Assessment of pulmonary rehabilitation (PR) safety in patients with chronic respiratory diseases

PR is strongly suggested for patients with chronic respiratory diseases and it is generally considered as a safe clinical practice. However, adverse events (AE) have not been systematically reported in the literature and definite data on PR safety are still lacking. The aim is to provide a systematic collection of AE occurring during PR in an in-patient population and to evaluate their possible relation with functional status. We prospectively evaluated the 611 patients admitted to our in-hospital PR Dept. from January 2015 to December 2016. All AE, both those occurred during the rehab sessions and causing their interruption (123 AE), and those occurred during patient hospital stay outside the rehab sessions (183 AE) were recorded. 190 out of 611 patients showed AE. Among those occurred during the rehab sessions, hypotension, dizziness and general discomfort were the most frequent, while chest pain (9 cases), cardiac arrhythmia (3 cases), fall (4 cases), severe dyspnea (2 cases) and severe de-saturation (6 cases) were less common. Among the AE occurred outside the rehab sessions, hypotension, acute exacerbations and inadvertent falls were the most frequent. Comparing patients who showed AE with those who did not, there was no significant difference in terms of age, BMI, respiratory impairment, number of comorbidities and PR outcome. On the contrary, in patients who showed AE, we observed a significant difference in terms of baseline Functional Impedance Measure (p=0.002), dyspnea (MRC, p=0.003) and 6 Min Walk Test (p=0.003). Our data show that PR is substantially safe and that a reduced functional status could be associated with the possible occurrence of AE during in-hospital PR