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

Objective: To compare the functional benefits and relative costs of adminis tering an intense short-term inpatient vs a longer outpatient pulmonary reh abilitation 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 sel ection criteria were compared with control subjects matched to them for age , sex, FEV1, and diagnosis of either COPD or asthma. Case subjects performe d 10 to 12 daily sessions (5 sessions a week) of inpatient PRP; control sub jects performed 20 to 24 sessions (3 sessions a week) of outpatient PRP. Me asurements: 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 eval uated. Results: Both PRPs resulted in similar significant improvements in cycloerg ometry 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 (f rom 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 fo r case subjects and from 8.9 +/-1.9 to 7.0 +/-1.8 for control subjects). Al though the single daily session was less expensive, the outpatient PRP tota l 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 im provement in exercise tolerance similar to a longer outpatient PRP but with lower costs. Whether a shorter outpatient PRP may get physiologic and clin ical benefits, while further reducing costs, must be evaluated by future co ntrolled, randomized, prospective studies.