Costs and benefits of pulmonary rehabilitation to COPD patients apply in primary health care

We aim to assess the costs and benefits of a pulmonary rehabilitation program based on walking activity in patients with COPD conducted in primary health care. Method: Seventy-two patients with COPD were selected, 40 patients were randomized in control group (CG) or pulmonary rehabilitation (PR). Thirty-four patients were included on study, 16 on CG (FEV1%pred:50.9±14%, FEV1/FVC:0.60±0.09) and 18 on PR (FEV1%pred:56 ± 0.5% FEV1/FVC:0.62±0.08). We assessed lung function, 6MWT, respiratory muscle strength, health-related quality of life (HRQoL), body composition and level of activity of daily living (ADL) before and after 8 weeks. The PR consisted on walking activity, during one hour, supervised tree times/week and unsupervised 2 times/week. The intensity of walking was controlled considering dyspnea sensation measure with Borg scale. Costs of PR were calculated following the Brazilian Health System costs reference. Results: The PR group showed improvement in 6MWT (PRΔ: 42 m vs CGΔ:-51m), sensation of dyspnea (PRΔ:-0.5 vs CGΔ:+1.3) and fatigue (PRΔ: -0.1 vs CGΔ: +0.9), BODE index (PRΔ: -0.5 vs CGΔ: +1.4) (p <0.01), HRQoL (PRΔ: -16.4 vs CGΔ: +14.3) and level of ADL (PR Δ: +6.4 vs CG Δ: -6.4) (p < 0.001). The final average cost per patient in PR group was 51,47 Euros (148,75 reais) and no exacerbation were observed. In CG, exacerbation was observed in 2 patients with a total cost of 238,46 Euros/patient (689,15 reais). Conclusions: The simple PR program based on walk activity demonstrated significantly clinical improvements and low costs of implementation in primary care of public health system in Brazil.