Extra-pulmonary features in COPD patients entering rehabilitation after stratification for MRC dyspnea grade

• Published in: Respiratory medicine Vol. 101; no. 12; pp. 2454 - 2463
• Main Authors: Spruit, Martijn A, Pennings, Herman-Jan, Janssen, Paul P, Does, Joan D, Scroyen, Sigrid, Akkermans, Marco A, Mostert, Rob, Wouters, Emiel F.M
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-12-2007; Elsevier; Elsevier Limited
• Subjects: Affect; Aged; Biological and medical sciences; Blood Gas Analysis; Body Composition; Body Mass Index; Chronic obstructive pulmonary disease, asthma; COPD; Disease-specific health status; Dyspnea; Dyspnea - classification; Dyspnea - physiopathology; Dyspnea - rehabilitation; Emphysema; Exercise intolerance; Exercise Therapy - methods; Exercise Tolerance; Female; Forced Expiratory Volume; Health Status Indicators; Hospitals; Humans; Lung - physiopathology; Male; Medical Research Council; Medical sciences; Middle Aged; Miscellaneous; Muscles - pathology; Oxygen therapy; Patient Selection; Pneumology; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Pulmonary/Respiratory; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Respiratory system : syndromes and miscellaneous diseases; Studies; Ventilation; Vital Capacity; Walking; Disease-specific health status; Dyspnea; Body composition; Exercise intolerance; Medical Research Council; COPD; Physical exercise; Disease; Council; Extrapulmonary; Scientific research; Bronchus disease; Chronic obstructive pulmonary disease; Obstructive pulmonary disease; Stratification; Pneumology; Human; Lung disease; Respiratory disease; Health; Patient; Medicine; Intolerance; Chronic; Health status; Rehabilitation(human); Rehabilitation
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2007.07.003

Summary Experts have stated that referral for rehabilitation of patients with chronic obstructive pulmonary disease (COPD) becomes appropriate when these patients become aware of their disability (e.g. usually grade 3 to 5 on the Medical Research Council (MRC) dyspnea scale). However, patients with MRC dyspnea grade 1/2 may also suffer from extra-pulmonary features, such as abnormal body composition, exercise intolerance and reduced disease-specific health status. In the present study, we have studied whether and to what extent chronic obstructive pulmonary disease (COPD) patients with MRC dyspnea grade 1/2 have extra-pulmonary features compared to patients with grade 3, 4 or 5? Pulmonary function, body composition, 6-min walking distance, peak exercise capacity, anxiety, depression and disease-specific health status have been assessed in 333 outpatients who had been referred for pulmonary rehabilitation. On average, patients with MRC dyspnea grade 1/2 had a better exercise tolerance and disease-specific health status compared to patients with grade 4 or 5. Nevertheless, grade 1/2 patients had a higher prevalence of muscle mass depletion. In addition, these patients did still have aberrant values in one or more of the aforementioned outcomes. On average, patients with MRC dyspnea grade 1/2 may clearly suffer from extra-pulmonary features, indicating the necessity to refer these patients for rehabilitation. Therefore, MRC dyspnea scale alone does not appear to be a suitable measure to identify most patients with COPD who have to be referred for rehabilitation.