Efficacy and safety of pulmonary rehabilitation training on lung function, quality of life, and T cell immune function in patients with stable chronic obstructive pulmonary disease: a randomized controlled trial

Yue, Ma; Chen, Yan; Zhang, Nan; Xu, Gelin; Wang, Yinglan; Sun, Yuhui; Bai, Cuiqing; Zuo, Zhitong

doi:10.21037/apm-22-451

Cited by 6 publications

(2 citation statements)

References 34 publications

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“…A large review by the Cochrane Collaboration [ 15 ] looking at 65 studies and 3822 participants to assess effects of pulmonary rehabilitation on COPD patients showed that pulmonary rehabilitation programmes provide clinically meaningful improvements for quality of life, SGRQ (mean difference (MD) total –6.9 points) and exercise capacity (MD +43.9 m). Only a few studies evaluated effects of pulmonary rehabilitation on lung function, and the changes reported were small (FEV 1 increase from 57.3% to 60.8% after 3 years [ 16 ]; FEV 1 decline of 18±22 mL per year over 7 years [ 17 ]; FEV 1 increase from 47.3±9.4% to 55.6±9.0% after 12 weeks [ 18 ]). Consistent with these effects, pulmonary function parameters did not improve overall after pulmonary rehabilitation in the presented trial, while exercise capacity increased.…”

Section: Discussionmentioning

confidence: 99%

Utility of rehabilitation prior to bronchoscopic lung volume reduction:post hocanalysis of the VENT trial

Brock,

Kontogianni,

Sciurba

et al. 2023

ERJ Open Res

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Background and objectiveRehabilitation programs are a valuable treatment modality for patients with chronic-obstructive pulmonary disease (COPD) to increase exercise capacity and quality of life. The utility of pulmonary rehabilitation (PR) prior to bronchoscopic lung volume reduction (BLVR) is unclear.MethodsWe performed a post-hoc analysis of the VENT trial, the first multicenter randomized trial comparing the safety and efficacy of BLVR. Patients completed a PR program prior to BLVR over 6–10 weeks and maintained by daily practice, consisting of endurance training, strength training and upper/lower limb exercise. Lung function and exercise parameters (six-minute-walking testing; 6-MWT) were assessed before and after rehabilitation and we tried to identify predictors for PR benefit.ResultsLung function and exercise capacity of 403 patients (mean age 63.3±7.4 years, 37.5% female, mean FEV130.1±7.6 l) were analyzed. Exercise capacity significantly improved from 331.6±98.8 to 345.6±95.3 m (p<0.001) in 6-MWT with 40.3% showing clinically meaningful improvements. Patients also experienced less dyspnea after 6-MWT, while pulmonary function parameters did not change significantly overall. Patients with lower exercise capacity at screening (6-MWT <250 m) benefited more from PR. The indication and prerequisites for BLVR were still present in all patients after PR.ConclusionThe national mandatory requirements for rehabilitation prior to BLVR, which apply to all COPD patients, should be reconsidered and specified for COPD patients who really benefit.

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Section: Discussionmentioning

confidence: 99%

Utility of rehabilitation prior to bronchoscopic lung volume reduction:post hocanalysis of the VENT trial

Brock,

Kontogianni,

Sciurba

et al. 2023

ERJ Open Res

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“…1 Others have previously reported the benefits of nonpharmacological management, such as smoking intervention, pulmonary rehabilitation, breathing exercises and education programmes in reducing symptoms and mortality, as well as improving lung function and health-related quality of life in patients with COPD. 29 – 36 In this study, COPD education was provided to almost all patients, but optimal self-management behaviour was evident in a much smaller proportion. Moreover, COPD knowledge was poor.…”

Section: Discussionmentioning

confidence: 80%

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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Background: Underdiagnosis and undertreatment pose major barriers to optimal management of chronic obstructive pulmonary disease (COPD) in China. Objective: The REAL trial was performed to generate reliable information on real-world COPD management, outcomes and risk factors among Chinese patients. Here, we present study outcomes related to COPD management. Design: It is a 52-week, prospective, observational, multicentre study. Methods: Outpatients (aged ⩾40 years) enrolled from 50 secondary and tertiary hospitals across six geographic regions of China were followed up for 12 months, with two onsite visits and by telephone every 3 months following baseline. Results: Between June 2017 and January 2019, 5013 patients were enrolled and 4978 included in the analysis. Mean [standard deviation (SD)] age was 66.2 (8.9) years, the majority of patients were male (79.5%) and mean (SD) time since COPD diagnosis was 3.8 (6.2) years. The most common treatments at each study visit were inhaled corticosteroids/long-acting beta-agonists (ICSs/LABAs; 28.3–36.0%), long-acting muscarinic antagonists (LAMAs; 13.0–16.2%) and ICS/LABA + LAMA (17.5–18.7%), but up to 15.8% of patients at each visit received neither ICS nor long-acting bronchodilators. The use of ICS/LABA, LAMA and ICS/LABA + LAMA differed across regions and hospital tiers; up to fivefold, more patients received neither ICS nor long-acting bronchodilators in secondary (17.3–25.4%) versus tertiary hospitals (5.0–5.3%). Overall, rates of nonpharmacological management were low. Direct treatment costs increased with disease severity, but the proportion of direct treatment costs incurred due to maintenance treatment decreased with disease severity. Conclusion: ICS/LABA, LAMA and ICS/LABA + LAMA were the most frequently prescribed maintenance treatments for patients with stable COPD in China, although their use differed between region and hospital tier. There is a clear need for improved COPD management across China, particularly in secondary hospitals. Registration: The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362; https://clinicaltrials.gov/ct2/show/NCT03131362 ). Plain language summary Treatment patterns in patients with COPD in China Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and irreversible airflow limitation. In China, many patients with this disease do not receive a diagnosis or appropriate treatment. Objective: This study aimed to generate reliable information on the treatment patterns among patients with COPD in China to help inform future management strategies. Study design and methods: Patients (aged ⩾40 years) were enrolled from 50 hospitals across 6 regions of China and physicians collected data over the course of 1 year during routine outpatient visits. Results: The majority of patients were receiving long-acting inhaled treatments, which are recommended to prevent worsening of the disease. Up to 16% of patients in this study, however, did not receive any of these recommended treatments. The proportion of patients who received long-acting inhaled treatments differed across regions and hospital tiers; there were about five times more patients in secondary hospitals (about 25%) who did not receive these treatments compared with those in tertiary hospitals (about 5%). Guidelines recommend that pharmacological treatment should be complemented by nondrug treatment, but this was only received by a minority of patients in this study. Patients with higher disease severity incurred greater direct treatment costs compared with those with milder disease. Maintenance treatment costs made up a smaller proportion of overall direct costs for patients with higher disease severity (60–76%) compared with patients with milder disease (81–94%). Conclusion: Long-acting inhaled treatments were the most frequently prescribed maintenance treatments among patients with COPD in China, but their use differed between region and hospital tier. There is a clear need to improve disease management across China, especially in secondary hospitals.

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The application effect of a pulmonary rehabilitation program based on empowerment theory for patients with COPD combined with heart failure

Zhang,

Gu,

Sun

et al. 2024

Medicine

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Background: Chronic obstructive pulmonary disease (COPD) and heart failure are often coexisting conditions that can severely impact patients’ cardiopulmonary function and quality of life. Pulmonary rehabilitation programs, particularly those based on empowerment theory, may improve clinical outcomes by enhancing self-efficacy and promoting patient engagement. Methods: A total of 70 patients with COPD and heart failure admitted to our hospital’s respiratory department from January 1, 2023, to April 31, 2024, were randomly assigned to either a control group (n = 35) or an observation group (n = 35). The control group received routine care, while the observation group underwent an empowerment-based pulmonary rehabilitation program in addition to routine care for 4 weeks. Lung function (forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation), arterial blood gas levels (partial pressure of carbon dioxide, partial pressure of oxygen, and arterial oxygen saturation), cardiac function (left ventricular ejection fraction and serum brain natriuretic peptide), cardiopulmonary function (heart rate, respiratory rate, and 6-minute walk test), self-efficacy, and rehabilitation compliance were measured before and after the intervention. Results: There were no significant differences between the groups before the intervention (P > 0.05). After the intervention, the observation group exhibited significant improvements in lung function, arterial blood gas levels, cardiac and cardiopulmonary function, and self-efficacy scores compared with the control group (P < 0.05). Rehabilitation compliance was also significantly higher in the observation group (P < 0.05). Conclusion: An empowerment-based pulmonary rehabilitation program effectively improves rehabilitation compliance, lung and heart function, and self-efficacy in COPD patients with heart failure, suggesting it has strong potential for clinical application.

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Efficacy and safety of pulmonary rehabilitation training on lung function, quality of life, and T cell immune function in patients with stable chronic obstructive pulmonary disease: a randomized controlled trial

Cited by 6 publications

References 34 publications

Utility of rehabilitation prior to bronchoscopic lung volume reduction:post hocanalysis of the VENT trial

Utility of rehabilitation prior to bronchoscopic lung volume reduction:post hocanalysis of the VENT trial

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

The application effect of a pulmonary rehabilitation program based on empowerment theory for patients with COPD combined with heart failure

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