Pulmonary Rehabilitation Is Associated With Decreased Exacerbation and Mortality in Patients With COPD: A Nationwide Korean Study

BACKGROUND:Poor uptake to pulmonary rehabilitation (PR) is still challenging around world. There have been few nationwide studies investigating whether PR impact patient's outcome in COPD. We investigated the change of annual PR implementation rate, medical costs, and COPD outcomes including exacerbation rates and mortality between year 2015 to 2019. RESEARCH QUESTION:Does PR implementation improve outcomes in patients with COPD in terms of direct cost, exacerbation and mortality? STUDY DESIGN AND METHODS:Data of patients with COPD extracted from a large Korean Health Insurance Review and Assessment service database (2015-2019) were analyzed to determine the trends of annual PR implementation rate and direct medical costs of PR. Comparison of COPD exacerbation rates between pre- and post-PR, as well as the time to first exacerbation and mortality rate according to PR implementation, were also assessed. RESULTS:Among all patients with COPD in Korea, only 1.43% received PR. However, the annual PR implementation rate gradually increased from 0.03% to 1.4% during 4 years, especially after health insurance coverage commencement. The direct medical cost was significantly higher in the PR than non-PR group, but the costs in these groups showed decreasing and increasing trends, respectively. Both the incidence rate and frequency of moderate-to-severe and severe exacerbations were lower during the post-PR compared to pre-PR period. The time to the first moderate-to-severe and severe exacerbations was longer in the PR than non-PR group. Finally, PR implementation was associated with a significant decrease in mortality. INTERPRETATION:We concluded that health insurance coverage increases PR implementation rates. Moreover, PR contributes towards improving outcomes including reducing exacerbation and mortality in patients with COPD. However, despite the well-established benefits of PR, its implementation rate remains suboptimal.