Pulmonary rehabilitation (PR) is critical in treating chronic obstructive pulmonary disease (COPD). COPD patients’ significant clinical heterogeneity may alter their response to PR. Identifying homogenous groups of patients who may or may not react to PR is critical to customizing patient management. For a study, researchers sought to identify unique clinical profiles of COPD patients and measure their 6-min walking distance (6MWD) response to in-patient PR.

It was a cohort study of COPD patients admitted to a rehabilitation clinic between January 2012 and December 2017. Pre-PR patients’ features, lung function, and 6-min walking test parameters were included in a hierarchical ascending clustering technique to find unique groups. 

About 4 different clusters were discovered among 835 patients. Cluster 1 (younger males, GOLD I-II, average walkers, obese; non-response rate: 16%), Cluster 2 (older women, GOLD II-III, slow walkers; 18%), and Cluster 3 were the most likely to exhibit clinically meaningful 6MWD improvement post-PR (responders) (older men, GOLD II-III, dyspneic, slow walkers; 11%). Cluster 4 was the most likely non-responder (older men, GOLD III-IV, dyspneic, very slow walkers, oxygen-dependent; 26%).

In terms of their 6MWD response to PR, the data revealed homogenous patient clusters reflecting clinically important subgroups of COPD patients. Clusters with the highest likelihood of being non-responders were older, more severe, had severe oxygen desaturation and dyspnea, had restricted 6MWD, and required long-term oxygen treatment. These findings may improve patient phenotyping in clinical practice and enable therapeutic individualization.

Reference: resmedjournal.com/article/S0954-6111(22)00126-3/fulltext

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