Effect of home based pulmonary rehabilitation on health related quality of life in COPD patients

John Mathew, Jayaprakash Balakrishnan, Sanjeev Nair


Background: Pulmonary rehabilitation is a proven strategy in the management of COPD, it’s a neglected area in our part of world and there are very few studies on home based pulmonary rehabilitation in COPD in our scenario and hence we evaluated the effectiveness of such a strategy. Aim of the research work was to study the effectiveness of home based pulmonary rehabilitation on health related quality of life, exercise tolerance, depression levels and perceived dyspnea as assessed by SGRQ (St. George Respiratory Questionnaire), 6MWTD (Six-Minute Walk Test distance), PHQ-9 (Patient Health Questionnaire-9), Modified Borg scale respectively.

Methods: Patients attending the Department of Pulmonary Medicine, Medical College Trivandrum, diagnosed as COPD based on GOLD guidelines who fulfil the inclusion and exclusion criteria were studied from January 2013 to June 2014. Patients were educated about the disease and need for rehabilitation, advised smoking cessation, nutritional modification. Breathing exercise, upper limb and lower limb exercises given for 6 weeks in a structured manner and followed up in every second week and analyzed using paired t- test. Pre and post rehabilitation assessment included the SGRQ, 6MWTD, PHQ-9, Modified Borg dyspnea scale was done.

Results: Around 40 patients had completed 6weeks of rehabilitation. There was a statistically and clinically significant improvement in quality of life, exercise tolerance, perceived dyspnoea was seen along with decrease in level of depression.

Conclusions: Home based pulmonary rehabilitation is a feasible alternative to institution based rehabilitation in the management of COPD and is associated with significant benefit.


COPD, Home based, Pulmonary rehabilitation

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Murray CJL, Lopez AD. Alternative projection of mortality and disability by cause 1990-2020: global burden of disease study. Lancet .1997;349:1498-504

Barnes PJ, Celli BR. Systemic manifestations and co-morbidities of COPD. Euro Respir J. 2009;33(5):1165-85.

Magnussen H, Watz H. Systemic inflammation in chronic obstructive pulmonary disease and asthma: relation with co morbidities. Proc Am Thorac Soc. 2009;6(8):648-51.

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD, 2014. Available at:

Yohannes AM, Baldwin RC, Connolly MJ. Predictors of 1-year mortality in patients discharged from hospital following acute exacerbation of chronic obstructive pulmonary disease. Age Aging. 2005;34:491-6.

American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2006;173:1390-413.

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007 May 1;131(5):4S-2S.

Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD003793.

Maltais F, Bourbeau J, Shapiro S, Lacasse Y, Perrault H, Baltzan M, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Annals Inter Med. 2008;149(12):869-78.

Behnke M, Taube C, Kirsten D, Lehnigk B, Jorres RA, Magnussen H. Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease. Res Med. 2000;94:1184-91.

Al Moamary MS. Pulmonary rehabilitation: The standard practice not yet standard. Ann Thorac Med. 2006;1:65-6.

Finnerty JP, Keeping I, Bullough I, Jones J. The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest. 2001 Jun 1;119(6):1705-10.

Lacasse Y, Brosseau L, Milne S, Martin S, Wong EE, Guyatt GH, Goldstein R, White J. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews. 2001(4).

Redelmeier D, Bayoumi A, Goldstein R, Guyatt G. Interpreting small differences in functional status: the six minute walk test in chronic lung disease patients. Am J Res Crit Care Med. 1997;155:1278- 82.

Wise RA, Brown CD Minimal clinically important differences in the six-minute walk test and the incremental shuttle walking test COPD. 2005;2(1):125-9.

Puhan MA, Mador MJ, Held U, Goldstein R, Guyatt GH, Schünemann HJ. Interpretation of treatment changes in six-minute walk distance in patients with COPD. Eur Respir J. 2008;32:637-43.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13.

Ries A. Minimally clinically important difference for the UCSD shortness of breath questionnaire, Borg scale, and visual analog scale. COPD. 2004;2:105-10.