A recent study found that early use of a pulmonary rehabilitation program improved several measures of pulmonary function in patients with comorbid asthma, chronic obstructive pulmonary disease (COPD), and obesity.
A study published in the Journal of Medicine and Life found that patients with asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) and obesity saw improvements after a short-term pulmonary rehabilitation (PR) program.
A total of 40 patients with ACO, with a mean (SD) age of 64.86 (9.81) years, participated in this study. The 40 participants were divided into 3 groups: normal body mass index (BMI), overweight, and obese. Patients in all 3 groups were also subdivided into the PR group, which had 7 patients from each group. The effectiveness of PR was compared with the control group.
The study was conducted from October 15, 2018, to February 10, 2020. All patients included were previously prescribed long-acting bronchodilators with inhaled corticosteroids (ICS). Patients were excluded if they had clinically significant orthopedic or cognitive impairment, previous history of thoracic surgical intervention, myocardial infarction, unstable cardiovascular disease, a BMI less than 18.5, or severe renal impairment.
All patients were interviewed with a series of questionnaires, including the COPD Assessment Test (CAT), the Asthma Control Test (ACT), and the modified Medical Research Council dyspnea scale (mMRC). The BODE (body mass index, forced expiratory volume in 1 second, dyspnea, and 6-minute walking test) index was used to evaluate the effectiveness of PR.
At baseline the forced expiratory volume in 1 second (FEV1) was lower in patients with normal BMI but the difference was not significant. Patients in the overweight group had better dyspnea status than patients in the obese and normal BMI groups. ACQ-5 score was higher in patients with obesity and patients’ exercise capacity was lower in the obese group. The BODE index was not significantly different among the groups.
After 6 months of PR, the BODE index decreased in each group but was significantly lower in patients in the overweight group (decrease of 43.6% compared with baseline and 40.7% lower than control group). Dyspnea mMRC scale scores decreased by 39.5% in the obese group and 45% in the overweight group. The 6-minute walking test scores significantly increased in all groups.
Total CAT scores also decreased by 25.4% and 31.2% in the obese and overweight groups, respectively. BMI decreased in the obese group by 9.4% compared with baseline. Body fat percentage and visceral fat level decreased by 13.6% and 19.7%, respectively, in patients in the obese group. FEV1 increased slightly after the PR program (5.1%, overweight; 6.1%, obese; 4.2%, normal BMI).
There were some limitations to this study. There were a small number of participants in this study, which did not allow the researchers to assess the optimal duration of the PR program.
The researchers concluded that the PR program significantly improves functional capability and BODE index, which can lead to dyspnea and CAT score reduction and improvement in pulmonary function. This improvement in pulmonary function can, in turn, help cause a decrease in BMI, body fat percentage, and visceral fat level and an increase in muscle mass in overweight and obese patients with ACO.
Huivaniuk O, Stupnytska H, Oleksandr F, Bocharov A. The effectiveness of short-term pulmonary rehabilitation program in patients with comorbid asthma, chronic obstructive pulmonary disease and obesity. J Med Life. 2022;15(2):196-201. doi:10.25122/jml-2021-0050