Long-term pulmonary rehabilitation progressively reduces hospitalizations and mortality in a cohort of patients with severe and very severe copd: a 5-year follow up.

Backgroud Pulmonary rehabilitation (PR) is recognized as a multidisciplinary intervention designed to reduce symptoms, improve functional status, and prevent acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Aim This study was aimed at evaluating the effects of a long-term PR program on the hospitalization rate and mortality of patients with severe and very severe COPD. Materials and methods This was a prospective study where cohorts of 195 patients undergoing a PR program were followed up for 5 years. They were divided into 3 groups: control (PR = 0 or 6 and ≤ 18 months) and adherence (PR = 24 months). All patients were evaluated every 6 months (D0, D6, D12, D18 and D24, and mapped annually concerning hospitalizations and mortality). Data were analysed by medians and interquartile ranges, and Kruskal-Wallis nonparametric comparative tests were applied. Comparisons of time to first admission and time to death were made using the Kaplan-Meier estimators, and the factors associated with these outcomes were modeled using semi-parametric Cox models. Results The results demonstrated a significant reduction in the rate of hospitalization and mortality. The protective effect seems to be dependent on the lengths of stay of patients in the PR program. Conclusions A multi-disciplinary, long-term PR program with individually tailored 96-week supervised interventions, reduces hospitalization rates and mortality in patients with severe and very severe COPD in a 5-year follow-up period. This protective effect on hospitalization and mortality is obtained from at least 18 months of intervention. Patients who stay longer in the PR program appear to experience a longer protective effect at the end of treatment. Clinical rehabilitation impact This Long-term PR program for patients with severe and very severe COPD produced progressively favourable clinical effects, thus reducing the frequency of hospitalizations and mortality in this population.