title: Reduction of exacerbation frequency in patients with COPD after participation in a comprehensive pulmonary rehabilitation program.
abstract: BACKGROUND
  Pulmonary rehabilitation (PR) is an important treatment option for chronic obstructive pulmonary disease (COPD) patients and might contribute to a reduction in exacerbation and exacerbation-related hospitalization rate.
  
  
  METHODS
  In this prospective study, all COPD patients that completed a comprehensive pulmonary rehabilitation program (PRP) between June 2006 and December 2012 were included. Self-reported exacerbation and hospitalization frequency 1 year before PR was retrospectively recorded. During the year following PR, exacerbation and hospitalization frequency was recorded with questionnaires.
  
  
  RESULTS
  For 343 patients, complete information on exacerbation and hospitalization rate was obtained. The mean number of exacerbations decreased significantly after participating in a PRP by 1.37 exacerbations/year (95% confidence interval 1.029 to 1.717) from 4.56±3.26 exacerbations in the year preceding PR to 3.18±2.53 in the year following PR (P<0.0005). The number of hospitalizations due to exacerbations decreased significantly by 0.68 hospitalizations/year (95% confidence interval 0.467 to 0.903) from 1.48±1.84 in the year preceding PR to 0.80±1.31 hospitalizations/year in the year following PR (P<0.0005). The proportion of patients with a frequent exacerbation type (more than two exacerbations/year) was reduced by 24%. Multivariate regression analysis to explore determinants that might predict reduction in exacerbation frequency or change in exacerbation pattern did not reveal clinically useful predictors, although patients with more exacerbations before PR had the highest potential for reduction.
  
  
  CONCLUSIONS
  In a large population of severely impaired COPD patients with high exacerbation rates, a significant reduction in exacerbation and hospitalization frequency was observed after participation in a comprehensive PRP.
authors.affiliation: Revant, Pulmonary Rehabilitation Center "Schoondonck," Breda, the Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van Ranst
authors.affiliation: Revant, Pulmonary Rehabilitation Center "Schoondonck," Breda, the Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Stoop
authors.affiliation: Revant, Pulmonary Rehabilitation Center "Schoondonck," Breda, the Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Meijer
authors.affiliation: Revant, Pulmonary Rehabilitation Center "Schoondonck," Breda, the Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Otten
authors.affiliation: Revant, Pulmonary Rehabilitation Center "Schoondonck," Breda, the Netherlands.
authors.forename: I G
authors.initials: IG
authors.lastname: van de Port
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: disease management; health care utilization; health status; hospitalization; self-management