Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study

Abstract

Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. Methods This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was used to assess the association between patients’ characteristics, comorbidities according to the Charlson index, treatment, and PR uptake. Results Among 48,638 patients aged ≥ 40 years admitted for a COPD exacerbation, 4,182 (8.6%) received PR within 90 days after discharge. General practitioner’s (GP) density (number of GPs for the population at regional level) and PR center facilities (number of beds for the population at regional level) were significantly correlated with PR uptake (respectively r = 0.64 and r = 0.71). In multivariate analysis, variables independently associated with PR uptake were female gender (aOR 1.36 [1.28–1.45], p < 0.0001), age (p < 0.0001), comorbidities (p = 0.0013), use of non-invasive ventilation and/or oxygen therapy (aOR 1.52 [1.41–1.64], p < 0.0001) and administration of long-acting bronchodilators (p = 0.0038). Conclusion This study using the French nationally exhaustive health insurance database shows that PR uptake after a severe COPD exacerbation is dramatically low and must become a high-priority management strategy.

Outcomes and Hospital Service Use Among Patients With COPD in a Nurse- and Allied Health–Led Clinic

“… 14 , 16 , 17 , 18 Our study reported similar outcomes in terms of reduction of mortality and hospitalization risks among patients with COPD as those in previous studies on pulmonary rehabilitation, while the magnitude of relative risk reduction of mortality reported in these studies (range, 31%-42%) was larger than for the NAHC-Respiratory program. 32 , 33 , 34 , 35 This difference may primarily be caused by differences in their service packages and how patients were targeted. The NAHC-Respiratory program provided a mixture of self-management education, risk factor midifications, and rehabilitation services to patients with COPD at primary care settings whose baseline mortality risk was relatively low, while the pulmonary rehabilitation services reported in the literature primarily targeted more high-risk patients following their excerbations and hospitalizations with a baseline annual mortality rate ranging from 17.3% to 25.2%.…”

“…The NAHC-Respiratory program provided a mixture of self-management education, risk factor midifications, and rehabilitation services to patients with COPD at primary care settings whose baseline mortality risk was relatively low, while the pulmonary rehabilitation services reported in the literature primarily targeted more high-risk patients following their excerbations and hospitalizations with a baseline annual mortality rate ranging from 17.3% to 25.2%. 32 , 34 , 35 …”

Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study (Preprint)

“…Alec Bass, PT, PhD 1 ; Sarah Géphine, PhD 2,3 ; Mickaël Martin, MSc 1 ; Marianne Belley, BSc 1 ; Manon Robic, MSc 3 ; Claudine Fabre, Pr 3 ; Jean-Marie Grosbois, MD 2 ; Geneviève Dion, MD 1 ; Didier Saey, PT, PhD 1 ; Arnaud Chambellan, MD 4 ; François Maltais, MD Corresponding author: Dr François Maltais, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CR-IUCPQ), Québec, Canada, G1V 4G5, francois.maltais@fmed.ulaval.ca…”

“…Unfortunately, access to rehabilitation care remains limited in many countries, including in Canada and France. Indeed, latest available estimates indicate that only 0.4% of individuals in Canada and 8.6% of individuals in France with COPD have access to pulmonary rehabilitation programs [2,3]. The development of new and innovative healthcare models, including in rehabilitation, is urgently needed to address this healthcare gap that is only expected to worsen with the aging populations in most advanced economies [2,4].…”

The Non-Paced 3-Minute Sit-to-Stand Test: Feasibility and Clinical Relevance for Pulmonary Rehabilitation Assessment

“…At a time when access to PR represents a major challenge in the management of individuals with COPD [ 5 , 6 ], home- or community-based interventions requiring minimal equipment may provide valuable alternatives to in-patient PR programs [ 7 , 8 ]. The 6-min walking test (6-MWT) is currently the most validated and widely used field test for evaluating exercise capacity in patients undergoing PR, but its application remains complex [ 9 ].…”