Pulmonary Rehabilitation

Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013; e13-e64. This guideline replaces the 2006 version, provides an updated definition of pulmonary rehabilitation, and highlights new data demonstrating the efficacy of pulmonary rehab in patients with COPD. It also addresses the use of pulmonary rehabilitation in other pulmonary diseases.
PMID: 24127811
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McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015; 2:CD003793. This review is comprised of many smaller studies (65 RCTs, 3,822 patients) and found rehab participation yielded clinically significant improvements in quality of life, symptoms, and exercise capacity.
PMID: 25705944
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Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomized controlled equivalence trial. Thorax  2017; 72:57-65. Pulmonary rehabilitation remains underutilized but a home-based approach has the potential to increase patient enrollment. This RCT of 166 patients, as well as other similar trials, found similar gains between health center-based and home-based groups. Unfortunately, neither group has sustained gains when measured at 12 months.
PMID: 27672116
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Nolan CM, Kliaraju D, Jones SE, et al. Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study. Thorax  2019; 74:996-998. This study explored whether the benefits of home pulmonary rehabilitation could be reproduced outside of a clinical trial.  This observational study of 154 patients found similar improvements in quality of life but smaller improvements in exercise capacity in the home group compared to the matched supervised group.  Based on this, the authors recommend home-based rehab be reserved for those unable to attend structured programs.
PMID: 31278173

Puhan MA, Gimeno-Santos E, Cates CJ, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016; 12:CD005305. Early studies suggest pulmonary rehabilitation instituted shortly after recovery from COPD exacerbation reduces the risk of readmission and possibly mortality. This analysis included 1,477 patients from 20 studies that varied substantially in study design. Among the 8 studies that assessed hospital readmission, there is “moderate-quality” evidence that PR reduces readmissions but there was a large degree of heterogeneity and the effect was smaller in newer studies.  The quality of evidence among 6 studies that assessed mortality was deemed “low” and no difference was found.
PMID: 27930803
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Stefan MS, Pekow PS, Priya A, et al. Association between initiation of pulmonary rehabilitation and rehospitalizations in patients hospitalized with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2021; 204:1015-1023. This study used a large Medicare database from 2014 and found that patients completing pulmonary rehabilitation within 90 days of COPD admission (1.5% of all patients) had a mean cumulative number of hospitalizations at 1 year of 0.95 compared to 1.15 for matched controls that did not complete rehab.
PMID: 34283694

***See also Pulmonary Function Tests section on Exercise Tests