Design of pulmonary rehabilitation programmes during acute exacerbations of COPD: a systematic review and network meta-analysis

Abstract

This systematic review aimed to systematise the different designs used to deliver pulmonary rehabilitation during acute exacerbations of COPD (AECOPD) and explore which ones are the most effective. PubMed, Scopus, Web of Science, EBSCO and Cochrane were searched. Randomised controlled trials comparing pulmonary rehabilitation or at least one of its components with usual care or comparing different components of pulmonary rehabilitation were included. Network meta-analysis was conducted in MetaXL 5.3 using a generalised pairwise modelling framework. Pooled effects compared each treatment to usual care. 42 studies were included. Most studies were conducted in an inpatient setting (57%) and started the intervention 24–48 h after hospital admission (24%). Exercise training (71%), education and psychosocial support (57%) and breathing techniques (55%) were the most used components. Studies combining exercise with breathing techniques presented the larger effects on exercise capacity (weighted mean difference (WMD) −41.06, 95% CI −131.70–49.58) and health-related quality of life (WMD 16.07, 95% CI 10.29–21.84), and breathing techniques presented the larger effects on dyspnoea (WMD 1.90, 95% CI 0.53–3.27) and length of hospitalisation (effect size =0.15, 95% CI −0.28–0.57). A few minor adverse events were found.Pulmonary rehabilitation is a safe intervention during AECOPD. Exercise, breathing techniques, and education and psychosocial support seem to be the core components for implementing pulmonary rehabilitation during AECOPD. Studies may now focus on comparisons of optimal timings to start the intervention, total duration of the intervention, duration and frequency of sessions, and intensity for exercise prescription.

Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin’s adjunct role

“…When it comes to the severe cases, most of the patients often appear to be delirious, and some may lose consciousness to be in a state of coma. Even worse, this may imperil their lives [27]. A ventilatorassisted support therapy is the primary method suitable for treating patients with ARF.…”

Key toolkits of non-pharmacological management in COPD: during and beyond COVID-19

“…There is rising evidence that PR is safe and effective during and after hospitalisation due to AECOPD [48]. Given the evidence that PR is effective with stable COPD patients, several studies have investigated the effect of PR during and after hospitalisation due to AECOPD.…”

Pulmonary Rehabilitation Programmes Within Three Days of Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

“… 15 , 32 Of relevant studies, ~57% have been conducted during hospitalization, 42% of which started within 48 h of hospital admission. 33 However, the starting time of PR is in a wide range, from admission to 2–3 weeks after discharge, which hampered judgement of the exact time to initiate PR. 33 Moreover, whether comprehensive PR 15 , 33 during hospitalization is safe and clinically effective is still controversial.…”

“… 33 However, the starting time of PR is in a wide range, from admission to 2–3 weeks after discharge, which hampered judgement of the exact time to initiate PR. 33 Moreover, whether comprehensive PR 15 , 33 during hospitalization is safe and clinically effective is still controversial. 6 , 34 This controversy may be related to six main factors: (i) different PR strategies have different effects; 33 (ii) the time window for starting PR differs; 33 (iii) the safety of initiating PR during hospitalization; 6 (iv) insufficient support for medical equipment; 35 (v) potential comorbidity instability and the contentious issue of using energy resources for exercise during early illness; (vi) different outcomes and outcome measures are used.…”

“… 33 Moreover, whether comprehensive PR 15 , 33 during hospitalization is safe and clinically effective is still controversial. 6 , 34 This controversy may be related to six main factors: (i) different PR strategies have different effects; 33 (ii) the time window for starting PR differs; 33 (iii) the safety of initiating PR during hospitalization; 6 (iv) insufficient support for medical equipment; 35 (v) potential comorbidity instability and the contentious issue of using energy resources for exercise during early illness; (vi) different outcomes and outcome measures are used. 36 Given the above considerations, we aimed to explore the efficacy of early PR for AECOPD patients <3 days of hospital admission to provide evidence for clinical practice.…”