Service des Maladies Respiratoires, CHU Bordeaux, Pessac, 33604, France.
Service de pneumologie, Centre Hospitalier de la Côte Basque, Bayonne, France.
Int J Chron Obstruct Pulmon Dis. 2024 Jul 5;19:1579-1589. doi: 10.2147/COPD.S460991. eCollection 2024.
Pulmonary rehabilitation (PR) is a type of multidisciplinary care strongly recommended after severe exacerbation of chronic obstructive pulmonary disease (COPD). Recently, a national French study reported a very low rate of PR uptake (8.6%); however, important clinical data were missing. Here, we aimed to identify the main factors associated with insufficient PR uptake after hospitalisation for COPD exacerbation.
This multicentre retrospective study included patients hospitalised with COPD exacerbation between 1 January 2017 and 31 December 2018, as identified by both coding and a detailed review of medical records. PR was defined as inpatient care in a specialised centre or unit within 90 days of discharge. Multivariate logistic regression was used to identify associations between PR uptake and patient characteristics, such as comorbidities, non-invasive ventilation (NIV), inhaled treatment, and forced expiratory volume in 1 second (FEV1).
Among the 325 patients admitted for severe COPD exacerbation, 92 (28.3%) underwent PR within 90 days of discharge. In univariate analysis, relative to those who underwent PR, patients without PR had significantly more comorbidities, were less often treated with triple bronchodilator therapy or NIV, and had a higher FEV1. In multivariate analysis, variables independently associated with the lack of PR uptake were the presence of comorbidities (adjusted odds ratio (aOR) = 1.28 [1.10-1.53], p = 0.003) and a higher FEV1 (aOR = 1.04 [1.02-1.06], p < 0.001). There was no significant correlation between PR uptake and departmental PR centre capacity (notably, some departments had no PR facilities).
These data highlight the lack of PR in the early stages of COPD. Collaboration among all healthcare providers involved in patient management is crucial for improved PR uptake.
肺康复（PR）是一种多学科护理，在慢性阻塞性肺疾病（COPD）严重恶化后强烈推荐。最近，一项法国全国性研究报告称，PR 的接受率非常低（8.6%）；然而，重要的临床数据却缺失了。在这里，我们旨在确定与 COPD 加重住院后 PR 接受率低相关的主要因素。
这是一项多中心回顾性研究，纳入了 2017 年 1 月 1 日至 2018 年 12 月 31 日期间因 COPD 加重住院的患者，这些患者是通过编码和详细的病历回顾确定的。PR 被定义为出院后 90 天内入住专门中心或单位的住院治疗。采用多变量逻辑回归来确定 PR 接受率与患者特征（如合并症、无创通气（NIV）、吸入治疗和 1 秒用力呼气量（FEV1））之间的关联。
在 325 名因严重 COPD 加重而入院的患者中，有 92 名（28.3%）在出院后 90 天内接受了 PR。在单变量分析中，与接受 PR 的患者相比，未接受 PR 的患者合并症更多，接受三联支气管扩张剂治疗或 NIV 的比例更低，FEV1 更高。在多变量分析中，与缺乏 PR 接受率相关的独立变量是合并症的存在（调整后的优势比（aOR）=1.28[1.10-1.53]，p=0.003）和更高的 FEV1（aOR=1.04[1.02-1.06]，p<0.001）。PR 接受率与部门 PR 中心容量之间没有显著相关性（值得注意的是，一些部门没有 PR 设施）。
这些数据突出了 COPD 早期 PR 缺乏的情况。所有参与患者管理的医疗保健提供者之间的协作对于提高 PR 接受率至关重要。
