Research Article

Effects of Pulmonary Rehabilitation Program on Patients With Chronic Obstructive Pulmonary Disease

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) impairs patients` quality of life and clinical outcomes. Pulmonary rehabilitation (PR) program can improve the functional capacity in patients with chronic lung disease. Thus, the study aimed to evaluate the effect of the PR program on the quality of life, anxiety, depression, and pulmonary function of patients with COPD.
Materials and Methods: In this single-group before-and-after clinical trial, adult patients with COPD and recent history of exacerbation were recruited. The intervention was a PR program, including training of breathing exercises at home and aerobic exercise program, twice a week about 30 to 60 min for 8 weeks. The program was prepared according to the patient’s tolerance by a sports medicine specialist in a pulmonary rehabilitation clinic. The primary outcome was quality of life measured by the St. George’s Respiratory Questionnaire (SGRQ). Secondary outcomes were assessing anxiety, depression, pulmonary function, COPD status, the ability to walk, and shortness of breathing. All outcomes were measured before and one week after the program.
Results: Twenty-two eligible patients of both genders (68% male and 32% female) with a Mean±SD age of 65.09±9.72 years finished the program. Quality of life was improved significantly following the intervention (51.49 [16.68] vs 4275 [15.63]; P<0.001]. Anxiety and depression (P<0.001), pulmonary function parameters, such as forced expiratory volume in 1 second (FEV1) (P<0.001) and FEV1/ forced vital capacity (FVC) ratio (P=0.015), COPD status (P=0.001), the ability of walk1ing (P<0.05), and shortness of breath (P=0.001) were improved significantly after the intervention.
Conclusion: The PR program resulted in clinical improvement in patients with COPD. Thus, we recommend that it be used besides medical management.

Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): A population-based prevalence study. The Lancet. 2007; 370(9589):741-50. [DOI:10.1016/S0140-6736(07)61377-4]

Gershon AS, Warner L, Cascagnette P, Victor JC, To T. Lifetime risk of developing chronic obstructive pulmonary disease: A longitudinal population study. The Lancet. 2011; 378(9795):991-6. [DOI:10.1016/S0140-6736(11)60990-2] [PMID]

Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine. 2007; 176(6):532-55. [DOI:10.1164/rccm.200703-456SO] [PMID]

Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. Journal of Global Health. 2015; 5(2):020415. [PMID] [PMCID]

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine. 2006; 3(11):e442. [DOI:10.1371/journal.pmed.0030442] [PMID] [PMCID]

Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, et al. Impact of COPD in North America and Europe in 2000: Subjects’ perspective of Confronting COPD International Survey. The European Respiratory Journal. 2002; 20(4):799-805. [DOI:10.1183/09031936.02.03242002] [PMID]

Jones PW, Agusti AG. Outcomes and markers in the assessment of chronic obstructive pulmonary disease. The European Respiratory Journal. 2006; 27(4):822-32. [DOI:10.1183/09031936.06.00145104] [PMID]

Esteban C, Quintana JM, Aburto M, Moraza J, Egurrola M, Pérez-Izquierdo J, et al. Impact of changes in physical activity on health-related quality of life among patients with COPD. The European Respiratory Journal. 2010; 36(2):292-300. [DOI:10.1183/09031936.00021409] [PMID]

Zamzam MA, Azab NY, El Wahsh RA, Ragab AZ, Allam EM. Quality of life in COPD patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2012; 61(4):281-9. [DOI:10.1016/j.ejcdt.2012.08.012]

Jenkins C, Rodriguez-Roisin R. Quality of life, stage severity and COPD. The European Respiratory Journal. 2009; 33(5):953-5. [DOI:10.1183/09031936.00019009] [PMID]

Tsiligianni I, Kocks J, Tzanakis N, Siafakas N, van der Molen T. Factors that influence disease-specific quality of life or health status in patients with COPD: A review and meta-analysis of Pearson correlations. Primary Care Respiratory Journal. 2011; 20(3):257-68. [DOI:10.4104/pcrj.2011.00029] [PMID] [PMCID]

Goldstein RS, Hill K, Brooks D, Dolmage TE. Pulmonary rehabilitation: A review of the recent literature. Chest. 2012; 142(3):738-49. [DOI:10.1378/chest.12-0188] [PMID]

McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews. 2015; (2):CD003793. [DOI:10.1002/14651858.CD003793.pub3] [PMID]

Waseem M, Lasi F, Valecha J, Samejo B, Sangrasi S, Ali S. Effectiveness of chest physiotherapy in cerebrovascular accident patients with aspiration pneumonia. Journal of Modern Rehabilitation. 2021; 15(1):47-52 [DOI:10.32598/JMR.15.1.7]

Rugbjerg M, Iepsen UW, Jørgensen KJ, Lange P. Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: A systematic review with meta-analyses. International Journal of Chronic Obstructive Pulmonary Disease. 2015; 10:791-801. [DOI:10.2147/COPD.S78607] [PMID] [PMCID]

Hashemi SY, Momenabadi V, Faramarzi A, Kiani A. Trends in burden of chronic obstructive pulmonary disease in Iran, 1995-2015: Findings from the global burden of disease study. Archives of Public Health. 2020; 78:45. [DOI:10.1186/s13690-020-00426-x] [PMID] [PMCID]

Jones PW, Quirk FH, Baveystock CM. The St George’s respiratory questionnaire. Respiratory Medicine. 1991; 85 Suppl B:25-31; discussion 33-7. [DOI:10.1016/S0954-6111(06)80277-5] [PMID]

Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research. 2002; 52(2):69-77. [DOI:10.1016/S0022-3999(01)00296-3] [PMID]

Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. European Respiratory Journal. 2009; 34(3):648-54. [DOI:10.1183/09031936.00102509] [PMID]

Stenton C. The MRC breathlessness scale. Occupational Medicine. 2008; 58(3):226-7. [DOI:10.1093/occmed/kqm162] [PMID]

Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: A randomised controlled trial. The Lancet. 2000; 355(9201):362-8. [DOI:10.1016/S0140-6736(99)07042-7]

Güell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000; 117(4):976-83. [DOI:10.1378/chest.117.4.976] [PMID]

Paz-Díaz H, Montes de Oca M, López JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. American Journal of Physical Medicine & Rehabilitation. 2007; 86(1):30-6. [DOI:10.1097/PHM.0b013e31802b8eca] [PMID]

von Leupoldt A, Hahn E, Taube K, Schubert-Heukeshoven S, Magnussen H, Dahme B. Effects of 3-week outpatient pulmonary rehabilitation on exercise capacity, dyspnea, and quality of life in COPD. Lung. 2008; 186(6):387-91. [DOI:10.1007/s00408-008-9089-3] [PMID]

Mirbagher-Ajorpaz N, Rezaei M. [The effect of pulmonary rehabilitation program on quality of life of elderly patients with chronic obstructive pulmonary disease (Persian)]. Zahedan Journal of Research in Medical Sciences. 2011; 13(1):30-5. https://www.sid.ir/en/journal/ViewPaper.aspx?id=205092

Lan CC, Chu WH, Yang MC, Lee CH, Wu YK, Wu CP. Benefits of pulmonary rehabilitation in patients with COPD with normal exercise capacity. Respiratory Care. 2013; 58(9):1482-8. [DOI:10.4187/respcare.02051] [PMID]

Masroor DD, Rafii F, Fadaeeaghdam N, Hoseini AF. [Health-related quality of life in patients with chronic obstructive pulmonary disease (Persian)]. Iran Journal of Nursing. 2012;25(76):19-27. http://ijn.iums.ac.ir/article-1-1279-en.html

Cheng ST, Wu YK, Yang MC, Huang CY, Huang HC, Chu WH, et al. Pulmonary rehabilitation improves heart rate variability at peak exercise, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease. Heart & Lung: The Journal of Critical Care. 2014; 43(3):249-55. [DOI:10.1016/j.hrtlng.2014.03.002] [PMID]

Jokar Z, Mohammadi F, Khankeh H, Rabiee Z, Falah Tafti S. [Effect of Home-based pulmonary rehabilitation on daily activity of patients with chronic obstructive pulmonary disease (Persian)]. Evidence Based Care Journal. 2015; 4(4):69-76. https://ebcj.mums.ac.ir/article_3658.html

Riario-Sforza GG, Incorvaia C, Paterniti F, Pessina L, Caligiuri R, Pravettoni C, et al. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: A number needed to treat study. International Journal of Chronic Obstructive Pulmonary Disease. 2009; 4:315-9. [DOI:10.2147/COPD.S5905] [PMID] [PMCID]

Brophy C, Kastelik J, Gardiner E, Greenstone M. Quality of life measurements and bronchodilator responsiveness in prescribing nebulizer therapy in COPD. Chronic Respiratory Disease. 2008; 5(1):13-8. [DOI:10.1177/1479972307087652] [PMID]

Yohannes AM, Connolly MJ. Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease. Clinical Rehabilitation. 2003; 17(5):465-71. [DOI:10.1191/0269215503cr637oa] [PMID]

Jones AY, Dean E, Chow CC. Comparison of the oxygen cost of breathing exercises and spontaneous breathing in patients with stable chronic obstructive pulmonary disease. Physical Therapy. 2003; 83(5):424-31. [DOI:10.1093/ptj/83.5.424] [PMID]

Izadi-Avangy F, Afshar M, Hajibagheri A. [Evaluation of the effectiveness of pursed-lip breathing education in COPD patients (Persian)]. Journal of Shahid Sadoughi University of Medical Sciences. 2006; 14(2):72-6. http://jssu.ssu.ac.ir/article-1-593-en.html

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007; 131(5 Suppl):4S-42S. [DOI:10.1378/chest.06-2418] [PMID]

Garrod R, Paul EA, Wedzicha JA. Supplemental oxygen during pulmonary rehabilitation in patients with COPD with exercise hypoxaemia. Thorax. 2000; 55(7):539-43. [DOI:10.1136/thorax.55.7.539] [PMID] [PMCID]

Janssen DJ, Spruit MA, Leue C, Gijsen C, Hameleers H, Schols JM, et al. Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chronic Respiratory Disease. 2010; 7(3):147-57. [DOI:10.1177/1479972310369285] [PMID]

Harrison SL, Greening NJ, Williams JE, Morgan MD, Steiner MC, Singh SJ. Have we underestimated the efficacy of pulmonary rehabilitation in improving mood? Respiratory Medicine. 2012; 106(6):838-44. [DOI:10.1016/j.rmed.2011.12.003] [PMID]

Paz-Díaz H, Montes de Oca M, López JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. American Journal of Physical Medicine & Rehabilitation. 2007; 86(1):30-6. [DOI:10.1097/PHM.0b013e31802b8eca] [PMID]

Lolak S, Connors GL, Sheridan MJ, Wise TN. Effects of progressive muscle relaxation training on anxiety and depression in patients enrolled in an outpatient pulmonary rehabilitation program. Psychotherapy and Psychosomatics. 2008; 77(2):119-25. [DOI:10.1159/000112889] [PMID]

Hogg L, Garrod R, Thornton H, McDonnell L, Bellas H, White P. Effectiveness, attendance, and completion of an integrated, system-wide pulmonary rehabilitation service for COPD: Prospective observational study. COPD. 2012; 9(5):546-54. [PMID]

von Leupoldt A, Taube K, Lehmann K, Fritzsche A, Magnussen H. The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD. Chest. 2011; 140(3):730-6. [DOI:10.1378/chest.10-2917] [PMID]

Oh EG. The effects of home-based pulmonary rehabilitation in patients with chronic lung disease. International Journal of Nursing Studies. 2003; 40(8):873-9. [DOI:10.1016/S0020-7489(03)00071-3]

Jones PW, Harding G, Wiklund I, Berry P, Tabberer M, Yu R, et al. Tests of the responsiveness of the COPD assessment test following acute exacerbation and pulmonary rehabilitation. Chest. 2012; 142(1):134-40. [DOI:10.1378/chest.11-0309] [PMID]

He M, Yu S, Wang L, Lv H, Qiu Z. Efficiency and safety of pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease. Medical Science Monitor. 2015; 21:806-12. [DOI:10.12659/MSM.892769] [PMID] [PMCID]

Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, et al. The COPD assessment test (CAT): Response to pulmonary rehabilitation. A multicentre, prospective study. Thorax. 2011; 66(5):425-9. [DOI:10.1136/thx.2010.156372] [PMID]

Files
IssueVol 16 No 1 (2022) QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/jmr.v16i1.385
Keywords
Pulmonary rehabilitation Chronic obstructive pulmonary disease Hospital anxiety and depression scale (HADS) questionnaire

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Pourgharib Shahi MH, Mohammadnejad SF, Gohari Moghadam K, Borna S, Sharafi SE, Naderpour Z. Effects of Pulmonary Rehabilitation Program on Patients With Chronic Obstructive Pulmonary Disease. jmr. 2022;16(1):23-30.