Effects of pulmonary rehabilitation on lung function in chronic obstructive pulmonary disease: the FIRST study

Background. Chronic obstructive pulmonary disease (COPD) causes an impairment of respiratory function, well reflected by the progressive decrease in forced expiratory volume in 1 second (FEV1). The only interventions able to slow down the FEV1 decline are smoking cessation and drug treatment. Pulmonary rehabilitation (PR), is claimed to improve exercise tolerance, symptoms and quality of life, but its effects on lung function have been scantly investigated. Aim. The aim of this paper was to evaluate, by the study named "FEV1 as an Index of Rehabilitation Success over Time" (FIRST), the effects of PR on lung function in patients with COPD, under drug treatment with inhaled corticosteroids or long-acting beta 2-agonists and/or tiotropium in various combinations, according to guidelines, during a 3-year period. Design. Observational, prospective, with two parallel groups study. Setting. PR setting in an urban hospital. Population. Two hundred fifty-seven COPD patients, 190 (103 males, mean age 71.1 +/- 7.1 years range 57-86 years) underwent PR and 67 (49 males, mean age 67.9 +/- 7.9 years, range 58-79 years) were treated only with drugs. Methods. Lung function was measured at baseline and at one-year intervals up to 3 years. The postbronchodilator FEV1 was used for statistical analysis. Results. In the PR group, FEV1 increased from 1240 mL (57.3% of predicted value) to 1252.4 mL (60.8%) after 3 years, whereas in the controls the values were 1367 mL (55% of predicted) at baseline and 1150 mL (51%) after 3 years. This difference was statistically significant (P<0.001). Conclusion. In patients with COPD on standard pharmacotherapy, PR significantly affected the decline of FEV1 over time. Clinical Rehabilitation Impact. The ability to substantially stop the FEV1 decline seems exclusive of PR when added to drug treatment. This finding warrants confirmation from randomized trials.