Many COPD Patients Who Have Flare-ups Are Not in Lung Rehabilitation Programs, UK Study Finds

Many COPD patients who have acute flare-ups are not taking part in pulmonary rehabilitation programs, a British study shows.

The research, “Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD,” was published in the journal CHEST.

COPD flare-ups not only harm patients’ health but also lead to them using more healthcare resources. In fact, many are treated in hospitals for one to three exacerbations a year.

Previous research has shown that pulmonary rehabilitation can reduce hospital admissions. The studies have also shown that doctors have been inconsistent in referring patients to such programs.

Researchers at Imperial College London decided to see whether rehabilitation programs could reduce COPD flare-ups and patient hospitalization rates in the United Kingdom. They based their study on information from the Clinical Practice Research Datalink and Hospital Episode Statistics database.

The team looked at both the doctor’s office visits and hospital admissions of 69,089 COPD patients whose condition was considered good enough for pulmonary rehabilitation.

Doctors did not refer the vast majority of them — 62,019, or 90 percent — to rehabilitation. Of the 6,437, or 1o percent, that they did refer, 634 declined to go.

A finding that seemed surprising at first was that patients who attended a pulmonary rehabilitation program had the same number of flare-ups and hospitalizations as they did the previous year, when they weren’t in rehabilitation.

One reason for the disconnect might be that a lot of patients failed to complete the rehabilitation program, the researchers said. Another factor that could have come into play is that some pulmonary rehabilitation programs are better than others. Researchers said they had no way of knowing the quality of the programs that patients attended.

The key takeaway from the study was still alarming — that the number of COPD patients  taking part in pulmonary rehabilitation programs is very low.

“This study highlights a major clinical issue that shows large proportions of patients are either not starting or are not completing PR [pulmonary rehabilitation], which is a result of low [doctor] referral rates,” Dr. Jennifer Quint, the study’s lead researcher, said in a press release.

“Results highlight that 0.98 percent of people refused a PR referral,” she said. “This shows that physicians have room to improve in referring patients to PR and that patients will likely be receptive to the referrals. As an intervention, there is great potential to be effective if patients are referred and can adhere to properly designed and delivered programs.”