Efficacy of a long-term pulmonary rehabilitation maintenance program for COPD patients in a real-life setting: a 5-year cohort study

• Published in: Respiratory research Vol. 22; no. 1; pp. 79 - 11
• Main Authors: Blervaque, Léo, Préfaut, Christian, Forthin, Hélène, Maffre, Francis, Bourrelier, Marion, Héraud, Nelly, Catteau, Matthias, Pomiès, Pascal, Jaffuel, Dany, Molinari, Nicolas, Hayot, Maurice, Gouzi, Fares
• Format: Journal Article
• Language: English
• Published: London BioMed Central 10.03.2021; BioMed Central Ltd; Nature Publishing Group; BMC
• Subjects: Care and treatment; Chronic obstructive pulmonary disease; Cluster analysis; Cohort analysis; COPD; Dyspnea; Human health and pathology; Life Sciences; Long-term effects; Lung diseases; Lung diseases, Obstructive; Maintenance; Maintenance programs; Medicine; Medicine & Public Health; Obstructive lung disease; Patients; Pneumology/Respiratory System; Pulmonary rehabilitation; Pulmonology and respiratory tract; Quality of life; Questionnaires; Rehabilitation; Respiration; Self help; Statistical analysis; Survival; Survival analysis; Trajectory analysis; Walking; France; Maintenance programs; Pulmonary rehabilitation; Survival; COPD
• ISSN: 1465-993X; 1465-9921; 1465-993X
• DOI: 10.1186/s12931-021-01674-3

Background Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnea in chronic obstructive pulmonary disease (COPD) patients. Maintenance programs can sustain the benefits for 12 to 24 months. Yet, the long-term effects (> 12 months) of pragmatic maintenance programs in real-life settings remain unknown. This prospective cohort study assessed the yearly evolution in the outcomes [6-min walking distance (6MWD), HRQoL, dyspnea] of a supervised self-help PR maintenance program for COPD patients followed for 5 years. The aim was to assess the change in the outcomes and survival probability for 1 to 5 years after PR program discharge in COPD patients following a PR maintenance program supported by supervised self-help associations. Methods Data were prospectively collected from 144 COPD patients who followed a pragmatic multidisciplinary PR maintenance program for 1 to 5 years. They were assessed yearly for 6MWD, HRQol (VQ11) and dyspnea (MRC). The 5-year survival probability was compared to that of a control PR group without a maintenance program. A trajectory-based cluster analysis identified the determinants of long-term response. Results Maintenance program patients showed significant PR benefits at 4 years for 6MWD and VQ11 and 5 years for MRC. The 5-year survival probability was higher than for PR patients without PR maintenance. Two clusters of response to long-term PR were identified, with responders being the less severe COPD patients. Conclusions This study provides evidence of the efficacy of a pragmatic PR maintenance program in a real-life setting for more than 3 years. In contrast to short-term PR, long-term PR maintenance appeared more beneficial in less severe COPD patients.