PURPOSE:The benefit of pulmonary rehabilitation (PR) has been well documented in patients with chronic obstructive pulmonary disease. Whether it is effective in patients with interstitial lung disease (ILD) has not been determined. We hypothesized that PR would improve functional status and dyspnea in patients with ILD.
METHODS:We retrospectively analyzed the records of patients diagnosed with ILD who had undergone PR at three different PR centers. All programs included exercise training and educational activities over a 6–8 week period. Change in six minute walk test distance (6MWD) and Borg dyspnea score after PR were determined. The impact of several predictor variables (age, gender, smoking history, baseline pulmonary function, long-term oxygen therapy (LTOT), baseline 6MWD, and PR center) was assessed using regression analysis.
RESULTS:Complete data was available for 99 patients. The median age was 68 years; 55% were men; 41% were never smokers and the rest were former smokers. Median baseline FVC was 60% of predicted and median baseline DLCO was 39% of predicted. Baseline median nadir oxygen saturation during 6 minute walk test was 90%; 66% were on LTOT. After PR, the 6MWD increased by a median of 53 meters (mean 56, standard deviation (SD) 69, p<0.0001) and the Borg score decreased by a median of 1.0 (mean -1.0, SD 1.6, p<0.0001). Nearly half (49%) of patients improved their 6MWD by > 54 meters, the accepted clinically meaningful difference. Of all the predictor variables, only baseline 6MWD had a significant impact on change in 6MWD (inverse correlation, p < 0.0001). No baseline 6MWD value could be identified above which PR was ineffective. Importantly, there was no difference between the PR centers.
CONCLUSION:Pulmonary rehabilitation is associated with statistical significant and clinically meaningful improvement in 6MWD and Borg dyspnea score. Patients with a worse baseline 6MWD may benefit the most from PR.
CLINICAL IMPLICATIONS:These findings support the use of PR in the treatment of patients with ILD and highlight the need for a randomized controlled trial.
DISCLOSURE:Chris Garvey, No Financial Disclosure Information; No Product/Research Disclosure Information