Seven-year time course of lung function, symptoms, health-related quality of life, and exercise tolerance in COPD patients undergoing pulmonary rehabilitation programs.

AIM: To evaluate the long-term course of outcome indexes in patients with chronic obstructive pulmonary disease (COPD) undergoing repeated pulmonary rehabilitation programs (PRP). DESIGN: Prospective, observational study. SETTING: Pulmonary Rehabilitation Center. PATIENTS: Forty-eight COPD patients (M 33, age 59.6+/-8.9 years, forced expiratory volume in 1s (FEV(1)) 58+/-16% predicted, DLCO 71+/-17% predicted.) undergoing 5 Day-Hospital based PRPs in a period of 7.2+/-0.8 years. MEASUREMENTS: Lung function, exercise capacity (incremental cycloergometry, test-6-minute walking test (6MWD)), dyspnoea (Baseline-BDI and Transitional-TDI Dyspnoea Index and Medical Research Council score-MRC), health-related quality of life (HRQL) (St. George Respiratory Questionnaire (SGRQ), and the derived BODE index were assessed pre and post each PRP. RESULTS: During follow-up, patients showed a 18+/-22 (mean+/-SEM)ml/year FEV(1) decline (95%CI: -24.4 to 11.6; p<0.001). Exercise tolerance and BDI remained stable over time whereas SGRQ improved (DeltaSGRQ total score: -9.6+/-14%, p<0.001). BODE index significantly worsened (from 1.27+/-1.14 to 1.98+/-1.64; p<0.001), being this change mainly attributable to worsening in FEV(1). Each PRP elicited significant improvement in exercise capacity, dyspnoea, SGRQ and BODE score. Post-PRP improvements in 6MWD, MRC and TDI were higher after the first three than after the last two PRPs (p<0.001), whereas the greatest gain in SGRQ was observed after PRP1 and then it was lower (p<0.03) but stable in the following periods of observation. CONCLUSION: Despite progressive lost in effectiveness of repeated PRP, COPD patients undergoing those programs do not show any significant worsening in exercise tolerance, dyspnoea and HRQL along a period of 7 years.

Tiotropium and exercise training in COPD patients: effects on dyspnea and exercise tolerance.

BACKGROUND: Exercise training improves exercise tolerance in chronic obstructive pulmonary disease (COPD). Tiotropium 18 microg once daily induces sustained bronchodilation throughout the day and reduces hyperinflation, one of the pathophysiological factors contributing to exertional dyspnea in COPD patients. AIM: To determine whether tiotropium enhances the effects of exercise training in patients with COPD. DESIGN: Multicenter, 25 week randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Twelve Italian Pulmonary Units practicing pulmonary rehabilitation. PATIENTS AND INTERVENTION: Two hundred thirty four COPD patients (196 males; mean age: 67.4 +/- 7.6; forced expiratory volume at 1 second (FEV1): 41.4 +/- 13.0% predicted) were randomised to tiotropium 18 microg or placebo inhalation capsules taken once daily. Both groups underwent a 8 week pulmonary rehabilitation program (PR) consisting of 3 exercise training session per week. MEASUREMENTS: Baseline, at the end of PR and after 12 weeks, patients completed pulmonary function testing, six minute walking test (6MWT), the Baseline and Transition Dyspnea Index (BDI and TDI), and the St. George's Respiratory Questionnaire (SGRQ). RESULTS: Relative to placebo, tiotropium had larger trough and post-study drug FEV1 responses on all test days. At the end of and 12 weeks following PR, patients on tiotropium showed no statistically significant differences in 6MWT compared to patients on placebo. Compared to the period immediately prior to PR, the mean improvement in 6MWT was only 29.7 meters (7.1%) for the combined cohort. Mean TDI focal scores at the end of PR were 3.60 for tiotropium and 2.25 for placebo (p < 0.01). At 12 weeks after PR, TDI focal scores were 2.71 for tiotropium and 2.11 for placebo (p = 0.16). Reduction in all four SGRQ component scores, indicating an improvement in health-related quality of life, was observed for the tiotropium group over the duration of the study compared to placebo but the differences were not statistically significant. During the study period, there were fewer exacerbations and exacerbation days in the tiotropium group. CONCLUSION: Although significant improvements were observed with perceived dyspnea, compared to placebo, the addition of tiotropium to pulmonary rehabilitation did not improve the 6MWT.