Early rehabilitation during hospital admission for COPD
Patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease and other chronic respiratory diseases, such as chronic asthma, bronchiectasis, and interstitial lung disease, are at increased risk of mortality, morbidity, and re-admission. Physical performance and health status are negatively affected by an acute event, and the patient may not fully recover. Pulmonary rehab in stable COPD is well established, but deterioration of physical fitness and skeletal muscle function may occur rapidly during the inpatient phase, and increase the risk of subsequent admission to hospital.
Is it safe and effective to start exercise based rehab in the acute phase when the patient is admitted? This RCT investigated in 389 patients whether early intervention:
1. reduces the risk of readmission over 12 months and
2. ameliorates the negative effects of the episode on physical performance and health status.
The intervention comprised prescribed, progressive aerobic, resistance, and neuromuscular electrical stimulation training, for 6 weeks, starting within 48 hrs of admission. Patients also received a self management and education package.
Conclusion: 60% readmission in the following year (62% in intervention, 58% in control group). Mortality at 12 months was higher in the intervention group, and physical performance nor health status was enhanced.
> From: Greening et al., BMJ 349 (2014) g4315. All rights reserved to The Author(s). Click here for the Pubmed summary.