A study published this month in the journal Thorax demonstrated that administering pulmonary rehabilitation to COPD patients immediately after hospital discharge related to an acute exacerbation (a significant shortness of breath event) cut subsequent readmission and hospital attendance for a re-exacerbation by 52%.
The UK based study examined 60 COPD patients who had been admitted to one of two different UK hospitals for an acute exacerbation event. The research team divided the 60 patients into two groups. One group received “usual care” post-discharge (post-discharge usual care is a term meaning providing patients basic instructions and medication prescriptions, but no specific follow-on therapy). The other group, denoted here as the rehab group, participated in an 8 week outpatient pulmonary rehab program. (Seymour JM, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010 May; 65(5):423-428)
The pulmonary rehab program involved twice weekly visits of 2 hours each over the 8 week period. In those sessions, patients participated in aerobic exercise and strength training exercise under the supervision of respiratory care professionals and received education counseling regarding breathing techniques and nutrition among other subjects.
The research team then evaluated how many COPD patients in each group were either readmitted to a hospital or visited a hospital emergency department for a subsequent exacerbation event during the 3 months from their initial hospital admission (during the 3 month period the rehab group was actively participating in the pulmonary rehab program).
Their data showed that only 2 of the 30 patients in the pulmonary rehab group were readmitted during the 3 month period following their initial exacerbation-related admission while 10 of the 30 COPD patients in the usual care group were readmitted. With regard to emergency department visits related to a subsequent exacerbation, the rehab group reported 6 of 30 and the usual care group reported 7 of 30. All together 8 of the 30 rehab group COPD patients were either readmitted or visited an emergency room in comparison to 17 of the 30 usual care group patients, hence the reported 52% fewer admissions/ED visits.
The researchers concluded, “Outpatient pulmonary rehabilitation immediately following an acute COPD exacerbation can reduce the risk of re-exacerbation requiring hospital attendance in the following 3 months.”
Interestingly, though the purpose of the study was to specifically examine hospital readmission/ED visit rates, the researchers also evaluated both groups for physical conditioning and quality of life measures. In doing so, they took baseline measurements of physical conditioning and recorded quality of life survey responses at the outset of the study for both groups. At the end of the 8 week pulmonary rehab program, both groups were evaluated again for physical conditioning and quality of life.
Consistent with other pulmonary rehab studies, the COPD patients who participated in the rehab program experienced significant improvements in physical conditioning and patient-reported quality of life compared to the usual care group. For example, on the endurance shuttle walk test (similar to the 6 minute walk test), COPD patients in the rehab group saw their average distance walked rise 88% between their pre-rehab and post-rehab evaluations. By comparison, the usual care group showed no improvement.
So, as we’ve related in previous articles, pulmonary rehab works. It improves physical conditioning, reduces shortness of breath, improves quality of life, reduces hospital admissions and reduces overall health care costs. We’re guessing that this study will catch the attention of US hospital administrators. Why? Because the quasi-government body that administers Medicare payments is tightening reimbursement eligibility/amounts for hospitalizations that result in a re-admission within 30 days of discharge. To these hospital administrators, the cost of offering reimbursable pulmonary rehab to COPD patients admitted with an exacerbation is surely lower than eating the cost of a subsequent hospital admission/emergency room visit.
One hopes that more doctors will prescribe pulmonary rehab for COPD patients as the evidence of its efficacy mounts so that one day pulmonary rehab will be considered “usual care” instead of an experimental therapy.
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