Predictors of Success of Inpatient Pulmonary Rehabilitation Program in COPD Patients

Abstract

Tomaž Hafner,1,2 Tinkara Pirc Marolt,1 Julij Šelb,1,2 Anja Grošelj,1 Tatjana Kosten,1 Anja Simonič,1 Mitja Košnik,1,2 Peter Korošec1,3 1University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; 2Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; 3Faculty of Pharmacy, University of Ljubljana, Ljubljana, SloveniaCorrespondence: Tomaž Hafner, UKPA Golnik, Golnik 36, 4204 Golnik, Slovenia, Tel [phone], Fax [phone], Email [email protected]: Pulmonary rehabilitation programs (PR) are an important part of the comprehensive treatment of patients with chronic pulmonary diseases. Patients respond individually to PR. The aim of this study is to identify potential predictors of success of PR to recognise patients who benefit most and to uncover possible reasons for poor response to PR.Patients and Methods: We included 121 patients with chronic obstructive pulmonary disease (COPD) who completed our 4-week inpatient PR without any exacerbations of disease during PR that could potentially affect PR outcomes. Improvement in distance of ≥ 30 m on the 6-minute walk test (6MWT) after PR was chosen as a primary marker of physical success. Ninety-one patients achieved improvement of ≥ 30 m on the 6MWT and were thus considered good responders, and 30 patients were poor responders with improvement in the distance of < 30 m on the 6MWT.Results: We compared baseline clinical characteristics, medication, lung function, physical capacity, body composition, and laboratory blood tests between groups of good and poor responders. The most prominent differences between groups were associated with differences in baseline body composition and erythrocyte-related parameters. Good responders had significantly lower body water content (p = 0.042) and higher body weight (p = 0.036), body fat content (p = 0.049), dry lean mass (p = 0.021), haemoglobin levels (p = 0.040), erythrocyte count (p = 0.017), haematocrit (p = 0.030) and iron level (p = 0.028).Conclusion: A more muscular body composition and a higher ability to transport oxygen from the blood to the muscles could be beneficial for the outcome of PR.Plain Language Summary: Pulmonary rehabilitation programs (PR) are important part of management of patients with chronic obstructive pulmonary diseases and other chronic pulmonary diseases. Nevertheless, PR are sparsely available to patients, and patients respond to PR individually. Our study will help identify patients who benefit most from PR and find possible reasons why the physical condition of some patients does not improve with PR. Only patients with chronic obstructive pulmonary disease who completed inpatient pulmonary rehabilitation program without any exacerbations of disease that could potentially affect PR outcomes were included in this study to determine what baseline patient characteristics could predict good and poor responders to PR. The results of our study suggest that a more muscular body composition and a higher ability to transport oxygen from the blood to the muscles could be beneficial to the outcome of PR. We suggest that before sarcopenic or anaemic patients are referred for PR, special care should first be taken to address and remedy their condition to maximise their physical gain in PR.Keywords: pulmonary rehabilitation, COPD, predictors, responders

Keywords

• pulmonary rehabilitation
• copd
• predictors
• responders