Efficacy of pulmonary rehabilitation for bronchiectasis and related factors: Which patients should receive the most treatment?

Abstract

Introduction: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. Results: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking status, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r =-0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r =-0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r =-0.563) and ΔSGRQ (p < 0.001, r =-0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r =-0.176) and Δanxiety (p = 0.007, r =-0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r =-0.267) and ΔSGRQ (p < 0.001, r =-0.648). Conclusions: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program.