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Comorbidity Associated With Referral to Pulmonary Rehabilitation in People Hospitalized With Chronic Obstructive Pulmonary Disease

Li, Lok Sze Katrina B Physio; Caughey, Gillian BSc, PhD; Johnston, Kylie BAppSc(Physio), PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: November/December 2014 - Volume 34 - Issue 6 - p 430–436
doi: 10.1097/HCR.0000000000000080
Pulmonary Rehabilitation

PURPOSE: Comorbid conditions are common in people with chronic obstructive pulmonary disease (COPD) and may affect therapeutic management. The aim of this study was to examine the association of comorbidity in people with COPD with referral to a pulmonary rehabilitation (PR) program.

METHODS: An analysis of data was conducted from an observational study of 88 people admitted to hospital with a primary diagnosis of COPD. Demographic and admission-related data were extracted and comorbidity scores (Charlson and Rx-Risk-V) were calculated.

RESULTS: Total comorbidity scores were not associated with referral to PR; however specific comorbid conditions were. The presence of anxiety (from medical records) was more frequent in those referred to PR (χ2 = 4.20; P = .04; OR, 7.0; 95% CI, 0.8–59.0). The presence of hypertension (as determined by Rx-Risk-V) was more likely to result in PR referral2 = 6.69; P = .01; OR, 6.8; 95% CI, 1.6–29.1), and, in those with arrhythmia, PR referral was less likely (χ2 = 4.22; P = .04; OR, 0.28; 95% CI, 0.08–0.99). Patients who had been referred to PR had lower forced expiratory volume in 1 second (FEV1 percent predicted) (P < .001) and greater hospital bed days in previous 3 years (P = .051). In a multivariate analysis, FEV1 percent predicted, bed days in the last 3 years, and Rx-Risk-V categories of hypertension and arrhythmia accounted for 25% of variance in referral to PR.

CONCLUSIONS: In addition to COPD disease severity and hospital utilization, specific comorbidities identified with a comprehensive system (ie, the Rx-Risk score) were associated with referral to PR in this sample.

This study examined the association of comorbidity with referral to pulmonary rehabilitation in a sample of people hospitalized with chronic obstructive pulmonary disease. Pharmacologically managed hypertension, absence of pharmacologically managed arrhythmia, and documented anxiety were related to referral, along with worse lung function and greater hospital utilization in the previous 3 years.

School of Health Sciences (Ms Li and Dr Johnston), and School of Pharmacy and Medical Sciences (Dr Caughey), University of South Australia, Adelaide, Australia.

Correspondence: Kylie Johnston, BAppSc(Physio), PhD, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia (

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins