BACKGROUND: Pulmonary rehabilitation for moderate chronic obstructive pulmonary disease in primary care could improve patients' quality of life. METHODS: This study aimed to assess the efficacy of a 3-month pulmonary rehabilitation (PR) program with a further 9 months of maintenance (RHBM group) compared with both PR for 3 months without further maintenance (RHB group) and usual care in improving the quality of life of patients with moderate COPD. We conducted a parallel-group, randomized clinical trial in Majorca primary health care in which 97 patients with moderate COPD were assigned to the 3 groups. Health outcomes were quality of life, exercise capacity, pulmonary function and exacerbations. RESULTS: We found statistically and clinically significant differences in the three groups at 3 months in the emotion dimension (0.53, 95%CI 0.06 to 1.01 in the usual care group; 0.72, 95%CI 0.26 to 1.18 the RHB group; 0.87, 95%CI 0.44 to 1.30 and the RHBM group) as well as in fatigue (0.47, 95%CI 0.17 to 0.78) in the RHBM group. After 1 year, these differences favored the long-term rehabilitation group in the domains of fatigue (0.56, 95%CI 0.22 to 0.91), mastery (0.79, 95%CI 0.03 to 1.55) and emotion (0.75, 95%CI 0.17 to 1.33). Between-group analysis only showed statistically and clinically significant differences between the RHB group and control group in the dyspnea dimension (0.79, 95%CI 0.05 to 1.52). No differences were found for exacerbations, pulmonary function or exercise capacity. CONCLUSIONS: We found that patients with moderate COPD and low level of impairment did not show meaningful changes in QoL, exercise tolerance, pulmonary function or exacerbation after a one-year, community based rehabilitation program. However, long-term improvements in the emotional, fatigue and mastery dimensions (within intervention groups) were identified. TRIAL REGISTRATION: ISRCTN94514482.

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