Seven-year time course of lung function, symptoms, health-related quality of life, and exercise tolerance in COPD patients undergoing pulmonary rehabilitation programs

Respir Med. 2007 Sep;101(9):1961-70. doi: 10.1016/j.rmed.2007.04.007. Epub 2007 May 24.


Aim: To evaluate the long-term course of outcome indexes in patients with chronic obstructive pulmonary disease (COPD) undergoing repeated pulmonary rehabilitation programs (PRP).

Design: Prospective, observational study.

Setting: Pulmonary Rehabilitation Center.

Patients: Forty-eight COPD patients (M 33, age 59.6+/-8.9 years, forced expiratory volume in 1s (FEV(1)) 58+/-16% predicted, DLCO 71+/-17% predicted.) undergoing 5 Day-Hospital based PRPs in a period of 7.2+/-0.8 years.

Measurements: Lung function, exercise capacity (incremental cycloergometry, test-6-minute walking test (6MWD)), dyspnoea (Baseline-BDI and Transitional-TDI Dyspnoea Index and Medical Research Council score-MRC), health-related quality of life (HRQL) (St. George Respiratory Questionnaire (SGRQ), and the derived BODE index were assessed pre and post each PRP.

Results: During follow-up, patients showed a 18+/-22 (mean+/-SEM)ml/year FEV(1) decline (95%CI: -24.4 to 11.6; p<0.001). Exercise tolerance and BDI remained stable over time whereas SGRQ improved (DeltaSGRQ total score: -9.6+/-14%, p<0.001). BODE index significantly worsened (from 1.27+/-1.14 to 1.98+/-1.64; p<0.001), being this change mainly attributable to worsening in FEV(1). Each PRP elicited significant improvement in exercise capacity, dyspnoea, SGRQ and BODE score. Post-PRP improvements in 6MWD, MRC and TDI were higher after the first three than after the last two PRPs (p<0.001), whereas the greatest gain in SGRQ was observed after PRP1 and then it was lower (p<0.03) but stable in the following periods of observation.

Conclusion: Despite progressive lost in effectiveness of repeated PRP, COPD patients undergoing those programs do not show any significant worsening in exercise tolerance, dyspnoea and HRQL along a period of 7 years.

MeSH terms

  • Aged
  • Carbon Dioxide / blood
  • Disease Progression
  • Dyspnea / etiology
  • Exercise Tolerance*
  • Female
  • Forced Expiratory Volume
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Oxygen / blood
  • Partial Pressure
  • Program Evaluation
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Quality of Life*
  • Respiratory Muscles / physiopathology
  • Vital Capacity


  • Carbon Dioxide
  • Oxygen