A revealing study published this month in the Kuwaiti journal Medical Principles and Practice showed significant health care utilization reductions for COPD patients who completed a pulmonary rehabilitation program.
The study was conducted in Saudi Arabia at the ONLY pulmonary rehabilitation clinic in the country. The results of the study echo similar results of studies conducted in other countries around the world – pulmonary rehabilitation consistently reduces subsequent emergency room visits, hospital stays, and length of hospital stays. Additionally, this study also demonstrated significant reductions in the use of antibiotics, steroids, and short-acting bronchodilator inhalers about the COPD patients who completed a pulmonary rehab program – a novel finding as depicted by the study author. (Al Moamary MS. Health care utilization among chronic obstructive pulmonary disease patients and effect of pulmonary rehabilitation. Med Princ Pract. 2010, 19(5):373-378, Epub 2010 Jul 14)
In this study, the research team looked retrospectively at the medical records of 50 COPD patients who were admitted to the King Abdulaziz Medical City Pulmonary Rehabilitation Center between 2004 and 2008. All of these patients had been initially admitted to the hospital for an acute exacerbation (a shortness of breath/coughing attack severe enough to require hospitalization) shortly immediately preceding enrollment into the rehab program. Of the 50 patients, 27 completed the pulmonary rehabilitation program (hereafter referred to as the compliant group) and 23 did not (noncompliant group).
The researchers sought to evaluate the differences between the compliant group and non-compliant group over the following 12 month period in terms of subsequent hospital visits/stays and prescription medication usage compared to the 12 months leading up to their entry into the pulmonary rehab program. The results were dramatically different between the two groups.
For example, the compliant group saw a 51% decrease in subsequent outpatient clinic visits, 60% decrease in emergency department visits, and a 72% drop in the length of hospital stays compared to their pre-pulmonary rehab experiences. By comparison, the non-compliant group visited outpatient clinics 14% more after bailing out of the pulmonary rehab program, visited emergency departments 14% more and experienced a mean increase in average hospital length of stay of 90%!
You could not paint a more convincing picture of the divergent experiences of COPD patients who pursue and complete pulmonary rehab programs versus those who don’t. These results are not novel – as mentioned above, previous studies around the globe have shown similar results (some more dramatic, others less dramatic – but the majority showing statistically significant differences in subsequent health care utilization). It makes you really scratch your head when you realize that even in the U.S. only 1-2% of COPD patients are ever admitted to a pulmonary rehab program. If there is a serious interest in reducing overall health care costs related to COPD (for both providers and patients), pulmonary rehab should become a standard treatment option for ALL COPD patients.
Separately, regarding subsequent usage of antibiotics, steroids, and short-acting bronchodilators, the Saudi Arabian study showed significant drops in reliance on these pharmacological agents in the compliant group compared to the non-compliant group.
Among the compliant group, short-acting bronchodilator use dropped 51%, antibiotic courses fell 53% and cumulative steroid dosage decreased by 31% compared to usage levels prior to entering and completing pulmonary rehabilitation. By comparison, the non-compliant group saw their usage of these three pharmacological options rise by 5%, 31% and 38% respectively. These are all significant differences and further reinforce the value of pulmonary rehabilitation.
As an aside, the researchers also reported that the compliant group saw their walking endurance rise 121 meters in the 6 minute walk test (a 54 meter rise is considered statistically significant by most researchers). Again, a clear indication of the power of pulmonary rehab.
The rehab program followed during the study was described the research team as follows, “1-hour session, 2–3 times per week over 8–12 weeks for a total of 18–24 sessions in an outpatient setting. The patients were discharged from the PR program at 8 weeks provided that they had completed 18 sessions or that they would complete 18 sessions within 8–12 weeks. The program consisted of exercises combining track or treadmill walking, upright cycling, stair stepping and arm ergometer. Direct small group education sessions were conducted by the PR physiotherapist. Both the exercise and education programs were carried out as previously described. The program provided exercise therapy consisting of combination treadmill or track walking, upright cycling, stair stepping and arm ergometer. The intensity of the exercises was individualized based on the patient’s tolerance, physiological parameters and PR physiotherapist judgment. Aerobic exercises comprised upper extremity, lower extremity, flexibility and strength. The educational component included modules covering obstructive and restrictive lung diseases, breath retraining, pulmonary hygiene, dietary modification, risk factor modification, pulmonary medications and equipment, stress management/relaxation, smoking cessation advice, exercise benefits, musculoskeletal injury prevention and overall pulmonary disease intervention.”
As regular readers of our e-letters and blog are well aware, we are strong proponents of pulmonary rehabilitation for COPD patients (and anyone else who suffers from chronic shortness of breath). If you can gain entry to a program in your area, we highly endorse participating in the program. If you can’t gain entry, there are still many aspects of pulmonary rehab you can practice at home or in a fitness center. We created our Breathe Better for Life guide and CD-ROM to assist COPD patients and others who suffer from persistent breathlessness with the resources to start such an at-home or fitness center based program (in consultation with your personal physician of course). Our program is based on guidelines established by the American Thoracic Society, European Respiratory Society, and the American College of Sports Medicine and has been reviewed and edited by prominent respiratory care professionals. To order Breathe Better for Life, visit www.breathebetterforlife.com.
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