A Feasibility Study of a Randomized Controlled Trial of Asthma-Tailored Pulmonary Rehabilitation Compared with Usual Care in Adults with Severe Asthma

Majd, Sally; Apps, Lindsay; Chantrell, Stacey; Hudson, Nicky; Eglington, Elizabeth; Hargadon, Beverley; Murphy, Anna; Singh, Sally; Bradding, Peter; Green, Ruth H.; Evans, Rachael A.

doi:10.1016/j.jaip.2020.05.052

Cited by 17 publications

(34 citation statements)

References 44 publications

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“…2 Data from high-income countries suggest that it also significantly reduces the direct costs of chronic obstructive pulmonary disease (COPD) by decreasing unnecessary use of the healthcare system, particularly unplanned hospital admissions. 3 While the bulk of this evidence is based on those with COPD, 2 there is also evidence supporting effectiveness of PR in people with other CRDs including asthma, 4 post-tuberculosis lung disease 5 and bronchiectasis. 6 In addition, PR is costeffective as it may be delivered using minimal, low-cost equipment, making its implementation feasible even in low-and middle-income countries (LMICs) where access to specialist exercise equipment may be limited.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals

Bickton¹,

Shannon²

2022

COPD

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Introduction: Low-and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low-and middle-income countries. Aim: This qualitative study explored barriers and enablers to pulmonary rehabilitation in low-and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings. Methods: Online-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low-or middle-income country. Anonymised interviews were audiorecorded, transcribed verbatim, and analysed using thematic analysis. Results: A total of seven healthcare professionals from seven low-and middle-income countries representing Africa, Asia, and South America were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Conclusion: Barriers to pulmonary rehabilitation in low-and middle-income countries include limited resources, low awareness, coronavirus disease 2019, and patient accessrelated costs. Enablers include local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low-and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.

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Section: Introductionmentioning

confidence: 99%

Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals

Bickton¹,

Shannon²

2022

COPD

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“…Twenty-two studies embedded one or more adjuvant interventions in the study intervention, 21,36,38,39,41,43,47,49,52,[55][56][57]59,60,61,[67][68][69][72][73][74][75][76]78 (eg, asthma education [n = 16], 21,38,41,47,49,52,57,59,60,[67][68][69][72][73][74][75][76]78 psychological counseling [n = 7], 52,56,57,59,60,68,69,78 diet counseling [n = 8], 49,52,55-57, 59,60,68,69 mindfulness [n = 1],…”

Section: Setting and Supervision Of Exercise Trainingmentioning

confidence: 99%

Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma

Valkenborghs

Anderson

Scott

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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This systematic review describes the characteristics and effects of exercise training interventions on improving performance-based measures of health-related physical fitness in adults with asthma. Supervised exercise training programs, particularly those aerobic in nature, are effective in eliciting clinically meaningful improvements in cardiorespiratory and functional fitness in adults with asthma.

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“… 11 Notably, in people with COPD, PR is supported by high-quality evidence of improvement in symptoms (dyspnoea, fatigue, anxiety, depression), exercise tolerance and overall health-related quality of life. 12 There is also evidence supporting PR for other CRDs including asthma, 13 p-TBLD 14 and bronchiectasis. 15 In high-income countries, PR significantly reduces the direct costs of COPD by decreasing healthcare system usage, particularly unplanned hospital admissions.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a single-centre mixed-method pre–post single-arm feasibility trial of a culturally appropriate 6-week pulmonary rehabilitation programme among adults with functionally limiting chronic respiratory diseases in Malawi

et al. 2022

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IntroductionMalawi has a substantial burden of chronic respiratory diseases (CRDs) which cause significant morbidity and loss of economic productivity, affecting patients, families and health systems. Pulmonary rehabilitation (PR) is a highly recommended non-pharmacological intervention in the clinical management of people with CRDs. However, Malawi lacks published evidence on the implementation of PR for people with CRDs. This trial will test the feasibility and acceptability of implementing a culturally appropriate hospital-based PR programme among adults with functionally limiting CRDs at Queen Elizabeth Central Hospital in Blantyre, Malawi.Methods and analysisThis is a single-centre mixed-methods pre–post single-arm feasibility trial. Ten patients aged ≥18 years, with a spirometry confirmed diagnosis of a CRD and breathlessness of ≥2 on the modified Medical Research Council dyspnoea scale, will be consecutively recruited. Their baseline lung function, exercise tolerance and health status will be assessed; including spirometry, Incremental Shuttle Walk Test and Chronic Obstructive Pulmonary Disease Assessment Test, respectively. Pretrial semistructured in-depth interviews will explore their experiences of living with CRD and potential enablers and barriers to their PR uptake. Along with international PR guidelines, these data will inform culturally appropriate delivery of PR. We initially propose a 6-week, twice-weekly, supervised centre-based PR programme, with an additional weekly home-based non-supervised session. Using combination of researcher observation, interaction with the participants, field notes and informal interviews with the participants, we will assess the feasibility of running the programme in the following areas: participants’ recruitment, retention, engagement and protocol adherence. Following programme completion (after 6 weeks), repeat assessments of lung function, exercise tolerance and health status will be conducted. Quantitative changes in clinical outcomes will be described in relation to published minimal clinically important differences. Post-trial semistructured interviews will capture participants’ perceived impact of the PR programme on their quality of life, enablers, and barriers to fully engaging with the programme, and allow iteration of its design.Ethics and disseminationEthical approval for this trial was obtained from University of Malawi College of Medicine Research and Ethics Committee (COMREC), Blantyre, Malawi (protocol number: P.07/19/2752) and University of Leicester Research Ethics Committee, Leicester, UK (ethics reference: 31574). The results of the trial will be disseminated through oral presentations at local and international scientific conferences or seminars and publication in a peer-reviewed journal. We will also engage the participants who complete the PR trial and the Science Communication Department at Malawi-Liverpool-Wellcome Trust Clinical Research Programme to organise community outreach activities within Blantyre to educate communities about CRDs and PR. We will also broadcast our trial results through national radio station programmes such as the weekly “Thanzi la Onse” (Health of All) programme by Times Radio Malawi. We will formally present our trial results to Blantyre District Health Office and Malawi Ministry of Health.Trial registration numberISRCTN13836793.

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A Feasibility Study of a Randomized Controlled Trial of Asthma-Tailored Pulmonary Rehabilitation Compared with Usual Care in Adults with Severe Asthma

Cited by 17 publications

References 44 publications

Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals

Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals

Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma

Protocol for a single-centre mixed-method pre–post single-arm feasibility trial of a culturally appropriate 6-week pulmonary rehabilitation programme among adults with functionally limiting chronic respiratory diseases in Malawi

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