It is not clear whether the benefits of pulmonary rehabilitation (PR) apply equally to patients with Chronic Obstructive Pulmonary Disease (COPD) with different levels of starting disability. We have therefore investigated the effect of pulmonary rehabilitation stratified by the MRC dyspnoea scale in patients with COPD. This is a retrospective, observational study of data collected from 450 consecutive patients with COPD attending outpatient PR: 247 male, mean (SD) age 69.5 (8.9) yrs and FEV(1) 44.6 (19.7)% predicted. The Incremental Shuttle Walk Test (ISWT) was performed before and after the seven-week course. 395 patients (88%) completed the programme. The mean (SD) baseline ISWT performance was 167 (113)m. The distribution of baseline MRC grades was 2 – 15.4%, 3 – 24.9%, 4 – 27.3% and 5 – 32.4%. The mean (95% CI) improvement in ISWT after PR for each MRC scale grade was highly significant (p<0.0005); 2 – 66 (50-83)m, 3 – 63 (50-75)m, 4 – 59 (49-70)m, and 5 – 54 (43-64)m.
Patients with COPD, of all MRC dyspnoea grades, benefit comparably from pulmonary rehabilitation achieving both statistically and clinically meaningful improvements in exercise performance. MRC grade should therefore not be used to exclude patients from pulmonary rehabilitation.