呼吸操对慢阻肺患者肺功能影响的探讨

目的观察呼吸操对慢性阻塞性肺病（COPD）患者恢复期血气以及对肺功能和缺氧耐受性的影响。方法对符合慢性肺心病及缓解期诊断标准的患者50例,随机分成锻炼组25例和对照组25例,锻炼组进行呼吸操锻炼,对照组口服安慰剂。两组于开始前和1个月后分别进行血气,肺功能、行走距离和生存质量测定。结果锻炼组结束后各项指标的改善与锻炼前比较差异有显著性。而对照组各项指标服安慰剂前后无明显变化。结论呼吸操对缓解期慢性阻塞性肺病（COPD）患者动脉血气、肺功能、运动能力及生存质量等均有重要影响。     

呼吸肌康复训练改善COPD的肺功能和生活质量

目的观察呼吸肌康复训练对慢性阻塞性肺疾病(COPD)患者的肺功能和生活质量的影响。方法将92例老年COPD患者采用数字表法随机分成2组,康复组51例,对照组41例,康复组患者进行呼吸肌康复训练,并定期随访督导,对照组给予COPD常规的治疗方法。两组患者观察治疗前后用力肺活量(FVC)和第一秒用力肺活量(FEV1)占预计值的百分比,检测卧位时动脉血氧分压(PO2)和二氧化碳分压(PCO2)的变化。结果经呼吸肌康复训练组患者的肺功能及血气分析结果较对照组明显改善,差异有显著性意义(P<0.01)。结论老年COPD患者进行长期、有效、个体化的呼吸康复训练可改善病人的肺功能,可提高患者的生活质量。     

参苓白术散治疗慢性阻塞性肺病呼吸肌疲劳的临床观察

目的观察参苓白术散治疗慢性阻塞性肺病（COPD）呼吸肌疲劳患者的疗效。方法 78例COPD缓解期呼吸肌疲劳患者,随机分为观察组和对照组,对照组患者给予常规治疗,观察组加用中药参苓白术散口服治疗。比较两组患者呼吸衰竭的发生率及呼吸困难的缓解率,治疗前后动脉血气中的PaO2和PaCO2,肺功能中的FEV1占预计值的百分比和FEV1/FVC的变化等。结果观察组呼吸衰竭的发生率为30%,呼吸困难的缓解率70%,均高于对照组（P〈0.05）。观察组治疗后动脉血气中PaO2呈升高趋势,PaCO2呈下降趋势,肺功能中的FEV1占预计值的百分比和FEV1/FVC治疗后数值均明显高于对照组（P〈0.01）,两组有显著差异。结论应用参苓白术散治疗COPD患者呼吸肌疲劳是一种行之有效的中西医结合治疗方法,值得临床进一步推广。     

营养支持与呼吸操提高COPD患者生存质量的探讨

目的观察营养支持与呼吸操对慢性阻塞性肺疾病(COPD)患者缓解期呼吸肌和生存质量的影响。方法将40例COPD缓解期患者随机分为两组,对照组和观察组,给予营养支持同时行呼吸操训练,3个月后分别进行肺功能及生存质量评估。结果观察组较对照组在肺功能及活动耐力、心理状态、社会适应能力等方面均明显改善(P<0.01)。结论营养支持与呼吸操训练能提高老年COPD患者呼吸功能和生存质量     

COPD患者的上下肢及呼吸肌锻炼的疗效评价

目的 探讨以上下肢及呼吸肌锻炼为主的呼吸康复锻炼对COPD稳定期患者的疗效.方法 随机选择处于稳定期的COPD患者80例,随机的分为肺康复组（n=40）与对照组（n=40）.对照组患者门诊行取药治疗,肺康复组在对照组治疗基础上采取上、下肢及呼吸肌锻炼.治疗8周后对两组肺功能进行评价.结果 治疗后,肺康复组肺功能和血气较对照组明显改善（P〈0.05）.结论 上、下肢及呼吸肌的康复锻炼可以明显改善COPD患者的肺功能,提高患者的生存质量,且不需要任何经济费用.     

长期家庭无创正压通气治疗稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床效果研究

目的 探讨家庭无创正压通气（NPPV）治疗稳定期慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的临床效果.方法 将2009年5月-2010年5月我院治疗的50例处于稳定期的COPD合并Ⅱ型呼吸衰竭患者随机分为治疗组和对照组,各25例.治疗组患者接受常规治疗＋ 家庭NPPV治疗,对照组患者接受常规治疗＋家庭氧疗治疗.出院后随访2年,比较两组出院时、出院2年后6 min行走距离、动脉血气分析、肺功能、辅助呼吸肌评分、生活质量、2年内再次住院次数及不良反应.结果 两组患者出院时6 min行走距离、用力肺活量（FVC）、1秒用力呼气末容积（FEV1）、PaCO2、PaO2、辅助呼吸肌评分及圣·乔治呼吸问卷（SGRQ）评分比较,差异均无统计学意义（P＞0.05）;出院2年后治疗组6 min行走距离、FVC、FEV1及PaO2高于对照组（P＜0.05）,PaCO2、辅助呼吸肌评分、SGRQ评分及再次住院次数低于对照组（P＜0.05）.结论 长期家庭NPPV治疗稳定期COPD合并Ⅱ型呼吸衰竭疗效肯定,能改善患者呼吸肌力恢复和收缩功能、纠正缺氧和高碳酸血症、延缓肺功能衰竭、提高患者生活质量.     

综合康复训练对慢性阻塞性肺部疾病患者生活质量的影响

目的探讨综合康复训练对慢性阻塞性肺部疾病（COPD）患者生活质量的影响。方法将72例COPD患者随机分为观察组和对照组各36例,对照组给予常规治疗和护理,同时进行呼吸训练。观察组在此基础上,给予腹式缩唇呼吸训练、全身性呼吸体操训练、耐力运动锻炼综合性康复训练。于干预前后评价两组的自觉症状、肺功能指标、生活质量。结果观察组自觉症状、肺功能指标、生活质量明显优于对照组。结论综合康复训练可改善肺功能,提高患者的生活质量。     

肺康复治疗对稳定期COPD患者肺功能及血气分析的影响

目的探讨肺康复治疗对稳定期慢性阻塞性肺疾病（COPD）患者肺功能及血气分析的影响。方法将80例稳定期COPD患者随机分为肺康复组（n=40）与对照组（n=40）,肺康复组给予体能锻炼、呼吸肌锻炼、氧疗、心理与行为干预等肺康复治疗措施,治疗6～8周,治疗前后测定肺功能及血气分析,比较两组患者肺功能及血气分析的变化。结果观察组治疗后肺功能、血气分析较治疗前及对照组治疗后均显著改善（P〈0．01）。结论肺康复治疗可提高稳定期COPD患者肺功能及血气分析,从而提高患者的生存质量。     

无创通气联合噻托溴铵在老年COPD伴Ⅱ型呼吸衰竭的临床应用

目的评价无创通气联合噻托溴铵在COPD伴Ⅱ型呼吸衰竭的临床疗效。方法将126例老年COPD合并Ⅱ型呼吸衰竭患者随机分入对照组与观察组,对照组患者接受常规治疗,观察组患者在常规治疗基础上给予无创通气联合噻托溴铵吸入,疗程4周。比较两组治疗后4周血气分析指标及肺功能的改变。结果治疗后4周观察组血气分析指标PaO2、PaCO2及pH值均显著优于对照组,差别具有统计学意义（P〈0.05）;与对照组相比,治疗后观察组肺功能指标FEV1、FVC和FEV1/FVC显著提高（P〈0.05）。结论无创通气联合噻托溴铵治疗老年COPD合并Ⅱ型呼吸衰竭可显著改善血气分析指标及肺功能,提高生活质量。     

呼吸操在重度慢性阻塞性肺疾病患者呼吸肌力量训练中的作用研究

目的观察中医养生呼吸训练操结合氧疗方法对重度慢性阻塞性肺疾病（COPD）稳定期患者康复治疗的作用。方法重度COPD男性病人39例中20例为对照组,采用单纯鼻导管吸氧,另19例为实验组,鼻导管吸氧结合呼吸操训练,治疗前以及六个月治疗后分别检测运动能力、血气分析、肺功能和呼吸肌力指标。结果六个月治疗后,鼻导管吸氧结合呼吸操训练组的各项指标均优于对照组（P〈0．05）。结论鼻导管结合呼吸操训练可有效提高慢性阻塞性肺疾病患者的呼吸肌的强度和耐力,增加肺活量,促进有效气体交换。     

家庭无创正压机械通气联合康复锻炼对慢性阻塞性肺疾病患者呼吸肌肌力的影响

目的评估家庭无创正压机械通气联合康复锻炼对稳定期重度慢性阻塞性肺疾病（COPD）患者呼吸肌肌力的影响。方法将56例经住院治疗处于稳定期的重度COPD患者分为无创呼吸机＋呼吸操组（治疗组,n=26）和无创呼吸机组（对照组,n=30）。分别观察治疗前、治疗后2年两组患者的最大吸气压（MIP）、跨膈压（Pdi）、最大跨膈压（Pdimax）及Pdi/Pdimax、CO_2分压（PaCO_2）、肺功能、6min行走距离（6MWD）、病死率及再住院率等指标。结果两组年龄、性别、COPD病程、体质量指数、PaCO_2、PaO_2、MIP、Pdi、Pdimax及Pdi/Pdimax、第一秒用力呼气容积实测值与预计值的比值（FEV_1%）、第一秒用力呼气容积占用力肺活量比值（FEV_1/FVC%）、6MWD和每年住院次数均具有可比性（均P〉0.05）。2的年后治疗组MIP,Pdi,Pdimax及Pdi/Pdimax,6MWD,每年住院次数分别为（76±6）cmH_2O,（48±5）cmH_2O,（126±11）cmH_2O,（0.38±0.01）,（263±33）m和（2.1±0.9）次/年,与对照组[（72±5）cmH_2O,（45±4）cmH_2O,（116±8）cmH_2O,（0.39±0.02）,（244±26）m,（2.6±0.9）次/年]比较均具有统计学意义（均P〈0.05）。治疗组死亡1例（1/26）,对照组2例（2/30）,两组比较差异无统计学意义（χ~2=0.02,P〉0.05）。结论长期家庭无创正压机械通气联合呼吸操康复锻炼治疗可以有效提高稳定期重度COPD患者呼吸肌肌力及呼吸肌耐力,改善运动功能,从而达到更好的长期治疗效果。     

肺康复对稳定期慢性阻塞性肺疾病的疗效分析

目的探讨肺康复锻炼对稳定期慢性阻塞性肺疾病患者的临床疗效及意义。方法 300例稳定期慢阻肺患者,采用前瞻性随机对照法分为两组:康复组(n=149)给予门诊慢阻肺健康宣教,包括饮食干预,戒烟教育,用药指导;肺康复锻炼(呼吸运动训练联合步行运动训练)。对照组(n=151)仅给予门诊慢阻肺健康宣教。比较6个月后两组患者的血气分析、肺功能、6MWD(6分钟步行距离)及慢阻肺急性加重期住院的次数等。结果 6个月后共234例完成试验,康复组(n=121)较对照组(n=113)的6MWD,血气分析等指标有明显改善,具有统计学意义(P0.05),而两组间肺功能FEV_1/FVC、FEV_1%和慢阻肺急性加重期住院的次数无统计差异(P0.05)。结论肺康复锻炼(呼吸运动训练联合步行运动训练)能有效提高PaO_2及降低PaCO_2,提高6MWD,适度改善运动耐力,是一种简便易行的康复锻炼方法,值得临床应用及推广。     

Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial

PURPOSE: Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease (COPD) in the short term, but their long-term effects are not known. We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD. SUBJECTS AND METHODS: One hundred patients were randomly assigned to receive either an exercise training program that included cycling, walking, and strength training (n = 50) or usual medical care (n = 50). Thirty-four patients in the training group were evaluated after 6 months (end of training), and 26 were evaluated after 18 months of follow-up. In the control group, 28 patients were evaluated at 6 months and 23 after 18 months. We measured pulmonary function, 6-minute walking distance, maximal exercise capacity, peripheral and respiratory muscle strength, and quality of life (on a 20 to 140-point scale), and estimated the cost-effectiveness of the program. RESULTS: At 6 months, the training group showed improvement in 6-minute walking distance [mean difference (training - control) of 52 m; 95% confidence interval (CI), 15 to 89 m], maximal work load (12 W; 95% CI, 6 to 19 W), maximal oxygen uptake (0.26 liters/min; 95% CI, 0.07 to 0.45 liters/min), quadriceps force (18 Nm; 95% CI, 7 to 29 Nm), inspiratory muscle force (11 cm H(2)O; 95% CI, 3 to 20 cm H(2)O), and quality of life (14 points; 95% CI, 6 to 21 points; all P <0.05). At 18 months all these differences persisted (P <0.05), except for inspiratory muscle strength. For 6-minute walking distance and quality of life, the differences between the training group and controls at 18 months exceeded the minimal clinically-important difference. CONCLUSION: Among patients who completed the 6-month program, outpatient training resulted in significant and clinically relevant changes in 6-minute walking distance, maximal exercise performance, peripheral and respiratory muscle strength, and quality of life. Most of these effects persisted 18 months after starting the program.     

Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation

BACKGROUND: Respiratory muscle endurance training (hyperpnea training) has been shown to have beneficial effects in patients with COPD. STUDY OBJECTIVES: The purpose of this study was to determine whether hyperpnea training, when added to an endurance exercise training program, would lead to additional benefits compared with endurance training alone in patients with COPD. SETTING AND PARTICIPANTS: Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program. Fifteen patients (mean [+/- SE] FEV1, 45 +/- 6% predicted) were randomized to combined therapy, and 14 patients (mean FEV1, 44 +/- 4% predicted) were randomized to endurance training. METHODS: Peak exercise capacity, exercise endurance time during constant workload cycle exercise, 6-min walk distance, quality of life as measured by the chronic respiratory questionnaire, respiratory muscle strength and endurance, and quadriceps fatigability were measured before and after endurance or combined training. RESULTS: After rehabilitation, peak exercise capacity, exercise endurance time, 6-min walk distance, and quality of life all increased in both groups, but there was no significant difference in the extent of improvement between groups. Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group (17.5 +/- 2.7 vs 8.5 +/- 2.5 min, respectively; p = 0.02). Respiratory muscle strength was significantly increased, and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group, but the difference between groups did not reach statistical significance. CONCLUSION: The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD. However, this improvement did not translate into additional improvement in quality of life or exercise performance.     

Inspiratory muscle training in patients with chronic obstructive pulmonary disease

To investigate the effects of inspiratory muscle resistive loading training (IMT) on exercise performance in chronic obstructive pulmonary disease (COPD), 13 patients undergoing standard pulmonary rehabilitation were divided into control (n = 6) and experimental (n = 7) groups. Prior to training, we measured inspiratory muscle strength and endurance, resting pulmonary function, and exercise performance on a bicycle ergometer (a progressive test and an endurance test at two thirds of maximal work load). We then determined their resistive loads for training by measuring their 10-min maximal sustainable resistance. Training by patients in the experimental group involved inspiring against a predetermined resistive load. The control subjects breathed through a sham training tube, so that studies were performed in double-blind fashion. The training consisted of 15-min sessions twice daily for 4 wk. The IMT dramatically improved inspiratory muscle endurance--represented as either sustainable inspiratory pressure (SIP) or endurance time at 60% of maximal inspiratory mouth pressure (Pimmax) at functional residual capacity. The SIP of the trained group increased from 29 +/- 11 to 46 +/- 11% of Pimmax (p less than 0.005). Training slightly increased inspiratory muscle strength (p less than 0.05), as determined by Pimmax. In contrast, resting pulmonary function and performance of both progressive and constant-load exercise remained unchanged. We conclude that 4-wk IMT in a pulmonary rehabilitation setting improves inspiratory muscle endurance in patients with COPD without changing pulmonary function or exercise performance.     

Effects of isolated cycle ergometer training on patients with moderate-to-severe chronic obstructive pulmonary disease

BACKGROUND: Pulmonary rehabilitation (PR) programs are beneficial to patients with chronic obstructive pulmonary disease (COPD), and lower-extremity training is considered a fundamental component of PR. Nevertheless, the isolated effects of each PR component are not well established. OBJECTIVE: We aimed to evaluate the effects of a cycle ergometry exercise protocol as the only intervention in a group of COPD patients, and to compare these results with a control group. METHODS: 25 moderate-to-severe COPD patients were evaluated regarding pulmonary function, respiratory muscle strength, exercise capacity, quality of life and body composition. Patients were allocated to one of two groups: (a) the trained group (TG; n = 13; 6 men) was submitted to a protocol of 24 exercise sessions on a cycle ergometer, with training intensity initially set at a heart rate (HR) close to 80% of maximal HR achieved in a maximal test, and load increase based on dyspnea scores, and (b) the control group (CG; n = 12; 6 men) with no intervention during the protocol period. RESULTS: TG showed within-group significant improvements in endurance cycling time, 6-min walking distance test, maximal inspiratory pressure and in the domain 'dyspnea' related to quality of life. Despite the within-group changes, no between-group significant differences were observed. CONCLUSION: In COPD patients, the results of isolated low-to-moderate intensity cycle ergometer training are not comparable to effects of multimodality and high-intensity training programs.     

Respiratory muscle endurance training in chronic obstructive pulmonary disease: impact on exercise capacity, dyspnea, and quality of life

Inspiratory muscle training may have beneficial effects in certain patients with chronic obstructive pulmonary disease (COPD). Because of the lack of a home training device, normocapnic hyperpnea has rarely been used as a training mode for patients with COPD, and is generally considered unsuitable to large-scale application. To study the effects of hyperpnea training, we randomized 30 patients with COPD and ventilatory limitation to respiratory muscle training (RMT; n = 15) with a new portable device or to breathing exercises with an incentive spirometer (controls; n = 15). Both groups trained twice daily for 15 min for 5 d per week for 8 wk. Training-induced changes were significantly greater in the RMT than in the control group for the following variables: respiratory muscle endurance measured through sustained ventilation (+825 +/- 170 s [mean +/- SEM] versus -27 +/- 61 s, p < 0.001), inspiratory muscle endurance measured through incremental inspiratory threshold loading (+58 +/- 10 g versus +21.7 +/- 9.5 g, p = 0.016), maximal expiratory pressure (+20 +/- 7 cm H(2)O versus -6 +/- 6 cm H(2)O, p = 0.009), 6-min walking distance (+58 +/- 11 m versus +11 +/- 11 m, p = 0.002), V O(2peak) (+2.5 +/- 0.6 ml/kg/min versus -0.3 +/- 0.9 ml/kg/min, p = 0.015), and the SF-12 physical component score (+9.9 +/- 2.7 versus +1.8 +/- 2.4, p = 0.03). Changes in dyspnea, maximal inspiratory pressure, treadmill endurance, and the SF-12 mental component score did not differ significantly between the RMT and control groups. In conclusion, home-based respiratory muscle endurance training with the new device used in this study is feasible and has beneficial effects in subjects with COPD and ventilatory limitation.     

Rehabilitation for patients with chronic obstructive pulmonary disease

OBJECTIVE: To develop a meta-analysis to determine the effectiveness of rehabilitation in patients with chronic obstructive pulmonary disease (COPD). DATA SOURCES: medline, cinhal, and Cochrane Library searches for trials of rehabilitation for COPD patients. Abstracts presented at national meetings and the reference lists of pertinent articles were reviewed. STUDY SELECTION: Studies were included if: trials were randomized; patients were symptomatic with forced expiratory volume in one second (FEV1) <70% or FEV1 divided by forced vital capacity (FEV1/FVC) <70% predicted; rehabilitation group received at least 4 weeks of rehabilitation; control group received no rehabilitation; and outcome measures included exercise capacity or shortness of breath. We identified 69 trials, of which 20 trials were included in the final analysis. DATA EXTRACTION: Effect of rehabilitation was calculated as the standardized effect size (ES) using random effects estimation techniques. RESULTS: The rehabilitation groups of 20 trials (979 patients) did significantly better than control groups on walking test (ES = 0.71; 95% confidence interval [95% CI], 0.43 to 0.99). The rehabilitation groups of 12 trials (723 patients) that used the Chronic Respiratory Disease Questionnaire had less shortness of breath than did the control groups (ES = 0.62; 95% CI, 0.35 to 0.89). Trials that used respiratory muscle training only showed no significant difference between rehabilitation and control groups, whereas trials that used at least lower-extremity training showed that rehabilitation groups did significantly better than control groups on walking test and shortness of breath. Trials that included severe COPD patients showed that rehabilitation groups did significantly better than control groups only when the rehabilitation programs were 6 months or longer. Trials that included mild/moderate COPD patients showed that rehabilitation groups did significantly better than control groups with both short- and long-term rehabilitation programs. CONCLUSION: COPD patients who receive rehabilitation have a better exercise capacity and they experience less shortness of breath than patients who do not receive rehabilitation. COPD patients may benefit from rehabilitation programs that include at least lower-extremity training. Patients with mild/moderate COPD benefit from short- and long-term rehabilitation, whereas patients with severe COPD may benefit from rehabilitation programs of at least 6 months.     

Cognitive training is ineffective in hypoxemic COPD: a six-month randomized controlled trial

Cognitive impairment is highly prevalent in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxemia, but the effect of cognitive training in patients with COPD has not been studied. The aim of the present study was to verify whether cognitive training can preserve cognitive abilities of patients with hypoxemic COPD. Our series consisted of 105 COPD patients with at rest (n = 36) or effort (n = 69) hypoxemia and free from concurrent dementing diseases. Neuropsychologic assessment included a screening test, the Mini Mental State Examination (MMSE), and a standardized confirmatory battery of neuropsychological tests, the Mental Deterioration Battery (MDB). After baseline assessment, patients were randomized to receive standardized multidimensional care (standardization of pharmacological therapy, health education, selection of inhalers according to patient's ability, respiratory rehabilitation, nutritional counseling, oxygen therapy, and control visits) with (n = 53) or without (n = 52) cognitive training aimed at stimulating attention, learning, and logical-deductive thinking. Cognitive performance was reassessed after 1.5, 4, and 6 months. The analysis of variance for repeated measures (ANOVA) having the group membership (study vs. control) as grouping factor was used to assess changes in cognitive performance. Both intervention and control groups showed no significant changes in cognitive performance except for a trend toward improvement in verbal fluency and verbal memory, but cognitive intervention had no significant effect. In conclusion, cognitive training seems ineffective in COPD. However, a multidimensional standardized therapeutic approach, as it was indistinctly provided to all patients, could help to slow or prevent cognitive decline.     

Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients

PURPOSE: Pulmonary rehabilitation is essential for managing chronic obstructive pulmonary disease (COPD). Housebound COPD patients are frequently excluded from this treatment because they are unable to access outpatient pulmonary rehabilitation programs because of the severity of their disease. This randomized controlled trial assesses the effects of a 12-week home-based pulmonary rehabilitation program for 60 housebound COPD patients older than 60 years. METHODS: Intervention patients received an individually tailored supervised walking and arm exercise program as well as individual multidisciplinary education sessions on COPD and its management. Outcomes were assessed using the 6-minute walk test, St George's respiratory questionnaire, and Borg score of perceived breathlessness. Healthcare utilization was assessed using hospital admission rates with exacerbation of COPD and average length of stay at readmission. RESULTS: Complete data for 23 patients in each group were available for analysis. There was no significant difference between groups on baseline measures. Compared with the control group, intervention patients demonstrated a significant improvement in 6-minute walk test (P = .023), Borg score of perceived breathlessness (P = .024), St George's respiratory questionnaire total score (P = .020), and impact subscore (P = .024). At 6 months, the intervention group had a significantly shorter average length of stay at readmission to hospital with exacerbation (P = .035). CONCLUSION: A 12-week home-based pulmonary rehabilitation is effective in improving exercise tolerance, perception of breathlessness, and quality of life for housebound COPD patients. To manage COPD in the community more effectively, health services should focus on expanding home-based pulmonary rehabilitation.