Pulmonary Rehabilitation program for Chronic Obstructive Pulmonary Disease – Findings from the EXpiRA+ Pilot Study

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and efforts to identify, diagnose and treat patients have been insufficient. Two primary healthcare units in Portugal have developed a pulmonary rehabilitation program (EXpiRA+), which aims to improve physical condition and muscular strength, to enable patient’s autonomy for daily activities, reducing psychosocial impact and improving quality of life, and to prevent COPD exacerbations.

Method: The program lasting 8 weeks included structured and supervised physical therapy and educational sessions. To verify the feasibility of the program, a pilot study was carried out with 4 patients. COPD patients classified as Gold B were evaluated at the beginning (0 weeks), 8 weeks (at the end of the program), and after 6 months, through the LDCAL (Ability to perform activities of daily living), CAT (Quality of life), HADS (Anxiety/depression), 6MWT (6-minute Walk Test), 1-minute sit-to-stand test (STS) and BODE Index. At 4 weeks evaluation was carried out using only the questionnaires. At 6 months, the number of exacerbations was also evaluated. For statistical analysis, the medians (P25-P75) were calculated and the Wilcoxon Sign Rank-Sum and Friedman tests were applied.

Results: Throughout the evaluations, we found an improvement in the 6MWT [380 (297-525); 463 (390-525); 480 (420-551); p=0.018], 1-STS [16.5 (11.5-24); 27 (20.5-39); 31(15-42); p=0.097) and in the CAT [17 (9.5-24); 5(3.5-10); 6(4-10); 9(7-15), p=0.05] and HADS questionnaires [12.5 (9-16); 8 (4.5-12); 4.5 (2.5-7); 4 (3.5-9); p=0.084].

Discussion: There was an improvement in physical exercise performance, muscle strength and quality of life, even 6 months after concluding the intervention program. The proposed methodology proved to be feasible and safe, showing the potential to significantly improve outcomes of patients with COPD.