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Bihiyga Salhi, PT; Guy Joos, MD, PhD, FCCP; Eric Derom, MD, PhD
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From the Department of Respiratory Medicine, Ghent University Hospital.

Correspondence to: Bihiyga Salhi, PT, Department of Respiratory Medicine, Ghent University Hospital, 7K12, IE De Pintelaan 185, B-9000 Ghent, Belgium; e-mail: Bihiyga.Salhi@UGent.be


Financial/nonfinancial disclosures: The authors have reported to CHEST 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


Chest. 2010;138(1):241-242. doi:10.1378/chest.10-0654
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To the Editor:

We appreciate the letter from Dr Ryerson et al, who rightly points out that the impact of current medical therapy on dyspnea, exercise tolerance, and quality of life is small in patients with interstitial lung diseases (ILD), leaving room for alternative or additional interventions. Evidence, based on seven studies published over the last 5 years in peer-reviewed journals, is now accumulating that pulmonary rehabilitation results in clinically significant improvements in patients with restrictive lung diseases. In other words, goals that cannot be reached by medical intervention are attained or enhanced by pulmonary rehabilitation. This is in line with data by Casaburi et al,1 who showed that there was a cumulative effect of rehabilitation on exercise tolerance in patients with COPD already treated with tiotropium.

Our data contrast with those of Holland et al,2 who showed no long-term effects after 9 weeks of rehabilitation. Indeed, our results showed that at least 12 weeks of rehabilitation are required to obtain clinically significant effects in patients with ILD, while further improvements may be expected after 12 weeks of additional training.3 This indicates that the duration of rehabilitation in ILD patients is critical. The available evidence, based on seven trials, should invite the community of pulmonologists to design a randomized clinical trial in which training characteristics, duration of rehabilitation, and long-term effects should be assessed in detail in patients with ILD. If the conclusions are positive, such a trial may provide a scientific basis to include rehabilitation in the management of therapy in patients with ILD and to convince insurance companies not to limit reimbursement of pulmonary rehabilitation solely to patients with COPD.

Casaburi R, Kukafka D, Cooper CB, Witek TJ Jr, Kesten S. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005;1273:809-817. [CrossRef] [PubMed]
 
Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax. 2008;636:549-554. [CrossRef] [PubMed]
 
Salhi B, Troosters T, Behaegel M, Joos G, Derom E. Effects of pulmonary rehabilitation in patients with restrictive lung diseases. Chest. 2010;1372:273-279. [CrossRef] [PubMed]
 

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Casaburi R, Kukafka D, Cooper CB, Witek TJ Jr, Kesten S. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005;1273:809-817. [CrossRef] [PubMed]
 
Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax. 2008;636:549-554. [CrossRef] [PubMed]
 
Salhi B, Troosters T, Behaegel M, Joos G, Derom E. Effects of pulmonary rehabilitation in patients with restrictive lung diseases. Chest. 2010;1372:273-279. [CrossRef] [PubMed]
 
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