The use of early supervised pulmonary rehabilitation is an effective intervention for the reduction of mortality following hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), according to the results of a systematic review and meta-analysis published in BMC Pulmonary Medicine.
Investigators sought to explore the effect on mortality of the use of a supervised early pulmonary rehabilitation program initiated during or within 4 weeks following hospitalization for AECOPD compared with usual post-exacerbation care or no pulmonary rehabilitation intervention. Secondary outcomes included days in hospital, COPD-related hospital readmissions, health-related quality of life (HRQoL), activities of daily living, exercise capacity (walking distance), risk for falls, and dropout rate.
A total of 13 randomized trials with 801 participants were included in the review. Findings from the meta-analysis demonstrated a clinically relevant reduction in mortality following early pulmonary rehabilitation (4 trials; 319 patients; relative risk [RR], 0.58; 95% CI, 0.35-0.98) and at the longest follow-up (3 trials; 127 patients; RR, 0.55; 95% CI, 0.12-2.57).
The use of early pulmonary rehabilitation was associated with 4.27 reduced number of days in the hospital (1 trial; 180 patients; 95% CI, –6.85 to –1.69) and a decreased rate of hospital readmissions (6 trials; 319 patients; RR, 0.47; 95% CI, 0.29-0.75). In addition, early pulmonary rehabilitation was linked to improvements in HRQoL and walking distance and did not affect dropout rates.
The investigators concluded that moderate quality of evidence from this study demonstrated decreased rates of mortality, number of days hospitalized, and number of hospital readmissions after the use of early pulmonary rehabilitation in patients hospitalized with an AECOPD. Although long-term effects on mortality were not statistically significant, improvements in HRQoL and exercise capacity seemed to persist for ≥12 months.
Therefore, the researchers recommended that early supervised pulmonary rehabilitation be used in patients with AECOPD, which should be initiated either during hospital admission or within 4 weeks following hospital discharge.
Ryrsø CK, Godtfredsen NS, Kofod LM, et al. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med. 2018;18(1):154.