Clinical and functional consequences of the forced interruption of pulmonary rehabilitation in patients with severe and very severe COPD during the COVID-19 pandemic

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is a condition characterized by persistent inflammation of the airways and airflow limitation. Patients with COPD gradually decrease in their physical ability and have a worsening of their functional capacity. Pulmonary rehabilitation programs aim to reverse physical deconditioning, muscle weakness, and improve patients' quality of life. Objective: To evaluate the effects of suspending the pulmonary rehabilitation program due to the requirement of social isolation during the pandemic on the frequency of exacerbations, hospitalizations, and morbidity and mortality of patients with severe and very severe COPD who had been undergoing pulmonary rehabilitation for at least three months before to the suspension. Methods: Observational, prospective, analytical study using data from a convenience sample consisting of 57 patients from a long-term pulmonary rehabilitation program for severe and very severe COPD. Data were analyzed and compared with the data before the program suspension, when all patients were evaluated, and after an 18-month interruption of rehabilitation, when they returned to the program. Results: The results showed that the discontinuation of the program resulted in a significant worsening of dyspnea (mean difference in mMRC: -0.50 ± 0.11; p<.001), health status (mean difference in CAT: -2.90 ± 0.80; p<.001), functional capacity (mean difference in 6MWT, m: 45.02 ± 8.90; p<.001), ventilatory muscle strength (mean difference in Pimax, cmH2O: 6.06 ± 0.82; p=0.019), and quality of life (mean difference in SF-36 and AQ-20: 16.12 ± 1.62 and -10.61 ± 2.33; p<.001), respectively.Thre was also an increase in the frequency of hospitalizations during the 18 months of suspension period. Mortality and accumulated survival showed an overall mortality rate of 0.64 per 100 person-months and a significant statistical difference in mortality rates between the pulmonary rehabilitation period and the suspension period. It was observed that the longer patient had been undergoing pulmonary rehabilitation (Group III) before the suspension of PR, the greater the survival over the period of suspension of pulmonary rehabilitation. Conclusion: The forced interruption of a long-term pulmonary rehabilitation program had a negative impact on the clinical status and quality of life of patients with COPD affected by the program suspension. This emphasizes the importance of long-term programs in the treatment and management of COPD and the need to ensure the continuity of programs that allow patients to remain active after pulmonary rehabilitation or in these of unexpected cases of suspension.