Combined pulmonary fibrosis and emphysema: effect of pulmonary rehabilitation in comparison with chronic obstructive pulmonary disease

Objective: To evaluate the effectiveness of short-term comprehensive inpatient pulmonary rehabilitation for patients with combined pulmonary fibrosis and emphysema (CPFE), and to compare responses with those of patients with chronic obstructive pulmonary disease (COPD) who underwent an identical programme. Design: Retrospective analysis of several outcome measures. Setting: Pulmonary ward at a 358-bed community teaching hospital. Methods: 3-week inpatient pulmonary rehabilitation programme assessed by pulmonary function tests, 6 min walk test and health-related quality of life (HRQL) using the Short Form-36 (SF-36). Results: 17 patients with CPFE and 49 patients with COPD were referred to and completed the programme between March 2007 and February 2015. Age, sex, smoking status, body mass index and the Medical Research Council dyspnoea grade were comparable between groups. In the CPFE group, improvement from the start of the programme to the programme end was observed in forced expiratory volume in 1 s (FEV1) (from 1.7 +/- 0.4 to 1.8 +/- 0.4, p=0.034); however, there was no significant improvement in the 6 min walk test (distance, SpO(2) nadir and Borg scale on exercise). With regard to HRQL, improvement was observed in physical function (p=0.015) whereas deterioration was observed in social functioning (p=0.044). In the COPD group, significant improvement was observed after the programme in the FEV1, 6 min walk test and 4 of the 8 SF-36 subscales. There was a significant difference in changes in the 6 min walk distance: -16.6 +/- 58.4 in CPFE versus 30.2 +/- 55.6 in COPD (p=0.009). In 2 domains, there was a significant difference in SF-36 scores between groups: Delta vitality, -6.3 +/- 22.4 in CPFE versus 11.3 +/- 21.1 in COPD, p=0.009; and Delta social functioning, -18.8 +/- 34.2 in CPFE versus 5.3 +/- 35.9 in COPD, p=0.027. Conclusion: Patients with COPD derived greater benefits than those with CPFE, from the relatively short periods of inpatient pulmonary rehabilitation.