Objective: To compare the functional benefits and
relative costs of administering an intense short-term inpatient vs a
longer outpatient pulmonary rehabilitation program (PRP) for patients
with chronic airway obstruction (CAO).
Retrospective case-control study.
ward and outpatient clinic of a rehabilitation center.
Patients: Forty-three patients (case subjects) selected on
the basis of selection criteria were compared with control subjects
matched to them for age, sex, FEV1, and diagnosis of either
COPD or asthma. Case subjects performed 10 to 12 daily sessions (5
sessions a week) of inpatient PRP; control subjects performed 20 to 24
sessions (3 sessions a week) of outpatient PRP.
Measurements: At baseline and after the PRP, an incremental
exercise test was performed, including evaluation of dyspnea and leg
fatigue by Borg scale (D and F, respectively) at each workload step.
The cost of PRP was also evaluated.
Results: Both PRPs
resulted in similar significant improvements in cycloergometry peak
workload (from 68 ± 18 to 82 ± 22 and from 75 ± 17 to
87 ± 27 W in case subjects and control subjects, respectively),
isoload D (from 6.4 ± 1.6 to 4.2 ± 1.8 for case subjects and from
8.5 ± 1.9 to 6.3 ± 2.4 for control subjects) and isoload F (from
6.6 ± 1.8 to 4.2 ± 1.8 for case subjects and from 8.9 ± 1.9 to
7.0 ± 1.8 for control subjects). Although the single daily session
was less expensive, the outpatient PRP total costs were greater because
of the higher number of sessions and the cost of daily
Conclusions: In patients with CAO, a
shorter inpatient PRP may result in improvement in exercise tolerance
similar to a longer outpatient PRP but with lower costs. Whether a
shorter outpatient PRP may get physiologic and clinical benefits, while
further reducing costs, must be evaluated by future controlled,
randomized, prospective studies.