Introduction: PR is key for the management of chronic respiratory patients COPD and is more complex for frail patients such as those on home NIV. We hypothesised that COPD patients on NIV would have a low PR referral rate. We aimed to report the incidence of PR in this population and to determine which group of patients were more likely to be referred.

Methods: Retrospective monocentric study including all COPD patients that were admitted to our centre for elective review of their home NIV between 2017 and 2019. From this cohort, we identified those who were referred and attended PR. All data were collected from hospital electronic medical record.

Results: 332 patients established on home NIV for COPD were identified (182 (55%) lone COPD, 150 (45%) COPD-OSA). Median PaCO₂ was 6.58 kPa for COPD and 6.00 kPa for COPD-OSA (p < 0.0001). Median time since NIV initiation was 12 months for COPD, 21 months for COPD-OSA. Median PS and EPAP was 15 and 5 cmH₂O for COPD, 13 and 8 cmH₂O for COPD-OSA.The incidence of PR referral was 34.6% (IC95: 29.7; 39.9), namely 115 patients. Patients referred to PR were significantly younger than those who were not (66 vs 69 yo p = 0.006), had a lower BMI: 28.4 [21.6; 34.6] versus 30.5 [24.9; 36.7] kg/m² (p = 0.018) and higher PaCO₂ 6.48 [5.80; 7.40] versus 6.20 [5.49; 6.97] kPa, (p = 0.009).There was no significant difference in lung function, smoking status, level of dyspnea or quality of life assessed by the Severe Respiratory Insufficiency questionnaire.

Conclusion: In our study, COPD patients were more likely to be referred to PR when they were young with a more advanced disease. However, the non-referred group is more likely to benefit of PR given a milder disease.