Airflow grades, outcome measures and response to pulmonary rehabilitation in individuals after an exacerbation of severe chronic obstructive pulmonary disease

Published:November 14, 2022DOI:


      • Pulmonary rehabilitation (PR) is recommended after COPD exacerbations.
      • We need priority access criteria to programs according to baseline characteristics.
      • Airflow severity grades or outcomes assessed do not influence success rate of PR.
      • Barthel dyspnoea index and short physical performance battery are sensitive to PR.



      Individuals with COPD may be staged according to symptoms and exacerbation history (GOLD groups: A-D) and on airflow obstruction (GOLD grades: 1–4). Guidelines recommend pulmonary rehabilitation (PR) for these individuals, including those recovering from an exacerbation (ECOPD)


      To evaluate whether in individuals with clinically severe COPD, recovering from an ECOPD, the effect size of an in-hospital PR program would be affected by airflow severity grades and assessed outcome measures.


      Retrospective, multicentre study. Participants were compared according to different GOLD airflow grades. In addition to the MRC dyspnoea scale, six-minute walking distance test and COPD assessment test (CAT), Barthel dyspnoea index (Bid), and Short Physical Performance Battery (SPPB) were assessed, evaluating the proportion of individuals reaching the minimum clinically important difference (MCID) (responders).


      Data of 479 individuals, completing the program were evaluated. Most of the participants were allocated in GOLD grades 4, (57.6%) and 3 (22.1%). All outcome measures significantly improved after PR (p < 0.05), without any significant difference in the proportion of responders in any measure.


      in individuals with severe COPD, recovering from ECOPD the success rate of PR does not depend on airflow severity, or outcome measure assessed. In addition to the most used outcome measures, also Bid and SPPB are sensitive to PR.



      AECOPD (Acute exacerbation of chronic obstructive pulmonary disease), ADL (Activities of daily living), Bid (Barthel index dyspnoea), CAT (COPD assessment test), CIRS (Cumulative illness rating scale), COPD (Chronic obstructive pulmonary disease), CRF (Chronic respiratory failure), ECOPD (Exacerbation of chronic obstructive pulmonary disease), FEV1 (Forced expiratory volume at one second), FVC (Forced vital capacity), GOLD (Global initiative for chronic obstructive lung disease), MCID (Minimum clinically important difference), MRC (Medical research council), PR (Pulmonary rehabilitation), SPPB (Short physical performance battery), 6MWT (Six-minute walking test)
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      1. 2022 GOLD REPORTS. Global Strategy for Prevention, diagnosis and management of COPD: 2022 Report. Available at: Accessed September 29, 2022.

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