Effectiveness of Pulmonary Rehabilitation in Reducing Health Resources Use in Chronic Obstructive Pulmonary Disease

Rubí M, Renom F, Ramis F, Medinas M, Centeno MJ, Górriz M, Crespí E, Martín B, Soriano JB. Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic obstructive pulmonary disease.ObjectiveTo determine the effectiveness of a multidisciplinary, outpatient pulmonary rehabilitation (PR) program in patients with severe and very severe chronic obstructive pulmonary disease (COPD). PR is recommended in advanced COPD, but there is limited evidence on the effectiveness of PR in reducing health care resources when applied in outpatients.DesignBefore and after intervention, a prospective research trial of patients enrolled in a PR program.SettingOutpatient respiratory department in a specialized hospital.ParticipantsWe considered prospectively 82 consecutive patients with advanced COPD and finally studied 72 patients who completed the PR intensive phase.InterventionPR program.Main Outcome MeasuresThe effectiveness of this PR program was assessed by comparing health resources use from the year before and the year after PR. Clinical variables including dyspnea; the body mass index, obstruction, dyspnea, exercise capacity (BODE) index; and the Chronic Respiratory Questionnaire and health resources use including the number of exacerbations, the number of hospitalizations, and days of hospitalization.ResultsPatients had a forced expiratory volume in the first second percentage predicted (mean ± SD) of 33.0±9.8 and a BODE index of 5.0±2.0. Significant improvements after PR were found in dyspnea, exercise capacity, and quality of life and on the BODE index (P<.05). Compared with the 12 months before PR, there were also significant reductions during the year after PR on exacerbations (3.4±3.5 vs 1.9±2.0, P=.002), hospitalizations (2.4±2.0 vs 0.9±1.2, P<.001), and days of hospitalization (36.1±32.7 vs 16.1±31.3, P<.001) (ie, a reduction of 44%, 63%, and 55%, respectively; all P<.05).ConclusionsWe conclude that a multidisciplinary, outpatient PR program substantially reduces health resources use in patients with severe and very severe COPD.