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Influence of Socioeconomic Deprivation on Short- And Long-Term Outcomes Of Home-Based Pulmonary Rehabilitation In Patients With Chronic Obstructive Pulmonary Disease

Grosbois J-M, Heluain-Robiquet J, Machuron F, et al.

Intl J COPD. 2019;14:2441–49.


Pulmonary rehabilitation (PR) is an intervention used to improve dyspnoea, exercise tolerance, quality of life, anxiety and depression in chronic obstructive pulmonary disease (COPD), regardless of disease severity. Despite this, fewer than 10% of all COPD patients participate in PR programs. Many patients report that they are unable to engage in PR due to a lack of available environmental resources such as transportation and social support. Socio-economic disadvantages, smoking status and the degree of physical impairment have also been shown to have an influence. Home-based PR may offer an innovative intervention that overcomes the issue of accessibility and provides officious treatment regardless of socioeconomic deprivation.

This observational study retrospectively analysed data from 459 COPD patients categorised as either socially deprived or non-socially deprived based on a cut-off of 30.17 on the Evaluation of Deprivation and Inequalities in Health Centres (EPICES) questionnaire. Patients received weekly PR sessions, composed of retraining exercises, physical activities, therapeutic education and psychosocial and motivational support. Exercise tolerance, levels of anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Measurements were taken before the PR program, then at 2, 4, and 8 months following treatment.

This study found that the socially deprived group were younger, more likely to be women, active smokers or living alone. The socially deprived group also had more severe depression and anxiety compared with the non-socially deprived group. Before treatment, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. The benefits of PR were sustained in both socially deprived and non-socially deprived individuals at 2, 8, and 14-month follow-up, with no significant differences in any of the outcome variables between groups. The percentage of patients showing clinically important improvements was the same in both groups. This suggests home-based PR could be an effective intervention in patients with COPD regardless of socioeconomic status.

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