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Original Research |

Effects of pulmonary rehabilitation on exacerbation number and severity in people with COPD: An historical cohort study using electronic health records

Elizabeth Moore; Roger Newson, Dr; Miland Joshi, Dr; Thomas Palmer; Kieran J. Rothnie, Dr; Sally Singh, Professor; Azeem Majeed; Michael Soljak, Dr; Jennifer K. Quint, Dr
Author and Funding Information

Conflict of Interest Disclosures

JKQ reports grants from the Medical Research Council (MRC), GlaxoSmithKline (GSK), British Lung Foundation (BLF), Wellcome Trust, during the conduct of the study, and personal fees from AstraZeneca and Boehringer Ingelheim, outside of the submitted work. MS reports other current research grants from Arthritis Research UK, Public Health England and the EU EITHealth Programme, with no conflicts of interest. SS reports grants from the National Institute for Health Research (NIHR), GlaxoSmithKline (GSK), Boehringer Ingelheim and Novartis and personal fees from Novartis and AstraZeneca. All other authors report no other conflicts of interest.

Department of Respiratory Epidemiology, Occupational Medicine & Public Health, Imperial College London, National Heart and Lung Institute, London, United Kingdom

Department of Primary Care and Pubic Health, Imperial College London, London, United Kingdom

Clinical Trials Unit, Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom

Department of Primary Care and Pubic Health, Imperial College London, London, United Kingdom

Department of Respiratory Epidemiology, Occupational Medicine & Public Health, Imperial College London, National Heart and Lung Institute, London, United Kingdom

Centre For Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Department of Primary Care and Pubic Health, Imperial College London, London, United Kingdom

Senior Clinical Research Fellow, Department of Primary Care and Pubic Health, Imperial College London, 323 Reynolds Building, St Dunstan’s Road, London, W6 8RP

Department of Respiratory Epidemiology, Occupational Medicine & Public Health, Imperial College London, National Heart and Lung Institute, London, United Kingdom

Corresponding author: Dr Jennifer Quint, Imperial College London. Department of Respiratory Epidemiology, Occupational Medicine & Public Health, Emmanuel Kaye Building, Room G48, 1B Manresa Road, London, SW3 6LR.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.05.006
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Abstract

Background  In previous systematic reviews, predominantly of randomised controlled trials, pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohort studies. We aimed to compare rates of hospitalized and general practice (GP) treated AECOPD before and after PR.

Methods  Using anonymised data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared one year before and after PR in patients referred for PR. Exacerbation rates were also compared between individuals eligible and referred for PR with those eligible and not referred.

Results  69,089 (64%) of the COPD patients in the cohort were eligible for PR. Of these, only 6,436 (9.3%) were recorded as having been referred for rehabilitation. 62, 019 (89.8%) were not referred and 634 (0.98%) declined referral. When combining GP and hospital exacerbations, people who were eligible and were referred for PR had a slightly higher but not statistically significant exacerbation rate (2.83 exacerbations/patient-year 95% CI: 2.66, 3.00) than those who were eligible but not referred (2.17 exacerbations/patient-year 95% CI: 2.11, 2.24).

Conclusions  This study found that less than 10% of patients who were eligible for PR were actually referred. Patients who were eligible and referred for (but not necessarily completed) PR did not have fewer GP visits and hospitalizations for AECOPD in the year after PR compared to those not referred or compared to the year before PR.


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