• 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, and Korean Pulmonary Rehabilitation Study Group.
• 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.
• Chest. 2024 Feb 1; 165 (2): 313322313-322.

BackgroundPoor 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 QuestionDoes PR implementation improve outcomes in patients with COPD in terms of direct cost, exacerbation, and mortality?Study Design And MethodsData 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.ResultsAmong 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.InterpretationWe 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.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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