Short- and Long-Term Responses to Pulmonary Rehabilitation in 922 Patients with COPD: A Real-World Database Study (2002–2019)

Abstract

Background/Objectives: Pulmonary rehabilitation (PR) is a cornerstone treatment for patients with chronic obstructive pulmonary disease (COPD), yet not all patients achieve clinically meaningful benefits. Evidence on the determinants of short- and long-term responses from real-world settings remains limited. The aim of this study was to quantify response rates to outpatient PR and identify baseline factors associated with achieving minimal clinically important differences (MCIDs) in the walking capacity 6 min walk test [6MWT] or endurance shuttle walk test [ESWT] and patient-reported outcomes (St. George’s Respiratory Questionnaire [SGRQ] or COPD Assessment Test [CAT]) at 10 weeks and 1-year follow-up. Methods: In this retrospective cohort study, data from a PR database (2002–2019) at Copenhagen University Hospital Hvidovre were analysed. Patients with COPD and complete data on one functional outcome ([6MWT] or [ESWT]) and one patient-reported outcome ([SGRQ] or [CAT]) were included. Multinomial regression models assessed associations between baseline variables and response categories. Results: Among 922 patients, 52% achieved clinically meaningful improvement following PR, and 47% of responders maintained these gains at 1 year. Response rates declined over time. Higher baseline symptom burden (CAT and SGRQ) and walking capacity showed mixed associations with short-term response. Younger age was the most consistent predictor of both short- and long-term responses, while higher baseline FEV1 was associated with sustained improvement at 1 year. Conclusions: Approximately half of patients with COPD benefit clinically from PR, with sustained improvements in nearly half at 1 year, and response is associated with baseline age, symptom burden, and functional capacity, underscoring the need for a more individualised approach to care.