A multidisciplinary pulmonary rehabilitation pathway for hospitalized patients with chronic lung disease and post-COVID syndrome: a prospective controlled cohort study

Abstract

Background
Patients with chronic lung disease (CLD) and post-COVID syndrome suffer from multidimensional impairment that is often incompletely addressed by pharmacotherapy alone. We evaluated a ward-based multidisciplinary pathway integrating pharmacotherapy, psychological support, and pulmonary rehabilitation.


Methods

In this prospective controlled cohort study, 360 hospitalized patients with CLD and post-COVID syndrome received integrated multidisciplinary care (
n
 = 120) or usual care (
n
 = 240). The primary outcomes were changes in PaCO₂, FEV₁% predicted, and CT-assessed residual radiological abnormality extent. Patient-reported outcomes, functional capacity, inflammation, and 6-month follow-up data were also assessed. Analyses used adjusted regression and IPTW.



Results

Integrated care was associated with greater improvements in the three primary outcomes: PaCO₂, adjusted β − 0.98 mmHg (95% CI − 1.21 to − 0.75;
P
 < 0.001); FEV₁% predicted, adjusted β 2.35% points (95% CI 1.53 to 3.17;
P
 < 0.001); and CT-assessed residual abnormality extent, adjusted β − 0.55% points (95% CI − 0.87 to − 0.24;
P
 < 0.001). Integrated care was also associated with greater improvements in SGRQ score, SAS score, 15-minute walking distance, CRP, ESR, and sleep-quality score. The composite early clinical benefit rate was higher in the integrated-care group than in the usual-care group, with an adjusted OR of 1.91 (95% CI 1.21 to 3.01;
P
 = 0.006). At 6 months, sleep quality was better and symptom-related medication use was lower, while rehospitalisation, acute exacerbation, and CT progression rates were similar between groups.



Conclusions
The integrated pathway was associated with broader short-term clinical improvement and lower symptom-related treatment burden at follow-up, although rehospitalisation, acute exacerbation, and CT progression rates were similar between groups.