International Journal of COPD (Feb 2023)

Impact of Cardiovascular and Metabolic Comorbidities on Long-term Outcomes of Home-based Pulmonary Rehabilitation in COPD

  • Grosbois JM,
  • Détrée A,
  • Pierache A,
  • Bautin N,
  • Pérez T,
  • Wallaert B,
  • Chenivesse C,
  • Le Rouzic O

Journal volume & issue
Vol. Volume 18
pp. 155 – 167

Abstract

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Jean-Marie Grosbois,1 Axelle Détrée,2 Adeline Pierache,3,4 Nathalie Bautin,5,6 Thierry Pérez,5,6 Benoit Wallaert,5,6 Cécile Chenivesse,5,6 Olivier Le Rouzic5,6 1FormAction Santé, Pérenchies, F-59840, France; 2Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France; 3Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France; 4CHU Lille, Department of Biostatistics, Lille, F-59000, France; 5Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France; 6CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, FranceCorrespondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email [email protected]: Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results.Research Question: This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients.Study Design and methods: Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement.Results: Patients (mean age 64.1± 11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2± 17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (− 5.0± 0.7 vs − 2.9± 0.8 and − 2.6± 0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14.Conclusion: Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.Keywords: anxiety, exercise tolerance, quality of life, comorbidities, home based pulmonary rehabilitation, COPD

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