Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005305. DOI: 10.1002/14651858.CD005305.pub2. Background: Pulmonary rehabilitation is a key part of managing stable chronic obstructive pulmonary disease (COPD). Systematic reviews show it has large clinical benefits for these patients. However, its effects on unstable COPD patients who have had an exacerbation are less clear. Objectives: To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other important patient outcomes (mortality, health-related quality of life, and exercise capacity). Search strategy: Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO, and the Cochrane Central Register of Controlled Trials. Searches were current as of July 2008. Selection criteria: Randomized controlled trials comparing pulmonary rehabilitation of any duration after COPD exacerbation with conventional care. Pulmonary rehabilitation programs needed to include at least physical exercise. Control groups received conventional community care without rehabilitation. Data collection and analysis: Pooled odds ratios and weighted mean differences (WMD) were calculated using fixed-effects models. Missing data were requested from the authors of the primary studies. Main results: Six trials involving 219 patients were identified. Pulmonary rehabilitation significantly reduced hospital admissions (pooled odds ratio 0.13 [95% CI 0.04 to 0.35], NNT 3 [95% CI 2 to 4], over 34 weeks) and mortality (pooled odds ratio 0.29 [95% CI 0.10 to 0.84], NNT 6 [95% CI 5 to 30] over 107 weeks). Pulmonary rehabilitation improved health-related quality of life, with results well above the minimal important difference. Exercise capacity improved in all trials. No adverse events were reported. Authors' conclusions: Evidence from small studies of moderate methodological quality suggests that pulmonary rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients after an exacerbation.Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005305. DOI: 10.1002/14651858.CD005305.pub2. Background: Pulmonary rehabilitation is a key part of managing stable chronic obstructive pulmonary disease (COPD). Systematic reviews show it has large clinical benefits for these patients. However, its effects on unstable COPD patients who have had an exacerbation are less clear. Objectives: To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other important patient outcomes (mortality, health-related quality of life, and exercise capacity). Search strategy: Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO, and the Cochrane Central Register of Controlled Trials. Searches were current as of July 2008. Selection criteria: Randomized controlled trials comparing pulmonary rehabilitation of any duration after COPD exacerbation with conventional care. Pulmonary rehabilitation programs needed to include at least physical exercise. Control groups received conventional community care without rehabilitation. Data collection and analysis: Pooled odds ratios and weighted mean differences (WMD) were calculated using fixed-effects models. Missing data were requested from the authors of the primary studies. Main results: Six trials involving 219 patients were identified. Pulmonary rehabilitation significantly reduced hospital admissions (pooled odds ratio 0.13 [95% CI 0.04 to 0.35], NNT 3 [95% CI 2 to 4], over 34 weeks) and mortality (pooled odds ratio 0.29 [95% CI 0.10 to 0.84], NNT 6 [95% CI 5 to 30] over 107 weeks). Pulmonary rehabilitation improved health-related quality of life, with results well above the minimal important difference. Exercise capacity improved in all trials. No adverse events were reported. Authors' conclusions: Evidence from small studies of moderate methodological quality suggests that pulmonary rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients after an exacerbation.