AB057. Does pulmonary hypertension exclude pulmonary rehabilitation in patients with COPD?

Background: Mild to moderate pulmonary hypertension is a frequent complication of chronic obstructive pulmonary disease (COPD), which is related to a higher risk of exacerbations, decreased exercise capacity and decreased survival. The last few years, exercise for patients with pulmonary hypertension has acquired a more important role. The risk of cardiovascular complications and syncope during exercise of moderate intensity is now hypothetical, while the benefits of pulmonary rehabilitation are expected to be very significant as much for the quality of life and the psychological state of the patients as for their exercise capacity. The aim of the study was to investigate whether secondary pulmonary hypertension in patients with COPD influence the outcomes of the pulmonary rehabilitation program.

Methods: Forty-one patients (♂/♀=30/11) with COPD of different stages attended a comprehensive pulmonary rehabilitation program. The patients were then divided into 2 groups whether they presented or not secondary pulmonary hypertension (PASP> ή =40 mmHg) (9/31) and were assessed before and at the completion of the program for the following parameters: mMRC, CAT, SGRQ, 6MWD, CPET. Pulmonary hypertension was assessed using Triplex echocardiography at a specific center.

Results: In the group of patients with pulmonary hypertension, statistically significant improvement was observed for the parameters: mMRC (Mean pre =2.67, Mean post =2.0, SD =0.562, P<0.01), SGRQ (Mean pre =58.04, Mean post =46.55, SD =2.89, P<0.01) and 6MWD (Mean pre =260.22, Mean post =320.56, SD =46.71, P<0.01). Respectively, in the group of patients without pulmonary hypertension, statistically significant improvement was observed for the parameters: mMRC (Mean pre =2.61, Mean post =1.74, SD =0.101, P<0.01), SGRQ (Mean pre =47.96, Mean post =39.53, SD =1.95, P<0.01), 6MWD (Mean pre =272.81, Mean post =334.03, SD =7.38, P<0.01), while there was in addition statistically significant improvement in the CAT (Mean pre =16.9, Mean post =12.42, SD =0.683, P<0.01) and CPET (VO2MAX%PRED, Mean pre =55.078, Mean post =60.283, SD =12.66, P<0.05).

Conclusions: Pulmonary rehabilitation seems to be effective and safe for all the patients with COPD, independently of the presence of secondary pulmonary hypertension. Thus, although patients without pulmonary hypertension showed more important improvements compared to the patients with pulmonary hypertension, patients with pulmonary hypertension shouldn’t be excluded from these programs. However, there is a need for further investigation in order to determine which are the more adequate exercise programs in this patient group.

Keywords: Pulmonary hypertension; rehabilitation; chronic obstructive pulmonary disease (COPD)