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Pulmonary rehabilitation impact on COPD exacerbation unclear, important

Results from randomized controlled trials and cohort studies conflict on whether pulmonary rehabilitation reduces physician visits and hospitalizations for patients with acute exacerbations of chronic obstructive pulmonary disease; however, evidence shows that rehabilitation is beneficial overall, maintaining its importance. 

“Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may require admission to hospital which can put a heavy burden on health systems,” Elizabeth Moore, MSc, of the Department of Respiratory Epidemiology Occupational Medicine and Public Health at Imperial College of London, and colleagues wrote. “Pulmonary rehabilitation is an important intervention in the management of COPD. However, the evidence relating to whether it reduces emergency room (ER) visits and hospitalizations for AECOPD is [inconclusive].”

The researchers identified and reviewed cohort studies and randomized controlled trials that evaluated AECOPD–related hospitalizations to assess the effect of pulmonary rehabilitation on patients with AECOPD. Unscheduled hospitalizations and emergency room visits were used to measure outcomes.

A meta-analysis of 18 studies compared hospitalization rates before and after pulmonary rehabilitation between recipients and non-recipients.

Overall, within ten randomized controlled trials, patients in the pulmonary rehabilitation group were hospitalized less frequently (0.62 hospitalizations/patient-year, 95% CI 0.33-1.16) compared to patient in the control group (0.97 hospitalizations/patient-year, 95% CI 0.67-1.40).

Additionally, five studies indicated that admission rates were significantly higher 12 months before rehabilitation compared to 12 months after (1.24 hospitalizations/patient-year, 95% CI 0.66-2.3 vs. 0.47 hospitalizations/patient-year, 95% CI 0.28-0.79).

However, according to a pooled result of three cohort studies, the reference group had fewer admissions than the pulmonary rehabilitation group suggesting that rehabilitation may not reduce the risk for prospective hospitalizations for some patients (0.18 hospitalizations/patient-year, 95% CI 0.11-0.32 vs. 0.28 hospitalizations/patient-year, 95% CI 0.25-0.32).

“Due to the heterogeneous nature of the studies and methodological limitations, further research is needed, particularly in terms of detecting if admissions were specifically for AECOPD, and the subsequent cost savings for healthcare services,” Moore and colleagues concluded. “Given that all patients with moderate to severe COPD should be referred to pulmonary rehabilitation, and overall results from this systematic review suggest pulmonary rehabilitation has an impact on reducing hospitalizations, this work should help to convince potential patients and healthcare providers of its importance.” – by Alaina Tedesco

Disclosure: Please see full study for complete list of relevant financial disclosures.