Chronic obstructive pulmonary disease (COPD) exacerbations are a significant cause of morbidity and mortality and with a substantially high cost worldwide. The objective of this study was to evaluate the impact of pulmonary rehabilitation (PR) on the exacerbation rate and on the frequency and duration of hospitalizations in patients with COPD. A secondary aim was to estimate the annual cost savings/patient of PR with respect to hospitalizations.
We studied 32 ex-smoking patients (age 62±7 years) with moderate-to-severe COPD (FEV1 38±6 %pred). Patients participated in a 12-week (36-session) program of PR consisting of education, nutritional intervention, physiotherapy, exercise and psychologic support. They completed a questionnaire for the previous year to assess the exacerbations while their emergency visits, admissions and length of hospital stay were found from the hospital records. Patients were followed for the year after PR with both scheduled and emergency visits and with telephone contacts.
The total annual number of exacerbations reduced from 112 pre-PR (3.5/patient) to 88 post-PR (2.8/patient)while the emergency visits decreased from 89 (2.8/patient) to 70 (2.2/patient). The significant decreases were found in hospitalizations (from 54 or 1.7/patient to 35 or 1.1/patient; p<0.05) and in hospital stay (from 648 days or 20.2/patient to 357 days or 11.2/patient; p<0.01). Considering the costs of PR program and of hospital days, the overall result is that the cost-savings for the 32 patients amounted to 9627 € (300 €/patient in approximation).
A comprehensive pulmonary rehabilitation program results to a significant reduction in frequency and duration of hospitalizations in patients with moderate-to-severe COPD. There is also a trend towards reducing the annual number of exacerbations and the emergency hospital visits.
These effects of pulmonary rehabilitation are very important, given that hospitalizations, among other detrimental effects, are an important factor of impairment in health-related quality of life and the principal source of increasing direct costs of COPD. Our results justify the need for reimbursement of rehabilitation programs for COPD patients by our National Public Health System.
Epaminondas Kosmas, None.