Pulmonary Rehabilitation is Associated with Increased 1-Year Survival in Stable COPD

Abstract Rationale Despite proven benefits, pulmonary rehabilitation faces limited access and utilization. Examining the effect of PR on survival is crucial to improving COPD prognosis and informing healthcare policies. Objective Determine the association between pulmonary rehabilitation and 1-year mortality in persons with COPD and no COPD-related hospitalization in the 90 days prior to starting pulmonary rehabilitation. Methods This retrospective cohort study analyzed data from persons with stable COPD who attended ≥ 1 center-based pulmonary rehabilitation session, January 1, 2010—June 30, 2024. Follow-up ended on June 30, 2025. The engaged group attended ≥ 2 sessions; the non-engaged group attended 1 session. Primary outcome was all-cause 1-year mortality. Cox proportional hazards models, adjusting for demographic and clinical factors, examined the association. Additional models assessed number of PR sessions and 1-year mortality. Results Of 23,621 patients (96.0% male, mean ± s.d. age 70.4 ± 7.5 years), 21,313 (90.2%) engaged in pulmonary rehabilitation and 2,308 (9.8%) did not. Within 1 year of last pulmonary rehabilitation session, 2,087 (8.8%) patients died. Compared to non-engaged, those who engaged in pulmonary rehabilitation had a 26% lower 1-year mortality rate (HR: 0.74, 95% CI [0.653, 0.844]. There was a significant trend of lower 1-year mortality with increasing number of pulmonary rehabilitation sessions (P < .001). Attending 8–15, 16–25, or 26–72 sessions was associated with a lower 1-year mortality rate compared to the non-engaged group (HRs: 0.79, 0.60, 0.62, respectively). Conclusions Engagement in center-based pulmonary rehabilitation is associated with greater survival in stable COPD, supporting need for policies to increase funding for and access to pulmonary rehabilitation.