Effect of early pulmonary rehabilitation on health care utilization and health status in patients hospitalized with acute exacerbations of COPD

Background and objective: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) incur heavy utilization of health-care resources for patients who require hospitalization. We evaluated whether an early outpatient pulmonary rehabilitation programme (PRP) after hospitalization for AECOPD could reduce acute health-care utilization over the succeeding year. Methods: Sixty patients admitted with AECOPD were randomized to either PRP or usual care (UC). The PRP group received 8 weeks of outpatient rehabilitation programme 2-3 weeks after discharge from hospital. Lung function, 6 min walk test and dyspnoea score were assessed at baseline, 3, 6, 9 and 12 months, while St George's respiratory questionnaire and cardiopulmonary exercise test were assessed at baseline, 3, 6 and 12 months. Results: The PRP and UC groups demonstrated a 53.3% and 43.3% risk of readmissions at 12 months (incident risk ratio 0.97 (95% CI: 0.57-1.60), P = 0.90). The mean readmission rates were 1.00 +/- 1.20 and 1.03 +/- 1.87 (P = 0.47) for the PRP versus UC groups respectively. The rates of AECOPD and emergency department visits were similar between the two groups. The St George's respiratory questionnaire total score was lower in the PRP group (40.15 +/- 19.10 vs 46.91 +/- 18.21, P = 0.01 and 42.3 +/- 20.06 vs 51.44 +/- 18.98 P = 0.01 at 3 and 6 months respectively). There were no statistically significant differences in the FEV1% predicted, dyspnoea score, 6 min walk test and maximal oxygen consumption during exercise test between PRP and UC at different time points. Conclusions: An early rehabilitation programme following AECOPD led to improvement in quality of life up to 6 months, but did not reduce health-care utilization at 1 year.