Pulmonary rehabilitation (PR) is a cornerstone of care for people with COPD. There is robust evidence that PR improves exercise capacity, enhances health-related quality of life (QoL) and reduces healthcare utilization. PR is strongly recommended in guidelines for COPD management. Despite the compelling evidence for its benefits, PR is delivered to less than 30% of people with COPD. Access is particularly challenging, an especially for those with the most progressed disease stages.

We recently completed a randomized clinical trial, showing that approximately 1.100 patients annually are offered conventional hospital-based PR during routine consultations in the Capital Region of Denmark, but at least 700 patients declines participation.

No major cohort studies have been published from people with severe and advanced COPD who opt out of traditional pulmonary rehabilitation. By establishing such cohort study, objective and qualitative knowledge from assessments and patient interviews is collected in patients we have very limited access to and knowledge of. Additionally, the collected data will give a deeper insight and understanding and possibly enable us to design new delivery models to be tested in proper study designs.

Objective This cohort study aims to describe and understand differences and similarities in characteristics among people with severe and advanced COPD who opt-in or opt out of PR services.

The study includes data from: socio-demographic, anthropometric, physical (function, activity, muscle strength, balance) characteristics as well as self-reported symptoms of anxiety, depression, fatigue, pain, lung symptoms, quality of life, sleep-quality, mortality, hospitaladmissions, length of stay and qualitative patient interviews.

Data from our completed trial study (NCT02667171) will be used as the opt-in PR comparison cohort.

Inclusion Criteria:

• Clinical diagnosis of COPD defined as a ratio of forced expiratory volume at one second (FEV1) to forced vital capacity < 0.70
• FEV1 <50%, corresponding to severe or very severe COPD
• Symptoms equivalent to the Medical Research Council (MRC) from 2 to 5
• Declines to participate in a conventional out-patient hospital-based PR program

Exclusion Criteria:

• Concurrent participation in or recent completion of pulmonary rehabilitation within the last twelve months.
• Dementia/ Cognitive impairment or uncontrolled psychiatric illness,
• An impaired hearing and / or vision which causes the instructions in the assessment is not understood.
• language difficulties which causes inability to follow instruction or complete patient reported outcome measures (PROM.)
• Any comorbidity that are contraindicated to the assesment protocol.

This is a prospective observational study of patients with COPD who declines participation in a conventional out-patient hospital-based PR program.

Proposal for data use should be addressed to Henrik.hansen.09@regionh.dk

Data access in Denmark are under very strict juristic data protection law.

Any possible access or sharing demands a part application to

1. Danish Data Protection Agency,
2. Ethics Committee of the Capital Region
3. National Health Data Authorities.

Only if the applications are approved data will be considered available for sharing. The authors will not be able to support this process and a prolonged process must be expected.

unresolved

Please read plan description