Pulmonary rehabilitation is associated with increased 1-year survival in stable chronic obstructive pulmonary disease

RATIONALE: Despite proven benefits, pulmonary rehabilitation (PR) faces limited access and utilization. Examining the effect of PR on survival is crucial to improving chronic obstructive pulmonary disease (COPD) prognosis and informing healthcare policies. OBJECTIVES: To determine the association between PR and 1-year mortality in persons with COPD and no COPD-related hospitalization in the 90 days prior to starting PR. METHODS: This retrospective cohort study analyzed data from persons with stable COPD who attended ≥1 center-based PR session, January 1, 2010 through June 30, 2024. Follow-up ended on June 30, 2025. The engaged group attended ≥2 sessions; the nonengaged 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. MEASUREMENTS AND MAIN RESULTS: Of 23 621 patients (96.0% male; mean ± SD age, 70.4 ± 7.5 years), 21 313 (90.2%) engaged in PR and 2308 (9.8%) did not. Within 1 year of the last PR session, 2087 (8.8%) patients died. Compared to nonengaged, those who engaged in PR 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 PR sessions (P <.001). Attending 8-15, 16-25, or 26-72 sessions was associated with a lower 1-year mortality rate compared to the nonengaged group (HRs: 0.79, 0.60, and 0.62, respectively). CONCLUSIONS: Engagement in center-based PR is associated with greater survival in stable COPD, supporting need for policies to increase funding for and access to PR.