OBJECTIVES: Few and contrastingly data are available about use of osteopathic manipulative treatment (OMT) in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Comparing the effects of the combination of pulmonary rehabilitation and OMT compared with pulmonary rehabilitation (PR) in patients with severely impaired COPD. SETTING: Rehabilitative pulmonary department. INTERVENTIONS: Patients underwent exercise training, OMT, educational support and nutritional and psychological counselling. MAIN OUTCOMES MEASURES: Exercise capacity through 6min walk test (6MWT -- primary outcome) and pulmonary function test (secondary outcomes) were evaluated at the beginning and at the end of the training. Patients were randomly assigned to receive PR+soft manipulation (G1) or OMT+PR (G2) for 5 days/week for 4 weeks. RESULTS: 20 stable COPD patients (5 female -- mean age 63.8 +/- 5.1 years; FEV1 26.9 +/- 6.3% of predicted) referred for in-patient pulmonary rehabilitation were evaluated. Respect to the baseline, 6 MWT statistically improved in both group. In particular, G2 group gained 72.5 +/- 7.5m (p = 0.01) and G1 group 23.7 +/- 9.7m. Between group comparison showed a difference of 48.8m (95% CI 17 to 80.6m, p = 0.04). Moreover, in G2 group we showed a decrease in residual volume (RV -- from 4.4 +/- 1.5l to 3.9 +/- 1.5l, p = 0.05). Between group comparison showed an important difference (-0.44l; 95% CI -0.26 to -0.62l, p = 0.001). Furthermore, only in G2 group we showed an increase in FEV1. CONCLUSIONS: This study suggests that OMT+PR may improve exercise capacity and reduce RV in severely impaired COPD patients with respect to PR alone.

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