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COPD – Reduced number of exacerbations

Evidence Summary (Updated 2022)
A large body of good quality observational data shows a reduction in hospital admissions due to COPD exacerbations.(1–4) Both early and late interventions with pulmonary rehabilitation reduced exacerbations and admissions . The evidence for admissions is discussed in more detail in the ‘reduced hospitalisations’ benefit.
This small meta-analysis of 2 studies suggested a statistically insignificant reduction in the risk of exacerbations with supervised maintenance exercise (risk ratio 0.79, 95% CI 0.52–1.19, P=0.25, I2=0%). They did however find on analysing 5 studies, a reduced risk of hospital admissions with the intervention group (risk ratio 0.62, 95% confidence interval (CI) 0.47–0.81, P<0.001).(5)
An extensive Cochrane systematic review found little or no difference between supervise maintenance programmes following PR and usual care groups in terms of exacerbations or all-cause hospitalisations.(6)
Shibuya et al, highlighted through meta-analysis, a clinically relevant reduction in readmission up to 3-6 months after PR interventions in both early (4 trials, 190 subjects; risk ratio [RR] 0.58, [95% CI 0.34–0.99]) and late groups (3 trials, 281 subjects; RR 0.48, [95% CI 0.32–0.71]).(7)

Quality of Evidence
Grade C – low quality.

Strength of recommendation
Grade 1 – strong recommendation.

A large body of good quality observational data shows a reduction COPD exacerbations. Both early and late interventions with pulmonary rehabilitation reduced exacerbations and admissions. The evidence base however is of low quality and can be conflicting at times .


  1. Benzo RP, Chang CCH, Farrell MH, Kaplan R, Ries A, Martinez FJ, et al. Physical activity, health status and risk of hospitalization in patients with severe chronic obstructive pulmonary disease. Respiration [Internet]. 2010 Jun [cited 2022 Oct 5];80(1):10–8. Available from:
  2. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Antó JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax [Internet]. 2006 Sep 1 [cited 2022 Oct 4];61(9):772–8. Available from:
  3. Garcia-Aymerich J, Serra I, Gómez FP, Farrero E, Balcells E, Rodríguez DA, et al. Physical activity and clinical and functional status in COPD. Chest [Internet]. 2009 Jul 1 [cited 2022 Oct 6];136(1):62–70. Available from:
  4. Chawla H, Bulathsinghala C, Tejada JP, Wakefield D, ZuWallack R. Physical activity as a predictor of thirty-day hospital readmission after a discharge for a clinical exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc [Internet]. 2014 Oct 1 [cited 2022 Oct 5];11(8):1203–9. Available from:
  5. Jenkins AR, Gowler H, Curtis F, Holden NS, Bridle C, Jones AW. Efficacy of supervised maintenance exercise following pulmonary rehabilitation on health care use: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis [Internet]. 2018 Jan 10 [cited 2022 Oct 5];13:257–73. Available from:
  6. Malaguti C, Dal Corso S, Janjua S, Holland AE. Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease. Cochrane Database Syst Rev [Internet]. 2021 Aug 17 [cited 2022 Oct 4];2021(8). Available from: /pmc/articles/PMC8407510/
  7. Shibuya M, Yamamoto S, Kobayashi S, Nishie K, Yamaga T, Kawachi S, et al. Pulmonary Rehabilitation for Patients After COPD Exacerbation. Respir Care [Internet]. 2022 Mar 1 [cited 2022 Oct 5];67(3):360–9. Available from: