Exercise training and inspiratory muscle training in patients with bronchiectasis

Pulmonary rehabilitation is now recommended by many professional respiratory societies as the standard of care for patients with chronic lung disease.^1–3 This has occurred because well designed prospective randomised controlled trials using valid responsive and interpretable outcome measures have convinced clinicians of its effectiveness. Benefits of pulmonary rehabilitation include improved health related quality of life, increased functional exercise capacity, and reduced healthcare resource utilisation.^4–6 The key determinant of the success of rehabilitation, and the one best supported by clinical evidence, is exercise training.

A frequently encountered challenge in respiratory medicine is that of extending the clinical application of treatment modalities, for which evidence was derived from one clinical circumstance, to other circumstances or diagnostic categories. For example, we recognise that long term oxygen therapy is life extending for patients with stable severe chronic obstructive pulmonary disease (COPD) who have resting hypoxaemia, but still wrestle with the challenge of whether it should be provided for those with transient exercise or sleep hypoxaemia, or those with other diagnoses not involved in landmark multicentre clinical trials. Such decisions are made using a combination of scientific evidence and clinical judgement, the latter being a less well defined entity that includes knowledge, experience, and common sense.

The paper by Newall and colleagues⁷ in this issue of Thorax obliges us to consider the evidence in …