • 3Royal Free Hospital, London, United Kingdom
Further Information

Publication History

Publication Date:
25 November 2009 (online)

    Permissions and Reprints

ABSTRACT

Patients who experience frequent exacerbations of chronic obstructive pulmonary disease (COPD) are known to have a higher mortality, reduced exercise capacity, and muscle atrophy. The next key challenges for the implementation of effective pulmonary rehabilitation are to reverse these changes and enable patients to recover from an exacerbation without serial decline in their functional capacity with each subsequent exacerbation. Current evidence suggests that early rehabilitation following an exacerbation may prove beneficial, although this has been described in a variety of guises and needs further evidence to identify the exact form that it should take. Other additional interventions such as the use of noninvasive ventilation, quadriceps muscle training, early ambulation with rollator frames, and inspiratory muscle training have been shown to demonstrate positive outcomes in these patients and may well complement outcomes achieved through early pulmonary rehabilitation programs. It is clear that further research into early pulmonary rehabilitation is required to identify the point at which it should start, what form it should take, how long programs should be to produce positive outcomes, and what the inclusion and exclusion criteria should be.

KEYWORDS

Early pulmonary rehabilitation - inspiratory muscle training - leg atrophy - noninvasive ventilation

REFERENCES

  • 1 Lacasse Y, Goldstein R, Lasserson T J, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2006;  (4) CD003793
    PubMedGoogle Scholar
  • 2 Trikalinos T A, Raman G, Kupelnick B et al.. Pulmonary Rehabilitation for COPD and Other Lung Diseases. Technology Assessment. Prepared by the Tufts–New England Medical Centre Evidence-Based Practice Centre for the Agency of Healthcare Research and Quality Rockville, MD; AHRQ 2006
    Google Scholar
  • 3 Chartered Society of Physiotherapy .The effectiveness of pulmonary rehabilitation: evidence and implications for physiotherapists. 2003. Available at: http://www.csp.org.ukwww.csp.org.uk
    Google Scholar
  • 4 Griffiths T L, Burr M L, Campbell I A et al.. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial.  Lancet. 2000;  355 362-368
    CrossrefPubMedGoogle Scholar
  • 5 Griffiths T L, Phillips C J, Davies S, Burr M L, Campbell I A. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme.  Thorax. 2001;  56 779-784
    CrossrefPubMedGoogle Scholar
  • 6 Golmohammadi K, Jacobs P, Sin D D. Economic evaluation of a community-based pulmonary rehabilitation program for chronic obstructive pulmonary disease.  Lung. 2004;  182 187-196
    PubMedGoogle Scholar
  • 7 California Pulmonary Rehabilitation Collaborative Group . Effects of pulmonary rehabilitation on dyspnea, quality of life, and healthcare costs in California.  J Cardiopulm Rehabil. 2004;  24 52-62
    CrossrefPubMedGoogle Scholar
  • 8 Wedzicha J A, Bestall J, Garnham R, Garrod R, Paul E A, Jones P W. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale.  Eur Respir J. 1998;  12 363-369
    CrossrefPubMedGoogle Scholar
  • 9 Wedzicha J A, Seemungal T AR. COPD exacerbations: defining their cause and prevention.  Lancet. 2007;  370 786-796
    CrossrefPubMedGoogle Scholar
  • 10 Seemungal T AR, Donaldson G C, Bhowmik A, Jeffries D J, Wedzicha J A. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  161 1608-1613
    CrossrefPubMedGoogle Scholar
  • 11 Hurst J R, Donaldson G C, Quint J K, Goldring J JP, Baghai-Ravary R, Wedzicha J A. Temporal clustering of exacerbations in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2009;  179 369-374
    CrossrefPubMedGoogle Scholar
  • 12 Seemungal T AR, Donaldson G C, Paul E A, Bestall J C, Jeffries D J, Wedzicha J A. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157 1418-1422
    CrossrefPubMedGoogle Scholar
  • 13 Burge S, Wedzicha J A. COPD exacerbations: definitions and classifications.  Eur Respir J. 2003;  41 46s-53s
    PubMedGoogle Scholar
  • 14 Donaldson G C, Seemungal T AR, Bhowmik A, Wedzicha J A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
    CrossrefPubMedGoogle Scholar
  • 15 Soler-Cataluña J J, Martínez-García M A, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.  Thorax. 2005;  60 925-931
    CrossrefPubMedGoogle Scholar
  • 16 Donaldson G C, Wilkinson T MA, Hurst J R, Perera W R, Wedzicha J A. Exacerbations and time spent outdoors in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2005;  171 446-452
    CrossrefPubMedGoogle Scholar
  • 17 Hamilton A L, Killian K J, Summers E, Jones N L. Muscle strength, symptom intensity, and exercise capacity in patients with cardiorespiratory disorders.  Am J Respir Crit Care Med. 1995;  152(6 Pt 1) 2021-2031
    CrossrefPubMedGoogle Scholar
  • 18 Bernard S, LeBlanc P, Whittom F et al.. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  158 629-634
    CrossrefPubMedGoogle Scholar
  • 19 Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD.  Am J Respir Crit Care Med. 1996;  153 976-980
    CrossrefPubMedGoogle Scholar
  • 20 Swallow E B, Reyes D, Hopkinson N S et al.. Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease.  Thorax. 2007;  62 115-120
    CrossrefPubMedGoogle Scholar
  • 21 Schols A M, Broekhuizen R, Weling-Scheepers C A, Wouters E F. Body composition and mortality in chronic obstructive pulmonary disease.  Am J Clin Nutr. 2005;  82 53-59
    PubMedGoogle Scholar
  • 22 Marquis K, Debigaré R, Lacasse Y et al.. Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2002;  166 809-813
    CrossrefPubMedGoogle Scholar
  • 23 Mostert R, Goris A, Weling-Scheepers C A, Wouters E F, Schols A M. Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease.  Respir Med. 2000;  94 859-867
    CrossrefPubMedGoogle Scholar
  • 24 Spruit M A, Gosselink R, Troosters T et al.. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I.  Thorax. 2003;  58 752-756
    CrossrefPubMedGoogle Scholar
  • 25 Crul T, Spruit M A, Gayan-Ramirez G et al.. Markers of inflammation and disuse in vastus lateralis of chronic obstructive pulmonary disease patients.  Eur J Clin Invest. 2007;  37 897-904
    CrossrefPubMedGoogle Scholar
  • 26 Martínez-Llorens J M, Orozco-Levi M, Masdeu M J et al.. Global muscle dysfunction and exacerbation of COPD: a cohort study [in Spanish].  Med Clin (Barc). 2004;  122 521-527
    PubMedGoogle Scholar
  • 27 Hopkinson N S, Tennant R C, Dayer M J et al.. A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary disease.  Respir Res. 2007;  8 25
    CrossrefPubMedGoogle Scholar
  • 28 Pitta F, Troosters T, Probst V S, Spruit M A, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD.  Chest. 2006;  129 536-544
    CrossrefPubMedGoogle Scholar
  • 29 Garcia-Aymerich J, Farrero E, Félez M A, Izquierdo J, Marrades R M, Antó J M. Estudi del Factors de Risc d’Agudització de la MPOC investigators . Risk factors of readmission to hospital for a COPD exacerbation: a prospective study.  Thorax. 2003;  58 100-105
    CrossrefPubMedGoogle Scholar
  • 30 Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Antó J M. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.  Thorax. 2006;  61 772-778
    CrossrefPubMedGoogle Scholar
  • 31 Decramer M, Gosselink R, Troosters T, Verschueren M, Evers G. Muscle weakness is related to utilization of health care resources in COPD patients.  Eur Respir J. 1997;  10 417-423
    CrossrefPubMedGoogle Scholar
  • 32 Kim S, Emerman C L, Cydulka R K, Rowe B H, Clark S, Camargo C A. MARC Investigators . Prospective multicenter study of relapse following emergency department treatment of COPD exacerbation.  Chest. 2004;  125 473-481
    CrossrefPubMedGoogle Scholar
  • 33 Spencer S, Jones P W. GLOBE Study Group . Time course of recovery of health status following an infective exacerbation of chronic bronchitis.  Thorax. 2003;  58 589-593
    CrossrefPubMedGoogle Scholar
  • 34 Donaldson G C, Wilkinson T MA, Hurst J R, Perera W R, Wedzicha J A. Exacerbations and time spent outdoors in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2005;  171 446-452
    CrossrefPubMedGoogle Scholar
  • 35 Puhan M A, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality: a systematic review.  Respir Res. 2005;  6 54
    CrossrefPubMedGoogle Scholar
  • 36 Puhan M A, Scharplatz M, Troosters T, Walters E H, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2009;  (1) CD005305
    PubMedGoogle Scholar
  • 37 Behnke M, Taube C, Kirsten D, Lehnigk B, Jörres R A, Magnussen H. Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease.  Respir Med. 2000;  94 1184-1191
    CrossrefPubMedGoogle Scholar
  • 38 Kirsten D K, Taube C, Lehnigk B, Jörres R A, Magnussen H. Exercise training improves recovery in patients with COPD after an acute exacerbation.  Respir Med. 1998;  92 1191-1198
    CrossrefPubMedGoogle Scholar
  • 39 Man W D, Polkey M I, Donaldson N, Gray B J, Moxham J. Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study.  BMJ. 2004;  329 1209
    CrossrefPubMedGoogle Scholar
  • 40 Murphy N, Bell C, Costello R W. Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation.  Respir Med. 2005;  99 1297-1302
    CrossrefPubMedGoogle Scholar
  • 41 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit.  Arch Phys Med Rehabil. 1998;  79 849-854
    CrossrefPubMedGoogle Scholar
  • 42 Hawkins P, Johnson L C, Nikoletou D et al.. Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease.  Thorax. 2002;  57 853-859
    CrossrefPubMedGoogle Scholar
  • 43 Keilty S E, Ponte J, Fleming T A, Moxham J. Effect of inspiratory pressure support on exercise tolerance and breathlessness in patients with severe stable chronic obstructive pulmonary disease.  Thorax. 1994;  49 990-994
    CrossrefPubMedGoogle Scholar
  • 44 Maltais F, Reissmann H, Gottfried S B. Pressure support reduces inspiratory effort and dyspnea during exercise in chronic airflow obstruction.  Am J Respir Crit Care Med. 1995;  151 1027-1033
    PubMedGoogle Scholar
  • 45 van ’t Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Training with inspiratory pressure support in patients with severe COPD.  Eur Respir J. 2006;  27 65-72
    CrossrefPubMedGoogle Scholar
  • 46 Probst V S, Troosters T, Celi S G. Effects of resistance training during hospitalisation due to an acute exacerbation of COPD preliminary results [abstract].  Eur Respir J (suppl). 2005; 
    PubMedGoogle Scholar
  • 47 Probst V S, Troosters T, Coosemans I et al.. Mechanisms of improvement in exercise capacity using a rollator in patients with COPD.  Chest. 2004;  126 1102-1107
    CrossrefPubMedGoogle Scholar
  • 48 Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD.  Chest. 2005;  128 3177-3182
    CrossrefPubMedGoogle Scholar
  • 49 Sánchez Riera H, Montemayor Rubio T, Ortega Ruiz F et al.. Inspiratory muscle training in patients with COPD: effect on dyspnea, exercise performance, and quality of life.  Chest. 2001;  120 748-756
    CrossrefPubMedGoogle Scholar
  • 50 Magadle R, McConnell A K, Beckerman M, Weiner P. Inspiratory muscle training in pulmonary rehabilitation program in COPD patients.  Respir Med. 2007;  101 1500-1505
    CrossrefPubMedGoogle Scholar
  • 51 Hill K, Jenkins S C, Philippe D L et al.. High-intensity inspiratory muscle training in COPD.  Eur Respir J. 2006;  27 1119-1128
    CrossrefPubMedGoogle Scholar

Christine MikelsonsM.Sc. 

Physiotherapy Department, Royal Free Hospital, Pond Street

London, NW3 2QG, UK

Email: christine.mikelsons@royalfree.nhs.uk

      >