Pulmonary rehabilitation in Iranian outpatients with mustard gas lung disease: a randomised controlled trial

Abstract

ObjectivePeople with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be beneficial in this condition.DesignAn assessor-blind, two-armed, parallel-design randomised controlled clinical trial.SettingSecondary care clinics in Iran.Participants60 men with breathlessness due to respiratory disease caused by documented mustard gas exposure, mean (SD) age 52.7 (4.36) years, MRC dyspnoea score 3.5 (0.7), St. George’s Respiratory Questionnaire (SGRQ) 72.3 (15.2).InterventionsParticipants were allocated either to a 6-week course of thrice-weekly PR (n=31) or to usual care (n=29), with 6-week data for 28 and 26, respectively.Outcome measuresPrimary endpoint was change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Secondary endpoints included 6 min walk distance, quadriceps strength and bulk, body composition and health status. For logistical reasons, blood tests that had been originally planned were not performed and 12-month follow-up was available for only a small proportion.ResultsAt 6 weeks, cycle endurance time increased from 377 (140) s to 787 (343) s with PR vs 495 (171) s to 479 (159) s for usual care, effect size +383 (231) s (p<0.001). PR also improved 6 min walk distance+103.2 m (63.6–142.9) (p<0.001), MRC dyspnoea score −0.36 (−0.65 to −0.07) (p=0.016) and quality of life; SGRQ −8.43 (−13.38 to −3.48) p<0.001, as well as quadriceps strength+9.28 Nm (1.89 to 16.66) p=0.015.ConclusionThese data suggest that PR can improve exercise capacity and quality of life in people with breathlessness due to mustard gas lung disease and support the wider provision of this form of care.Trial registration numberIRCT2016051127848N1.