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Review ArticleSystematic Review

Pulmonary Rehabilitation for Patients After COPD Exacerbation

Manaka Shibuya, Shuhei Yamamoto, Shuken Kobayashi, Kenichi Nishie, Takayoshi Yamaga, Shohei Kawachi and Atsuhiko Matsunaga
Respiratory Care March 2022, 67 (3) 360-369; DOI: https://doi.org/10.4187/respcare.09066
Manaka Shibuya
Department of Rehabilitation, Kitasato University Hospital, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
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  • For correspondence: [email protected]
Shuhei Yamamoto
Department of Rehabilitation, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
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Shuken Kobayashi
Department of Rehabilitation, Kitasato University Hospital, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
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Kenichi Nishie
The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan and Department of Respiratory Medicine, Iida Municipal Hospital, 438, Yawatamachi, Iida, Nagano, Japan.
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Takayoshi Yamaga
Department of Occupational Therapy, Health Science University, 7187 Kodachi, Fujikawaguchiko-machi, minamitsuru-gun, Yamanashi, Japan.
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Shohei Kawachi
Department of Biomedical Laboratory Science, Graduate School of Medicine, Shinshu University, 3-1-1, Asahi, Matsumoto, Nagano, Japan and Institute for Biomedical Sciences, Shinshu University, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
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Atsuhiko Matsunaga
Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan and Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
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Abstract

BACKGROUND: The aim of this study was to clarify the effectiveness of pulmonary rehabilitation in patients after exacerbations of COPD and to explore the initiation timing of pulmonary rehabilitation.

METHODS: Systematic review and meta-analysis were performed to assess the effects of pulmonary rehabilitation in subjects with exacerbations of COPD on mortality and readmission compared with usual care. We searched for studies published up to October 2020 in MEDLINE, Embase, Cochrane Library, and other sources. Risk of bias was assessed for the randomization process, deviations from intended interventions, missing outcome data, outcome measurements, and selection of the reported result using the Risk of Bias 2 tool. We pooled mortality and readmission data and performed comparisons between pulmonary rehabilitation and usual care. The subgroup analysis compared pulmonary rehabilitation at different start times (early: ≤ 1 week from admission; and late: > 1 week from admission).

RESULTS: We identified 10 randomized trials (1,056 participants). Our meta-analysis showed a clinically relevant reduction in readmission up to 3–6 months after pulmonary rehabilitation in both early group (4 trials, 190 subjects; risk ratio [RR] 0.58, [95% CI 0.34–0.99]) and late group (3 trials, 281 subjects; RR 0.48, [95% CI 0.32–0.71]). However, pulmonary rehabilitation had no significant effect on mortality 1 y later compared with usual care (4 trials, 765 subjects; RR 1.27, [95% CI 0.91–1.79]).

CONCLUSIONS: Pulmonary rehabilitation showed short-term effects for subjects with exacerbations of COPD even if initiated within 1 week; however, further study is required to determine its long-term effects.

  • chronic obstructive pulmonary disease
  • exercise
  • hospitalization
  • meta-analysis
  • mortality
  • rehabilitation

Footnotes

  • Correspondence: Manaka Shibuya PT PhD, Department of Rehabilitation, Kitasato University Hospital, 1–15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252–0375, Japan. E-mail: manaka.s{at}kitasato-u.ac.jp
  • The authors have declared no conflicts of interest.

  • The study was performed at Department of Rehabilitation, Kitasato University Hospital, 1–15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (3)
Respiratory Care
Vol. 67, Issue 3
1 Mar 2022
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Pulmonary Rehabilitation for Patients After COPD Exacerbation
Manaka Shibuya, Shuhei Yamamoto, Shuken Kobayashi, Kenichi Nishie, Takayoshi Yamaga, Shohei Kawachi, Atsuhiko Matsunaga
Respiratory Care Mar 2022, 67 (3) 360-369; DOI: 10.4187/respcare.09066

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Pulmonary Rehabilitation for Patients After COPD Exacerbation
Manaka Shibuya, Shuhei Yamamoto, Shuken Kobayashi, Kenichi Nishie, Takayoshi Yamaga, Shohei Kawachi, Atsuhiko Matsunaga
Respiratory Care Mar 2022, 67 (3) 360-369; DOI: 10.4187/respcare.09066
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Keywords

  • chronic obstructive pulmonary disease
  • exercise
  • hospitalization
  • meta-analysis
  • Mortality
  • rehabilitation

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