Analysis Observes Mortality Factors in Respiratory Rehabilitation

Filipina Aguiar

A retrospective analysis of patients undergoing long-term respiratory rehabilitation for chronic diseases including asthma and chronic obstructive pulmonary disease (COPD) showed a mortality rate near 40% at 5 years post-initiation.

The data, presented virtually during the European Respiratory Society (ERS) 2020 Congress this week, also depicted prognostic factors involved in such rehabilitation programs.

Investigators, led by Filipa Aguiar, of the Pneumology Department at the Braga Public Hospital in Portugal, conducted the retrospective review to better interpret the particular benefits and influential factors of rehabilitation—as well as what those elements mean toward patient mortality.

As they noted, respiratory diseases including COPD are known to gradually impair a patient’s physical ability while reducing their health-related quality of life.

“Respiratory rehabilitation has proved to have clinical benefits in some pathologies but there is a lack of long-term results,” they wrote. “The objective of this study was to examine the five-year mortality and prognostic factors in a respiratory rehabilitation program.”

The team conducted a retrospective assessment of the patients integrated into such a program in the Matosinhos Local Health Unit. Follow-up ran from 2014-2019.

Among their observed 73 patients, median age was 66.0 years (±10.7), with nearly three-fourths (72.6%) being male. The majority of patients suffered from COPD (77.1%), while another 7.1% had diffuse lung diseases, 5.7% had asthma, 4.3% had bronchiectasis, and 2.9% had restrictive syndromes.

Median patient forced expiratory volume at 1 second (FEV1) was 43.5% (±18.1), and median FVC was 66.0% (±20.0). Median residual volume was 181.0% (±59.4), and median six-minute walking test (6-MWT) distance was 420 m (±116.2).

All but 6 patients completed the program in 2014 and were eligible for follow-up.

Aguiar and colleagues reported that 46.6% of patients repeated the program, and another 24.7% repeated the program ≥3 times. Additionally, 17.8% maintained at-home exercises post-program.

At 5 years, investigators observed that lower baseline FVC values (P = .038), distance walked in the 6-MWT (P = .024), and superior values of pulmonary arterial systolic pressure (PASP) were all associated with worse prognoses for health status.

Just 61.6% of patients were still alive at the five-year follow-up—38.4% died. The majority of patients died from respiratory pathology exacerbation (57.7%), then infections (30.7%), cardiovascular disease (7.7%), and lung cancer (3.8%).

Aguiar and colleagues concluded they observed “satisfactory” maintenance of rehabilitation program among patients with chronic respiratory disease—both in hospital and home settings.

“Respiratory rehabilitation is an undervalued tool to patients with respiratory diseases and it’s crucial to identify precociously the patients to refer to respiratory rehabilitation and improve the long-term results,” they wrote.

The study, “Five-year Follow-up of a Respiratory Rehabilitation Program,” was presented at ERS 2020.