Respiratory Biofeedback Training as an Adjunct Intervention in Pulmonary Rehabilitation for Late-Stage COPD: A Pilot Trial

Background: Chronic obstructive pulmonary disease (COPD) is associated with persistent dyspnea, reduced functional capacity, and significant cognitive and affective impairments. Pulmonary rehabilitation improves the physical and psychological condition , however residual symptoms often remain, especially in patients with advanced disease. Respiratory biofeedback training (RBT) may help modulate autonomic and emotional responses to dyspnea, offering a potential adjunctive intervention. Methods: This pilot study investigated the effects of RBT integrated into a standard program of pulmonary rehabilitation for hospitalized patients with very severe COPD (GOLD stage 4 and an mMRC dyspnea score of ≥3 despite maximal pharmacological therapy). Thirty patients were randomized to receive either standard pulmonary rehabilitation alone (control group) or in combination with daily RBT sessions for three weeks (biofeedback group). Pre- and post-treatment assessments included measures of dyspnea, functional performance, quality of life, cognitive function and mood. Data were analyzed using Bayesian repeated-measures ANOVA, and results were normalized using Minimal Clinically Important Differences (MCIDs). Results: Both groups showed significant improvements in respiratory and functional outcomes (e.g., mMRC, 6MWT), with no group differences. However, the biofeedback group demonstrated greater improvements in cognitive performance (MoCA) and depressive symptoms (HADS-D). Conclusions: While RBT did not enhance dyspnea or physical performance in patients receiving inpatient pulmonary rehabilitation, it was associated with significant gains in cognitive and emotional outcomes. These findings suggest that RBT may serve as a valuable neuropsychological adjunct in the management of late-stage COPD.