Clinical Briefs-By Louis Kuritzky, MD

Results of Outpatient Multidisciplinary Pulmonary Rehabilitation

The benefit of pulmonary rehabilitation for COPD has been demonstrated in meta-analysis to be beneficial over the short term (i.e., < 6 months). This trial, on the other hand, investigated long-term effects of pulmonary rehabilitation on use of health services, talking, and overall health status.

To be included in the study, patients must demonstrate an FEV1 less than 60% predicted, with less than 20% reversibility after bronchodilator (beta-agonist), in stable condition for at least two months. Rehabilitation included occupational therapy, physiotherapy, diet counseling, and assistance with smoking cessation. Visits were arranged three times weekly for six weeks. Measurement of walking was done by the 10-meter shuttle-walk test; overall health status was measured by the SF-36.

Though not a primary end point of the study, relative risk of death in the treatment group was 0.5 when compared to the control (usual care) group. Pulmonary functions were equal in both groups. Although equal numbers of persons were admitted to the hospital from both groups, the actual number of admissions and number of days spent in the hospital was significantly less for the treated group. Walking, breathlessness, and overall health-status outcomes were more favorable in the treatment group. Griffiths and colleagues conclude that pulmonary rehabilitation should be incorporated into the traditional algorithm for long-term COPD management.

Griffiths TL, et al. Lancet 2000; 355:362-368.