The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

Introduction/Objective The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method The prospective observation study included stable COPD patients between January 2015 and December 2018.The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results Study included 1,674 patients (956 males, age 65.93 +/- 8.45, current or ex-smokers 94.9%; 21 >= BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307-0.577); p < 0.001) and BMI >= 21kg/m(2) (RR 0.605; 95% CI (0.380-0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720-3.280); p < 0.001) and FEV1 < 80% (RR 2.021; 95% CI (1.303-3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.