Tweaking pulmonary rehabilitation programs to help re-engage COPD patients who drop out because of severe exacerbations is worth the effort.
According to new research from the COPD, Health Status and Comorbidities (CHANCE) Study, patients with severe exacerbations requiring hospital admission are the most likely group to drop out from pulmonary rehabilitation (PR) programs.
“However, when completing PR after a severe exacerbation, patients generally respond positively, although less pronounced,” the Dutch study involving Frits Franssen from the Maastricht University Medical Centre in The Netherlands said.
Mild to moderate exacerbations did not affect dropout or diminish response to PR, the study found.
“These results emphasise that disease instability during PR should not discourage patients and healthcare professionals from PR continuation.”
The study of 476 patients with moderate to very severe but stable COPD found most (88%) completed their PR program. The PR options included an 8-week inpatient or 16-week outpatient program, each consisting of 40 sessions.
Medical problems and hospitalisations were the most common causes of drop out.
PR completers recorded improvements in health status across multiple measures including COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and Hospital Anxiety and Depression Scale (HADS) scores, as well as 6-minute walking and constant work rate tests.
The researchers suggested a number of strategies for keeping hospitalised patients with severe exacerbations engaged with PR, including neuromuscular electrical stimulation (NMES) and resistance training.
“Early start of NMES during admission, and continuation during PR are probably good options to prevent deterioration after initial gain during PR,” the study said.
They said in-hospital rehabilitation during severe exacerbations might also be an effective bridge between hospitalisation and PR continuation.
“Probably the program should be adjusted depending on the specific patients, for example extension of program duration, providing a less or more intensive program.”