Abstract:

Objective To investigate the strategies of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD) of different severity. Methods Eighty-nine patients with COPD in stable stage were divided into moderate COPD group (n=32), severe COPD group (n=36) and very severe COPD group (n=21). Each group of patients were randomly subdivided into pulmonary rehabilitation strategy group 1, pulmonary rehabilitation strategy group 2 and  control group, and were intervened for 20 weeks. BODE index, 6 minute walking distance (6MWD), Modified Medical Research Council Scale (MMRC), pulmonary function(FEV1), body mass index (BMI) and acute exacerbation frequency of COPD were compared before and after intervention and among groups. Results After pulmonary rehabilitation intervention for 20 weeks, 6MWD in patients with moderate and severe COPD treated with strategy 2 significantly improved （P<0.01）, while BODE index, MMRC, BMI and FEV1 after intervention were not significantly different from those before intervention (P>0.05）. MMRC of patients with very severe COPD treated with strategy 1 significantly improved after intervention （P<0.05）, while BODE index, 6MWD, BMI and FEV1 after intervention were not significantly different from those before intervention (P>0.05）. BODE index and 6MWD of severe COPD group treated with strategy 2 improved significantly (P<0.000 1), and MMRC of very severe COPD group treated with strategy 1 improved significantly （P<0.01）. Poisson regression analysis revealed that acute exacerbation frequency of severe COPD patients significantly reduced by pulmonary rehabilitation （P<0.01）, while there was no significant change in the other groups (P>0.05). Conclusion Patients with different severity of COPD may take different pulmonary rehabilitation strategies to achieve the optimal effect.

Key words: chronic obstructive pulmonary disease, pulmonary rehabilitation, BODE index, 6 minute walking test, Modified Medical Research Council Scale, acute exacerbation frequency