Chest
Volume 135, Issue 2, February 2009, Pages 442-447
Journal home page for Chest

Original Research
Dyspnea
Pulmonary Rehabilitation in Interstitial Lung Disease: Benefits and Predictors of Response

https://doi.org/10.1378/chest.08-1458Get rights and content

Background

Data examining the role of pulmonary rehabilitation (PR) in interstitial lung disease (ILD) are limited. We tested the hypothesis that PR can improve functional status and dyspnea in a large group of patients with ILD, and that certain baseline patient variables can predict this improvement.

Methods

Data from patients who were referred to PR with a diagnosis of ILD were included. Baseline and post-PR variables were recorded, and changes in 6-min walk test (6MWT) distance and dyspnea were evaluated. The impact of baseline variables on change in 6MWT distance and dyspnea were analyzed.

Results

A statistically significant difference was seen in both the change in Borg score and 6MWT distance after PR (p < 0.0001). These changes were consistent with previously established clinically significant differences. Baseline 6MWT distance was a significant predictor of change in 6MWT distance (p < 0.0001), with increasing baseline 6MWT distance predicting a smaller improvement after PR.

Conclusions

These results suggest that PR should be considered as a standard of care for patients with ILD.

Section snippets

Study Subjects

Records of patients with a diagnosis of ILD who had been referred for PR at one of three centers (Seton Medical Center, Daly City, CA; Inova Fairfax Hospital, Falls Church, VA; or John Muir Health, Concord, CA) between January 2003 and March 2008 were retrospectively collected and analyzed. Inclusion criteria were a referring diagnosis of ILD and documentation of pre- and post-PR variables (see following). Institutional review board approval for this project was obtained at all sites.

Variables Recorded

Variables

Study Population

One hundred thirteen patients were identified. Nine patients had incomplete data due to not finishing the PR program, and five patients had missing or inconsistent data points. The most common reason for not completing the PR program was undergoing lung transplantation (44%). Other reasons included cardiac complications (11%), back pain (11%), patient relocation (11%), noncompliance (11%), and unspecified health issues (11%). Complete data were available for 99 patients. These patients

Discussion

This study represents the largest study of PR in ILD published to date and is novel in its analysis of potential clinical predictors of response. These data strongly suggest that PR is beneficial for patients with ILD and that it should become the standard of care in this population, particularly for those with poor baseline functional status. Our results show a clinically significant improvement in both functional status (as measured by 6MWT distance) and dyspnea (as measured by Borg score

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      Chronic immobility and postural stiffness resulting in reduced mobility of the thorax, may be related to the underlying lung fibrosis (stiff lungs). Treatment options often include medical management consisting of corticosteroids, intravenous immunoglobulins, anti-fibrotic therapy, azathioprine, bosentan, cyclophosphamide, methotrexate, mycophenolate, acetylcysteine, etc. and people with ILD may eventually require lung transplantation in the later stages [12,13]. Evidence suggests that pulmonary rehabilitation (PR) programs, which include exercise training, improve functional ability and symptoms in people with ILD [12].

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    The authors have no conflicts of interest to disclose.

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