Current status of pulmonary rehabilitation and impact on prognosis in patients with IPF in South Korea

<bold>Background:</bold> The clinical benefits of pulmonary rehabilitation (PR) in patients with idiopathic pulmonary fibrosis (IPF) have been limited to improving dyspnea, exercise capacity, and quality of life. We aimed to investigate the long-term effects of PR in patients with IPF in terms of exacerbation risk and mortality. <bold>Methods:</bold> The Nationwide Korean Health Insurance Review and Assessment Service (HIRA) database was used in this study. We analyzed the annual PR implementation rate since 2016 following its coverage in the health insurance system. IPF case were defined using the International Classification of Diseases 10th Revision (ICD-10) codes and rare intractable disease codes. The risk of acute exacerbation (AE) and mortality in IPF patients with or without PR were analyzed. <bold>Results:</bold> Among the 4,228 patients with eligible IPF, only 205 (4.85%) received PR during the study period. More patients in the PR group were treated with pirfenidone and systemic steroids, and consequently, medical expenses were 3 to 6 times higher than that of the non-PR group. The risk of AE was significantly higher in the PR group (Odds ratio, 3.04; 95% CI, 2.29-4.04) Moreover, the mortality rate was higher in the PR group (43.4% vs. 33.9%) and older age (≥70 years), male sex, more comorbidities, and PR were associated with a higher mortality risk, whereas the use of pirfenidone reduced risk. <bold>Conclusions:</bold> PR was applied in only a minority of patients with IPF, and it has not succeeded in reducing the risk of AE and mortality. A prospective study targeting early stage and less severe patients is needed to evaluate the impact of PR considering the intractable, progressive nature of IPF disease itself.