Respiratory Rehabilitation Benefits Patients With COPD and Suspected PH

Respiratory rehabilitation proved to significantly influence exercise tolerance in patients with pulmonary hypertension-associated chronic obstructive pulmonary disease (PH-COPD), according to a recent study published in Respiratory Medicine and Research.¹

Pulmonary hypertension (PH) is a frequent complication seen in patients with chronic obstructive pulmonary disease (COPD) that can vary in severity, with severe PH associated with recurring exacerbations and increased mortality. Although there is no cure for COPD, recommended treatments advise quitting smoking, using an inhaler, and pulmonary rehabilitation. Although researchers debate what should be included in the rehabilitation given the physical limitations patients with COPD often experience, this study found that patients with COPD, with and without PH, both benefited from respiratory rehabilitation (RR).^1,2 In patients with PH-COPD, respiratory rehabilitation is recommended to manage COPD symptoms rather than pulmonary hypertension itself. However, RR is also recommended for patients with stable pulmonary arterial hypertension (PAH) receiving optimized medical therapy. To further understand the impact of this treatment, researchers evaluated the effectiveness and tolerance of RR in patients with echocardiogram-suspected PH-COPD when compared with those with COPD and no suspected PH.¹

The retrospective, comparative observational study was conducted between 2013 and 2023 in the University Hospital of Poitiers in France and included adult patients diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease.

Echocardiography was used to assess the suspected PH diagnoses. Patients were included in the suspected PH-COPD (s-PH-COPD) if the echocardiography probability of PH was intermediate or high without signs of systolic or diastolic left ventricular failure, assessed by measuring systolic pulmonary artery pressure (sPAP). The primary end point was the effectiveness of RR assessed by the difference in the 6-minute walking distance (6MWD) test.

The RR course patients engaged in was a 3-week outpatient program spanning a median of 31 days and offered adapted physical activity, such as cycling or using a treadmill. One week of the course included interval training rotating through sessions of endurance, walking, ventilatory gymnastics, segmental gymnastics, and one monthly 5 to 10 km outdoor walk. Fifty-three patients completed the course.

Respiratory Rehabilitation Improves Exercise Capacity in COPD With and Without Suspected PH

There were 59 patients included in the study, 11 of whom were in the s-PH-COPD group and 48 in the COPD without PH group. The patient population was primarily male, with a median age of 65 years. All patients were either current or ex-smokers. Comorbidities among patients included obstructive sleep apnea, heart rhythm disorder, and depressive syndrome.

Baseline sPAP was significantly higher in the s-PH-COPD group when compared with the COPD without PH group. The median initial 6MWD was 380 m in the s-PH-COPD group when compared with the 431 m in the COPD without PH group.

At the end of the RR course, the 6MWD improved in both the s-PH–COPD group (75.5 m [−24 to 121], P = .04) and the COPD without PH group (33 m [6 to 63], P = .0001). The difference in 6MWD between the 2 groups was not significant.

“These findings are consistent with existing literature on the interest of RR in PAH and PH of other etiologies,” the study authors wrote.

The retrospective design and incomplete data, including the absence of VO₂ max and quality-of-life assessments, limited the analysis. Additionally, pulmonary hypertension was assessed by echocardiography rather than right heart catheterization, which may have led to misclassification and may limit the generalizability of the findings.

“These results highlight the need for prospective studies with larger sample sizes that include different PH-COPD phenotypes, randomization, and comprehensive evaluations—such as assessment of PH via right heart catheterization, when necessary; measurement of VO₂ max; and quality of life assessments,” the study authors concluded.

References

1. Giffa C, Beuvon SC, Croqette M, et al. Effectiveness and tolerance of respiratory rehabilitation in suspected pulmonary hypertension associated with chronic obstructive pulmonary disease. Respir Med Res. 2026;90. doi:10.1016/j.resmer.2026.101297

2. Arnold MT, Dolezal BA, Cooper CB. Pulmonary rehabilitation for chronic obstructive pulmonary disease: highly effective but often overlooked. Tuber Respir Dis. 2020;83(4):257-267. doi:10.4046/trd.2020.0064