Maintenance programme after COPD pulmonary rehabilitation (PR): Differences in long-term BODE index between responders and non-responders

Aim: To assess how BODE index change throughout the course of a maintenance period after PR, with regard to the response to the initial 8-wk outpatient programme. Methods: Data were analyzed from a multi-centric, prospective and randomized study on COPD PR in which after completion of the outpatient phase, patients were randomly assigned to a supervised (intervention group) versus non-supervised (control group) maintenance protocol. Conditions to be considered as a responder to initial PR were ΔBODE index > -1 point, but also ΔBODE ≤ -1 point, only if Δ6MWD (6min walking distance) was greater than 35m. Patients not fulfilling these conditions were considered as non-responders. In the present analysis, patients' BODE index was assessed, at months 12 & 24 during the follow-up. Results: 133 out of 143 patients completed the initial period [64 (9) years; BODE index 4.8 (1.6)]. Among them, 66.4% were responders. At 12-month, 98 patients continued in the study, and intriguingly, only non-responder patients in both intervention and control groups continued to improve, obtaining ΔBODE= -0.6 (1) and -0.1 (1.1) respectively, opposite responders, who obtained ΔBODE=0.4 (1) intervention and 0.35 (1.5) control patients. At the 24-month point, 75 patients still remained in the study and again, only non-responders in the intervention group improved BODE: -0.5 (1.3). Analysis of variance (ANOVA) showed no statistical differences between groups Conclusion: A majority of patients response to PR (BODE index), but in those initially non-responders, maximal improvements may take longer to be achieved, independently the maintenance program carried out.