COPD: respiratory rehabilitation relieves dyspnoea

Clinical bottom line (level 1a)

  1. Patients with COPD who undertake a respiratory rehabilitation program have increased exercise capacity and feel less breathless, have greater control and are less tired.
Lacasse et al: Lancet 1996; 348: 1115-1119
Expires November 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: COPD (FEV 1 < 70%; or FEV 1 /FVC < 0.7
  • Intervention: respiratory rehabilitation for at least 4 weeks compared with no rehabilitation
  • Outcome: exercise capacity, quality of life


    • Articles found in any language using Medline and CINAHL, 1966 to 1995 (search terms: (exp, lung disease, obstructive), (exp, rehabilitation or exp, exercise therapy) and (research design or longitudinal studies or evaluation study or randomised controlled trial) ) and reviewing reference lists of relevant articles and abstracts of international meetings. Experts and original authors were also contacted.

    Selection criteria: by 2 independent reviewers
    Appraisal criteria: based on concealed randomisation
    Articles excluded if: not stated

    14 studies found involving 468 patients. Within outcomes studied: maximum exercise capacity (11 trials, 309 patients) and 6min walk test (11 trials, 413 patients) and HRQL (6 trials, 239 patients enrolled, but ?number analysed)
    Studies were found to be homogeneous

    The evidence

    • maximum exercise capacity: pooled effect size 0.3 SD (95% CI: 0.1 to 0.6)
    • mean difference in distance walked in 6 minute: 56 m (95% CI: 28 to 93)
    • improvement in health-related quality of life
      • dyspnoea: 1.0 (95% CI: 0.6 to 1.5)
      • fatigue: 0.8 (95% CI: 0.4 to 1.0)
      • emotional function: 0.6 (95% CI: 0.2 to 1.0)
      • mastery: 0.8 (95% CI: 0.5 to 1.2)

    Comments

    1. Rehabilitation was carried out in a wide range of settings (at home, outpatient clinics, inpatients)
    2. Unclear how these results relate to improvements in activities of daily living.
    3. The trials are likely to come from centres with expertise and resources and in motivated patients. Benefits may not be as great in another setting although similar results were reported from an uncontrolled trial of a 'program pragmatically adapted for clinical utility'.

    Citation

    1. Lacasse Y, Wong E, Guyatt GH, et al: meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 1996; 348: 1115-1119
    Search Terms:
    Contributor: Bob Phillips and Chris BallGerard Ryan, November 1999
    Reviewer:

    Clinical Question.
    Patient
    Intervention or Exposure
    Outcome