Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study

• Published in: Respiratory research Vol. 24; no. 1; p. 102
• Main Authors: Guecamburu, Marina, Coquelin, Anaëlle, Rapin, Amandine, Le Guen, Nelly, Solomiac, Agnès, Henrot, Pauline, Erbault, Marie, Morin, Sandrine, Zysman, Maéva
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.04.2023; BioMed Central; BMC
• Subjects: Acute exacerbation of COPD; Ambulatory care; Bronchodilators; Care and treatment; Chronic obstructive pulmonary disease; Comorbidity; Demographic aspects; Diagnosis; Disease Progression; Dosage and administration; Economic aspects; Family physicians; Female; Fitness training programs; Health aspects; Health care disparities; Health care policy; Health disparities; Health inequalities; Health insurance; Health risks; Heart failure; Hospitalization; Hospitals; Humans; Insurance; Lung diseases; Lung diseases, Obstructive; Male; Medical density; Medical referrals; Mortality; Mortality risk; Multivariate analysis; Obstructive lung disease; Physical training; Population studies; Primary care; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary rehabilitation; Quality of Life; Rehabilitation; Respiratory agents; Retrospective Studies; Social aspects; Software; Ventilators; France; Medical density; Acute exacerbation of COPD; Pulmonary rehabilitation; Health inequalities
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-023-02393-7

Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was used to assess the association between patients' characteristics, comorbidities according to the Charlson index, treatment, and PR uptake. Among 48,638 patients aged ≥ 40 years admitted for a COPD exacerbation, 4,182 (8.6%) received PR within 90 days after discharge. General practitioner's (GP) density (number of GPs for the population at regional level) and PR center facilities (number of beds for the population at regional level) were significantly correlated with PR uptake (respectively r = 0.64 and r = 0.71). In multivariate analysis, variables independently associated with PR uptake were female gender (aOR 1.36 [1.28-1.45], p < 0.0001), age (p < 0.0001), comorbidities (p = 0.0013), use of non-invasive ventilation and/or oxygen therapy (aOR 1.52 [1.41-1.64], p < 0.0001) and administration of long-acting bronchodilators (p = 0.0038). This study using the French nationally exhaustive health insurance database shows that PR uptake after a severe COPD exacerbation is dramatically low and must become a high-priority management strategy.