From the Department of Medicine (Drs Ryerson and Collard), School of Medicine, University of California San Francisco, and Pulmonary Rehabilitation (Ms Garvey), Seton Medical Center.
Correspondence to: Harold R. Collard, MD, FCCP, 505 Parnassus Ave, Box 0111, San Francisco, CA 94143; e-mail: firstname.lastname@example.org
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Collard has served as a consultant to Actelion, Gilead, and Intermune. Ms Garvey has been on advisory boards and a speakers bureau for Boehringer Ingelheim and Sepracor. Dr Ryerson has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).
© 2010 American College of Chest Physicians
We read with interest the recent study in CHEST by Salhi and colleagues1 and the accompanying editorial by Varadi and Goldstein2 (February 2010) that described the effects of pulmonary rehabilitation in patients with interstitial lung disease (among other restrictive pulmonary conditions). The study adds to the existing literature supporting the use of pulmonary rehabilitation in this population. Unfortunately, despite a growing body of evidence, pulmonary rehabilitation is, in our opinion, underused in patients with interstitial lung disease because of a lack of physician awareness and a lack of coverage by health insurance organizations.
We know of seven studies of pulmonary rehabilitation in interstitial lung disease published in the past 5 years (some of which were not mentioned in the article or editorial).1,3-8 Two of these studies were randomized controlled trials.5,8 The results of all seven studies have been remarkably consistent (Table 1). The largest study found a mean improvement in 6-min walk distance of 56 m and suggested that subjects with a worse baseline walk distance experienced greater benefit.3 These findings support the editorial comment that patients with worse disease may benefit more.2 Taken together, these and other previous studies provide a solid evidence base for pulmonary rehabilitation in interstitial lung disease.
6MWD = 6-min walk distance; ILD = interstitial lung disease; NA = not assessed; RCT = randomized controlled trial.
Outcomes reported are mean difference between pulmonary rehabilitation and control groups or mean change from initiation to completion of pulmonary rehabilitation.
Outcome improved in at least one dyspnea or quality-of-life tool, but did not improve in all tools used in that study.
Includes seven subjects with ventilatory restriction due to skeletal abnormalities.
Currently, there are no proven effective pharmacologic therapies for many patients with interstitial lung disease. Such patients, however, can still benefit from pulmonary rehabilitation. Reduced activity levels because of dyspnea and misconceptions about the safety of exercise can lead to cardiovascular and peripheral muscle deconditioning, as seen in Salhi et al.1 We agree with the authors’ hypothesis that pulmonary rehabilitation exerts its effect on these nonpulmonary limitations to exercise. We strongly urge the interstitial lung disease research community to pursue further study in this area and encourage policymakers to reassess the evidence for the use of pulmonary rehabilitation in patients with interstitial lung disease.
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