Medical guidelines say that any patient admitted to the hospital for chronic obstructive pulmonary disease (COPD) should enroll in a pulmonary rehabilitation program after discharge. Not surprisingly, a new study from researchers at the University of Massachusetts found that pulmonary rehabilitation starting within 90 days of hospital discharge reduced death at one year significantly. What was surprising was that less than two percent of patients took advantage of a pulmonary rehabilitation program.
COPD includes the diseases emphysema and chronic bronchitis. It affects about 16 million Americans. Causes include smoking and air pollution. COPD is a progressive disease. One way to slow down the progression is implementing the lessons learned in a pulmonary rehabilitation program, which includes instructions in exercise, diet and taking medications. Pulmonary rehabilitation has been shown to improve exercise tolerance, reduce flare ups, reduce hospital admissions and improve quality of life for COPD patients. In fact, pulmonary rehab is one of the most effective treatments for COPD.
The new study is published in JAMA. Using Medicare records, the researchers went back and looked at pulmonary rehab use following hospital admissions for COPD in 2014. There were close to 200,000 admissions at more than 4,000 US hospitals reviewed. The average age of the patients was 77. They found that only 1.5% of the patients actually entered a pulmonary rehab program in the three months after discharge from the hospital.
The researchers compared the rate of death at one year after discharge between patients who had pulmonary rehab within three months to patients who did not have rehab in those first three months. Although only about 7% of the rehab patients had died at one year, the death rate for the other patients was about 20%—a significant increased rate of death.
This study answered the main question the researchers were looking at—does pulmonary rehab after hospitalization for COPD improve survival? It does. But the study raised another serious question. Why do so few patients take advantage of pulmonary rehabilitation?
Editorial comment accompanying the study suggests that both doctors and patients need to be more aware of the importance of pulmonary rehab and its effect on survival. Another problem may be lack of funding for and availability of these programs. If you or someone you care about has been discharged from the hospital with COPD, this study suggests that you really need to find a pulmonary rehabilitation program within 90 days. The study found that people who started rehab earliest and had more sessions had the best chance of being alive after one year.
Source: The study “Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries” published in JAMA.