For patients with chronic obstructive pulmonary disease (COPD), a pragmatic, supervised, self-help pulmonary rehabilitation maintenance program can extend the benefits of initial pulmonary rehabilitation for more than 3 years, according to a well-designed observational study published in Respiratory Research.

Pulmonary rehabilitation has been shown to improve exercise capacity, health-related quality of life (HRQoL), and dyspnea in patients with COPD. While maintenance programs can sustain the benefits for 12 to 24 months, long-term effects (>12 months) of pragmatic maintenance programs in real-life settings remain unknown.

Therefore, researchers assessed the yearly evolution in the outcomes (6-minute walking distance [6MWD], HRQoL, dyspnea) of a supervised self-help pulmonary rehabilitation maintenance program for 144 patients with COPD followed for 5 years in a prospective cohort study. The 5-year survival probability was compared with that of a control pulmonary rehabilitation group without a maintenance program, and a trajectory-based cluster analysis identified the determinants of long-term response.

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The researchers found that the patients in the maintenance program demonstrated significant pulmonary rehabilitation benefits at 4 years for 6MWD and the VQ11 short HRQoL questionnaire, and at 5 years for the modified Medical Research Council (MRC) dyspnea score. The 5-year survival probability was higher than for pulmonary rehabilitation patients without pulmonary rehabilitation maintenance. The researchers identified 2 clusters of response to long-term pulmonary rehabilitation, with responders being patients with less severe COPD.

“This long-term follow-up study is the first to show the time course of major [pulmonary rehabilitation] outcomes for more than 3 years in patients included in a [pulmonary rehabilitation] maintenance program in a real-life setting,” the researchers concluded. “Although complementary research studies with other designs are warranted, this study adds valuable information regarding the indications and decisions for pulmonary rehabilitation.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Blervaque L, Préfaut C, Forthin H, et al. Efficacy of a long-term pulmonary rehabilitation maintenance program for COPD patients in a real-life setting: a 5-year cohort study. Respir Res. Published online March 10, 2021. doi:10.1186/s12931-021-01674-3