Semptomatik KOAH Hastalarında Ayakta Pulmoner Rehabilitasyon ile Mortalite Arasındaki Bağlantı: PR mortaliteyi azaltmada bir olasılık mıdır?

Year 2025, Volume: 4 Issue: 3, 71 - 81, 29.09.2025

Yelda Varol , Hülya Şahin , Özgür Batum , Günseli Balcı , Filiz Güldaval , Gülru Polat Ali Kadri Çırak

https://doi.org/10.57221/izmirtip.1747163

Abstract

Amaç: Ayakta pulmoner rehabilitasyonun (OPR) KOAH hastalarında mortalite üzerindeki etkisi çok az anlaşılmıştır. Bu çalışmanın amacı, OPR programını tamamlamanın KOAH hastalarında 3 yıllık mortalite üzerindeki etkisini değerlendirmektir.
Gereç ve yöntem: Çalışmaya Ocak 2012 ile Aralık 2015 tarihleri arasında OPR'ye uygun olan 447 KOAH hastası dahil edilmiştir. 288 KOAH hastası programı tamamlarken (8 hafta, haftada 2 kez), 159 kişi programa başlamamış veya programı bırakmıştır. Bulgular üç gruba ayrılmıştır: programı tamamlayanlar, programı bırakanlar ve programa başlamayanlar.
Sonuç: 3 yıllık takip sonucunda, programı tamamlayan hastaların mortalitesi, tamamlamayanlara göre istatistiksel olarak anlamlı derecede düşük bulunmuştur. PR'nin etkisini ölçmek için yapılan Cox regresyon ve çok değişkenli analiz sonucunda, PR'yi bırakan hastaların mortalitesi, programı tamamlayanlara göre 1,93 kat daha yüksek bulunmuştur (p=0,012, HR:1,1-3,2). PR'ye başlamayan hastaların mortalitesi ise programı tamamlayanlara göre 2,08 kat daha yüksek bulunmuştur (p=0,014, HR:1,1-3,7). PR programını tamamlayan KOAH hastalarının mortalite oranının daha düşük olduğu bulunmuştur.
Anahtar Kelimeler: KOAH, pulmoner rehabilitasyon, mortalite, sağlık durumu, egzersiz kapasitesi

Keywords

KOAH , pulmoner rehabilitasyon , mortalite , sağlık durumu , egzersiz kapasitesi

The Link Between Outpatient Pulmonary Rehabilitation and Mortality in Symptomatic COPD Patients: Is PR a possibility in reducing mortality?

Abstract

Aim: The effect of outpatient pulmonary rehabilitation (OPR) on mortality in COPD patients is little understood. The aim of this study was to evaluate the effect of completing an OPR program on 3-year mortality in patients with COPD.
Materials and methods: The study included 447 COPD patients who were eligible for the OPR between January 2012 and December 2015. While 288 COPD patients finished the program (8 weeks, 2 times a week), 159 individuals did not begin the program or dropped out. The findings were classified into three groups: those who completed the program, those who dropped out, and those who did not begin the program.
Conclusion: After 3-years follow up, the mortality of the patients who completed the program were statistically significantly lower than those who did not. As a result of the cox regression, multivariate analysis to measure the effect of PR, the mortality of patients who dropped out the PR was 1.93 times higher than those who completed it (p=0.012, HR:1.1-3.2). The mortality of patients who did not start PR was 2.08 times higher than those who completed it (p=0.014, HR:1.1-3.7). The mortality rate of patients with COPD who completed the PR program was found to be lower.
Keywords: COPD, pulmonary rehabilitation, mortality, health status, exercise capacity

Keywords

COPD , pulmonary rehabilitation , mortality , health status , exercise capacity

References

• 1. Gold 2020 Report; Global Strategy for The Diagnosis, Management, And Prevention of COPD page:16, Rehabilitation, Education & Self-Management part page:57.
• 2. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2:CD003793. doi: 10.1002/14651858.
• 3. Sahin H, Naz I, Varol Y, Aksel N, Tuksavul F, Ozsoz A. Is a pulmonary rehabilitation program effective in COPD patients with chronic hypercapnic failure? Expert Rev Respir Med. 2016;10:593-598. doi: 10.1586/17476348.2016.1164041.
• 4. Hakamy A, Bolton CE, McKeever TM. The effect of pulmonary rehabilitation on mortality, balance, and risk of fall in stable patients with chronic obstructive pulmonary disease: A systematic review. Chronic Respiratory Disease. 2017;14:54-62. doi: 10.1177/1479972316661925.
• 5. GOLD executive committee. Global strategy for diagnosis, management and prevention of COPD. [Last accessed date: 14.07.2016]. [updated 2009; accessed 2010 July 1]. Avaliable from: http://www.goldcopd.com.
• 6. Selzler AM, Simmonds L, Rodgers WM, Wong EYL, and Stickland MK. Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Predictors of Program Completion and Success. COPD. 2012;9:538-545. doi: 10.3109/15412555.2012.705365.
• 7. Sahin H, Varol Y, Naz I, Tuksavul F. Effectiveness of pulmonary rehabilitation in COPD patients receiving long-term oxygen therapy. Clin Respir J. 2018;12:1439-1446. doi: 10.1111/crj.12680.
• 8. Varol Y, Şahin H, Aktürk Ü, Kömürcüoğlu B. Effect of Pulmonary Rehabilitation on the Value of the Inspiratory Capacity-to-Total Lung Capacity (IC/TLC) Ratio to Determine Response to Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease. Turk Thorac J. 2019;20:224-229. doi: 10.5152/TurkThoracJ.2018.089.
• 9. Rodriguez-Roisin R. Toward a consensus definition for COPD exac- erbations. Chest. 2000;117:398-401. doi: 10.1378/chest.117.5_suppl_2.398s.
• 10. Takechi Y. Intervention for COPD Exacerbation – how to prevent and treat COPD exacerbation? Gan To Kagaku Ryoho. 2016;43:61-63.
• 11. Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest. 2005;128:2005-2011.
• 12. Cao C, Wang R, Wang J, Bunjhoo H, Xu Y, Xiong W. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One. 2012;7:e43892.
• 13. Menezes AM, Pérez-Padilla R, Wehrmeister FC, Lopez-Varela MV, Muiño A, Valdivia G, et al. FEV1 is a better predictor of mortality than FVC: the PLATINO cohort study. PLoS One. 2014 Oct 6;9(10):e109732.
• 14. Martinez FJ, Han MK, Andrei AC, Wise R, Murray S, Curtis JL, et al; National Emphysema Treatment Trial Research Group. Longitudinal change in the BODE index predicts mortality in severe emphysema. Am J Respir Crit Care Med. 2008 Sep 1;178(5):491-9.
• 15. Moberg M, Vestbo J, Martinez G, Williams JE, Ladelund S, Lange P, et al. Validation of the i-BODE index as a predictor of hospitalization and mortality in patients with COPD participating in pulmonary rehabilitation. COPD. 2014 Aug;11(4):381-7.
• 16. Celli BR. Predictors of mortality in COPD. Respir Med. 2010;104:773-779. 17. Saraiva C, Abreu T, Neves D, Rodrigues F. Mortality Predictive Factors in Subjects with COPD After a Pulmonary Rehabilitation Program: A 3-Year Study. Respir Care. 2016;61:1179-1185.
• 18. Özdemir T, Candemir I, Ergün P, Türkkani MH, Koç O. Patients with COPD who underwent pulmonary rehabilitation in Turkey: prevalence, distribution, and mortality. Turk J Med Sci. 2020;50:141-147. doi: 10.3906/sag-1901-224.
• 19. Sahin H, Naz I. Why are COPD patients unable to complete the outpatient pulmonaryrehabilitation program? Chron Respir Dis. 2018;15:411-418. doi: 10.1177/1479972318767206.
• 20. Sahin H, Varol Y, Naz I, Aksel N, Tuksavul F, Ozsoz A. The effect of pulmonary rehabilitation on COPD exacerbation frequency per year. Clin Respir J. 2018;12:165-174. doi: 10.1111/crj.12507.