Does the benefit from pulmonary rehabilitation differ between phenotypes in chronic obstructive pulmonary disease?

Abstract

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a disease caused by airway and/or parenchymal pathology. Therefore, some patients inevitably have chronic bronchitis and some patients have emphysema. The current thinking is that exercise affects these two major phenotypes differently. In this study, we investigated the benefits of pulmonary rehabilitation (PR) in chronic bronchitis- and emphysema-predominant COPD patients. METHODS: Retrospective data of chronic bronchitis- and emphysema-predominant COPD patients who completed an outpatient 8-week PR program between the years 2013 and 2017 in the PR unit of our hospital were examined. Demographic data (age, sex, body mass index, smoking history, long-term oxygen therapy, noninvasive ventilation, emergency admissions, and number of hospitalizations) were recorded. The patients were divided into two groups: chronic bronchitis predominant and emphysema predominant. Patients were assigned to the emphysema-predominant group based on radiology results. Patients were assigned to the chronic bronchitis-predominant group according to clinical description. The two groups were compared using the recorded data cited above. RESULTS: Of the 146 patients, 85 (58.2%) were assigned to the emphysema-predominant group and 61 (41.8%) were assigned to the chronic bronchitis-predominant group. There was no difference between the two groups in age and gender. Pulmonary function test (PFT) parameters (forced expiratory volume in 1 s and diffusing capacity of the lungs for carbon monoxide (DLCO)), arterial blood gas values (pO2, PCO2, and SpO2), 6 min of walking time, and quality of life scores were significantly improved after PR. However, there was no difference between the emphysema- and chronic bronchitis-predominant groups in terms of the improvements after PR. CONCLUSION: In this study, it was observed that the improvement due to PR seen in COPD patients was independent of phenotype. Therefore, all COPD patients should be encouraged to participate in PR programs regardless of their phenotypes.