In-hospital short-term training program for patients with chronic airway obstruction

Objective: To compare the functional benefits and relative costs of administering an intense short-term inpatient vs a longer outpatient pulmonary rehabilitation program (PRP) for patients with chronic airway obstruction (CAO). Design: Retrospective case-control study. Setting: Pulmonary ward and outpatient clinic of a rehabilitation center. Patients: Forty-three patients (case subjects) selected on the basis of selection criteria were compared with control subjects matched to them for age, sex, FEV₁, and diagnosis of either COPD or asthma. Case subjects performed 10 to 12 daily sessions (5 sessions a week) of inpatient PRP; control subjects performed 20 to 24 sessions (3 sessions a week) of outpatient PRP. Measurements: At baseline and after the PRP, an incremental exercise test was performed, including evaluation of dyspnea and leg fatigue by Borg scale (D and F, respectively) at each workload step. The cost of PRP was also evaluated. Results: Both PRPs resulted in similar significant improvements in cycloergometry peak workload (from 68 ± 18 to 82 ± 22 and from 75 ± 17 to 87 ± 27 W in case subjects and control subjects, respectively), isoload D (from 6.4 ± 1.6 to 4.2 ± 1.8 for case subjects and from 8.5 ± 1.9 to 6.3 ± 2.4 for control subjects) and isoload F (from 6.6 ± 1.8 to 4.2 ± 1.8 for case subjects and from 8.9 ± 1.9 to 7.0 ± 1.8 for control subjects). Although the single daily session was less expensive, the outpatient PRP total costs were greater because of the higher number of sessions and the cost of daily transportation. Conclusions: In patients with CAO, a shorter inpatient PRP may result in improvement in exercise tolerance similar to a longer outpatient PRP but with lower costs. Whether a shorter outpatient PRP may get physiologic and clinical benefits, while further reducing costs, must be evaluated by future controlled, randomized, prospective studies.