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

Joon Young Choi; Ki Uk Kim; Deog Kyeom Kim; Yu-Il Kim; Tae-Hyung Kim; Won-Yeon Lee; Seong Ju Park; Yong Bum Park; Jin Woo Song; Kyeong-Cheol Shin; Soo-Jung Um; Kwang Ha Yoo; Hyoung Kyu Yoon; Chang Youl Lee; Ho Sung Lee; Ah Young Leem; Won-Il Choi; Seong Yong Lim; Chin Kook Rhee; Korean Pulmonary Rehabilitation Study Group

doi:10.1016/j.chest.2023.09.026

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

Chest. 2024 Feb;165(2):313-322. doi: 10.1016/j.chest.2023.09.026. Epub 2023 Oct 6.

Authors

Joon Young Choi¹, Ki Uk Kim², Deog Kyeom Kim³, Yu-Il Kim⁴, Tae-Hyung Kim⁵, Won-Yeon Lee⁶, Seong Ju Park⁷, Yong Bum Park⁸, Jin Woo Song⁹, Kyeong-Cheol Shin¹⁰, Soo-Jung Um¹¹, Kwang Ha Yoo¹², Hyoung Kyu Yoon¹³, Chang Youl Lee¹⁴, Ho Sung Lee¹⁵, Ah Young Leem¹⁶, Won-Il Choi¹⁷, Seong Yong Lim¹⁸, Chin Kook Rhee¹⁹; Korean Pulmonary Rehabilitation Study Group

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
² Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Seo-gu, Busan, South Korea.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
⁴ Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea.
⁶ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
⁷ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gangdong Sacred Heart Hospital, The Hallym University, Seoul, South Korea.
⁹ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
¹⁰ Division of Pulmonology and Allergy, Department of Internal Medicine, Regional Center for Respiratory Disease, College of Medicine, Yeungnam University, Daegu, South Korea.
¹¹ Division of Respiratory Medicine, Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, South Korea.
¹² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
¹³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
¹⁴ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea.
¹⁵ Division of Respiratory Medicine, Soonchunhyang University CheonAn Hospital, Cheonan, Chungcheongnam-do, South Korea.
¹⁶ Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
¹⁷ Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Deogyang-gu, Goyang-si, Gyeongji-do, South Korea.
¹⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹⁹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. Electronic address: chinkook77@gmail.com.

PMID: 37806492
DOI: 10.1016/j.chest.2023.09.026

Abstract

Background: Poor uptake to pulmonary rehabilitation (PR) is still challenging around the world. There have been few nationwide studies investigating whether PR impacts patient outcomes in COPD. We investigated the change of annual PR implementation rate, medical costs, and COPD outcomes including exacerbation rates and mortality between 2015 and 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-PR and post-PR, and the time to first exacerbation and mortality rate according to PR implementation, were also assessed.

Results: Among all patients with COPD in South 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 group than the 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 period compared with the pre-PR period. The time to the first moderate-to-severe and severe exacerbations was longer in the PR group than the 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 toward improving outcomes including reducing exacerbation and mortality in patients with COPD. However, despite the well-established benefits of PR, its implementation rate remains suboptimal.

Keywords: COPD; HIRA database; exacerbation; mortality; nationwide cohort study; pulmonary rehabilitation.

MeSH terms

Disease Progression
Humans
Insurance, Health
Pulmonary Disease, Chronic Obstructive*
Republic of Korea / epidemiology