Presence of extra-pulmonary treatable traits in people with COPD increases the likelihood of responding to pulmonary rehabilitation

Abstract

Introduction: Evidence suggests that people with chronic obstructive pulmonary disease (COPD) who have worse clinical status (e.g., higher symptom burden) at baseline respond better to pulmonary rehabilitation. Identification of treatable traits in this population might help to better distinguish responders from non-responders, which could aid optimisation of the intervention in the future. This study aimed to explore the impact of pulmonary rehabilitation on extra-pulmonary traits of people with COPD and whether the presence of these treatable traits at baseline influences the type of response (responder or non-responder) to pulmonary rehabilitation. Methods: An observational retrospective study was conducted. A comprehensive extra-pulmonary treatable traits’ assessment including symptoms (dyspnoea, fatigue, anxiety, and depression), functional status, balance, impact of the disease and healthrelated quality of life, was conducted before and after a 12-week com-munity-based pulmonary rehabilitation programme. Pre-post differences between people with or without each TT were compared with independent samples t-tests or Mann-Whitney U tests. The proportion of responders between groups (with or without treatable traits) were explored with chi-square tests and odds ratio. Results: A total of 102 people with COPD (70 [65; 75] years old, 78% male, FEV1 47 [36; 60]% predicted) were included. People with COPD had a median [min-max] of 3 [0-7] treatable traits per person and each responded on average to 5 [0-9] outcomes of pulmonary rehabilitation. People with identified treatable traits at baseline were more responsive than those without them in all outcomes (p < 0.05) except for the 1-minute sit-to-stand test. The presence of treatable traits increased the likelihood of being a good responder in all outcomes (OR: 1.72-19.95) except for the 1-minute sit-to-stand test (p = 0.175).Conclusions: Identification of extra-pulmonary treatable traits in people with COPD showed potential to inform on pulmonary rehabilitation responsiveness and might therefore be an important strategy for patient selection, treatment personalisation and optimisation.