COPD

Pulmonary rehab benefits lost after 12 months


The benefits of pulmonary rehabilitation in COPD  are evident for 12 months then diminish to below pre-program levels, Queensland research shows.

Emergency department presentations and hospital lengths of stay for COPD were significantly reduced in 426 people who undertook an eight week pulmonary rehab course, an observational study conducted at the Prince Charles Hospital, Brisbane, found.

But the benefits, seen in patients with an average FEV1 of 49.3 % predicted at baseline, were seen only in the first 12 months after undergoing pulmonary rehab. In the subsequent 12-24 month period the rates of hospitalisation significantly increased above pre-program levels.

Published in the BMJ Open, the study showed that emergency department presentations/person/year decreased from a pre-program level of 1.15 to 0.9 in the first 12 months after pulmonary rehab (p=0.003); but increased in the 12–24 months period to 2.0 (p<0.001).

There was no significant decrease in respiratory admissions after pulmonary rehab but the hospital days/person/year decreased from 4.0 to 2.5 in the 12 months after pulmonary rehab (p<0.001), then increased in the 12–24 months period to 6.1 days, (p=0.004).

The researchers said the greatest benefit from pulmonary rehab was seen in patients who had at least one pre-program respiratory-related hospital admission.

In this group there was a 39% mean reduction in the number of respiratory-related hospitals admissions, a 50% decrease in days spent in hospital (50.5%) and a 33% decrease in the number of ED presentations during the first 12 months post program when compared with the preceding 12 months.

These improvements equated to 112 fewer respiratory-related hospital admissions, 864 fewer days spent in hospital and 119 fewer ED presentations for the group of 156 pulmonary rehabilitation participants.

The study investigators said their findings of a diminishing benefit in hospital utilisation after 12 months were similar to those seen for other COPD outcomes including improvements in exercise capacity, health-related quality of life and dyspnoea.

The diminishing effect was possibly due to disease progression, impacts from comorbidities and a decline in compliance with regular exercise and other health maintenance strategies, they suggested.

“Our finding supports the recent international statement that pulmonary rehabilitation may provide greater benefits in healthcare utilisation during the post-exacerbation period than for people with more stable disease,” they wrote.

“ A possible explanation for the greater benefit seen in this group is that they may be more deconditioned, and hence have more to gain from rehabilitation.

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