Long-term pulmonary rehabilitation progressively reduces hospitalizations and mortality in patients with severe COPD: a 5-year follow-up

BACKGROUND: Pulmonary rehabilitation (PR) is recognized as a multidisciplinary intervention designed to reduce symptoms, improve functional status, and prevent acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). AIM: This study was aimed at evaluating the effects of a long-term PR program on the hospitalization rate and mortality of patients with severe and very severe COPD. DESIGN: Longitudinal, prospective study. SETTING: Pulmonary rehabilitation program at our institution. POPULATION: A cohort of 195 patients undergoing a PR program was followed up for 5 years. They were divided into three groups: control (PR<3 months), partial adherence (PR>6 and ≤18 months) and adherence (PR=24 months). METHODS: This was a prospective study where All patients were evaluated every 6 months (D0, D6, D12, D18 and D24, and mapped annually concerning hospitalizations and mortality). Data were analyzed by medians and interquartile ranges, and Kruskal-Wallis non-parametric comparative tests were applied. Comparisons of time to first admission and time to death were made using the Kaplan-Meier estimators, and the factors associated with these outcomes were modeled using semi-parametric Cox models. RESULTS: The results demonstrated a significant reduction in the rate of hospitalization and mortality. The protective effect seems to be dependent on the lengths of stay of patients in the PR program. CONCLUSIONS: A multi-disciplinary, long-term PR program with individually tailored 96-week supervised interventions, reduces hospitalization rates and mortality in patients with severe and very severe COPD in a 5-year follow-up period. This protective effect on hospitalization and mortality is obtained from at least 18 months of intervention. Patients who stay longer in the PR program appear to experience a longer protective effect at the end of treatment. CLINICAL REHABILITATION IMPACT: This long-term PR program for patients with severe and very severe COPD produced progressively favorable clinical effects, thus reducing the frequency of hospitalizations and mortality in this population.