• pulmonary rehabilitation
• COPD pathology

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), are a leading cause of morbidity and mortality.1 Individuals with COPD often suffer progressive declines in health status, increasing symptom burden, and frequent interactions with the healthcare system due to exacerbations and hospitalisations.2 The significant and growing burden of chronic respiratory disease underscores the need for innovations in treatment and delivery of services. Thorax presents two papers that attempt to address this need—albeit with different outcomes.3 4

Cox and colleagues3 report on a large, multicentred, randomised controlled trial that evaluates whether home-based telerehabilitation (TR) was equivalent to centre-based pulmonary rehabilitation (PR) in patients with chronic respiratory disease. This study addresses a major priority for the care of individuals with chronic respiratory disease—how to improve availability and accessibility for PR, a highly effective intervention. PR improves dyspnoea, exercise capacity and functional status, and decreases healthcare utilisation in stable COPD.5 It also improves outcomes after a COPD exacerbation, with reduced readmissions and improved survival.6 Despite these proven benefits, PR is delivered to less than 2% of patients who would benefit. The reasons for underutilisation are complex and multifactorial, but common obstacles include lack of available programmes and limited accessibility to established programmes.7

The investigators report on 142 participants randomised to 16 sessions of either TR or centre-based PR, demonstrating no significant differences between groups for the primary outcome of dyspnoea, as measured by the dyspnoea domain of the Chronic Respiratory …