Evaluation of pulmonary rehabilitation program for patients with chronic respiratory diseases other than COPD

Abstract Description

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Authors (including presenting author) :

Ko WN(1), Mok YWT(2), Lum CMC(3), Ng HPB(1), Chan HLI(1), Lau WLC(1), Wong HY(1)

Affiliation :

(1) Occupational Therapy Department, Kowloon Hospital,(2) Respiratory Medical Department, Kowloon Hospital,(3)Department of Medicine and Geriatrics, Shatin Hospital

Introduction :

Pulmonary rehabilitation program (PRP) is a non-pharmacological treatment approach for patients with chronic obstructive pulmonary disease (COPD). Studies showed that the use of PRP could help patients increase exercise capacity, improve psychological well-being, and reduce hospital utilization. A global survey on the overall content and organizational aspects of PRP showed that most participants recruited to PRP were COPD patients. However, the American Thoracic Society / European Respiratory Society statement and the British Thoracic Society guideline for PRP elaborated that pulmonary rehabilitation is not limited to COPD patients, but also people with other chronic lung diseases (CLD), such as pulmonary fibrosis, bronchiectasis, chronic asthma, and pre/post lung transplant. In Kowloon Hospital, other than providing PRP for COPD patients, patients with other chronic respiratory diseases were also referred. However, the characteristics of these patients and the effect of rehabilitation remained unexplored. Therefore, this project was initiated for service evaluation.

Objectives :

To compare the characteristics of PRP participants with and without COPD. To evaluate the effect of pulmonary rehabilitation to patients with chronic respiratory diseases other than COPD.

Methodology :

PRP participants aged over 60 who were recruited by Kowloon Hospital from 1st Jan 2013 to 31st Dec 2018 were included in the study. Patients were split into 2 sub-groups according to their lung functions. Subjects with FEV1/FVC below 70% were classified as COPD and subjects with FEV1/FVC above 70% were classified as non-COPD. Sub-group comparison between COPD and non-COPD subjects on demographics data were done. Within each sub-group, the change in rehabilitation parameters from PRP recruitment to PRP completion, 3 months post PRP follow up and 6 months post PRP FU were evaluated.

Result & Outcome :

174 COPD and 24 non-COPD subjects were identified in the study. The subjects of both subgroups were mostly male and completed an average of 20 sessions of rehabilitation. The mean FEV1/FVC ratios of COPD subjects and non-COPD subjects were 41.1% and 83.9% respectively. In further subgroup analysis with data of non-COPD subjects, the most common diagnosis groups were Bronchiectasis (n=8), Pneumoconiosis (n=8) and Idiopathic Pulmonary Fibrosis (IPF). for these subjects, there were significant improvement in the Monitored Functional Task Evaluation score (MFTE) (p=0.01) and the Six-Minute Walk test distance (6MWT) (p< 0.01) upon completion of PRP. While for COPD subgroups, there were significant improvement in ADL, MFTE, 6MWT, Shortness of Breath Questionnaire score and Chronic Respiratory Questionnaire scores (p< 0.01). Detailed outcomes related to outcomes at follow up session and hospital utilisation would be further analyzed and presented in the later study period. Conclusion Non-COPD subjects recruited to PRP in Kowloon Hospital were mainly patients with Bronchiectasis and lung fibrosis. Preliminary analysis showed that patients with CLD other than COPD could also receive benefits from PRP in terms of functional and exercise capacity. In the future, further study on the effects of PRP on specific diagnosis groups of these non-COPD subjects was recommended.