Conference: 2008 International PHA Conference and Scientific Sessions
Release Date: 06.20.2008
Presentation Type: Abstracts
Connors G.L., Hess S., Shumway J., Lamberti J.P.
INOVA Fairfax Hospital, Falls Church, VA, USA
BACKGROUND: Utilization of pulmonary rehabilitation (PR) as a treatment intervention for Pulmonary Hypertension (PH) patients is not well established. At present, PH patients are referred to pulmonary rehabilitation at Inova Fairfax Hospital by the PH Clinic in the Advanced Lung Disease Program. Currently pulmonary rehabilitation is a standard of care and treatment intervention for chronic obstructive pulmonary disease patients. The medical management of the PH patient population has traditionally been pharmacologic. These patients have decreased exercise capacity, limited quality of life and poor prognosis as a result of the right heart failure. The PH patient must function at home or work in daily activities, yet no guidelines exist to direct safe activity and exercise prescriptions for these patients in PR.
METHODS: A retrospective analysis was completed on outcome data of 6 PH patients referred to PR from January through June 2007. The PH patients participated in comprehensive PR for 8 weeks, two days/week, 3-4 hrs/day. The PR program included assessment (respiratory therapy with 6 MWT and nutrition), education, supervised exercise, psychosocial intervention and long-term adherence. The 6 patients were all female, ages 32 to 77 with a mean age of 51. The outcomes evaluated included: 6 MWT,
Hospital Anxiety and Depression Scale (HAD) and the St. George Respiratory Questionnaire (SGRQ).
RESULTS: 6 of the 6 PH patients completed PR with a 94% attendance rate. 3 of the PH patients had a secondary diagnosis of: scleroderma, crest limited and OSA. The mean pulmonary diagnostic data was: FVC 2.61L, 86% predicted, FEV1 1.98L, 79% predicted, DLCO 13 mL/mmHg/min, 56% predicted. 3 of the 6 patients never smoked and 3 were former smokers with a mean 18 pack history. The mean 6 MWT data was: maximum BORG scale pre 3.2, post 1.5; lowest oxygen saturation SpO2 pre 93%, post 94%; maximum heart rate pre 119, post 124; total distance pre 401 meters, post 487 meters.; level of energy expenditure (MET) pre 2.88, post 3.0. The mean HAD Anxiety score was pre 7.3, post 4.8; mean HAD Depression score was pre 6.6, post 3.2.; mean SGRQ total was pre 50%, post 30%.
COMMENTS AND CONCLUSIONS: Comprehensive PR in this select patient population with PH resulted in improved outcomes of exercise tolerance and functional level with an improvement in 6 MWT distance of 86 meters and quality of life improvement with the HAD Anxiety score improvement of 66 %, HAD Depression score improvement of 48 % and SGRQ total improvement of 60 %. Establishing the role that Pulmonary Rehabilitation has in this patient group as an adjunct to medical treatment is important with parameters established how to safely exercise these patients and recommendations on how to adapt each component of PR to the PH patients’ needs. We must be able to offer PH patients more to improve their quality of life. The science community needs to be challenged to look beyond pharmaceutical treatment. The answer may be pulmonary rehabilitation.