Introduction: Pulmonary rehabilitation (PR) is a key non-pharmacological intervention in chronic obstructive pulmonary disease (COPD), with well-established benefits on symptoms and functional capacity. However, evidence regarding its impact on exacerbation outcomes is limited. Materials and Methods: This study aimed to assess the impact of PR on symptoms, functional capacity, and exacerbation outcomes in COPD patients, and to identify predictors of post-rehabilitation exacerbations. We conducted a retrospective observational study including patients with COPD who completed a hospital-based pulmonary rehabilitation (PR) programme between 2021 and 2024. Demographic data, comorbidities, and lung function parameters (post-bronchodilator FEV1 and DLCO, % predicted) from the preceding year were collected. Symptoms (mMRC, CAT), functional capacity (6-minute walk test, 6MWT), and exacerbation frequency and severity were analysed for the 12 months before and after PR. Paired non-parametric tests were used for comparisons. Multivariate logistic regression and time-to-event analyses were performed to identify predictors of post-rehabilitation exacerbations. Results: Sixty-two PR programmes involving 60 patients were analysed (two patients completed the programme twice at different time points). Mean age was 69.0±7.2years; most patients were male (83.3%) and former smokers (76.7%). The majority were classified as GOLD E (51.6%), with a median FEV1 41.2% predicted and DLCO 53.3% predicted. Pulmonary rehabilitation was associated with significant improvements in mMRC and CAT scores (p<0.001). The median number of exacerbations decreased from 1 to 0 in the 12 months after rehabilitation, without statistical significance (p=0.097). Patients who achieved a clinically significant improvement in the 6MWT (51.6%) had a significantly longer time to first exacerbation after PR (p=0.040). Prior-year exacerbation frequency was the only independent predictor of post-rehabilitation exacerbations identified (OR 2.94, 95% CI 1.17–7.35; p=0.021). No predictors of delayed exacerbations were identified in time-to-event analysis. Conclusions: In this study, PR significantly improved symptom burden in COPD, while prior exacerbation history remained the main determinant of post-rehabilitation exacerbations.
Salgueira et al. (Wed,) studied this question.