Eine pneumologische Rehabilitation nach akuter Exazerbation der COPD senkt die Rate erneuter Exazerbationen

Marc Spielmanns; Andrea Meier; Aurelia Winkler; Rainer Glöckl; Christoph Nell; Andreas Rembert Koczulla; Tobias Boeselt; Peter Alter; Friederike Magnet; Jan Hendrik Storre; Wolfram Windisch

doi:10.1055/s-0042-121346

DMW - Deutsche Medizinische Wochenschrift, Table of Contents

Dtsch Med Wochenschr 2017; 142(02): e10-e19
DOI: 10.1055/s-0042-121346

Originalarbeit

Eine pneumologische Rehabilitation nach akuter Exazerbation der COPD senkt die Rate erneuter Exazerbationen

Pulmonary Rehabilitation after Acute Exacerbation of COPD Reduces the Rate of Reexacerbations

Marc Spielmanns^*

¹Medizinischen Klinik und ambulante pneumologische Rehabilitation in Leverkusen (APRiL), Remigius-Krankenhaus, Leverkusen Opladen

⁴Lehrstuhl Pneumologie, Universität Witten/Herdecke

,

Andrea Meier^*

¹Medizinischen Klinik und ambulante pneumologische Rehabilitation in Leverkusen (APRiL), Remigius-Krankenhaus, Leverkusen Opladen

,

Aurelia Winkler

¹Medizinischen Klinik und ambulante pneumologische Rehabilitation in Leverkusen (APRiL), Remigius-Krankenhaus, Leverkusen Opladen

,

Rainer Glöckl

⁶Abteilung Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Schön Klinik Berchtesgadener Land, Schönau am Königssee

⁷Abteilung für Prävention, Rehabilitation und Sportmedizin, Klinikum rechts der Isar, Technische Universität München (TUM), München

,

Christoph Nell

⁵Philipps Universität Marburg, Klinik für Innere Medizin, Schwerpunkt Pneumologie und Intensivmedizin

,

Andreas Rembert Koczulla

⁵Philipps Universität Marburg, Klinik für Innere Medizin, Schwerpunkt Pneumologie und Intensivmedizin

,

Tobias Boeselt

⁵Philipps Universität Marburg, Klinik für Innere Medizin, Schwerpunkt Pneumologie und Intensivmedizin

,

Peter Alter

⁵Philipps Universität Marburg, Klinik für Innere Medizin, Schwerpunkt Pneumologie und Intensivmedizin

,

Friederike Magnet

³Abteilung Pneumologie, Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln

⁴Lehrstuhl Pneumologie, Universität Witten/Herdecke

,

Jan Hendrik Storre

²Universitätsklinikum Freiburg

³Abteilung Pneumologie, Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln

,

Wolfram Windisch

³Abteilung Pneumologie, Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln

⁴Lehrstuhl Pneumologie, Universität Witten/Herdecke

› Author Affiliations

Abstract

Zusammenfassung

Ziel der Studie Die akute Exazerbation einer COPD (AECOPD) stellt für die Patienten ein erhebliches Risiko dar und ist für die Prognose mitentscheidend. Bisherige Ergebnisse über die Auswirkungen einer pneumologischen Rehabilitation (PR) auf die Exazerbationsfrequenz nach AECOPD sind uneinheitlich. Es wurde eine prospektive, fallkontrollierte Studie mit dem Ziel durchgeführt, den Einfluss der PR auf die Exazerbationsfrequenz nach AECOPD zu messen.

Patienten und Methoden Eine PR wurde bei 57 COPD-Patienten nach AECOPD durchgeführt. Davon konnten 30 nach einem Jahr nachuntersucht werden und wurden mit 32 Kontrollpatienten (KG = hospitalisiert wegen AECOPD ohne PR) verglichen. Die Anzahl der Exazerbationen wurde innerhalb der Gruppen und zwischen den Gruppen analysiert. Registrierung: DRKS Nr. 00 006 847.

Ergebnisse Im Intragruppenvergleich war die Exazerbationsrate in der PR-Gruppe im Jahr nach der Rehabilitation signifikant niedriger (0,97 ± 1,52 vs. 2,67±1,12; p < 0,001). Ebenfalls signifikant niedriger zeigte sich die Anzahl der Exazerbationen im Intergruppenvergleich nach einem Jahr in der PR-Gruppe vs. KG-Gruppe (0,97 ± 1,52 vs 2,16 ± 1,25; p < 0,001).

Schlussfolgerung Es konnte gezeigt werden, dass durch die PR im Untersuchungszeitraum von einem Jahr die Exazerabationsrate nach AECOPD im Vergleich prä/post und im Intergruppenvergleich zur KG-Gruppe signifikant gesenkt werden konnte. Weitere prospektive Studien, die den Stellenwert der PR nach AECOPD untersuchen, sind erforderlich.

Abstract

Objective Acute exacerbation of COPD (AECOPD) provides for patients a significant hazard and is crucial for the prognosis. Data on the effects of pulmonary rehabilitation (PR) on the frequency of reexacerbations after AECOPD are inconsistent. A prospective, case-control study was conducted with the aim of measuring the impact of PR on the frequency of reexacerbations after AECOPD.

Patients and Methods A PR was performed in 57 patients with COPD after AECOPD. 30 participants were followed-up after one year and compared to 32 Control-Group (KG = hospitalized for AECOPD without PR). The rate of reexacerbations was both retrospectively in the year preceding the AECOPD, and prospectively in the year after AECOPD analyzed within groups and between groups.

Results In the intra group comparison the exacerbation rate was significantly lower in the PR-group in the year after rehabilitation (0.97 ± 2.67 vs. 1.52 ± 1.12; p < 0.001). The intergroup comparison also showed a significantly lower number of exacerbations for the PR-group (0.97 ± 1.52 vs 2.16 ± 1.25; p < 0.001).

Conclusion It was shown that the exacerbation rate after an AECOPD could be significantly reduced in the PR-group in comparison to the KG-group during the investigation period of one year by PR. More prospective studies are required to define the value of PR in the context of AECOPD.

Schlüsselwörter

pneumologische Rehabilitation - COPD - SGRQ - CAT - HADS - Exazerbation

Key words

pulmonary rehabilitation - COPD - SGRQ - CAT - HADS - exacerbation

Full Text

References

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Supplementary Material

Extended Abstract