This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbation. This recommendation places a high value on improving clinical outcomes and a lower value on the burden and cost of pulmonary rehabilitation. For patients who are hospitalized with a COPD exacerbation, we suggest not initiating pulmonary rehabilitation during hospitalization (conditional recommendation, very low quality of evidence).

Pulmonary rehabilitation implemented during hospitalization increases mortality. Pulmonary rehabilitation implemented within 3 weeks after discharge following a COPD exacerbation reduces hospital admissions and improves quality of life, while pulmonary rehabilitation implemented within 8 weeks after discharge increases exercise capacity. Research is needed to identify the interventions that provide the greatest benefits; some studies suggest that a combination of regular exercise with breathing technique training may be best, but additional investigations are needed. Studies employing methodologies of implementation science (also known as knowledge translation) are needed to test strategies that systematically target barriers and facilitators of integrating pulmonary rehabilitation into the care of patients with COPD exacerbation after hospital discharge.

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