Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD
ABSTRACT Background and objective Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess difference...
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| Veröffentlicht in: | Respirology (Carlton, Vic.) Vic.), 2017-07, Vol.22 (5), p.942-949 |
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| creator | Braeken, Dionne C.W. Spruit, Martijn A. Houben‐Wilke, Sarah Smid, Dionne E. Rohde, Gernot G.U. Wouters, Emiel F.M. Franssen, Frits M.E. |
| description | ABSTRACT
Background and objective
Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess differences in dropout and outcomes of PR between COPD with and without AEs.
Methods
Clinically stable patients with moderate‐to‐very severe COPD (age: 64.1 ± 9.1 years, 55.6% males, forced expiratory volume in 1 s (FEV1
): 48.6 ± 20.0% predicted) were assessed during PR (inpatient and outpatient). Mild‐to‐moderate AEs were defined as ‘the prescription of systemic glucocorticosteroids and/or antibiotics, following an acute increase in respiratory symptoms’. Severe AEs were defined as ‘a hospital admission due to an AE’. Health status was measured by COPD Assessment Test (CAT), COPD‐specific version of the St George's Respiratory Questionnaire (SGRQ‐C) and Clinical COPD Questionnaire (CCQ). Symptoms of anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS). Exercise capacity was measured with the 6‐min walking test (6MWT) and constant work rate test (CWRT).
Results
A total of 518 patients were assessed during a pre‐rehabilitation assessment. Four hundred and seventy‐six patients started PR, of whom 419 (88.0%) completed it. A larger proportion of patients who dropped out had a severe AE during PR (20.0% vs 3.5%, P |
| doi_str_mv | 10.1111/resp.12987 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1863222412</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1920552058</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3577-8f3ef8103aa13df1074ef954033a1439b09af8dbc5c8eb44bc90bd0ede2405873</originalsourceid><addsrcrecordid>eNp90MtKxDAUBuAgiveNDyABNyJ0zK02Xco4XkCYwcs6pOkpU2mTmrSM8_ZmrLpwYSDkLL78JD9CJ5RMaFyXHkI3oSyX2Rbap0KQhErBt-PMGU-yLM_30EEIb4QQnpJ0F-0xSXnkfB-Zh7bTpseuwvChDfhC97WzATuLdbkED9YA1rbEbuiNayFsaDc0rbPar7GHpS7qpu6_ruHa4i5OYPuAV3W_xNP54uYI7VS6CXD8fR6i19vZy_Q-eZzfPUyvHxPD0yxLZMWhkpRwrSkvK0oyAVWeCsK5poLnBcl1JcvCpEZCIURhclKUBEpggqTxN4fofMztvHsfIPSqrYOBptEW3BAUlVecMSYoi_TsD31zg7fxdYrmjKRp3DKqi1EZ70LwUKnO1238tqJEbapXm-rVV_URn35HDkUL5S_96ToCOoJV3cD6nyj1NHtejKGfrvGO8A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1920552058</pqid></control><display><type>article</type><title>Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Braeken, Dionne C.W. ; Spruit, Martijn A. ; Houben‐Wilke, Sarah ; Smid, Dionne E. ; Rohde, Gernot G.U. ; Wouters, Emiel F.M. ; Franssen, Frits M.E.</creator><creatorcontrib>Braeken, Dionne C.W. ; Spruit, Martijn A. ; Houben‐Wilke, Sarah ; Smid, Dionne E. ; Rohde, Gernot G.U. ; Wouters, Emiel F.M. ; Franssen, Frits M.E.</creatorcontrib><description>ABSTRACT
Background and objective
Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess differences in dropout and outcomes of PR between COPD with and without AEs.
Methods
Clinically stable patients with moderate‐to‐very severe COPD (age: 64.1 ± 9.1 years, 55.6% males, forced expiratory volume in 1 s (FEV1
): 48.6 ± 20.0% predicted) were assessed during PR (inpatient and outpatient). Mild‐to‐moderate AEs were defined as ‘the prescription of systemic glucocorticosteroids and/or antibiotics, following an acute increase in respiratory symptoms’. Severe AEs were defined as ‘a hospital admission due to an AE’. Health status was measured by COPD Assessment Test (CAT), COPD‐specific version of the St George's Respiratory Questionnaire (SGRQ‐C) and Clinical COPD Questionnaire (CCQ). Symptoms of anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS). Exercise capacity was measured with the 6‐min walking test (6MWT) and constant work rate test (CWRT).
Results
A total of 518 patients were assessed during a pre‐rehabilitation assessment. Four hundred and seventy‐six patients started PR, of whom 419 (88.0%) completed it. A larger proportion of patients who dropped out had a severe AE during PR (20.0% vs 3.5%, P < 0.001). Completers with severe AE showed a deterioration in 6MWT, while completers without AE and with mild‐to‐moderate AE improved (−24.8 (95% CI: −94.0 to 44.5) vs 24.2 (95% CI: 16.0 to 32.5) vs 25.1 (95% CI: 14.0 to 36.3) metres, P = 0.042). No other significant differences were observed in outcomes comparing completers with and without AE during PR.
Conclusion
Mild‐to‐moderate AEs do not affect dropout or response of PR, although severe AEs are associated with dropout. AEs should not lead to discontinuation of PR, as response is in general not affected.
Impact of mild‐to‐moderate and severe exacerbations on dropout and pulmonary rehabilitation (PR) in COPD were assessed. Mild‐to‐moderate exacerbations did not affect dropout or response to PR and should not lead to discontinuation of PR. Severe exacerbations are associated with dropout, but patients completing PR generally respond positively yet less pronounced</description><identifier>ISSN: 1323-7799</identifier><identifier>EISSN: 1440-1843</identifier><identifier>DOI: 10.1111/resp.12987</identifier><identifier>PMID: 28139873</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Antibiotics ; Anxiety ; Chronic obstructive pulmonary disease ; Depression ; Disease Progression ; dropout ; exacerbations ; Female ; Forced Expiratory Volume - physiology ; Health Status ; Hospitalization ; Humans ; Longitudinal Studies ; Male ; Mental depression ; Middle Aged ; Patient Compliance ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - psychology ; Pulmonary Disease, Chronic Obstructive - rehabilitation ; pulmonary rehabilitation ; Rehabilitation ; Respiratory diseases ; response ; School dropouts ; Surveys and Questionnaires ; Treatment Outcome ; Walking</subject><ispartof>Respirology (Carlton, Vic.), 2017-07, Vol.22 (5), p.942-949</ispartof><rights>2017 Asian Pacific Society of Respirology</rights><rights>2017 Asian Pacific Society of Respirology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3577-8f3ef8103aa13df1074ef954033a1439b09af8dbc5c8eb44bc90bd0ede2405873</citedby><cites>FETCH-LOGICAL-c3577-8f3ef8103aa13df1074ef954033a1439b09af8dbc5c8eb44bc90bd0ede2405873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fresp.12987$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fresp.12987$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28139873$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Braeken, Dionne C.W.</creatorcontrib><creatorcontrib>Spruit, Martijn A.</creatorcontrib><creatorcontrib>Houben‐Wilke, Sarah</creatorcontrib><creatorcontrib>Smid, Dionne E.</creatorcontrib><creatorcontrib>Rohde, Gernot G.U.</creatorcontrib><creatorcontrib>Wouters, Emiel F.M.</creatorcontrib><creatorcontrib>Franssen, Frits M.E.</creatorcontrib><title>Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD</title><title>Respirology (Carlton, Vic.)</title><addtitle>Respirology</addtitle><description>ABSTRACT
Background and objective
Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess differences in dropout and outcomes of PR between COPD with and without AEs.
Methods
Clinically stable patients with moderate‐to‐very severe COPD (age: 64.1 ± 9.1 years, 55.6% males, forced expiratory volume in 1 s (FEV1
): 48.6 ± 20.0% predicted) were assessed during PR (inpatient and outpatient). Mild‐to‐moderate AEs were defined as ‘the prescription of systemic glucocorticosteroids and/or antibiotics, following an acute increase in respiratory symptoms’. Severe AEs were defined as ‘a hospital admission due to an AE’. Health status was measured by COPD Assessment Test (CAT), COPD‐specific version of the St George's Respiratory Questionnaire (SGRQ‐C) and Clinical COPD Questionnaire (CCQ). Symptoms of anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS). Exercise capacity was measured with the 6‐min walking test (6MWT) and constant work rate test (CWRT).
Results
A total of 518 patients were assessed during a pre‐rehabilitation assessment. Four hundred and seventy‐six patients started PR, of whom 419 (88.0%) completed it. A larger proportion of patients who dropped out had a severe AE during PR (20.0% vs 3.5%, P < 0.001). Completers with severe AE showed a deterioration in 6MWT, while completers without AE and with mild‐to‐moderate AE improved (−24.8 (95% CI: −94.0 to 44.5) vs 24.2 (95% CI: 16.0 to 32.5) vs 25.1 (95% CI: 14.0 to 36.3) metres, P = 0.042). No other significant differences were observed in outcomes comparing completers with and without AE during PR.
Conclusion
Mild‐to‐moderate AEs do not affect dropout or response of PR, although severe AEs are associated with dropout. AEs should not lead to discontinuation of PR, as response is in general not affected.
Impact of mild‐to‐moderate and severe exacerbations on dropout and pulmonary rehabilitation (PR) in COPD were assessed. Mild‐to‐moderate exacerbations did not affect dropout or response to PR and should not lead to discontinuation of PR. Severe exacerbations are associated with dropout, but patients completing PR generally respond positively yet less pronounced</description><subject>Aged</subject><subject>Antibiotics</subject><subject>Anxiety</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Depression</subject><subject>Disease Progression</subject><subject>dropout</subject><subject>exacerbations</subject><subject>Female</subject><subject>Forced Expiratory Volume - physiology</subject><subject>Health Status</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Patient Compliance</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - psychology</subject><subject>Pulmonary Disease, Chronic Obstructive - rehabilitation</subject><subject>pulmonary rehabilitation</subject><subject>Rehabilitation</subject><subject>Respiratory diseases</subject><subject>response</subject><subject>School dropouts</subject><subject>Surveys and Questionnaires</subject><subject>Treatment Outcome</subject><subject>Walking</subject><issn>1323-7799</issn><issn>1440-1843</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90MtKxDAUBuAgiveNDyABNyJ0zK02Xco4XkCYwcs6pOkpU2mTmrSM8_ZmrLpwYSDkLL78JD9CJ5RMaFyXHkI3oSyX2Rbap0KQhErBt-PMGU-yLM_30EEIb4QQnpJ0F-0xSXnkfB-Zh7bTpseuwvChDfhC97WzATuLdbkED9YA1rbEbuiNayFsaDc0rbPar7GHpS7qpu6_ruHa4i5OYPuAV3W_xNP54uYI7VS6CXD8fR6i19vZy_Q-eZzfPUyvHxPD0yxLZMWhkpRwrSkvK0oyAVWeCsK5poLnBcl1JcvCpEZCIURhclKUBEpggqTxN4fofMztvHsfIPSqrYOBptEW3BAUlVecMSYoi_TsD31zg7fxdYrmjKRp3DKqi1EZ70LwUKnO1238tqJEbapXm-rVV_URn35HDkUL5S_96ToCOoJV3cD6nyj1NHtejKGfrvGO8A</recordid><startdate>201707</startdate><enddate>201707</enddate><creator>Braeken, Dionne C.W.</creator><creator>Spruit, Martijn A.</creator><creator>Houben‐Wilke, Sarah</creator><creator>Smid, Dionne E.</creator><creator>Rohde, Gernot G.U.</creator><creator>Wouters, Emiel F.M.</creator><creator>Franssen, Frits M.E.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201707</creationdate><title>Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD</title><author>Braeken, Dionne C.W. ; Spruit, Martijn A. ; Houben‐Wilke, Sarah ; Smid, Dionne E. ; Rohde, Gernot G.U. ; Wouters, Emiel F.M. ; Franssen, Frits M.E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3577-8f3ef8103aa13df1074ef954033a1439b09af8dbc5c8eb44bc90bd0ede2405873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Antibiotics</topic><topic>Anxiety</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Depression</topic><topic>Disease Progression</topic><topic>dropout</topic><topic>exacerbations</topic><topic>Female</topic><topic>Forced Expiratory Volume - physiology</topic><topic>Health Status</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Mental depression</topic><topic>Middle Aged</topic><topic>Patient Compliance</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - psychology</topic><topic>Pulmonary Disease, Chronic Obstructive - rehabilitation</topic><topic>pulmonary rehabilitation</topic><topic>Rehabilitation</topic><topic>Respiratory diseases</topic><topic>response</topic><topic>School dropouts</topic><topic>Surveys and Questionnaires</topic><topic>Treatment Outcome</topic><topic>Walking</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Braeken, Dionne C.W.</creatorcontrib><creatorcontrib>Spruit, Martijn A.</creatorcontrib><creatorcontrib>Houben‐Wilke, Sarah</creatorcontrib><creatorcontrib>Smid, Dionne E.</creatorcontrib><creatorcontrib>Rohde, Gernot G.U.</creatorcontrib><creatorcontrib>Wouters, Emiel F.M.</creatorcontrib><creatorcontrib>Franssen, Frits M.E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Respirology (Carlton, Vic.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Braeken, Dionne C.W.</au><au>Spruit, Martijn A.</au><au>Houben‐Wilke, Sarah</au><au>Smid, Dionne E.</au><au>Rohde, Gernot G.U.</au><au>Wouters, Emiel F.M.</au><au>Franssen, Frits M.E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD</atitle><jtitle>Respirology (Carlton, Vic.)</jtitle><addtitle>Respirology</addtitle><date>2017-07</date><risdate>2017</risdate><volume>22</volume><issue>5</issue><spage>942</spage><epage>949</epage><pages>942-949</pages><issn>1323-7799</issn><eissn>1440-1843</eissn><abstract>ABSTRACT
Background and objective
Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess differences in dropout and outcomes of PR between COPD with and without AEs.
Methods
Clinically stable patients with moderate‐to‐very severe COPD (age: 64.1 ± 9.1 years, 55.6% males, forced expiratory volume in 1 s (FEV1
): 48.6 ± 20.0% predicted) were assessed during PR (inpatient and outpatient). Mild‐to‐moderate AEs were defined as ‘the prescription of systemic glucocorticosteroids and/or antibiotics, following an acute increase in respiratory symptoms’. Severe AEs were defined as ‘a hospital admission due to an AE’. Health status was measured by COPD Assessment Test (CAT), COPD‐specific version of the St George's Respiratory Questionnaire (SGRQ‐C) and Clinical COPD Questionnaire (CCQ). Symptoms of anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS). Exercise capacity was measured with the 6‐min walking test (6MWT) and constant work rate test (CWRT).
Results
A total of 518 patients were assessed during a pre‐rehabilitation assessment. Four hundred and seventy‐six patients started PR, of whom 419 (88.0%) completed it. A larger proportion of patients who dropped out had a severe AE during PR (20.0% vs 3.5%, P < 0.001). Completers with severe AE showed a deterioration in 6MWT, while completers without AE and with mild‐to‐moderate AE improved (−24.8 (95% CI: −94.0 to 44.5) vs 24.2 (95% CI: 16.0 to 32.5) vs 25.1 (95% CI: 14.0 to 36.3) metres, P = 0.042). No other significant differences were observed in outcomes comparing completers with and without AE during PR.
Conclusion
Mild‐to‐moderate AEs do not affect dropout or response of PR, although severe AEs are associated with dropout. AEs should not lead to discontinuation of PR, as response is in general not affected.
Impact of mild‐to‐moderate and severe exacerbations on dropout and pulmonary rehabilitation (PR) in COPD were assessed. Mild‐to‐moderate exacerbations did not affect dropout or response to PR and should not lead to discontinuation of PR. Severe exacerbations are associated with dropout, but patients completing PR generally respond positively yet less pronounced</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>28139873</pmid><doi>10.1111/resp.12987</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Antibiotics Anxiety Chronic obstructive pulmonary disease Depression Disease Progression dropout exacerbations Female Forced Expiratory Volume - physiology Health Status Hospitalization Humans Longitudinal Studies Male Mental depression Middle Aged Patient Compliance Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - psychology Pulmonary Disease, Chronic Obstructive - rehabilitation pulmonary rehabilitation Rehabilitation Respiratory diseases response School dropouts Surveys and Questionnaires Treatment Outcome Walking |
| title | Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD |
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